Patient Education and Self-Care for the Management of Jaw Pain upon Awakening: A Randomized Controlled Clinical Trial Comparing the Effectiveness of Adding Pharmacologic Treatment with Cyclobenzaprine or Tizanidine

Aims: To compare the effectiveness of adding cyclobenzaprine, tizanidine, or placebo to patient education and a self-care management program for patients with myofascial pain and specifically presenting with jaw pain upon awakening. Methods: Forty-five patients with a diagnosis of myofascial pain based on the guidelines of the American Academy of Orofacial Pain participated in this 3-week study. The subjects were randomly assigned into one of three groups: placebo group, TZA group (tizanidine 4 mg), or CYC group (cyclobenzaprine 10 mg). Patients were evaluated for changes in pain intensity, frequency, and duration by using the modified Severity Symptoms Index and changes in sleep quality with the use of the Pittsburgh Sleep Quality Index. Data were analyzed by ANOVA and post-hoc or nonparametric statistical tests as appropriate. Results: All three groups had a reduction in pain symptoms and improvement of sleep quality based on a comparison of pretreatment and treatment scores. However, no significant differences among the groups were observed at the posttreatment evaluation. Conclusion: The use of tizanidine or cyclobenzaprine in addition to self-care management and patient education was not more effective than placebo for the management of patients with myofascial jaw pain upon awakening.

O Efeito da Manipulação Miofascial sobre o Limiar Doloroso em Atletas Durante Período Competitivo

Introduction: The myofascial pain syndrome (SDM) is one of the most common causes of musculoskeletal pain. One of the possible treatments for SDM is the type of physiotherapy myofascial manipulation. Objective: This study aimed to analyze the effect of manipulative technique with myofascial pain threshold before and after applying the technique in athletes during competition period. Methods: Participated in the study 62 subjects of both genders, aged between 14 and 38 (19.64 + 4.89), who had myofascial pain syndrome, 32 oh the treatment group and 30 divided equally between control group and the placebo group. All were athletes and operated by the Department of Sport and Leisure in the city of Marilia – SP and were in competitive period. The volunteers were evaluated according to their musculoskeletal symptoms to prove the necessity of performing the technique of myofascial manipulation. Confi rmed the need to assess the pressure pain threshold (LDP) using a digital dynamometer. After the measurement, patients underwent treatment or using the technique of myofascial manipulation, or a sliding surface for the placebo or no treatment for the control group followed by the immediate reassessment of the LDP. Results: The results were normalized by Kolmogrov-Smirnov test (KS). Through the ANOVA test found no differences between the initial LDP thresholds between groups. To compare pre and post LDP of the three groups we used the paired t test. Signifi cant difference (p=0.0001) between the values of pain threshold before and after application of myofascial manipulation for the treated group and not signifi cant for the control group (p=0.45) and placebo (p=0.16). Conclusion: We conclude then that the myofascial manipulation technique is able to increase pain threshold after micro-musculoskeletal injuries in athletes in competitive period.

Bruxismo do sono e disfunção temporomandibular: avaliação clínica e polissonográfica

O objetivo deste estudo foi buscar um melhor entendimento sobre a dor músculo-esquelética crônica da face e sua relação com o bruxismo do sono. Quarenta pacientes foram avaliados de acordo com o Research Diagnostic Criteria for Temporomandibular Disorders: Grupo A - 20 pacientes com DTM, com média de idade de 32,7 anos e duração média da dor de 4,37 anos; Grupo B - 20 pacientes sem DTM, com média de idade de 30,8 anos. As variáveis do sono e do bruxismo foram avaliadas em exame polissonográfico. As características clínicas foram estatisticamente diferentes entre os dois grupos: o grupo A apresentou maior freqüência de auto-relato de dor matinal (p=0,0113) e estalido articular (p=0,0269), maior grau de sintomas físicos não específicos (p=0,001) e de limitações da função mandibular (p=0,001). Não houve diferença estatisticamente significativa para as variáveis do bruxismo: número de episódios de bruxismo por hora, número de surtos por episódio e por hora, duração total, porcentagem em cada estágio do sono, tipo e amplitude dos episódios. A arquitetura do sono mostrou-se dentro dos parâmetros de normalidade, sem nenhuma diferença estatisticamente significativa entre os dois grupos. Conclusões: as características clínicas dos pacientes com bruxismo do sono, com e sem DTM, são diferentes, mas as características do sono e do bruxismo são similares. Mais estudos são necessários para esclarecer as razões pelas quais alguns pacientes com bruxismo do sono desenvolvem dor milfascial crônica e outros não.

Nosectomia em felinos portadores de carcinoma espinocelular - Relato de sete casos

Squamous cell carcinoma is a keratinocytes malignant tumor, the definitive diagnosis of this disease is based on histopathology examination of the lesions. The cats nostrils is one of regions commonly affected by this neoplasm. The response to chemotherapeutic agents, cryosurgery and radiotherapy is poor and for this reason surgical resection is instituted for remove the greatest amount of tissue engaged and provide free margins, in case of nasal involvement are indicated nosectomy often needing reconstructive techniques using as advance flaps for synthesis of surgical wounds. Due to the high incidence of feline patients with this entity, this study aims to report and discuss the effectiveness of nosectomy in seven cats with the disease. It is concluded that nosectomy as a therapeutic technique effective in five of seven cats, resecting tumor margin and providing acceptable time and quality life.

Two-stage rumenostomy in buffaloes

Background: Rumenostomy may be performed for therapeutic and digestibility research purposes in bovines, small ruminants and camelids. Several studies requires romenostomy in buffaloes in order to sample ruminal content for laboratorial assays. However, complications and outcome of rumenostomy was poorly studied in buffaloes. Therefore, the aim of the current study was to describe a two-stage rumenostomy technique in buffaloes, focused on intra and post-operative period.Materials, Methods & Results: Nine Murrah buffaloes were submitted to a 36-h and 12-h of food and water fastening. The animals were given acepromazine and maintained in standing position. Flank local anesthesia was carried out. A circular skin incision was carried out in the center of the left flank, followed by divulsion of the external and internal obliques and transversus abdominus muscles, and incision of the peritoneum. Subsequently, a segment of the dorsal aspect of the rumen was grasped and pulled through the flank incision. The rumen was attached to the peritoneum and skin incision margins in four points (dorsal, ventral, cranial and caudal). Additional simple interrupted sutures attaching the rumen serosa to the skin were applied subsequently. Four additional interrupted horizontal mattress sutures were applied equidistantly, taking bites only in the skin and rumen serosa. Following 12 h, the second stage was carried out. The buffaloes were prepared and restrained as performed for the first stage. A circular flap was excised from the exteriorized rumen and the silicone romenostomy cannula was placed. Clinical parameters, postoperative recovery, weight and behavioral pain scale were assessed. Positioning and anesthesia regimen were adequate for the achievement of the procedure. However, two animals fell in the restraint chute during the first surgical stage. Mild ischemia of the exteriorized rumen segment was observed on the second surgical stage, which resulted in less hemorrhage and enhanced cannula positioning. Complete cicatrization and permanent adhesion of the rumen to the skin were achieved. No ruminal leakage to the abdominal cavity occurred. No signs of pain were reported. There were few cases of laxity of the romenostomy opening leading to drop of cannula, myiasis on the margin of the stoma site and few cases of mild ruminal content leakage on the long-term assessment.Discussion: Restraint in standing position was considered adequate, although lateral recumbence constitutes another option. However, higher risk of contamination and technical difficulties in placing the cannulas are expected if lateral recumbence is considered. In other trials using acepromazine, no accidental recumbence occurred. Xylazine was also indicated for chemical restraint of buffaloes. It is known that flexible cannulas provide better anatomic adjustment and adaptation as well as being effective for sampling ruminal content, as seen in the current study. Ruminal leakage is one of the most frequent complications of romenostomy, which may affect animal's welfare. The animals in the current study presented no variations on the body score, even though on those presenting cannula loosening or ruminal content leakage. Moreover, no significant changes of the ruminal content parameters were noticed. Myiasis was also reported following ruminal surgical interventions, which were mainly attributed to extensive breeding. Loss of the cannula, subcutaneous emphysema and suture dehiscence are common complications of romenostomy. Nonetheless, none of those complications were found on the current study. Thus, romenostomy was feasible and efficient for sampling and performing assays of the ruminal content in buffaloes.

Comportamento forrageiro de abelhas visitantes de Solanun lycocarpum (Solanaceae) St. Hill e aspectos da biologia floral

A polinização é um serviço indireto prestado pelos ecossistemas, de valor ambiental e econômico para a sociedade humana. Em função dessa importância, a conservação de espécies de abelhas nativas é fundamental e o conhecimento de aspectos da biologia e ecologia dessas espécies é a base para a proposição de planos de manejo e conservação. Neste trabalho, foram feitas observações focais, avaliando os padrões de atividades diárias e sazonais, com ênfase no comportamento de coletas de recursos de abelhas nativas em flores de Solanum lycocarpum, uma espécie em que é característica a síndrome de polinização vibrátil. Os visitantes observados foram dez espécies de abelhas: Apis mellifera L., Oxaea flavescens K.; Centris sp1, Centris sp2, Exomalopsis sp.., Xylocopa suspecta M., Xylocopa frontalis K., Bombus morio S., Bombus atratus F., Trigona sp., além de espécies de abelhas da família Halictidae. As abelhas maiores, como Xylocopa, Oxaea, Centris e Bombus são certamente os polinizadores mais eficientes de Solanum lycocarpum. Isso se deve ao comportamento dessas abelhas nas flores, particularmente em relação à posição da abelha em relação ao cone de anteras quando forrageia e à seqüência de movimentos que cada uma desenvolve nas flores.

Subepithelial connective tissue graft: a case report

Introduction and objective: Marginal tissue recession represents a common condition in Periodontology. Miller's Classes I and II recessions, in which the etiological factors are well diagnosed and eliminated, show great predictability of total coverage when the technique of subepithelial connective tissue graft is used. This technique success has been mainly attributed to the double blood supply for graft's nutrition, originating from the connective tissue of both the periosteum and flap. Case report and conclusion: The authors reported a clinical case in which a Miller's Class I recession was treated by the surgical technique of subepithelial connective tissue graft, obtaining total coverage, eliminating the aesthetic deficiency and the dentin hypersensitivity complained by patient.

Tratamento de recessões gengivais múltiplas: uma abordagem mais conservadora

Periodontal therapy has undergone significant changes in recent decades. While in the past the only goal was to restore gingival health, with no concern about the possible consequences of the disease treatment, currently the procedures are performed in a less invasive manner, to maintain aesthetic periodontal results or even recover them. Gingival recession is an alteration frequently found in patients and may be a complaint for causing various complications. For their treatment, several surgical techniques are reported in the literature. The techniques that are more predictable are those that associate a subepithelial connective tissue graft and a coronally repositioned flap. The original technique consists in performing two vertical incisions for an extensive release of the flap and its stabilization in a coronal position. Although this procedure is extremely widespread in the literature, the search for less invasive surgeries without the use of vertical incisions are the current aim of periodontal plastic surgeries, since they present several advantages. The aim of this paper is to demonstrate a case where adjacent, deep and multiple recessions were present resulting in aesthetic problems, which was resolved by a less invasive approach using a surgical technique in envelope and a subepithelial connective tissue graft.

Rehabilitacion oral sobre implantes instalados por medio de la tecnica sin colgajo (flapless) y carga inmediata

The oral rehabilitation with osseointegrated implants is a well-documented treatment with high rate of success. Nevertheless, demands related to treatment time and surgical technique began to appear. In this context, the procedure of immediate loading in which the dental prosthesis is placed right after implant surgery has become a constant practice. Although immediate loading has been an important advance, minimally invasive procedures, such as implant placement without raising a mucoperiosteal flap (flapless) are increasingly being performed. Association of immediate loading with the flapless technique improves acceptance by patients and professionals, because no suturing is required. Moreover, it reduces swelling, bleeding during and after surgery, postoperative pain, surgery time, discomfort and hematoma, as well as the need for postoperative medication. These characteristics ease the stages of rehabilitation soon after implant placement, cooperating with prosthodontist's work. Thus, the proposal of this study is to present a clinical case of oral rehabilitation with osseointegrated implants and fixed prosthesis in both arches, in which the flapless technique was applied, followed by immediate loading. It will discuss the diagnosis, prosthetic planning, surgical/prosthodontic procedures and follow-up for 20 months.

Tratamento estético periodontal: revisão de literatura sobre alguns tipos de cirurgias

Currently, periodontal aesthetics has been prized for harmony of the smile. The clinical crown lengthening, gingival excess or altered passive eruption, is effectively corrected by periodontal surgery. The purpose of this paper is to show, through a literature review, some types of surgery on clinical crown lengthening and root coverage. Clinical crown lengthening is done to Change the size of the anterior teeth and to optimize the cosmetic result of treatment with new coronal restoration and other cosmetic dental care. In general, the treatment plan and the choice of operative technique begin with careful clinical examination. Recessions tissue can be defined as a displacement of the gingival margin toward the junction mucogingival exposing the root surface. These, when present, impacting on patient comfort by providing the occurrence of cervical dentin hypersensitivity, and the esthetic, the amendment of the gum line. Successful treatment of recessions is based on knowledge of its etiology and assessment of predictability of surgical techniques that aim to root coverage. Through literature review, we can conclude that the types of surgery most often used are: 1) to increase the clinical crown, gingivectomy, flap surgery and gingivoplasty osteotomy, and 2) for root coverage, the use will depend on the amount of gum keratinized and especially the classification of Miller.

Lesão endoperio: apicectomia com abordagem palatina: Relato de caso clínico com 30 meses de acompanhamento

Traditionally, the apicoectomies are carried out with the vestibular approach for visibility and easiness of access. The aim of this study was to present a case report of a patient with extensive injury endo-periodontal opted for the surgical access through a palatal incision. The patient presented with abscess drainage via periodontal ligament. The periodontal probing coincident with the radiographic apex in mesial tooth on dental element 22. Radiographically it was noted that the periapical lesion extended from the distal of the tooth 11 to the mesial of tooth 23. The tooth 22 had undergone endodontic treatment and showed signs of shutter material extravasation. It was decide to carry out an approach by the Palatine of the tooth to prevent gingival. After the flap elevation, the injury was debrided and apicoectomy was performed. The patient reported no pain or discomfort after surgery. Furthermore, as follow-up of 30 months there was total remission of signs and symptoms presented initially and absence of gingival recession. Therefore, according to the results showed in this case report, it is suggested that the Palatine access is an alternative approach that can be successfully employed in cases of apicoectomies in order to avoid the occurrence of gingival recessions.

Aplicação do enxerto conjuntivo subepitelial para recobrimento de recessões em dentes inferiores

Some regions of the oral cavity present anatomical conditions that seem to hinder the result of gingival recessions coverage. Thus, the aim of this case report was to present two surgeries for gingival recessions coverage in the mandibular teeth performed on the same patient with the follow-up of 24 months. Patient RP, 35 years old, male, Caucasian, nonsmoker, systemically healthy, sought care at the clinic of specialization course in Periodontics from the Araraquara Dental School (Foar-Unesp). His main complaint was the gingival recessions within the lower teeth 33, 34, 35, 43, 44 and 45. Besides the aesthetic nuisance, the patient reported occasional dentin sensitivity. For resolution of the case was referred to the technique of subepithelial connective tissue graft associated with a coronally advanced flap. After 2 years of surgery, it was observed an excellent root guards with significant aesthetic improvement of the case. It can be concluded that the subepithelial connective tissue graft technique was effective in covering of type class I gingival recessions of Miller, even in a region that provides a difficult procedure.

Hemangiossarcoma corneal em cão

Hemangiosarcoma is a malignant neoplasm and its corneal presentation is uncommon in the dog. The present work reports a case of primary corneal hemangiosarcoma on a mongrel female dog, 20kg, nine years old with a 2 month history of a mass with progressive growth in the right eye. The ophthalmic examination of the right eye showed blepharospasm, moderated conjunctival hyperemia and the presence of a reddish irregular nodule on the dorsal region of the cornea, occupying approximately 60% of the cornea. The ocular ultrasound revealed that the neoplasm affected only the cornea and the cytological examination diagnosed a malignant mesenchymal neoplasm. The patient was submitted to keratectomy followed by a third eyelid flap. The excised material was sent for histopathological analysis that diagnosed hemangiosarcoma. Fifteen days after surgery the third eyelid flap was removed and the ophthalmic examination revealed recurrence of the tumor, with the mass occupying the entire cornea and part of the bulbar conjunctiva. The patient was submitted to enucleation. No alterations were observed on the abdominal ultrasound and thoracic radiography, showing the primary characteristics of the disease. Two years after surgery the patient is clinically healthy, without any signs of recurrence or metastasis. Despite the surgical excision of the tumor with free margins, in cases of hemangiosarcoma with aggressive behavior, the enucleation should be considered as a viable option for a successfull therapeutic protocol and better prognosis of the patient.

Dimensional changes in soft tissues around dental implants following free gingival grafting: an experimental study in dogs

ObjectiveTo study the buccal dimensional tissue changes at oral implants following free gingival grafting, with or without including the keratin layer, performed at the time of implant installation into alveolar mucosa.Material and methodsThe mandibular premolars and first molars were extracted bilaterally in six Beagle dogs. In the right side of the mandible (Test), flaps were first elevated, and the buccal as well as part of the lingual masticatory mucosa was removed. An incision of the periosteum at the buccal aspect was performed to allow the flap to be coronally repositioned. Primary wound closure was obtained. In the left side, the masticatory (keratinized) mucosa was left in situ, and no sutures were applied (Control). After 3months of healing, absence of keratinized mucosa was confirmed at the test sites. Two recipient sites were prepared at each side of the mandible in the region of the third and fourth premolars. All implants were installed with the shoulder placed flush with the buccal alveolar bony crest, and abutments were connected to allow a non-submerged healing. Two free gingival mucosal grafts were harvested from the buccal region of the maxillary canines. One graft was left intact (gingival mucosal graft), while for the second, the epithelial layer was removed (gingival connective tissue graft). Subsequently, the grafts were fixed around the test implants in position of the third and fourth premolars, respectively. After 3months, the animals were euthanized and ground sections obtained.ResultsSimilar bony crest resorption and coronal extension of osseointegration were found at test and control sites. Moreover, similar dimensions of the peri-implant soft tissues were obtained at test and control sites.ConclusionsThe increase in the alveolar mucosal thickness by means of a gingival graft affected the peri-implant marginal bone resorption and soft tissue recession around implants. This resulted in outcomes that were similar to those at implants surrounded by masticatory mucosa, indicating that gingival grafting in the absence of keratinized mucosa around implants may reduce the resorption of the marginal crest and soft tissue recession.

Surgical Treatment of Severe Frontal Bone Fracture

Craniofacial trauma can lead to several complications. The combined fractures of anterior and posterior walls of the frontal bone are almost always followed by lesions in nasofrontal orifices and disruption of nasofrontal ostia or ducts, a significant factor for the development of early and late complications after sinus fractures. This article reports a case of trauma patient, who underwent neurological evaluation and at first showed good general condition. Computed tomography noted fracture of the anterior and posterior walls of the frontal sinus and small foci of pneumocephalus in the cerebral cortex. The patient was monitored periodically and 9 days after trauma showed increased areas of pneumocephalus in prefrontal cortex, cerebrospinal fluid draining, and large dura mater lesion, with signs of necrosis and inflammation (meningitis). The necrotic tissues were removed, and dura mater was repaired through the approximation with resorbable wire polyglactin 910 5-0, oxidized cellulose application, and bonding with human fibrin sealant (fibrinogen, thrombin, and calcium chloride). Sinusectomy, frontal sinus, and nasofrontal duct obliteration with pedicled pericranium flap were performed. Tomographically, a reanatomization was noted in frontal region, and a 12-month follow-up showed no complication. The use of fibrin glue to repair dura mater lacerations, as well as the pedicle pericranium flap for frontal sinus and nasofrontal duct obliteration, is an efficient method for treating fractures of the frontal bone.