Use of Botulinum Toxin in Orofacial Clinical Practice.

INTRODUCTION: Botulinum neurotoxin (BoNT) is a potent biological toxin and powerful therapeutic tool for a growing number of clinical orofacial applications. BoNT relaxes striated muscle by inhibiting acetylcholine's release from presynaptic nerve terminals, blocking the neuromuscular junction. It also has an antinociceptive effect on sensory nerve endings, where BoNT and acetylcholine are transported axonally to the central nervous system. In dentistry, controlled clinical trials have demonstrated BoNT's efficiency in pathologies such as bruxism, facial paralysis, temporomandibular joint (TMJ) disorders, neuropathic pain, sialorrhea, dystonia and more. AIM: This study's aim was to conduct a systematic literature review to assess the most recent high-level clinical evidence for BoNT's efficacy and for various protocols (the toxin used, dilution, dosage and infiltration sites) used in several orofacial pathologies. MATERIALS AND METHODS: We systematically searched the MedLine database for research papers published from 2014 to 2019 with randomly allocated studies on humans. The search included the following pathologies: bruxism, dislocation of the TMJ, orofacial dystonia, myofascial pain, salivary gland disease, orofacial spasm, facial paralysis, sialorrhea, Frey syndrome and trigeminal neuralgia. RESULTS: We found 228 articles, of which only 20 met the inclusion criteria: bruxism (four articles), orofacial dystonia (two articles), myofascial pain (one article), salivary gland disease (one article), orofacial spasm (two articles), facial paralysis (three articles), sialorrhea (four articles) or trigeminal neuralgia (three articles). DISCUSSION: The clinical trials assessed showed variations in the dosage, application sites and musculature treated. Thus, applying BoNT can reduce symptoms related to motor muscular activity in the studied pathologies efficiently enough to satisfy patients. We did not identify the onset of any important side effects in the literature reviewed. We conclude that treatment with BoNT seems a safe and effective treatment for the reviewed pathologies.

The effects of informed consent format on preoperative anxiety in patients undergoing inferior third molar surgery

OBJECTIVES: To evaluate the effect of informed consent format on preoperative anxiety of patients. MATERIAL AND METHODS: We performed a prospective study (91 patients) undergoing lower third molar extraction. Patients were distributed into three groups. Informed consent for surgery was obtained through a written document, an oral interview or a video recording. Afterwards, patients were asked about their anxiety level and the effect the informed consent had had on it. RESULTS: Whereas the information conveyed both in oral and written formats relieved the patient to some extent (in a scale of -3 to +3) 0.97±1.21 and 0.29±0.97, respectively), the video recording increased patient's anxiety in a statistically significant way (in a scale of -3 to +3, -0.57±1.43). The difference obtained between the values obtained in oral and written information was not statistically significant. DISCUSSION: The most adequate format, according to our study, would be the oral format

The effects of informed consent format on preoperative anxiety in patients undergoing inferior third molar surgery.

OBJECTIVE: To evaluate the effect of informed consent format on preoperative anxiety of patients. MATERIAL AND METHODS: We performed a prospective study (91 patients) undergoing lower third molar extraction. Patients were distributed into three groups. Informed consent for surgery was obtained through a written document, an oral interview or a video recording. Afterwards, patients were asked about their anxiety level and the effect the informed consent had had on it. RESULTS: Whereas the information conveyed both in oral and written formats relieved the patient to some extent (in a scale of -3 to +3) 0.97 ± 1.21 and 0.29 ± 0.97, respectively), the video recording increased patient's anxiety in a statistically significant way (in a scale of -3 to +3, -0.57 ± 1.43). The difference obtained between the values obtained in oral and written information was not statistically significant. DISCUSSION: The most adequate format, according to our study, would be the oral format.

Actualización en microimplantes de relleno perioral atendiendo a su permanencia / Update on facial filler microimplants and their durability

Introducción y objetivo. El uso de materiales de relleno facial para la corrección de arrugas, pliegues y otros defectos es cada vez más demandado por nuestros pacientes. Se trata de materiales que al ser infiltrados provocan un aumento de volumen. Pueden clasificarse en función del tiempo de permanencia en el cuerpo en temporales o biodegradables (entre 4 y 8 meses), semipermanentes (entre 12 y 18 meses) y permanentes (no biodegradables). Nuestro trabajo tiene por objeto repasar los materiales de relleno que actualmente están aprobados por la Agencia del Medicamento en septiembre de 2010. Material y métodos. Hemos revisado a través de la página web oficial de la Agencia Española del Medicamento los materiales de rellenos aprobados por la misma en septiembre de 2010, para posteriormente hacer una revisión de la literatura científica más reciente sobre ellos. Resultados. Estos son: el ácido hialurónico, colágeno y agarosa para los materiales temporales; el ácido poliláctico, la hidroxiapatita de calcio y la policaprolactona como materiales semipermanentes; y el polimetilmetracrilato y las acrilamidas en el grupo de los materiales permanentes. Discusión. Las características ideales que debería cumplir un relleno facial son ser biocompatible, no cancerígeno, no teratógeno, no migratorio y tener resultados satisfactorios con durabilidad. Estos tipos de materiales son productos sanitarios y deben cumplir la normativa de la Agencia Española del Medicamento. Por tanto, solo deben ser utilizados por profesionales cualificados y preparados específicamente en este terreno. Conclusiones. Los rellenos temporales son los que más se emplean con fines estéticos. Sin embargo, es necesario el conocimiento de la naturaleza de cada material, sus indicaciones y las posibles complicaciones que pueden aparecer tras su uso para poder así sacar el máximo beneficio y obtener los mejores resultados posibles(AU)

Introduction and aim. The use of facial filling materials for the correction of wrinkles, folds and other faults is increasingly demanded by our patients. They are materials that on having been infiltrated lead to an increase in volume. These products can be classified depending on the time of they remain in the body and as temporary or biodegradable (between 4 and 8 months), semi-permanent (between 12 and 18 months) and permanent (not biodegradable). The aim of this work is to review the facial filling materials that are currently approved by the Spanish Medicines and Health Devices Agency (AEMPS) in September, 2010. Material and methods. The official web page of the AEMPS was searched for facial filling materials approved in September, 2010. A review was then made of the most recent scientific literature on these materials. Results. The temporary materials used are hyaluronic acid, collagen and agarose gel, with polylactic acid, calcium hydroxyapatite, and polycaprolactone as semi-permanent materials, and polymethyl methacrylate and the acrylamides in the group of the permanent materials. Discussion. The ideal characteristics for a facial filler are that it should be biocompatible, non-carcinogenic, non-teratogenic, non-migratory, and have satisfactory results with permanence. These types of materials are health products and must comply with the regulations of the AEMPS. Therefore, they must only be used by qualified professionals specifically trained in this area. Conclusions. The temporary face fillers are those that are most used for aesthetic purposes. Nevertheless, knowledge is required on the nature of every material, its indications, and the possible complications that can appear after his use, to be able to achieve the maximum benefits and obtain the best possible results(AU)

Actualización de materiales de relleno semipermanentes y no permanentes / No disponible

El uso material de relleno para aumento de tejidos blandos data de finales del Siglo XIX. Se han utilizado una larga lista de materiales como grasa autóloga, parafina, silicona, colágeno bovino, que sigue creciendo en la actualidad. Su mecanismo de acción es similar en todos ellos: se trata de materiales supuestamente inertes que al ser infiltrados provocan un aumento de volumen. Nuestro trabajo repasa los materiales semipermanentes y permanentes existentes en la actualidad, ya sean semipermanentes (aquellos cuya duración se aproxima al año) o permanentes (no biodegradables). Entre los primeros se encuentra el ácido poliláctico, cuya duración oscila entre los 12 y 18 meses y la Hidroxiapatita de calcio, de duración similar al anterior. En el segundo grupo hallamos al metacrilato, las acrilamidas y las polialquilimidas (AU)

The use of filler material to increase soft tissue dating from the last nineteenth century. We used a long list of materials such as autologous fat, paraffin, silicone, bovine collagen, which keeps growing at present. The mechanism of action is similar in all of them: this is supposedly inert materials to be infiltrated to cause an increase in volume. Our study reviews the materials semi-permanent and permanent that exist nowaday, semi-permanent (whose duration is about a year) or permanent (not biodegradable). Included in the first group we can findpolylactic acid, whose duration ranged between 12 and 18 months and calcium hydroxyapatite, similar to the previous term. The second group are the methacrylate, acrylamide and the polialquilimidas (AU)

Rejuvenecimiento del tercio facial medio e inferior con relleno de ácido poliláctico e hilos tensores / No disponible

En la clasificación de Glogau muestra un grado IV con discromías, queratosis visibles y arrugas marcadas en reposo. Sus labios están en una fases dos de evolución con deshidratación, pérdida de tonicidad y leve atrofia del borde del bermellón. En la escala WSRS de gravedad de la arruga se diagnostica un grado tres (moderada), con pliegues inicialmente profundos, arruga visible en reposo, perono al estirar la piel. Se propone a la paciente tratamiento de relleno facial e hilos tensores para la mejoría de la atrofia dérmica, restitución de los volúmenes perdidos debido a la atrofia grasa, minimizar la profundidad de las arrugas primarias y la ptosis de la piel (AU)

In the classification of a sample Glogauer discromías with grade IV, marked keratosis visible wrinkles at rest. Her lips are in a phase two of evolution with dehydration, loss of tone and slight atrophyof the vermilion border. On a scale of severity of WSRS wrinkle wasdiagnosed with grade three (moderate), initially with deep folds,wrinkles visible at rest, but not to stretch the skin. It is proposed to the patient the treatment facial fillers and thread tensioners for the improvement of dermal atrophy, restitution of lostvolumes due to fat atrophy, minimizing the depth of wrinkles andprimary ptosis of the skin (AU)

Remodelación del ovalo facial: hidroxiapatita de calcio vs ácido poliláctico / No disponible

Los casos que presentamos son pacientes que tras su tratamiento odontológico quieren mejorar la armonía del dibujo de su contorno facial. El objetivo principal es mostrar, a través de la presentación de ambos casos, la importancia de realizar un estudio previo sobre la pérdida de volumen de estos pacientes de estética, que posibilítela resolución del problema con el material de implante adecuado, dependiendo de que esta atrofia sea de tejido duro o blando y del grado de arrugas y ptosis que presenten (AU)

The cases that we present are patients after dental treatment to improve the harmony of your facial contour drawing. The main objective is to show, through the presentation of both cases, the importance of conducting a study about the loss of volumen in these esthetics patients, which allows solving the problem with the implant material suitable, depending on this atrophy is soft or hard tissue and the degree of wrinkling and ptosis present (AU)

Efficacy and safety of sodium hyaluronate in the treatment of Wilkes stage II disease.

PURPOSE: To show whether an intra-articular (IA) infiltration of 1 mL sodium hyaluronate (SH) into the temporomandibular joint (TMJ) would significantly reduce pain and improve joint function in Wilkes stage II disease, compared with the oral administration of a combination of methocarbamol and paracetamol. PATIENTS AND METHODS: Forty-one patients with Wilkes stage II disease were selected and randomly assigned to 2 groups. The experimental group received 1 IA infiltration of SH with assessments at days 14, 28, 56, and 84. The control group was given 2 tablets of a combination of methocarbamol 380 mg and paracetamol 300 mg every 6 hours for 4 weeks, with assessments at days 14 and 28. RESULTS: Forty-one patients were randomized into the study (SH: 20 patients, control drug: 21 patients). A statistically significant difference (P < . 05) was detected in favor of the SH group from day 56 onward for TMJ pain at rest, from day 14 onward for pain on jaw opening, and at days 28 and 56 for pain on mastication. The TMJ function was statistically significantly (P < .05) better in the test group at all follow-up visits. The global evaluation of efficacy by both, the patients and investigators, was better for the test group. No adverse reactions were detected with SH. CONCLUSIONS: An IA infiltration of SH showed better efficacy in reducing pain and improving joint function in Wilkes stage II disease, compared with the oral administration of methocarbamol-paracetamol tablets.