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1.
Niger J Clin Pract ; 23(10): 1407-1413, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047698

RESUMO

Aims: In this study, using Beck depression inventory (BDI), we aimed to determine alterations in the emotional state of patients who had impacted third molars (M3) extracted owing to postoperative pain, edema, and trismus.In this prospective clinical trial, which was conducted at Tokat Gaziosmanpasa University, Faculty of Dentistry, Department of Maxillofacial Surgery Clinic, we studied 60 patients (30 males and 30 females), who were 18-47 years old (the mean of 25.6 years of age). The patients with M3 with moderate preoperative pain intensities, edema, and maximal mouth opening (MMO) data were recorded, and BDI was applied to determine their emotional states. The patients were re-evaluated using BDI to detect alterations in their emotional state owing to pain intensity, edema, and trismus on postoperative second and seventh day. Subjects and Methods: Descriptive statistical analysis, Chi-square, and independent t-test were utilized to interpret the obtained data. Results: According to our findings, a statistically significant relationship was observed between BDI scores and gender on the second postoperative day (P = 0.004), and between MMO and BDI scores on the second and seventh postoperative day (P = 0.012, P = 0.045). Pain intensity scores on the postoperative sixth hour and seventh day were significantly correlated with BDI scores on the postoperative second and seventh day (P = 0.000/ P = 0.000/P = 0.002/P = 0.004/P = 0.010/P = 0.017/P = 0.001/P = 0.000). Conclusions: Our results suggest that the pain and trismus owing to the M3 surgery were significantly correlated with an increase in the postoperative BDI scores.


Assuntos
Depressão/diagnóstico , Edema/psicologia , Dente Serotino/cirurgia , Dor Pós-Operatória/psicologia , Extração Dentária/psicologia , Adolescente , Adulto , Cárie Dentária/epidemiologia , Depressão/epidemiologia , Depressão/psicologia , Edema/epidemiologia , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Extração Dentária/métodos , Extração Dentária/estatística & dados numéricos , Trismo/epidemiologia , Trismo/psicologia , Turquia/epidemiologia , Adulto Jovem
2.
Ann R Coll Surg Engl ; 102(9): 733-736, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32808802

RESUMO

Children provided with general anaesthesia for dental extractions at East Surrey Hospital were audited to determine the percentage of children who were prescribed adequate pain management in accordance with guidance published by the Association of Paediatric Anaesthetists of Great Britain and Ireland. Three audit cycles were completed. Data were collected retrospectively through case note review. The results from the first cycle showed that only 47% of children were prescribed with a recommended analgesic regimen. Implementation of change included the development of a protocol for analgesic delivery, which was disseminated to the anaesthetic and dental teams. Full compliance with the audit standards was then demonstrated in the second and third cycles. This audit demonstrates the importance of multidisciplinary collaboration in order to provide high standards of care for children undergoing dental extractions under general anaesthesia. The protocol developed could be applied to other surgical day case procedures for children to improve the patient experience.


Assuntos
Anestesia Dentária/métodos , Anestesia Geral/métodos , Manejo da Dor/métodos , Melhoria de Qualidade , Extração Dentária/métodos , Analgésicos/uso terapêutico , Anestesia Dentária/normas , Anestesia Geral/normas , Criança , Protocolos Clínicos , Fidelidade a Diretrizes , Humanos , Manejo da Dor/normas , Medição da Dor , Estudos Retrospectivos , Inquéritos e Questionários , Extração Dentária/efeitos adversos , Extração Dentária/normas
3.
Cochrane Database Syst Rev ; 7: CD004345, 2020 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-32712962

RESUMO

BACKGROUND: Pathology relating to mandibular wisdom teeth is a frequent presentation to oral and maxillofacial surgeons, and surgical removal of mandibular wisdom teeth is a common operation. The indications for surgical removal of these teeth are alleviation of local pain, swelling and trismus, and also the prevention of spread of infection that may occasionally threaten life. Surgery is commonly associated with short-term postoperative pain, swelling and trismus. Less frequently, infection, dry socket (alveolar osteitis) and trigeminal nerve injuries may occur. This review focuses on the optimal methods in order to improve patient experience and minimise postoperative morbidity. OBJECTIVES: To compare the relative benefits and risks of different techniques for surgical removal of mandibular wisdom teeth. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 8 July 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library; 2019, Issue 6), MEDLINE Ovid (1946 to 8 July 2019), and Embase Ovid (1980 to 8 July 2019). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication. SELECTION CRITERIA: Randomised controlled trials comparing different surgical techniques for the removal of mandibular wisdom teeth. DATA COLLECTION AND ANALYSIS: Three review authors were involved in assessing the relevance of identified studies, evaluated the risk of bias in included studies and extracted data. We used risk ratios (RRs) for dichotomous data in parallel-group trials (or Peto odds ratios if the event rate was low), odds ratios (ORs) for dichotomous data in cross-over or split-mouth studies, and mean differences (MDs) for continuous data. We took into account the pairing of the split-mouth studies in our analyses, and combined parallel-group and split-mouth studies using the generic inverse-variance method. We used the fixed-effect model for three studies or fewer, and random-effects model for more than three studies. MAIN RESULTS: We included 62 trials with 4643 participants. Several of the trials excluded individuals who were not in excellent health. We assessed 33 of the studies (53%) as being at high risk of bias and 29 as unclear. We report results for our primary outcomes below. Comparisons of different suturing techniques and of drain versus no drain did not report any of our primary outcomes. No studies provided useable data for any of our primary outcomes in relation to coronectomy. There is insufficient evidence to determine whether envelope or triangular flap designs led to more alveolar osteitis (OR 0.33, 95% confidence interval (CI) 0.09 to 1.23; 5 studies; low-certainty evidence), wound infection (OR 0.29, 95% CI 0.04 to 2.06; 2 studies; low-certainty evidence), or permanent altered tongue sensation (Peto OR 4.48, 95% CI 0.07 to 286.49; 1 study; very low-certainty evidence). In terms of other adverse effects, two studies reported wound dehiscence at up to 30 days after surgery, but found no difference in risk between interventions. There is insufficient evidence to determine whether the use of a lingual retractor affected the risk of permanent altered sensation compared to not using one (Peto OR 0.14, 95% CI 0.00 to 6.82; 1 study; very low-certainty evidence). None of our other primary outcomes were reported by studies included in this comparison. There is insufficient evidence to determine whether lingual split with chisel is better than a surgical hand-piece for bone removal in terms of wound infection (OR 1.00, 95% CI 0.31 to 3.21; 1 study; very low-certainty evidence). Alveolar osteitis, permanent altered sensation, and other adverse effects were not reported. There is insufficient evidence to determine whether there is any difference in alveolar osteitis according to irrigation method (mechanical versus manual: RR 0.33, 95% CI 0.01 to 8.09; 1 study) or irrigation volume (high versus low; RR 0.52, 95% CI 0.27 to 1.02; 1 study), or whether there is any difference in postoperative infection according to irrigation method (mechanical versus manual: RR 0.50, 95% CI 0.05 to 5.43; 1 study) or irrigation volume (low versus high; RR 0.17, 95% CI 0.02 to 1.37; 1 study) (all very low-certainty evidence). These studies did not report permanent altered sensation and adverse effects. There is insufficient evidence to determine whether primary or secondary wound closure led to more alveolar osteitis (RR 0.99, 95% CI 0.41 to 2.40; 3 studies; low-certainty evidence), wound infection (RR 4.77, 95% CI 0.24 to 96.34; 1 study; very low-certainty evidence), or adverse effects (bleeding) (RR 0.41, 95% CI 0.11 to 1.47; 1 study; very low-certainty evidence). These studies did not report permanent sensation changes. Placing platelet rich plasma (PRP) or platelet rich fibrin (PRF) in sockets may reduce the incidence of alveolar osteitis (OR 0.39, 95% CI 0.22 to 0.67; 2 studies), but the evidence is of low certainty. Our other primary outcomes were not reported. AUTHORS' CONCLUSIONS: In this 2020 update, we added 27 new studies to the original 35 in the 2014 review. Unfortunately, even with the addition of these studies, we have been unable to draw many meaningful conclusions. The small number of trials evaluating each comparison and reporting our primary outcomes, along with methodological biases in the included trials, means that the body of evidence for each of the nine comparisons evaluated is of low or very low certainty. Participant populations in the trials may not be representative of the general population, or even the population undergoing third molar surgery. Many trials excluded individuals who were not in good health, and several excluded those with active infection or who had deep impactions of their third molars. Consequently, we are unable to make firm recommendations to surgeons to inform their techniques for removal of mandibular third molars. The evidence is uncertain, though we note that there is some limited evidence that placing PRP or PRF in sockets may reduce the incidence of dry socket. The evidence provided in this review may be used as a guide for surgeons when selecting and refining their surgical techniques. Ongoing studies may allow us to provide more definitive conclusions in the future.


Assuntos
Dente Serotino/cirurgia , Extração Dentária/métodos , Dente Impactado/cirurgia , Adulto , Viés , Drenagem/métodos , Alvéolo Seco/etiologia , Humanos , Lábio , Mandíbula , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos das Sensações/etiologia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/etiologia , Irrigação Terapêutica/métodos , Língua , Extração Dentária/efeitos adversos , Técnicas de Fechamento de Ferimentos , Adulto Jovem
4.
Rev. esp. cir. oral maxilofac ; 42(2): 69-75, abr.-jun. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-189943

RESUMO

OBJETIVO: Evaluar el efecto antinflamatorio de la administración preoperatoria de la asociación de dexametasona con vitaminas B en cirugías de tercer molar mandibular. MATERIALES Y MÉTODOS: Estudio experimental conformado por 54 pacientes de 18-25 años, que se asignaron en dos grupos: al grupo control se le administró 4 mg de dexametasona y al grupo experimental la asociación de 4 mg de dexametasona con vitaminas B1, B6 y B12; ambos por vía intramuscular antes de la cirugía. El efecto antinflamatorio se determinó por la evaluación del dolor y la tumefacción. El dolor se evaluó mediante la escala visual análoga, el tiempo para analgesia de rescate y el consumo total de analgésicos. La tumefacción se evaluó mediante mediciones del contorno facial. RESULTADOS: Se demostró que la intensidad máxima de dolor apareció a las 24 horas, siendo este significativamente menor en el grupo experimental (4,0 vs. 5,8 cm), p < 0,05; luego los valores fueron disminuyendo progresivamente a las 48 horas, siendo significativamente menor el valor en el grupo experimental (3,3 vs. 5,4 cm), p < 0,05. El grupo experimental demostró un mayor tiempo para analgesia de rescate (2,48 vs. 2,08 h), p > 0,05; y menor consumo de analgésicos (8,5 vs. 9,4 tab), p < 0,05. La tumefacción facial se incrementó progresivamente hasta el tercer día, sin diferencia significativa entre los grupos (45,4 vs. 46 cm), p > 0,05. CONCLUSIONES: Se evidenció una significativa mayor actividad analgésica y un significativo menor consumo total de analgésicos en el grupo experimental en comparación con el grupo control. No se evidenció diferencia significativa en la tumefacción


OBJECTIVE: To evaluate the antiinflammatory effect of the preoperative administration of the dexamethasone associated with B vitamins in mandibular third molar surgeries. MATERIALS AND METHODS: Experimental study, which consisted of 54 patients aged 18-25 years, who were assigned in two groups: control group was administered dexamethasone 4 mg and the experimental group, the association of dexamethasone 4 mg with vitamins B1, B6, B12; both intramuscularly before surgery. The anti-inflammatory effect was determined by the evaluation of pain and swelling. The pain was evaluated by means of the analogous visual scale, time for rescue analgesia and total analgesic consumption. The swelling was assessed by facial contour measurements. RESULTS: It was demonstrated that the maximum intensity of pain was at 24 hours, being this significantly lower in the experimental group (4.0 vs. 5.8 cm), p < 0.05; then the values were gradually decreasing at 48 hours, with the value in the experimental group being significantly lower (3.3 vs. 5.4 cm), p < 0.05. The experimental group showed a longer time for rescue analgesia (2.48 vs. 2.08 h), p > 0.05; and lower analgesic consumption (8.5 vs. 9.4 tab), p < 0.05. The facial swelling increased progressively until the third day, without significant differences between the groups (45.4 vs. 46 cm), p > 0.05. CONCLUSIONS: There was a significant higher analgesic activity and a significantly lower total analgesic consumption in the experimental group compared to the control group. There were no significant differences in swelling


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Dexametasona/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Dente Serotino/cirurgia , Extração Dentária/métodos , Complexo Vitamínico B/uso terapêutico , Resultado do Tratamento
5.
Cochrane Database Syst Rev ; 5: CD003879, 2020 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-32368796

RESUMO

BACKGROUND: Prophylactic removal of asymptomatic disease-free impacted wisdom teeth is the surgical removal of wisdom teeth in the absence of symptoms and with no evidence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is performed in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the affected area. Removal of asymptomatic disease-free wisdom teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an review originally published in 2005 and previously updated in 2012 and 2016. OBJECTIVES: To evaluate the effects of removal compared with retention (conservative management) of asymptomatic disease-free impacted wisdom teeth in adolescents and adults. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 May 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2019, Issue 4), MEDLINE Ovid (1946 to 10 May 2019), and Embase Ovid (1980 to 10 May 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov)and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. . SELECTION CRITERIA: We included randomised controlled trials (RCTs), with no restriction on length of follow-up, comparing removal (or absence) with retention (or presence) of asymptomatic disease-free impacted wisdom teeth in adolescents or adults. We also considered quasi-RCTs and prospective cohort studies for inclusion if investigators measured outcomes with follow-up of five years or longer. DATA COLLECTION AND ANALYSIS: Eight review authors screened search results and assessed the eligibility of studies for inclusion according to the review inclusion criteria. Eight review authors independently and in duplicate conducted the risk of bias assessments. When information was unclear, we contacted the study authors for additional information. MAIN RESULTS: This review update includes the same two studies that were identified in our previous version of the review: one RCT with a parallel-group design, which was conducted in a dental hospital setting in the United Kingdom, and one prospective cohort study, which was conducted in the private sector in the USA. Primary outcome No eligible studies in this review reported the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth on health-related quality of life Secondary outcomes We found only low- to very low-certainty evidence of the effects of removal compared with retention of asymptomatic disease-free impacted wisdom teeth for a limited number of secondary outcome measures. One prospective cohort study, reporting data from a subgroup of 416 healthy male participants, aged 24 to 84 years, compared the effects of the absence (previous removal or agenesis) against the presence of asymptomatic disease-free impacted wisdom teeth on periodontitis and caries associated with the distal aspect of the adjacent second molar during a follow-up period of three to over 25 years. Very low-certainty evidence suggests that the presence of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting the adjacent second molar in the long term. In the same study, which is at serious risk of bias, there is insufficient evidence to demonstrate a difference in caries risk associated with the presence or absence of impacted wisdom teeth. One RCT with 164 randomised and 77 analysed adolescent participants compared the effect of extraction with retention of asymptomatic disease-free impacted wisdom teeth on dimensional changes in the dental arch after five years. Participants (55% female) had previously undergone orthodontic treatment and had 'crowded' wisdom teeth. No evidence from this study, which was at high risk of bias, was found to suggest that removal of asymptomatic disease-free impacted wisdom teeth has a clinically significant effect on dimensional changes in the dental arch. The included studies did not measure any of our other secondary outcomes: costs, other adverse events associated with retention of asymptomatic disease-free impacted wisdom teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). AUTHORS' CONCLUSIONS: Insufficient evidence is available to determine whether asymptomatic disease-free impacted wisdom teeth should be removed or retained. Although retention of asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting adjacent second molars in the long term, the evidence is very low certainty. Well-designed RCTs investigating long-term and rare effects of retention and removal of asymptomatic disease-free impacted wisdom teeth, in a representative group of individuals, are unlikely to be feasible. In their continuing absence, high quality, long-term prospective cohort studies may provide valuable evidence in the future. Given the current lack of available evidence, patient values should be considered and clinical expertise used to guide shared decision-making with people who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain these teeth, clinical assessment at regular intervals to prevent undesirable outcomes is advisable.


Assuntos
Dente Serotino/cirurgia , Extração Dentária/métodos , Dente Impactado/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Conduta Expectante
6.
J Appl Oral Sci ; 28: e20190690, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348445

RESUMO

Objective To investigate the effects of intro-oral injection of parathyroid hormone (PTH) on tooth extraction wound healing in hyperglycemic rats. Methodology 60 male Sprague-Dawley rats were randomly divided into the normal group (n=30) and DM group (n=30). Type 1 diabetes mellitus (DM) was induced by streptozotocin. After extracting the left first molar of all rats, each group was further divided into 3 subgroups (n=10 per subgroup), receiving the administration of intermittent PTH, continuous PTH and saline (control), respectively. The intermittent-PTH group received intra-oral injection of PTH three times per week for two weeks. A thermosensitive controlled-release hydrogel was synthesized for continuous-PTH administration. The serum chemistry was determined to evaluate the systemic condition. All animals were sacrificed after 14 days. Micro-computed tomography (Micro-CT) and histological analyses were used to evaluate the healing of extraction sockets. Results The level of serum glucose in the DM groups was significantly higher than that in the non-DM groups (p<0.05); the level of serum calcium was similar in all groups (p>0.05). Micro-CT analysis showed that the DM group had a significantly lower alveolar bone trabecular number (Tb.N) and higher trabecular separation (Tb.Sp) than the normal group (p<0.05). The histological analyses showed that no significant difference in the amount of new bone (hard tissue) formation was found between the PTH and non-PTH groups (p>0.05). Conclusions Bone formation in the extraction socket of the type 1 diabetic rats was reduced. PTH did not improve the healing of hard and soft tissues. The different PTH administration regimes (continuous vs. intermittent) had similar effect on tissue healing. These results demonstrated that the metabolic characteristics of the hyperglycemic rats produced a condition that was unable to respond to PTH treatment.


Assuntos
Hormônios e Agentes Reguladores de Cálcio/farmacologia , Diabetes Mellitus Experimental/fisiopatologia , Hormônio Paratireóideo/farmacologia , Extração Dentária/métodos , Alvéolo Dental/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Animais , Glicemia/análise , Cálcio/sangue , Hidrogéis , Masculino , Osteogênese/efeitos dos fármacos , Osteogênese/fisiologia , Distribuição Aleatória , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Ferida Cirúrgica/tratamento farmacológico , Fatores de Tempo , Alvéolo Dental/diagnóstico por imagem , Resultado do Tratamento , Microtomografia por Raio-X
7.
Medicine (Baltimore) ; 99(15): e19397, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282695

RESUMO

A considerable number of patients with prominent mandibular angle have mandibular third molar impaction that needs surgical removal. Mandibular reduction is a popular and effective surgery to correct prominent mandibular angle, but it has been rarely performed simultaneously with impacted third molar extraction. In order to decrease the number of operations and suffering of patients, safely performing these 2 operations together is necessary and important. From January 2016 to June 2018, patients received mandibular reduction and impacted mandibular third molar extraction together were retrospectively reviewed. Forty-seven patients receiving long-curve mandibular reduction (n = 12) or simple mandibular reduction (n = 35) were included in this study. A total of 65 impacted mandibular third molars were extracted during mandibular reduction. One patient had hematoma within facial soft tissue which reabsorbed spontaneously. Seven patients who underwent long-curve mandibular reduction reported transient inferior lip numbness for several weeks. No infection or poor wound healing was reported. No immediate or delayed mandibular fracture occurred. All the patients were satisfied with both the aesthetic result of mandibular reduction and the unnecessity of receiving a secondary surgery to extract the impacted third molar. Simultaneously performing mandibular reduction and impacted mandibular third molar extraction can effectively reduce the number of operations and patients' suffering. It is also safe with adequate pre-op assessment, professional surgical knowledge, proper use of surgical instruments, meticulous surgical procedures, and correct post-op care.


Assuntos
Osteotomia Mandibular/métodos , Dente Serotino , Extração Dentária/métodos , Adulto , Feminino , Humanos , Estudos Retrospectivos , Adulto Jovem
8.
Braz Oral Res ; 34: e003, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32022222

RESUMO

This retrospective study evaluated facial profile pleasantness determined by two protocols of Class II treatment. The sample comprised facial profile silhouettes obtained retrospectively from the pretreatment (T1) and posttreatment (T2) cephalograms of 60 patients (42 males and 18 females) divided into two groups. One group of 30 patients (mean age of 12.84 years) was treated with the extraction of maxillary first premolars (mean treatment time of 2.7 years), and the other group of 30 patients (mean age of 12.81 years) was treated with a mandibular advancement appliance (Forsus) (mean treatment time of 2.49 years). The facial profile silhouettes (T1 and T2) were randomly distributed in an album containing one patient per sheet. The examiners consisted of 60 orthodontists and 60 lay individuals, who analyzed the profiles in regard to facial pleasantness, using the Likert scale. A comparison between stages T1 and T2 of the two treatment protocols and between the examiners was performed by mixed-design analysis of variance at a significance level of 5%. The results demonstrated a significant difference between T1 and T2 (greater scores for T2 compared to T1), and between lay individuals and orthodontists (orthodontists assigned higher scores), but with no significant difference between the treatment protocols. Both protocols produced positive effects on the facial profile esthetics, from the standpoint of lay individuals and orthodontists.


Assuntos
Estética Dentária , Face/patologia , Má Oclusão de Angle Classe II/patologia , Má Oclusão de Angle Classe II/terapia , Extração Dentária/métodos , Adolescente , Análise de Variância , Dente Pré-Molar/cirurgia , Cefalometria , Criança , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Aparelhos Ortodônticos Fixos , Ortodontia Corretiva/métodos , Ortodontistas , Percepção , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento
9.
Life Sci ; 248: 117460, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32092331

RESUMO

AIM: This study determined the optimum gamma irradiation dosage to sterilize sodium hyaluronate (HY), single-walled carbon nanotubes (SWCNT), multi-walled carbon nanotubes (MWCNT) and CNT functionalized with HY (HY-SWCNT and HY-MWCNT), evaluated the structural integrity of the materials and assessed whether sterilized materials kept biological properties without affecting renal function. MAIN METHODS: Materials were submitted to dosages of 100 gγ to 30 Kgγ and plated onto agar mediums for colony forming units (CFUs) counting. Sterilized samples were inoculated with 107Bacillus clausii, submitted again to gamma irradiation, and plated in agar mediums for CFUs counting. Scanning electron microscope was used for structural evaluation of sterilized materials. Tooth sockets of rats were treated with sterilized materials for bone formation assessment and renal function of the animals was analyzed. KEY FINDINGS: The optimum gamma dosage for sterilization was 250 gγ for HY and 2.5 Kgγ for the other materials without meaningful structural changes. Sterilized materials significantly increased bone formation (p < 0.05) and they did not compromise renal function and structure. SIGNIFICANCE: Gamma irradiation efficiently sterilized HY, SWCNT, MWCNT, HY-SWCNT and HY-MWCNT without affecting structural aspects while maintaining their desirable biological properties.


Assuntos
Materiais Dentários/efeitos da radiação , Raios gama , Ácido Hialurônico/efeitos da radiação , Nanotubos de Carbono/efeitos da radiação , Osteogênese/efeitos dos fármacos , Alvéolo Dental/efeitos dos fármacos , Animais , Bacillus clausii/efeitos da radiação , Contagem de Colônia Microbiana , Materiais Dentários/química , Materiais Dentários/farmacologia , Humanos , Ácido Hialurônico/química , Ácido Hialurônico/farmacologia , Testes de Função Renal , Masculino , Dente Molar/cirurgia , Nanotubos de Carbono/química , Nanotubos de Carbono/ultraestrutura , Ratos , Ratos Wistar , Esterilização/métodos , Extração Dentária/métodos , Alvéolo Dental/microbiologia , Alvéolo Dental/fisiologia , Alvéolo Dental/cirurgia , Cicatrização/efeitos dos fármacos
10.
FASEB J ; 34(2): 2595-2608, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31919918

RESUMO

Dendritic cells are an important link between innate and adaptive immune response. The role of dendritic cells in bone homeostasis, however, is not understood. Osteoporosis medications that inhibit osteoclasts have been associated with osteonecrosis, a condition limited to the jawbone, thus called medication-related osteonecrosis of the jaw. We propose that disruption of the local immune response renders the oral microenvironment conducive to osteonecrosis. We tested whether zoledronate (Zol) treatment impaired dendritic cell (DC) functions and increased bacterial load in alveolar bone in vivo and whether DC inhibition alone predisposed the animals to osteonecrosis. We also analyzed the role of Zol in impairment of differentiation and function of migratory and tissue-resident DCs, promoting disruption of T-cell activation in vitro. Results demonstrated a Zol induced impairment in DC functions and an increased bacterial load in the oral cavity. DC-deficient mice were predisposed to osteonecrosis following dental extraction. Zol treatment of DCs in vitro caused an impairment in immune functions including differentiation, maturation, migration, antigen presentation, and T-cell activation. We conclude that the mechanism of Zol-induced osteonecrosis of the jaw involves disruption of DC immune functions required to clear bacterial infection and activate T cell effector response.


Assuntos
Conservadores da Densidade Óssea/farmacologia , Osso e Ossos/efeitos dos fármacos , Células Dendríticas/metabolismo , Homeostase/imunologia , Doenças Maxilomandibulares/imunologia , Osteonecrose/tratamento farmacológico , Ácido Zoledrônico/farmacologia , Animais , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/imunologia , Células Dendríticas/imunologia , Homeostase/efeitos dos fármacos , Imidazóis/farmacologia , Doenças Maxilomandibulares/tratamento farmacológico , Osteoclastos/efeitos dos fármacos , Osteoclastos/imunologia , Osteonecrose/imunologia , Extração Dentária/métodos , Cicatrização/efeitos dos fármacos
11.
Haemophilia ; 26(2): 183-199, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31962377

RESUMO

Due to the global prevalence of oral disease, tooth extraction is the most common surgical procedure required in general population thus likely to be similarly common in patients with haemophilia, especially those in older age and those living in countries with restricted resources. There are little or no consensus about optimal level and duration of factor replacement (FRP) therapy required to prevent bleeding complication following surgery and low levels of evidence to inform protocols and guidelines. The goal of this article was to review the literature regarding haematological treatment protocols and to assess their effectiveness in prevention of bleeding complications during and after tooth extractions in people with haemophilia. A total number of 29 articles were identified. Only two of the studies were randomized controlled trials, and meta-analysis was not possible. Significant heterogeneity regarding haematological regimes, dental surgical procedures, disease severity and sample size of published studies which are unable to reliably inform the provision of safe dental surgery was noted. Based on the haematological regimens, all studies were classified into one of three groups: pre- and postoperative FRP or DDAVP, single preoperative FRP or DDAVP, and no FRP treatment. The overall reported bleeding rate in case of both pre- and postoperative FRP and single dose FRP preoperative is similar, 11.9% and 11.4%, respectively, indicating that minimizing the use of clotting factor concentrate is possible if proper local haemostatic measures are provided. Strictly designed prospective studies with higher number of patients are necessary to get firm conclusions about optimal FRP treatment required to prevent bleeding complications during and after oral surgery in patients with haemophilia.


Assuntos
Medicina Baseada em Evidências/métodos , Hemofilia A/complicações , Extração Dentária/métodos , Consenso , Humanos
12.
J. appl. oral sci ; 28: e20190690, 2020. graf
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1101255

RESUMO

Abstract Objective To investigate the effects of intro-oral injection of parathyroid hormone (PTH) on tooth extraction wound healing in hyperglycemic rats. Methodology 60 male Sprague-Dawley rats were randomly divided into the normal group (n=30) and DM group (n=30). Type 1 diabetes mellitus (DM) was induced by streptozotocin. After extracting the left first molar of all rats, each group was further divided into 3 subgroups (n=10 per subgroup), receiving the administration of intermittent PTH, continuous PTH and saline (control), respectively. The intermittent-PTH group received intra-oral injection of PTH three times per week for two weeks. A thermosensitive controlled-release hydrogel was synthesized for continuous-PTH administration. The serum chemistry was determined to evaluate the systemic condition. All animals were sacrificed after 14 days. Micro-computed tomography (Micro-CT) and histological analyses were used to evaluate the healing of extraction sockets. Results The level of serum glucose in the DM groups was significantly higher than that in the non-DM groups (p<0.05); the level of serum calcium was similar in all groups (p>0.05). Micro-CT analysis showed that the DM group had a significantly lower alveolar bone trabecular number (Tb.N) and higher trabecular separation (Tb.Sp) than the normal group (p<0.05). The histological analyses showed that no significant difference in the amount of new bone (hard tissue) formation was found between the PTH and non-PTH groups (p>0.05). Conclusions Bone formation in the extraction socket of the type 1 diabetic rats was reduced. PTH did not improve the healing of hard and soft tissues. The different PTH administration regimes (continuous vs. intermittent) had similar effect on tissue healing. These results demonstrated that the metabolic characteristics of the hyperglycemic rats produced a condition that was unable to respond to PTH treatment.


Assuntos
Animais , Masculino , Ratos , Hormônio Paratireóideo/farmacologia , Extração Dentária/métodos , Cicatrização/efeitos dos fármacos , Alvéolo Dental/efeitos dos fármacos , Diabetes Mellitus Experimental/fisiopatologia , Osteogênese/efeitos da radiação , Osteogênese/fisiologia , Glicemia/análise , Distribuição Aleatória , Cálcio/sangue , Ratos Sprague-Dawley , Hidrogéis , Ferida Cirúrgica/tratamento farmacológico
13.
Rev. esp. cir. oral maxilofac ; 41(4): 189-193, oct.-dic. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-191805

RESUMO

OBJETIVO: En los estudios sobre biomateriales e ingeniería de tejidos se emplean células de la pulpa dental para regenerar o sustituir las deficiencias de tejido óseo en la cavidad oral. Para evaluar su potencial clínico se utilizan modelos de cultivo celular, en los cuales se aplican diversos métodos de extracción de la pulpa dental. Pero aún no está claro qué método es el más conveniente. Por ello, el propósito de este estudio fue comparar el método de fractura mecánica y el método de corte en la viabilidad celular. MATERIAL Y MÉTODOS: Se extrajo el tejido pulpar de dientes completamente desarrollados y sanos de 32 pacientes de entre 18 y 40 años mediante dos técnicas: el método de fractura mecánica (grupo 1) y el método de corte (grupo 2). Para determinar la viabilidad celular se usó el colorante azul de tripán. Las células teñidas de azul (muertas) y las células birrefringentes (vivas) fueron contabilizadas en el microscopio óptico. RESULTADOS: Al emplear el método de fractura mecánica se obtuvo un 87,72 % de viabilidad celular, mientras que al aplicar el método de corte se logró una menor viabilidad: 83,59 %. Al analizar los datos (n = 16 por grupo) bajo la prueba t de Student se obtuvo una diferencia significativa (p = 0,006). CONCLUSIONES: El método de fractura mecánica permite obtener una viabilidad celular más alta en comparación al método de corte, empleado en dientes extraídos dentro de las 24 horas


AIM: In biomaterials and tissue engineering studies, dental pulp cells are used to regenerate or replace deficiencies of bone tissue in the oral cavity. To evaluate its clinical potential, cell culture models are employed, in which different extraction methods of the dental pulp are applied. Mainly, the tooth is broken by fracture mechanics and the cutting method to obtain the dental pulp. However, it is not clear yet which method is the most convenient. Therefore, the purpose of this study was to compare the effect of two methods of fracture mechanical and cutting methods on the dental pulp cell viability. METHODOLOGY: Dental pulp tissue was removed of fully developed and healthy teeth of 32 patients between 18 to 40 years, through two techniques: the methods of fracture mechanics (group 1) and cutting (group 2). To determine the cell viability, trypan blue dye was used. The cells were counted in the microscope, blue stained cells (dead) and birefringent (living). RESULTS: Using the mechanical fracture method, 87.72 % of cell viability was obtained. While with the cutting method was achieved a lower viability 83.59 %. There was a significant difference (p = 0.006) when analyzing the data (n = 16 per group) under t-Student test. CONCLUSIONS: The use of mechanical fracture method for the extraction of the dental pulp tissue allows to obtain higher percentages of cell viability compared to cutting method


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Polpa Dentária/fisiologia , Extração Dentária/métodos , Sobrevivência Celular/fisiologia , Fraturas dos Dentes , Extração Dentária/estatística & dados numéricos , Procedimentos Cirúrgicos Ortognáticos/métodos , Técnicas In Vitro/métodos
14.
Plast Reconstr Surg ; 144(6): 1393-1402, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764658

RESUMO

BACKGROUND: Mandibular angle fractures are common and frequently involve a tooth in the fracture line. Despite trends toward more conservative indications for tooth extraction during open repair, the literature remains heterogeneous. This review aims to ascertain the effect of tooth extraction/retention on patient outcomes following mandible open reduction and internal fixation and to evaluate the evidence surrounding indications for extraction. METHODS: PubMed, EMBASE, the Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov were queried through March of 2018 for English language publication on adults with traumatic mandibular fractures. The review protocol was not registered online. Quality of evidence was assigned using the Grading of Recommendations Assessment, Development and Evaluation methodology. Meta-analyses were performed when definitions of outcomes were deemed similar. RESULTS: Overall, 26 of 1212 identified studies met inclusion criteria. Indications for tooth extraction and rates of extraction varied considerably across studies. The quality of evidence was low or very low for all outcomes. Tooth retention was associated with lower overall complications (OR, 0.54; 95 percent CI, 0.37 to 0.79), major complications requiring readmission or reoperation (OR, 0.47; 95 percent CI, 0.24 to 0.92), and malocclusion (OR, 0.56; 95 percent CI, 0.32 to 0.97); there was no difference in wound issues or nonunion. Removal of asymptomatic teeth was associated with inferior alveolar nerve injury (39.4 percent versus 16.1 percent). CONCLUSIONS: The literature is limited by retrospective study deign and poor follow-up; however, when indicated, tooth extraction is not associated with an increased risk of infection or nonunion. Removal of asymptomatic teeth was associated with a risk of inferior alveolar nerve injury. Additional high-quality studies are needed to evaluate potentially expanded indications for tooth extraction.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Mandibulares/cirurgia , Redução Aberta/métodos , Extração Dentária/métodos , Humanos , Mandíbula/cirurgia , Dente Serotino/cirurgia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Infecção da Ferida Cirúrgica/etiologia
15.
Biomed Res Int ; 2019: 2797210, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31781606

RESUMO

Background: Endoscopy has seen a significant development over recent years in various medical fields with its application expanding from the support of minimal invasive surgery to in situ imaging. In this context, the application of endoscopic techniques to assess the quality of the regenerated bone in situ in the drill hole before implant placement is an appealing approach. Aim: The aim of this study was to use short distance support immersion endoscopy (SD-SIE) to compare the quality of regenerated bone in healed postextraction sites, which are grafted with an in situ hardening ß-TCP, against ungrafted sites, before implant placement. This assessment was based on microscopic bone analysis in combination with the blood vessel count. Method: 13 spontaneously healed and 13 grafted postextraction sites in 3 men and 6 women, aged 26-83 years, were evaluated using SD-SIE after 4-6 months. SD-SIE was applied in drill holes before implant placement, and videos were taken from representative central buccal areas. The video recordings were analyzed using Image J software for (1) number of blood vessels per area (NBV), (2) relative area of vessels (VA), (3) relative area of mineralized bone (MBA), (4) relative area of unmineralized bone (UMBA), and (5) relative area of bone substitute (BSA). Results: The grafted sites showed more (1) NBV as well as (2) VA (8.6 ± 1.1; 2.03 ± 0.28%) than the ungrafted sites (2.5 ± 0.6; 1.18 ± 0.36%) (independent t-test; p < 0.05); (3) MBA and (4) UMBA were similar to those in the grafted sites (86.3 ± 2.2 %; 13.7 ± 2.2 %) and to the ungrafted sites (89.5 ± 3.7%; 10.5 ± 3.6%) (independent t-test; p > 0.05); and (5) BSA in the grafted sites was 18.2 ± 5.4%. Conclusion: SD-SIE is an interesting new approach for in situ assessment of bone quality and blood supply before implant placement. The regenerated bone in ß-TCP grafted extraction sockets showed an increased vascularization compared to ungrafted sites providing a vital support for subsequent implant placement.


Assuntos
Perda do Osso Alveolar/cirurgia , Perda do Osso Alveolar/terapia , Processo Alveolar/cirurgia , Regeneração Óssea/ética , Substitutos Ósseos/administração & dosagem , Fosfatos de Cálcio/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Processo Alveolar/efeitos dos fármacos , Materiais Biocompatíveis/administração & dosagem , Regeneração Óssea/efeitos dos fármacos , Estudos de Casos e Controles , Implantação Dentária Endo-Óssea/métodos , Implantes Dentários , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Extração Dentária/métodos
16.
BMC Oral Health ; 19(1): 248, 2019 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727038

RESUMO

BACKGROUND: The aim of this study was to evaluate the clinical outcome of autotransplantation of mature third molars to fresh molar extraction sockets using 3D replicas. METHODS: Ten patients underwent teeth autotransplantation with or without GBR. We observed the mobility, percussion, radiography examination, the probing depth and the masticatory function of the transplanted teeth during 2 years following up, which were transplanted into fresh molar sockets by using 3D replicas, and GBR when it is necessary. RESULTS: The average extra-oral time of donor tooth had been shortened to 1.65 min when used the 3D replica. Some probing depth of the transplanted tooth were deeper than 3 mm at 4 or 5 weeks temporarily. And one patient felt slight sensitive when chewing with soft food at 4 weeks, then disappeared. The clinical examination of the autotransplantation teeth during 1 year follow-up showed no sign of failure. CONCLUSIONS: The tooth autotransplantation using 3D replica with or without GBR is an effective method which can reduce the extra-oral time of the donor teeth and may result in less failure.


Assuntos
Dente Serotino/transplante , Extração Dentária/métodos , Alvéolo Dental/cirurgia , Dente Impactado/cirurgia , Transplante Autólogo , Regeneração Óssea , Seguimentos , Regeneração Tecidual Guiada Periodontal , Humanos , Estudos Retrospectivos , Resultado do Tratamento
17.
J Coll Physicians Surg Pak ; 29(11): 1111-1113, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31659974

RESUMO

Hypercementosis is an excessive cementum deposition at the tooth root apex which occurs pathologically and represents as a body reaction to various stimulating factors including infection or endodontic treatment in most cases. Although hypercementosis mostly complicates teeth extraction, it is rare in daily dental practice. In the present case report, a generalised maxillary and mandibular hypercementosis in a young female patient is represented with a detailed description of its histologic, radiographic, and clinical characteristics followed by a review of surgical technique. It is clinically relevant to correlate hypercementosis of teeth, the feasibility of the best surgical method, in order to achieve a safe uncomplicated extraction.


Assuntos
Hipercementose/cirurgia , Extração Dentária/métodos , Adulto , Feminino , Humanos , Hipercementose/diagnóstico por imagem
18.
Am J Orthod Dentofacial Orthop ; 156(4): 453-463, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31582117

RESUMO

INTRODUCTION: Extraction of one mandibular incisor in adolescents and adults can simplify orthodontic treatment in 2 major circumstances: (1) severe crowding of the mandibular but not the maxillary incisors, and (2) mild anterior crossbite with good alignment in both arches. Despite its potential advantages, this method has had limited use in most practices. There have been 3 major objections: (1) the possibility of unsightly black triangles because of loss of interdental papilla height, (2) a possible tooth size discrepancy that would affect occlusal relationships, and (3) patient concerns about a visible extraction site. All 3 objections now can be overcome. METHODS: For 37 consecutively treated single-incisor-extraction patients, preparation of the extraction site for the tooth to be extracted was done by tipping it lingually while simultaneously closing the space in front of it. Treatment outcomes and the effect of age at the time of treatment were evaluated. RESULTS: In patients below age 20, this approach eliminated post-treatment black triangles and almost eliminated partial loss of the interdental papilla. It reduced the previously reported prevalence of these problems in patients aged 20-40 years and did not seem to be helpful in those aged over 40 years. This positive effect was achieved because of maintenance of alveolar crest height that supports the interdental papillae. Tooth size discrepancy caused by incisor extraction was largely compensated by the different labio-lingual orientation of maxillary and mandibular anterior teeth. The extraction space quickly disappeared during extraction site preparation. CONCLUSIONS: The new procedure of extraction site preparation described in this paper offers more favorable outcomes for post-treatment prevalence of black triangles in younger patients but shows limited efficacy in older patients. Camouflage of a mild skeletal Class III problem is the major indication for this extraction pattern. About 3% of Icelandic orthodontic patients appear to be good candidates for this treatment, and this finding should be reasonably generalizable to other populations of European descent.


Assuntos
Incisivo/cirurgia , Mandíbula/cirurgia , Extração Dentária/métodos , Técnicas de Movimentação Dentária/métodos , Adolescente , Adulto , Idoso , Cefalometria/métodos , Criança , Estética Dentária , Feminino , Humanos , Islândia , Incisivo/diagnóstico por imagem , Masculino , Má Oclusão de Angle Classe III/terapia , Mandíbula/diagnóstico por imagem , Pessoa de Meia-Idade , Fotografação , Resultado do Tratamento
19.
Biomed Res Int ; 2019: 7679319, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31531367

RESUMO

Aims: To assess the bone dimensional changes after extraction and alveolar ridge preservation (ARP) using primary coverage (closed flap technique, CFT) or healing by secondary intention (open flap technique, OFT). Materials and Methods: Ten patients (split mouth design) were planned for extraction and ARP. All sites received ARP with freeze-dried bone allograft (FDBA) and nonresorbable membrane after extraction. Clinical standardized measurements were used to assess the dimensional alterations of the alveolar ridge. Results: All patients completed the study, and a total of 20 sites were randomized to CFT or OFT group. Center height (mean difference of 8.1 mm, SD =1.9 CFT, and 7.5 mm, SD= 1.8 OFT) and buccal height (mean difference of 0.8 mm, SD =1.0 CFT, and 0.3 mm, SD= 1.1 OFT) were significantly different within the same group. However, there was no statistically significant difference between groups. In the OFT group, the keratinized tissue width was higher and the pain VAS scores at 24 hours were lower compared with the CFT (p = 0.004 and p = 0.006, respectively). Conclusions: Leaving the flap open did not have any effects on the dimensional changes of bone height or width. However, there was a wider band of keratinized tissue and less pain with the CFT compared with the OFT. The study protocol was registered at ClinicalTrials.gov, Identifier NCT03136913.


Assuntos
Processo Alveolar/cirurgia , Aumento do Rebordo Alveolar/métodos , Preservação Biológica/métodos , Retalhos Cirúrgicos/fisiologia , Idoso , Transplante Ósseo/métodos , Feminino , Liofilização/métodos , Humanos , Masculino , Membranas Artificiais , Pessoa de Meia-Idade , Projetos Piloto , Extração Dentária/métodos
20.
Niger J Clin Pract ; 22(9): 1189-1195, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489852

RESUMO

Aim: The aim of the present study was to determine whether the use of advanced platelet rich fibrin based on the low speed+ centrifugation concept (A-PRF+) might improve the pain management and healing of delayed wound healing among cases of alveolar osteitis following mandibular third molar extraction. Materials and Methods: The patients (N = 40) with a complaint of alveolar osteitis following third molar extractions were divided into two groups: Group I (control; saline only); and Group II (use of A-PRF+). Pain was evaluated using the visual analogue scale (VAS). Soft tissue healing was assessed by the modified Index of Landry, Turnbull and Howley and bone density was assessed with the i-Dixel 2.1.8.2 software. Inter-group comparisons were analyzed by means of a student t-test and the Mann Whitney U test to identify group samples. Analysis of variance and the Friedman test were applied for repeated measurements. The Wilcoxon test and Bonferroni's test for multiple comparisons were conducted at the time-factor level. Yates Correction was used to compare qualitative data. Results: In regard to pain, A-PRF+ application demonstrated rapidly and continually reduced pain intensity at each respective time in comparison to the control. Statistically, the healing rates of epithelium and hard tissue were significantly faster in the A-PRF+ application group (p: 0.000, P < 0.05). Conclusions: The results show that A-PRF+ might represent an improved and accelerating therapeutic development for hard and soft tissue healing in management of alveolar osteitis that is also effective in reducing pain.


Assuntos
Alvéolo Seco/terapia , Adesivo Tecidual de Fibrina/administração & dosagem , Dente Serotino/cirurgia , Fibrina Rica em Plaquetas , Complicações Pós-Operatórias/terapia , Extração Dentária/efeitos adversos , Cicatrização/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Mandíbula , Manejo da Dor , Estudos Prospectivos , Extração Dentária/métodos , Escala Visual Analógica
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