Comparison of the Postoperative Effects of Local Antibiotic versus Systemic Antibiotic with the Use of Platelet-Rich Fibrin on Impacted Mandibular Third Molar Surgery: A Randomized Split-Mouth Study.

The surgery of the impacted mandibular third molar is the most frequent procedure in dentistry. The prescription of systemic antibiotics after the third molar extraction is widespread among dentists, but this is still argumentative. This study is aimed at evaluating the postoperative effects of local antibiotic mixed with platelet-rich fibrin (PRF) and a postoperative systemic antibiotic prescribed for mandibular third molar surgery. The study included 75 patients divided into a control and 4 test groups (n = 15). In the control group, only PRF was placed into the extracted socket, and no antibiotic was prescribed. In the first and third groups, PRF was applied to the socket; penicillin and clindamycin were prescribed as oral medications, respectively. In the second and fourth groups, only PRF combined with penicillin and clindamycin was applied into the socket, respectively. The outcome variables were pain, swelling, analgesic intake, and trismus. These variables were also assessed based on the first, second, third, and seventh days following the operation. Unpaired Student's t-test and Mann-Whitney U test were used for analysis. There were significant differences in the total VAS pain scores between the control and group 3 (p < 0.05), groups 1 and 2 (p < 0.01), and group 4 (p < 0.001) in ascending order. For analgesic intake, there was no significant difference for group 1 (p > 0.05). However, there were statistical differences between the control group and groups 2 and 3 (p < 0.01) and group 4 (p < 0.001). Trismus and swelling did not differ among the groups (p > 0.05). This study showed that the effects of local and systemic antibiotics with the use of PRF reduced postoperative outcomes. Moreover, local antibiotics with PRF may be a viable method to avoid the possible side effects of systemic antibiotics.

Oxytetracycline-hydrocortisone ointment reduces the occurrence of both dry socket and post-extraction pain after third molar extraction: An observational study.

OBJECTIVES: Dry socket and post-extraction pain are typical discomforts experienced by patients after tooth extraction. In this study, we inserted gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after lower third molar extraction and then evaluated the occurrence of dry socket and post-extraction pain compared with gauze non-insertion. METHODS: This retrospective study was carried out on patients undergoing lower third molar extraction in the Department of Oral Surgery at Shizuoka Prefectural General Hospital in Shizuoka, Japan from November 2018 to October 2019. A comparison was carried out between a gauze-insertion group and a non-insertion group. The occurrence versus non-occurrence of dry socket was determined, and degree of pain was assessed based on a visual analogue scale (VAS) and on patients reporting the number of loxoprofen sodium oral analgesic tablets (60mg/tablet) that they had taken. Dry socket was defined as patient-reported spontaneous pain that did not subside 1 to 3 days postoperatively. Spontaneous post-extraction pain was recorded four times: on the operative day, on the first postoperative day (POD1), on POD3, and during suture removal (POD7). RESULTS: The occurrence of dry socket was lower in the gauze-insertion group than in the non-insertion group (0.9%, 2/215 vs. 19.6%, 9/46, p<0.001). The results also showed that both VAS-defined pain level and the number of analgesic tablets taken were lower in the gauze-insertion group than in the non-insertion group on POD3 and POD7. CONCLUSIONS AND CLINICAL RELEVANCE: Inserting gauze coated with oxytetracycline-hydrocortisone ointment into the extraction socket immediately after third molar extraction reduces the occurrence of both dry socket and post-extraction pain.

The efficacy of etodolac and ibuprofen, regarding gender, on pain, edema and trismus after impacted lower third molar surgery: A randomized prospective clinical split-mouth study / La eficacia del etodolaco y del ibuprofeno, según el sexo, sobre el dolor, el edema y trismo después de la cirugía del tercer molar inferior impactado: un estudio prospectivo aleatorizado estudio clínico de boca dividida

Background: This study aimed to conduct a randomized prospective study about the efficacy of etodolac andibuprofen on trismus, pain and edema regarding gender of patients submitted to impacted lower third molar teethextraction.Material and Methods: Thirty patients aging between 16 and 35 year-old were submitted to the exodontia of im-pacted lower third molars. During the postoperative period, patients received nine ibuprofen (600 mg) or etodolac(300 mg) pills via oral administration immediately after surgery and repeated doses every eight hours during threedays. Patients were evaluated regarding pain, trismus and edema.Results: Sixteen men and fourteen women participated of the study. No statistical difference was establishedregarding gender according to the evaluated parameters. However, etodolac use showed better results regardingpain, trismus and edema.Conclusions: Pain, edema and trismus after impacted third molars extraction were not influenced by gender.(AU)

Is Dexamethasone superior to Ketorolac in reducing pain, swelling and trismus following mandibular third molar removal? A split mouth triple-blind randomized clinical trial

Background: The preemptive use of anti-inflammatory drugs, such as corticosteroids and NSAIDs, has the po-tential to reduce pain, swelling and trismus following oral surgery. The aim of this study was to compare theefficacy of dexamethasone and ketorolac tromethamine in reducing pain, swelling and trismus after mandibularthird molar removal.Material and Methods: The researches implemented a triple-blind, randomized clinical trial. The study was con-ducted with ASA I individuals aging between 18 and 35 years, which were randomized and submitted to twointerventions, one with 8mg dexamethasone and the other with 20mg ketorolac tromethamine given 1h before theprocedure. The primary predictor variable was the use of dexamethasone or ketorolac. The primary outcome vari-able was the postoperative pain level, measured with a Visual Analogue Scale. The secondary outcome variableswere the amount of rescue analgesic consumed, swelling and trismus. Repeated-measures ANOVA and t-test forpaired samples were used to compare the means. Significance was set at p < 0.05.Results: Fifty individuals were randomized and allocated to intervention, and the sample was composed of 40subjects who completed the study (27 female and 13 male). Dexamethasone, when compared to ketorolac trometh-amine, showed a significantly higher reduction in pain level at 8h, 16h, 24h, 32h, 40h and 72h, in swelling and tris-mus at 24h, 48h, 72h and 7 days and in total number of rescue analgesics taken up to 72h postoperative (p < 0.05). Conclusions: The clinical performance of dexamethasone in controlling pain, swelling and trismus after mandibularthird molar removal was superior to ketorolac tromethamine’s.(AU)

Efficacy of methylprednisolone on pain, trismus and quality of life following surgical removal of mandibular third molars: a double-blind, split-mouth, randomised controlled trial / Eficacia de la metilprednisolona sobre el dolor, el trismo y la calidad de vida después de la extirpación quirúrgica de los terceros molares mandibulares: un ensayo controlado aleatorio, doble ciego, de boca dividida

Background: The objective of the present study was to compare the efficacy of different doses of methylpredniso-lone on postoperative sequelae and quality of life (QoL) following surgical removal of mandibular third molars(SRM3).Material and Methods: Fifty-two patients (16 men and 36 women, mean age 25.9 years, range: 18-39) with bilateralimpacted mandibular third molars were randomly allocated into intraoperative muscular injection of either 20mg,30mg, 40mg methylprednisolone or saline injection. Baseline measurements were obtained preoperatively andcompared with assessment after one day, three days, seven days and one month. Pain and trismus were estimatedby visual analog scale score and interincisal mouth opening, respectively. Subjective assessment of QoL includedOral Health Impact Profile (OHIP-14). Descriptive and generalized estimating equation analyses were made andexpressed as mean values with a 95% confidence interval.Results: Methylprednisolone revealed no significant differences in pain, trismus and QoL compared with placebo.Higher prevalence of postoperative pain and worsening in QoL were observed with increased age (P=0.00).Smoking and increased time of surgery decreased mouth opening in the early healing phase (P=0.00).Conclusions: The present study revealed no significant improvement of methylprednisolone on postoperative se-quelae and QoL following SRM3 compared with placebo.(AU)

Remineralising Dentine Caries Using Sodium Fluoride with Silver Nanoparticles: An In Vitro Study.

OBJECTIVE: To investigate the remineralizing and staining effects of sodium fluoride (NaF) solution with polyethylene glycol-coated silver nanoparticles (PEG-AgNPs) on artificial dentine caries. MATERIALS AND METHODS: Demineralized human dentine blocks were allocated to three groups. The blocks in group 1 underwent a topical application of a 12% silver diamine fluoride (SDF, 14,150 ppm fluoride) solution. The blocks in group 2 received a topical application of a 2.5% NaF (11,310 ppm fluoride) with PEG-AgNPs (400 ppm silver). The blocks in group 3 received deionized water. All blocks were subjected to pH cycling for 8 days. The surface morphology and cross-sectional features were investigated using scanning electron microscopy (SEM). The color parameters, crystal characteristics, lesion depth, and collagen degradation of the blocks were assessed using digital spectrophotometry, X-ray diffraction (XRD), micro-computed tomography, and spectrophotometry with a hydroxyproline assay, respectively. RESULTS: The SEM showed that dentine collagen was exposed in group 3 but not in groups 1 and 2. The mean lesion depths in groups 1 to 3 were 118±7 µm, 121±14 µm, and 339±20 µm, respectively (groups1,2<3; p<0.001). The data indicated that fluoridated PEG-AgNPs introduced no significant color effect on dentine, but SDF caused distinct discoloration. The XRD indicated that silver chloride was formed in group 1, and fluorapatite was detected in groups 1 and 2. The concentration of hydroxyproline liberated from collagen was significantly less in groups 1 and 2 than in group 3. CONCLUSION: The use of NaF solution with PEG-AgNPs can remineralize artificial dentine caries and inhibit collagen degradation without causing significant tooth staining.

Evaluation of gap formation at the composite resin-tooth interface after using universal adhesives: In vitro SEM study using the replica technique.

The aim of this study was to evaluate gap formation after using two universal adhesives, Peak Universal Bond (P), which contains chlorhexidine and Adhese Universal (A), which contains 10-MDP monomer, and to compare them with two gold standard adhesives. The adhesives were tested in different etching modes, etch-and-rinse (ER) or self-etch (SE), and under thermomechanical loading (TML). Two identical Class V cavities were prepared in each of 30 human third molar teeth, and resin-composite restorations were made. Before and after TML, replicas of the restorations were prepared. Gap formation and their frequency according to the modified classification of Blunck and Zaslansky and the width of the maximum marginal gap (MG) were separately evaluated in enamel and dentin. Gap frequency did not differ significantly only in the enamel before TML, despite the use of different adhesives or etching modes. At both timepoints, the highest MG values were obtained with the Peak Universal Bond self-etch (PSE) group in enamel (6.2 µm before TML, 12.2 µm after TML) and the Peak Universal Bond etch-and-rinse (PER) group in dentine (21.3 µm before TML, 35.5 µm after TML). After TML, there was a significant increase of gap frequency for Adhese universal self-etch (ASE) group and MG values for PER, PSE, ASE groups at the resin-enamel interface, and gap frequency and MG values for all groups at the resin-dentin interface. Universal adhesive with 10-MDP monomer have beneficial effect on the resin-dentin interface, while chlorhexidine may reduce the resistance of the universal adhesive system to oral cavity conditions.

Ultrastructural changes in the cemento-enamel junction caused by acidic beverages: An in vitro study.

The present in vitro study was aimed at evaluating the morphological changes in the cemento-enamel junction (CEJ) after exposure to acidic beverages using the scanning electron microscopy (SEM). The initial pH and titratable acidity (TA) was analyzed from follow groups: (I) Coca cola, (II) orange juice, (III) Cedevita, (IV) Red Bull, (V) Somersby cider, and (VI) white wine. The CEJ samples (n = 64), obtained from unerupted third molars, were allocated to one control (artificial saliva, n = 16) and six experimental groups (n = 8). The experimental samples were immersed in beverages (50 ml) for 15 min, three times daily, 10 days, and in artificial saliva between immersions. SEM analysis was performed in a blind manner, according to scoring scale. One-way ANOVA and Tukey's post hoc tests, as well as Kruskal-Wallis and Mann-Whitney U test used for statistical analysis. The pH values of the acidic beverages ranged from 2.65 (Coca cola) to 3.73 (orange juice), and TA ranged from 1.90 ml (Coca cola) to 5.70 ml (orange juice) of NaOH to reach pH 7.0. The SEM analysis indicated statistically significant differences between the control samples and those immersed in acidic beverages. The Groups IV, I, and II, showed the highest CEJ damage grade while those of the Group VI were the lowest. All the tested acidic beverages caused morphological changes in the CEJ with a smaller or larger exposure of dentine surface, and were not always related to the pH or TA of acidic beverages.

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.

Effect of erosive and abrasive stress on sealing ability of different desensitizers: In-vitro study.

This in vitro study examined the sealing ability of different desensitizing agents under a chemo-mechanical stress condition. For the study, a total of 144 extracted, caries-free human third molars were used to produce 1 mm-thick dentin discs. The specimens were divided randomly into four groups: Superseal (SS), Gluma (GL), Gluma Self-etch (GS), and Tooth Coat (TC). For each group, the permeability was measured before and after applying the desensitizer, after being exposed to Coca Cola for 5 minutes, and after 3150 strokes of a brushing abrasion. The decrease in permeability after the erosive and abrasive stress was analyzed by ANOVA and Tukey post hoc test. As a result, the dentin permeability decreased significantly for all desensitizers immediately after application (p < 0.05). SS and GS showed a significant difference in permeability reduction observed immediately after application and after acid action with Coca Cola (p < 0.05). After brushing abrasion, the permeability reduction decreased significantly for all desensitizers tested in this study (p < 0.05). TC showed the largest decrease in dentinal permeability compared to that of the other desensitizers and the differences were significant after brushing abrasion (p < 0.05). All tested desensitizers were effective in reducing dentin permeability. The behavioral characteristics under erosive and abrasive stress varied according to the products used. TC exhibited excellent sealing ability among the other desensitizers.

Safety and sedative effect of intranasal dexmedetomidine in mandibular third molar surgery: a systematic review and meta-analysis.

OBJECTIVE: The focus of this meta-analysis was to assess the sedative effect and safety of intranasal dexmedetomidine (Dex) in mandibular third molar surgery. METHODS: The PubMed/Medline, Web of Science, Cochrane Library, and China National Knowledge Infrastructure databases were searched for studies published until May 1, 2018. Eligible studies were restricted to randomized controlled trials (RCTs) and controlled clinical trials. The evaluation indicators mainly included the bispectral index, observer assessment of alertness/sedation scale, systolic blood pressure, and heart rate. Data for each period in the Dex and control groups were pooled to evaluate its sedative effect and safety. RESULTS: Five RCTs met the inclusion criteria. This study included 363 patients: 158 patients received intranasal inhalation of Dex before surgery, and 158 patients were negative controls. The pooled results showed a good sedative effect during tooth extraction when intranasal inhalation of Dex was performed 30 minutes before third molar extraction (assessment of alertness/sedation, Dex vs control SMD -1.20, 95% CI -1.73 to -0.67, I 2=0, P=0.95; bispectral index, Dex vs control SMD -11.68, 95% CI -19.49 to -3.87, I 2=89%; P=0.0001), and parameters returned to normal within 90 minutes after inhalation. During the operation, blood pressure and heart rate decreased to some extent, but the decreases did not exceed 20% of the baseline, and all patients returned to normal conditions within 90 minutes after inhalation. CONCLUSION: Intranasal inhalation of Dex 30 minutes before third molar extraction can provide a good sedative effect, and large-sample multicenter RCTs are needed to evaluate the analgesic effect of Dex.

Is bromelain effective in controlling the inflammatory parameters of pain, edema, and trismus after lower third molar surgery? A systematic review and meta-analysis.

The aim of this systematic review was to evaluate the clinical evidences of the bromelain in minimizing inflammatory parameters such as pain, edema, and trismus after lower third molar surgeries. An electronic search was conducted in six databases through November 2017. The eligibility criteria included randomized and non-randomized clinical trials and/or comparative studies that used bromelain after lower third molar surgeries. The search strategy resulted in 117 articles. Following the selection process, seven studies were included in the systematic review and four in the meta-analysis. In terms of the risk of bias analysis, all the evaluated studies were classified as low or unclear risk of bias in the following criteria: selection bias, detection bias, and reporting bias. The final quantitative analysis of the variables showed that the use of bromelain resulted in greater reduction of pain levels (mean difference [MD]: -0.38; 95% confidence interval [CI; -0.66 to -0.09]), edema (MD: -0.34; 95% CI [ -0.68 to -0.01]), and trismus (MD: -2.01; 95% CI [ -3.99 to -0.02]) among the analyzed groups. The results suggest that the bromelain appears to be effective in the control of pain, edema, and trismus after lower third molar surgeries; however, further high-quality studies are needed to confirm this finding.

Remineralization Potential of Three Different Dentifrices using Raman Spectroscopy and Confocal Laser Scanning Microscope.

Aim: The aim of this study was to compare the remineralization potential of three different dentifrices using Raman spectroscopy and confocal laser scanning microscopy (CLSM). Materials and methods: Totally, 30 extracted intact impacted third molar teeth were selected and the crown of each tooth in a group was separated from the root and longitudinally sectioned into four parts with each section under a subgroup, of which one section was an untreated section, the second and the third sections were demineralized in a demineralizing solution, and the third section was remineralized after demineralization. The teeth in the three groups were demineralized for 4 days and then treated with 0.21% sodium fluoride dentifrice with trical-cium phosphate, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and NovaMin for 14 days, following which the teeth surfaces were studied using Raman spec-troscopy and CLSM to assess the remineralization potential of the three dentifrices. The data were recorded and analyzed statistically. Results: Raman spectroscopic analysis revealed better remin-eralization with CPP-ACP, which was statistically significant from the groups treated with the NovaMin dentifrice and the fluoride-containing dentifrice.Confocal laser scanning microscopic examination also revealed significant differences between the three groups with the NovaMin-containing dentifrice demonstrating a greater remineralization of the surface when compared with the CPP-ACP dentifrice. The teeth samples treated with fluoride-containing dentifrice demonstrated the least reminer-alization among the three groups. Conclusion: It can be concluded that the demineralized samples of teeth treated with CPP-ACP showed the highest concentration of phosphate ions when analyzed using Raman spectroscopy, and the microscopic examination using confocal laser revealed a better surface remineralization of the demin-eralized samples when treated with the NovaMin technology. Clinical significance: There is a great need to find ways to enhance the remineralization process and transfer such knowledge into clinical therapy to alter caries balance for the better, especially in individuals with a high cariogenic bacterial challenge. Keywords: Casein phosphopeptide-amorphous calcium phosphate, Fluoride, NovaMin, Remineralization, Tricalcium phosphate.

Mineral density in carious dentine after treatment with calcium silicates and polyacrylic acid-based cements.

AIM: To test the hypothesis that polyacrylic acid-based and calcium silicate materials are able to increase mineral density of artificially demineralized dentine produced by a microcosm model for caries formation. METHODOLOGY: Forty-five dentine cavities were prepared in nine sound human third molars (five in each tooth). Specimens received a bacterial inoculum and were incubated in BHI plus 5% of sucrose for 96 h to allow biofilm formation. After that, the specimens were scanned in a high energy micro-CT (baseline stack) and then, each cavity was filled with different cements: zinc polycarboxylate (Poly Zinc™, Prevest DenPro, Jammu, India), conventional glass-ionomer (Ketac Molar, 3M ESPE, Seefeld, Germany) and two calcium silicate-based materials (MTA, Angelus, Londrina, Brazil and Biodentine™, Septodont, Saint Maur des Fosses, France) whilst the central cavity was filled with utility wax (negative control). Specimens were kept for 45 days under simulated intrapulpal pressure using simulated body fluid and after, they were again scanned (treated stacks). Reconstruction of the acquired projections was accomplished using standardized parameters, and the percentage mineral density change was calculated around each cavity. Data were tested for normality using the Shapiro-Wilk test, followed by nonparametric methods. RESULTS: A microcosm artificial caries model was able to cause dentine demineralization (±90% related to sound dentine). Significant increases in dentine mineral density were achieved using MTA or Poly Zinc™ (43.56% and 41.64% remineralization), followed by Biodentine™ (36.40%) and Ketac Molar (32.54%), P < 0.05. CONCLUSION: All cements increased mineral density in demineralized dentine, but zinc polycarboxylate cement and MTA had greater bioactive potential. Micro-CT proved to be an effective method to evaluate changes in mineral density within dentine in contact with bioactive materials.

Population pharmacokinetics of articaine with 1:200,000 epinephrine during third molar surgery and simulation of high-dose regimens.

BACKGROUND AND OBJECTIVES: Articaine is more and more used in third molar surgery under local anesthesia (LA). The objectives of this analysis were to characterize the pharmacokinetics of articaine for this type of surgery and to simulate dosing regimens. METHODS: Non-linear mixed-effects modeling conducted in Monolix 4.4.0 was used to describe articaine plasma concentration-time data from 20 patients. Monte Carlo simulations were then performed to evaluate the probability of cardiotoxic target attainment (PCTA) of various dosage regimens. RESULTS: Articaine concentration data were best described by a linear one-compartment model, with an additional depot compartment for submucosal route with a zero-order transfer to central compartment. Age and gender were found to influence duration transfer (Tk0) and elimination rate constant (Ke), respectively. Simulated maximum recommended dose regimen (7mg/kg) had a PCTA of 0%. Simulated higher doses of 10mg/kg and 15mg/kg had a PCTA of 0% and about 1-4%, respectively. CONCLUSIONS: The model adequately described the articaine pharmacokinetics. This is the first PK model qualified for articaine administered by submucosal route. The simulations suggest that maximum recommended dose regimen is safe concerning the cardiotoxicity in healthy patients.

Anti-inflammatory steroid use in impacted third molar surgery: a systematic review.

Oral surgery procedures involve traumatization of mucosal and bony tissues, and lengthy interventions can lead to inflammatory post-operative sequelae. In the bony tissues in particular, the inflammatory processes can affect healing. Modern drug therapies provide valid support for lowering the risk of occurrence of post-operative inflammatory signs. The two main types of agents used are nonsteroidal anti-inflammatory drugs and/or corticosteroids, which act on two different molecular pathways in the inflammatiory process. The aim of this systematic review is to examine the different corticosteroids used in oral surgery procedures, their indications for use, and their route of administration, to provide the clinician with a useful scheme for correct pharmacological management of post-operative inflammation. To identify studies eligible for inclusion in this systematic review, we performed a literature search up to April 2017 of the electronic databases, considering published papers from 2007 to 2017. The search terms included steroids, third molar, oral surgery, RCT [randomized controlled trial], human, and clinical trial. Only articles in English language were considered.

Remineralizing potential of a 60-s in vitro application of Tooth Mousse Plus.

BACKGROUND: No published studies exist on the remineralizing potential of Tooth Mousse Plus® (TMP) when applied for less than 3 min. AIM: To evaluate (i) the remineralizing potential of TMP on artificial carious lesions, when applied thrice daily for 60 s, and (ii) the benefit of using a fluoridated dentifrice prior to TMP application. DESIGN: Carious lesions, 120-200 µm deep, were produced by placing molars in demineralizing solution for 96 h, and sections 100-150 µm thick were then randomly assigned to four groups. Specimens were treated thrice daily with a non-fluoridated (Group A), or 1000 ppm F dentifrice (Group B), or TMP (Group C), or a 1000 ppm F dentifrice followed by TMP application (Group D), and then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography. RESULTS: Post-treatment maximum mineral content at the surface zone (Vmax ) was significantly increased and lesion depth (LD) significantly decreased in Group C, while only the Vmax increased in Group D. Increase in LD was observed in Group B; however, no significant differences were noted in percentage LD changes between groups B, C, and D (P > 0.05). CONCLUSIONS: TMP applied for 60 s significantly remineralized the artificial carious lesions. No additional benefit was evident when TMP was preceded by treatment with 1000 ppm F dentifrice.

[Influence of Coca-Cola on early erosion and surface microhardness of human enamel: an in situ study].

OBJECTIVE: Assessed the effect of single dose attack of Coca-Cola on early erosion and surface microhardness of permanent human enamel, in order to provide diet instructions on minimum amount and frequency of carbonated beverage consumption. METHODS: Eighty enamel slabs were prepared out of 10 extracted human mandibular third molars, and distributed into 8 groups with randomized block design(n=10). Ten generally healthy volunteers with normal saliva secretion wore acrylic palatal appliances containing 2 enamel slabs, with formation of a salivary pellicle 2 h ahead. The volunteers were instructed to drink 100 ml fresh Coca-Cola within 20 s. And then the alterations of the enamel slabs were measured using a Vicker's microhardness tester at 1, 2, 4, 6, 8, 10, 20 and 30 min after the consumption of Coca-Cola. For each volunteer, the experiment was carried out in four days, 2 samples were examined each time. Data were analyzed using Kruskal-Wallis and Wilcoxon tests(α =0.05). RESULTS: Significant decreases in surface microhardness(SMH)were observed in each time point(P<0.01). The percentages of surface microhardness changes on each exposure time were(12.2±3.9)%,(16.8±5.5)%,(16.7±5.6)%,(16.2±6.2)%,(16.6±9.0)%,(15.6±3.7)%,(13.8±4.8)% and(11.4±3.2)%, respectively. Significant differences were observed between G1 min and G2-8 min(P=0.029), G2-8 min and G30 min(P=0.008). CONCLUSIONS: Single intake of 100 ml Coca-Cola could lead to significant decrease of enamel microhardness and initiate erosion of enamel surface. Enamel surface microhardness decreased to the lowest points at 2-8 min, and began to recover after 10 min. The enamel surface microhardness could not fully recovered to the baseline level in 30 min if no intervention was performed.

The effect of dentine surface preparation and reduced application time of adhesive on bonding strength.

OBJECTIVE: This study evaluated the effects of surface preparation and the application time of adhesives on the resin-dentine bond strengths with universal adhesives. METHODS: Sixty molars were cut to exposed mid-coronal dentine and divided into 12 groups (n=5) based on three factors; (1) adhesive: G-Premio Bond (GP, GC Corp., Tokyo, Japan), Clearfil Universal Bond (CU, Kuraray Noritake Dental Inc., Okayama, Japan) and Scotchbond Universal Adhesive (SB, 3M ESPE, St. Paul, MN, USA); (2) smear layer preparation: SiC paper ground dentine or bur-cut dentine; (3) application time: shortened time or as manufacturer's instruction. Fifteen resin-dentine sticks per group were processed for microtensile bond strength test (µTBS) according to non-trimming technique (1mm(2)) after storage in distilled water (37 °C) for 24h. Data were analyzed by three-way ANOVA and Dunnett T3 tests (α=0.05). Fractured surfaces were observed under scanning electron microscope (SEM). Another 12 teeth were prepared and cut into slices for SEM examination of bonded interfaces. RESULTS: µTBS were higher when bonded to SiC-ground dentine according to manufacturer's instruction. Bonding to bur-cut dentine resulted in significantly lower µTBS (p<0.000). Shortening the application time resulted in significantly lower bond strength for CU on SiC and GP on bur-cut dentine. SEM of fractured surfaces revealed areas with a large amount of porosities at the adhesive resin interface. This was more pronounced when adhesives were bonded with a reduced application time and on bur cut dentine. CLINICAL SIGNIFICANCE: The performance of universal adhesives can be compromised on bur cut dentine and when applied with a reduced application time.

Graded changes in enamel component volumes resulted from a short tooth bleaching procedure.

AIM: To test the hypothesis that changes in enamel component volumes (mineral, organic, and water volumes, and permeability) are graded from outer to inner enamel after a short bleaching procedure. MATERIALS AND METHODS: Extracted unerupted human third molars had half of their crowns bleached (single bleaching session, 3 × 15 min), and tooth shade changes in bleached parts were analyzed with a spectrophotometer. Ground sections were prepared, component volumes and permeability were quantified at histological points located at varying distances from the enamel surface (n=10 points/location), representing conditions before and after bleaching. RESULTS: Tooth shade changes were significant (p<0.001; 95% CI=-1/-8; power=99%), and most of the enamel layer was unaffected after bleaching, except at the outer layers. Multiple analysis of covariances revealed that most of the variance of the change in enamel composition after bleaching was explained by the combination of the set of types of component volume (in decreasing order of relevance: mineral loss, organic gain, water gain, and decrease in permeability) with the set of distances from the enamel surface (graded from the enamel surface inward) (canonical R(2)=0.97; p<0.0001; power>99%). CONCLUSIONS: Changes in enamel composition after a short bleaching procedure followed a gradient within component volumes (mineral loss>organic gain>water gain>decrease in permeability) and decreased from the enamel surface inward.