A aplica����o de plasma rico em plaquetas na regenera����o dos tecidos periodontais

O periodonto �� uma unidade biol��gica e funcional, constitu��da pela gengiva, pelo cemento, pelo ligamento periodontal e pelo osso alveolar. O seu processo de cicatriza����o envolve mecanismos fisiol��gicos complexos que requerem a a����o dos fatores de crescimento, p��ptidos oriundos da desgranula����o das plaquetas. Neste sentido surge o Plasma Rico em Plaquetas como um produto aut��logo, obtido a partir da centrifuga����o do sangue do pr��prio paciente e que visa melhorar a cicatriza����o dos tecidos ap��s procedimentos enquadrados na Medicina Dent��ria. Esta revis��o bibliogr��fica baseou-se numa pesquisa realizada na base de dados MEDLINE, via pubmed. Foram utilizadas as palavras-chave ���plasma rich in growth factors���, ���platelet-rich plasma���, ���oral surgery���, ���dental implants���, ���sinus lift���, ���third molar surgery��� e ���bone regeneration���. Ap��s leitura de 40 artigos, foram descartados 9 pela sua pouca relev��ncia no contexto. O objetivo �� avaliar a efetividade da aplica����o de plasma rico em plaquetas na regenera����o dos tecidos periodontais em situa����es cl��nicas como alv��olos p��s-extracionais, cirurgias de implantes, cirurgias de eleva����o do seio maxilar e na regenera����o ��ssea. A efetividade em tecidos moles parece ser consensual. A efetividade no tecido ��sseo �� alvo de contradi����o entre os diversos autores, concluindo-se que h�� necessidade de mais estudos randomizados e controlados para que se possa responder �� quest��o com evid��ncia cient��fica suficiente.

Bacteriologic investigation of the effects of sodium hypochlorite and chlorhexidine during the endodontic treatment of teeth with apical periodontitis

SIQUEIRA JR. et al. Bacteriologic investigation of the effects of sodium hypochlorite and chlorhexidine during the endodontic treatment of teeth with apical periodontitis. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., v. 104, n. 1, p. 122-130, 2007.

Antibioterapia profil��tica na extra����o de terceiros molares inclusos

Contextualiza����o: A extra����o de terceiros molares �� um dos atos cl��nicos mais realizados em Cirurgia Oral. A presen��a de um terceiro molar incluso pode estar na origem de uma variedade de complica����es. Pericoronarite, c��ries dent��rias e doen��a periodontal s��o algumas das indica����es para extra����o de terceiros molares inclusos. A antibioterapia profil��tica para a preven����o de complica����es p��s-operat��rias como a alveolite e a infe����o do local cir��rgico �� ainda um assunto que gera alguma controv��rsia, particularmente em indiv��duos saud��veis. Objetivo: Estudar a necessidade da antibioterapia profil��tica na extra����o de terceiros molares e os seus potenciais riscos e benef��cios. Materiais e M��todos: Foi efetuada uma pesquisa bibliogr��fica na base de dados da MEDLINE/PubMed e no motor de busca da ResearchGate. Adicionalmente, foram coletados artigos de interesse da bibliografia recolhida e consultados alguns livros de forma a complementar a informa����o obtida. Conclus��o: N��o existe um consenso no que toca �� profilaxia antibi��tica na extra����o de terceiros molares. Os m��dicos dentistas devem, por isso, efetuar uma avalia����o cuidada do estado cl��nico de cada paciente de forma a tomar uma decis��o consciente relativamente �� administra����o de antibi��ticos com o intuito de prevenir complica����es p��s-operat��rias da cirurgia de terceiros molares inclusos.

Piezocirurgia no consult��rio de Medicina Dent��ria

A presente Tese de Mestrado em Medicina Dent��ria tem como tema a Piezocirurgia e, sobre ela, pretende-se saber a sua aplicabilidade no consult��rio do M��dico Dentista, nomeadamente na ��rea da Cirurgia oral. A pesquisa bibliogr��fica foi realizada atrav��s de bases de dados, como a Medline, Science Direct e a Pub-Med, entre outras. Limitou-se a pesquisa, temporalmente, entre 2000 e 2016, e nas l��nguas Portuguesa e Inglesa. Excluiu-se todas as refer��ncias a estudos animais e, todas as que, em nada, contribuir��am para o conte��do especificado. A cirurgia Piezoel��ctrica �� uma t��cnica de osteotomia atraum��tica, quando comparada a t��cnicas convencionais, e que revoluciona a ��rea da Cirurgia Oral, atrav��s do seu corte preciso e altamente selectivo, mas tamb��m atrav��s do fen��meno de cavita����o que a caracteriza, e que garante um campo operat��rio livre, uma ��ptima visibilidade, e, consequentemente, uma maior seguran��a do operador, culminando tudo isto no sucesso do tratamento. A sua maior desvantagem �� o tempo de trabalho que requere, contudo este tende a diminuir, e a ser ainda menor que o tempo de trabalho exigido na cirurgia convencional. In��meras s��o as aplica����es da Piezocirurgia, mas na ��rea da Medicina Dent��ria, nomeadamente na Cirurgia Oral, destaca-se o levantamento do seio maxilar, o aumento da crista ��ssea, a extrac����o dos terceiros molares impactados e a cirurgia ortogn��tica.

Effect of sonic and ultrasonic activation on organic tissue dissolution from simulated grooves in root canals using sodium hypochlorite and EDTA

Aim: To compare soft-tissue dissolution by sodium hypochlorite, with an EDTA intermediate rinse, with or without activation with passive ultrasonic activation (PUI) or sonic activation using the Endoactivator (EA) or Eddy tips (ED). Methodology: The root canals of eighty-three human maxillary central incisors were chemo-mechanically prepared and the teeth split. A standardized longitudinal intracanal groove was created in one of the root halves. Eighty-three porcine palatal mucosa samples were collected, adapted to fit into the grooves and weighed. The re-assembled specimens were randomly divided into four experimental groups (n = 20), based on the final rinse: no activation; EA; PUI; ED, using 2.5% sodium hypochlorite, with an EDTA intermediate rinse. A control group (n = 3) was irrigated with distilled water without activation. The solutions were delivered using a syringe and needle 2 mm from working length. Total irrigation time was 150 s, including 60 s of activation in the specific groups. The study was carried out at 36 �� 2 ��C. The porcine palatal mucosa samples were weighed after completion of the assays. Student paired t-test and anova were used to assess the intra- and intergroup weight changes. The multiple comparisons were evaluated using Bonferroni correction (�� = 0.05). Results: Weight loss occurred in all experimental groups. Irrigant activation resulted in greater weight loss when compared to the nonactivated group [vs. EA (P = 0.001); vs. PUI (P < 0.001); vs. ED (P < 0.001)]. No significant differences were found amongst the different activation systems. Conclusions: Activation increased the tissue-dissolving activity of irrigants from artificial grooves in root canals of maxillary central incisors. �� 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Ceramic-veneered zirconia frameworks in full-arch implant rehabilitations: A 6-month to 5-year retrospective cohort study

Purpose: This was a retrospective cohort study designed to evaluate the clinical performance of ceramicveneered zirconia frameworks. Materials and Methods: Patients were recruited according to defined inclusion criteria. All patients were checked every 4 months from the time of definitive rehabilitation. At the end of 2013, all patients were rescheduled and rechecked for study purposes. The restorative procedures assessment was performed by previously established methods. The primary outcomes were the survival and success rates of the prosthesis. Descriptive statistics were used for the patient's demographics, implant distribution, and occurrence of complications. To study the survival and success of the prostheses, a Cox Regression analysis was used with a model constructed in a forward conditional stepwise mode. Predictive variables were included in the model, and adjusted survival curves were obtained for each outcome. Results: From 2008 to 2013, 75 patients were rehabilitated with 92 implant-supported, screw-retained, full-arch ceramic-veneered zirconia framework rehabilitations. The range of follow-up was between 6 months and 5 years. From the 92 full implant-supported screw-retained full-arch rehabilitations, Cox regression analysis indicated that within a 5-year time frame, the probability of framework fracture, major chipping, minor chipping, or any of the former combined to occur was 17.6%, 46.5%, 69.2%, and 90.5%, respectively. Conclusion: Results suggest zirconia as a suitable material for framework structure in implant-supported, full-arch rehabilitations. However, it experiences a high incidence of technical complications, mainly due to ceramic chipping. Further clinical studies should aim to ascertain the effects of clinical features and manufacturing procedures on the survival rates of these prostheses. �� 2016 by Quintessence Publishing Co Inc.

Deep venous thrombosis prophylaxis in oral and maxillofacial surgery: a Brazilian survey

Background : Deep venous thrombosis (DVP) is a frequent disease. Prophylaxis is the best means to reduce its incidence, for lowering morbidity and mortality rates and treatment costs caused by its complications. Objective : To evaluate the knowledge and use of any kind of DVT prophylaxis by Brazilian Oral and Maxillofacial surgeons. Materials and Methods : A questionnaire was sent to all Oral and Maxillofacial surgeons associated to the Brazilian College of Oral and Maxillofacial Surgeons that have a valid e-mail address. The data retrieved was evaluated and tabulated. Results : Of the 1100 questionnaires sent, only 4% were retrieved. The 42 retrieved were included in the study. Twenty six of the surgeons do not use any kind of deep venous thrombosis (DVT) prophylaxis, 11 use mechanical means as elastic compressive stockings or pneumatic compressive devices for prophylaxis, and 5 uses low-molecular weight heparins (LMWH) as the choice for prophylaxis. Conclusion : The data collected, despite the low rate of participation (4%) by the surgeons, shows that this subject still does not receive proper attention. Whereas other medical specialties make routine use of prophylactic means maybe the maxillofacial surgeons lack concern on that matter.

Impact of bariatric surgery on oral health conditions: 6-months cohort study

Funda����o de Amparo �� Pesquisa do Estado de S��o Paulo (FAPESP)

Influence of Roux-en-Y Gastric Bypass Surgery on Vitamin C, Myeloperoxidase, and Oral Clinical Manifestations: A 2-Year Follow-Up Study

Background: Bariatric surgery influences the intake and absorption of nutrients. The serum concentrations of vitamin C, myeloperoxidase (MPO) and oral clinical manifestations were examined in patients two years after Roux-en-Y gastric bypass (RYGB). Methods: Clinical prospective-study with control-group (CG; n = 26), assessed only once, and the bariatric-group (BG; n = 26), assessed in the basal period and at 12 and 24 months after surgery. The mean ages in the CG and BG were 37.8 +/- 1.51 and 39.6 +/- 1.93 years, respectively, and their body mass indices were 22.07 +/- 0.29 and 45.62 +/- 1.46 kg/m2, respectively. Results: At 12 months after surgery, increased episodes of vomiting (P &lt; .001) and dental hypersensitivity (P=.012) were observed, with a reduction in the saliva buffering capacity of 21.3 2.9% (P=.004). At 24 months after RYGB, we detected a significant reduction in serum vitamin C (32.9 +/- 5.3%, P &lt; .001) and MPO values were higher than in the basal period (P = .032). With regard to oral hygiene habits, 92.3% of patients reported frequent tooth brushing and 96.1% used fluoride, which were similar across the two years. However, dental hypersensitivity (P = .048) was significantly increased than baseline. Conclusions: The results demonstrated that vitamin C deficiency and increased vomiting after RYGB for morbid obesity may contribute to increased periodontal disease. The fact it is impossible to determine which factors (diet, poor compliance with supplementation, vomiting, poor oral hygiene) contributed to the dental problems in these patients is a shortcoming of the report. (Nutr Clin Pract. 2012; 27: 114-121)

Predictors of swallowing outcome in patients treated with surgery and radiotherapy for advanced oral and oropharyngeal cancer

Retaining effective swallowing is a key element when optimising outcomes in the management of head and neck cancer. We report the functional swallowing outcomes for a cohort of 31 individuals with advanced oral and oropharyngeal cancer who underwent free or pedicled flap reconstruction of surgical defects. Swallowing was assessed pre and immediately post surgery and at four months post treatment. Swallowing assessments were related to site, size and volume of defect and composition of flap reconstruction. The effect of radiotherapy on swallowing was assessed among 17 of the 31 individuals who were submitted to radiotherapy after surgery. The proportion of patients on a total oral diet four months post treatment varied significantly by site of defect (Fishers exact test p=0.006), from 100% (7/7) of patients with a lateral defect to only 22% (2/9) of patients with a central defect. The proportion of patients on a total oral diet at the final assessment did not vary by flap reconstruction or radiotherapy.

Patients with oral tumors. Part 1: Prosthetic rehabilitation following tumor resection. Resection prosthetics: surgery, implants and prosthetic treatment

The present study reports on the surgical and prosthodontic rehabilitation of 46 patients, 31 male and 15 female, after resection of oral tumors. The treatment was carried out from 2004 to 2007 at the Department of Prosthodontics, University of Bern, with a follow-up time of 3 to 6 years. The average age at diagnosis was 54 years. 76% of all tumors were squamous cell carcinoma, followed by adenocarcinoma. Resection of the tumors including soft and/or hard tissues was performed in all patients. 80% of them additionally underwent radiotherapy and 40% chemotherapy. A full block resection of the mandible was perfomed in 23 patients, and in 10 patients, the tumor resection resulted in an oronasal communication. 29 patients underwent grafting procedures, mostly consisting of a free fibula flap transplant. To enhance the prosthetic treatment outcome and improve the prosthesis stability, a total of 114 implants were placed. However, 14 implants were not loaded because they failed during the healing period or the patient could not complete the final treatment with the prostheses. The survival rate of the implants reached 84.2% after 4 to 5 years. Many patients were only partially dentate before the tumors were detected, and further teeth had to be extracted in the course of the tumor therapy. Altogether, 31 jaws became or remained edentulous. Implants provide stability and may facilitate the adaptation to the denture, but their survival rate was compromised. Mostly, patients were fitted with removable prostheses with obturators in the maxilla and implant-supported complete dentures with bars in the mandible. Although sequelae of tumor resection are similar in many patients, the individual intermaxillary relations, facial morphology and functional capacity vary significantly. Thus, individual management is required for prosthetic rehabilitation.

The surgery of oral diseases and malformations, their diagnosis and treatment,

Mode of access: Internet.

Oral ibuprofen for acute postoperative pain

In this short communication we wanted to find out what is the analgesic effect of single dose oral Ibuprofen for adults with postoperative pain? Ibuprofen at 200mg and 400mg are effective in producing at least 50% pain relief in patients with moderate to severe postoperative pain (at least 30mm on a VAS). They are safe to use without common adverse effects. The use of Ibuprofen 200mg or 400mg should be considered as standard practice or protocol for pain relief in post-operative settings. Clinicians should consider a range of factors before prescribing or administering Ibuprofen for acute post-operative pain, including but not limited to, the duration of pain relief with Ibuprofen of different doses, Ibuprofen formulation, cost and patient preference.

Is flapless implant surgery a viable option in posterior maxilla? : a review

This article reviews the literature on the outcome of flapless surgery for dental implants in the posterior maxilla. The literature search was carried out in using the keywords: flapless, dental implants and maxilla. A hand search and Medline search were carried out on studies published between 1971 and 2011. The authors included research involving a minimum of 15 dental implants with a followup period of 1 year, an outcome measurement of implant survival, but excluded studies involving multiple simultaneous interventions, and studies with missing data. The Cochrane approach for cohort studies and Oxford Centre for Evidence- Based Medicine were applied. Of the 56 published papers selected, 14 papers on the flapless technique showed high overall implant survival rates. The prospective studies yielded 97.01% (95% CI: 90.72���99.0) while retrospective studies or case series illustrated 95.08% (95% CI: 91.0���97.93) survival. The average of intraoperative complications was 6.55% using the flapless procedure. The limited data obtained showed that flapless surgery in posterior maxilla areas could be a viable and predictable treatment method for implant placement. Flapless surgery tends to be more applicable in this area of the mouth. Further long-term clinical controlled studies are needed.