Comparison of the anesthetic effect of alkalized lidocaine versus non-alkalized lidocaine administered at a slow rate in mandibular primary molars.

Background: There are several invasive dental procedures that require local anesthetics. However, its infiltration is usually associated with anxiety and fear, increasing the perception of pain in pediatric patients. For this reason, it is important to evaluate different strategies for its application. We compared the anesthetic effect of the administration of 2% lidocaine with epinephrine 1:80000 non-alkalized at slow speed and alkalized at fast speed to block the inferior alveolar nerve in deciduous molars. Methods: A crossover clinical trial was carried out whose sample consisted of 38 patients between 6-10 years who required bilateral pulp treatment in their first mandibular primary molars. At the first appointment, they received 2% lidocaine with 1:80000 alkalinized epinephrine administered at a fast rate, and at the second appointment, 2% lidocaine with 1:80000 non-alkalized epinephrine administered at a low speed. We evaluated the onset of action, duration of the anesthetic effect, and intensity of pain during its infiltration. Results: We found that non-alkalized lidocaine at slow speed had a shorter onset time of action (57.21±22.21 seconds) and longer duration of effect (170.82±43.75 minutes) compared to administration of alkalinized lidocaine at fast speed (74.03±22.09 seconds, 148.24±36.24 minutes, respectively). There was no difference in the level of pain intensity. Conclusion: In this study, the slow administration of the non-alkalized local anesthetic showed a shorter onset time of action and a longer duration of the anesthetic effect in comparison with the alkalized local anesthetic administered at a rapid rate in the blockade of the inferior alveolar nerve in deciduous molars.

Variación del ángulo SN-Frankfort en los diferentes biotipos faciales / Variation of the SN-Frankfort angle in the different facial biotypes

RESUMEN Introducción: La determinación del ángulo SN-Frankfort ha sido una constante utilizada por muchas décadas con un valor de 7°, sin embargo, son diversas las investigaciones que han refutado esta afirmación, debido a que los factores sociodemográficos influyen en la variación de este ángulo. Asimismo, la importancia de determinarlo es pieza clave para establecer un diagnóstico certero. Objetivo: Evaluar la variación del ángulo SN-Frankfort según el biotipo facial en pacientes. Métodos: Estudio descriptivo, transversal, retrospectivo y observacional. La muestra estuvo conformada por 225 radiografías cefalométricas laterales de pacientes entre 12 a 35 años que acudieron al Servicio de Ortodoncia del Hospital Hipólito Unanue durante los años 2014-2017. Se cumplieron los criterios de inclusión y la selección se realizó de forma probabilística por el método aleatorio simple. Para la evaluación de las radiografías cefalométricas se realizó el trazado manual. El biotipo facial se determinó mediante el índice de VERT y luego se obtuvo el ángulo SN-Frankfort. Se emplearon dos métodos estadísticos para la evaluación de la concordancia y reproducibilidad: El índice de Kappa para la evaluación del biotipo facial y el coeficiente de correlación interclase para la determinación del ángulo. Resultados: El promedio del ángulo SN-Frankfort en los pacientes con biotipo dolicofacial fue de 10,46 ± 3,02°, con biotipo mesofacial 10,12 ± 3,03° y con biotipo braquifacial 10,39 ± 3,48°. Los pacientes del sexo femenino presentaron una mayor angulación SN-Frankfort (10,69 ± 3,04) en comparación con los pacientes del sexo masculino (9,73 ± 3,23); p= 0,026. Conclusiones: Existe una variación en el ángulo SN-Frankfort según el tipo de biotipo facial, sin embargo, estas diferencias no fueron significativas. De modo contrario, se encontró que existe una significativa mayor angulación de ángulo SN-Frankfort en los pacientes del sexo femenino(AU)

ABSTRACT Introduction: Determination of the SN-Frankfort angle has been a constant used for many decades with a value of 7°. However, several studies have refuted that statement, based on the influence of sociodemographic factors on the variation of this angle. On the other hand, the importance of its determination is crucial to achieve an accurate diagnosis. Objective: Evaluate the variation of the SN-Frankfort angle according to the facial biotype of patients. Methods: A descriptive cross-sectional observational retrospective study was conducted. The sample was 225 lateral cephalometric radiographs of patients aged 12-35 years attending the Orthodontics Service of Hipólito Unanue Hospital in the period 2014-2017. Inclusion criteria were complied with, and selection was made by simple random probability sampling. Manual tracing was performed to evaluate the cephalometric radiographs. Facial biotype was determined by the VERT index, and the SN-Frankfort angle was then obtained. Two statistical methods were used for agreement and reproducibility evaluation: the Kappa index for evaluation of the facial biotype and the interclass correlation coefficient for determination of the angle. Results: Average SN-Frankfort angle was 10.46 ± 3.02° for the dolichofacial biotype, 10.12 ± 3.03° for the mesofacial biotype and 10.39 ± 3.48° for the brachifacial biotype. Female patients had greater SN-Frankfort angulation (10.69 ± 3.04) than male patients (9.73 ± 3.23); p= 0.026. Conclusions: Variation was found in the SN-Frankfort angle according to the facial biotype, but those differences were not significant. Significantly greater SN-Frankfort angulation was found among female patients(AU)

Comparison of the anti-inflammatory effectiveness of dexamethasone as pre-surgical and post-surgical therapy in mandibular third molar surgery: a randomized clinical trial / Comparación de la efectividad antiinflamatoria de dexametasona como terapia prequirúrgica y postquirúrgica en la cirugía del tercer molar mandibular: ensayo clínico aleatorizado

Objective: To compare the anti-inflammatory effectiveness of dexa-methasone as pre-surgical and post-surgical therapy in mandibular third molar surgery. Materials and methods: Randomized clinical trial conducted in 60 patients in need of mandibular third molar extraction, ages ranging from 16 to 35 years old, at the Department of Oral and Maxillofacial Surgery of the Arzobispo Loayza National Hospital during the period of January-March, 2016. Patients were distributed in two randomized groups: Group A received 4mg dexamethasone intramuscular before the surgery, and Group B received the same medication post-surgery. Facial edema was assessed using the distance between facial points, trismus was evaluated using the interincisal distance, and pain intensity was determined using a Numerical Scale (NS). Results: Facial edema values were lower in Group A at 60 minutes (p=0.002) and after the first (p=0.001) and third days (p=0.009), compared to Group B. Regarding trismus, no significant differences between the groups were found. Regarding pain intensity, the highest point was recorded at 6 hours in both groups; however, no significant differences between the groups were found. Conclusion: Pre-surgical dexamethasone administration produced a significantly greater reduction in facial edema after mandibular third molar surgery.

Objetivo: Comparar la efectividad antiinflamatoria de dexametasona como terapia prequirúrgica y postquirúrgica en la cirugía del tercer molar mandibular. Materiales y métodos: Ensayo clínico aleatorizado que incluyó a 60 pacientes de 16 a 35 años del Servicio de Cirugía Bucal y Maxilofacial del Hospital Nacional Arzobispo Loayza con necesidad de exodoncia de tercer molar mandibular durante el periodo de enero a marzo del 2016. Se distribuyeron en dos grupos aleatoriamente: El grupo A recibió prequirúrgicamente 4 mg de dexametasona vía intramuscular y el grupo B recibió la misma medicación postquirúrgicamente. Se evaluó el edema facial, mediante la distancia entre puntos faciales, el trismus mediante la distancia interincisal y la intensidad de dolor mediante la Escala Numérica (EN). Resultados: Los valores del edema facial fueron menores en el grupo A a los 60 minutos (p=0,002), primer (p=0,001) y tercer día (p=0,009) en comparación al grupo B. Respecto al trismus, no se encontró diferencia significativa entre los grupos durante las evaluaciones realizadas. Respecto al dolor, la mayor intensidad se percibió a las 6 horas en ambos grupos; sin embargo, no se encontró diferencia significativa entre los grupos durante todas las evaluaciones realizadas. Conclusión: La administración prequirúrgica de dexametasona produjo una significativa mayor reducción del edema facial posterior a la cirugía del tercer molar mandibular.