Belmiro Cavalcanti do Egito Vasconcelos

Sensitivity and Specificity of Pantomography to Predict Inferior Alveolar Nerve Damage During Extraction of Impacted Lower Third Molars

PURPOSE The purpose of the study was to assess the sensitivity and specificity of maxillary radiographic image findings in predicting nerve lesions in third molar surgery. PATIENTS AND METHODS A total of 260 third molars were assessed prior to surgical removal by means of panoramic radiography in the sample of 153 patients (73.8% female). The tooth root was classified according to the presence or absence of a radiological sign of a close relationship with the mandibular canal. Of the 260 cases assessed, the presence of a radiological sign of a close relationship with the mandibular canal was recorded in 159 cases. RESULTS Of the 260 cases, 9 (3.5%) presented postsurgical sensory complications. Though this percentage was higher among those in which there was judged to be a radiological sign of a close relationship with the mandibular canal than in those without such a sign, no significant association was shown to exist between the presence of the radiological sign and postsurgical changes in the inferior alveolar nerve (P = .94). The positive and negative predictive values were 0.03 and 0.97, respectively. Calculations on the results of the radiological examination in relation to the frequency of nerve lesions yielded values of 66% for sensitivity and 39% for specificity. CONCLUSIONS Panoramic radiography does not provide the reliable images required for predicting nerve lesions in third molar surgery.

Comparative Study of the Effect of a Tube Drain in Impacted Lower Third Molar Surgery

PURPOSE Postoperative variables such as pain, swelling, and trismus after surgery of the impacted lower third molars are the main concerns of dental clinicians and surgeons. Many authors claim that the use of a drain could help control these variables. The purpose of this study was to evaluate the effect of the use of a tube drain in impacted lower third molar surgery. MATERIALS AND METHODS Fifty-three patients of both genders with bilateral impacted lower third molars comprised our comparative study. The patients were divided into 2 groups: in the first the suture procedure was accomplished using a drain, and in the second the suture procedure was accomplished without a drain. The postoperative pain, swelling, and trismus were evaluated at 24 hours, 72 hours, 7 days, and 15 days. RESULTS In the group in which the drain was used, the control of the swelling variable was statistically significant at 24 and 72 hours (P <.001) in comparison with the group in which the drain was not used. However, pain and trismus were not statistically significant at the evaluation period. CONCLUSION The use of the drain helps to control swelling. However, it had no effect on pain or trismus.

Targeted assessment of the temporomandibular joint in patients with rheumatoid arthritis.

PURPOSE This observational study was done to identify the signs and symptoms of temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis (RA) and to assess the association between these and quantitative measurements for the evaluation of rheumatologic disease. PATIENTS AND METHODS The sample comprised 61 patients suffering from RA whose signs and symptoms of TMJ were recorded by means of a questionnaire (scale of limited mandibular function) and clinical measurements (pain during jaw movement, limitation of maximal mouth opening, joint sounds, tenderness on TMJ palpation, tenderness on masticatory muscle palpation). These findings were correlated with the quantitative measurements for evaluating RA: duration of the disease, positivity for rheumatoid factor, Health Assessment Questionnaire (HAQ) score, number of edematous and painful joints, and overall assessment of functional status. RESULTS In terms of overall figures, 70.5% of the patients presented with at least 1 sign or symptom, 49.2% had at least 1 symptom, and 54.1% had at least 1 sign. The variable pain on movement was associated with the number of painful joints and the overall assessment findings (P < .05). Sound on movement was positively associated with the number of edematous joints (P = .0291). The scale of limited mandibular function was statistically significantly correlated with 4 quantitative measurements (P = .0283 to .0448). The variable pain on palpation of the masticatory muscles was associated with the number of painful joints (P = .0023). Pain on palpation of the TMJ was statistically significantly associated with the HAQ score (P = .0344) and with the number of painful joints (P = .0006). CONCLUSION A significant percentage of the patients with RA have signs and symptoms of TMJ involvement, and the scale of limited mandibular function proved to be an important measurement tool.

Prevalence of oral mucosa lesions in diabetic patients: a preliminary study

AIM The present study aimed to evaluate the prevalence of superficial lesions in the oral cavity mucosa in diabetic patients. METHODS The sample was made of 30 patients. To obtain these results we did rigorous clinical and complementary tests. RESULTS Of the 30 patients, 9 (30%) were males and 21 (70%) females. Of the studied patients, 40% were below 60 years of age, and 60% were older than 60 years. Thirteen different types of mucosal alterations were diagnosed. Tongue varicose veins (36.6%) and candidiasis (27.02%) were the most prevalent. Such alterations can be associated with the fact that these conditions are commonly found in senile patients and are also associated with prolonged wear of dentures. Xerostomia was diagnosed in only 1 (3.33%) patient, disagreeing with most of the studies observed in the literature. CONCLUSION Most of the diabetic patients presented at least one type of oral mucosa lesion or alteration.

The Methodological Quality of Systematic Reviews Comparing Temporomandibular Joint Disorder Surgical and Non-Surgical Treatment

BackgroundTemporomandibular joint disorders (TMJD) are multifactor, complex clinical problems affecting approximately 60–70% of the general population, with considerable controversy about the most effective treatment. For example, reports claim success rates of 70% and 83% for non-surgical and surgical treatment, whereas other reports claim success rates of 40% to 70% for self-improvement without treatment. Therefore, the purpose of this study was to (1) identify systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment, (2) evaluate their methodological quality, and (3) evaluate the evidence grade within the systematic reviews.MethodsA search strategy was developed and implemented for MEDLINE, Cochrane Library, LILACS, and Brazilian Dentistry Bibliography databases. Inclusion criteria were: systematic reviews (± meta-analysis) comparing surgical and non-surgical TMJD treatment, published in English, Spanish, Portuguese, Italian, or German between the years 1966 and 2007(up to July). Exclusion criteria were: in vitro or animal studies; narrative reviews or editorials or editorial letters; and articles published in other languages. Two investigators independently selected and evaluated systematic reviews. Three different instruments (AMSTAR, OQAQ and CASP) were used to evaluate methodological quality, and the results averaged. The GRADE instrument was used to evaluate the evidence grade within the reviews.ResultsThe search strategy identified 211 reports; of which 2 were systematic reviews meeting inclusion criteria. The first review met 23.5 ± 6.0% and the second met 77.5 ± 12.8% of the methodological quality criteria (mean ± sd). In these systematic reviews between 9 and 15% of the trials were graded as high quality, and 2 and 8% of the total number of patients were involved in these studies.ConclusionThe results indicate that in spite of the widespread impact of TMJD, and the multitude of potential interventions, clinicians have expended sparse attention to systematically implementing clinical trial methodology that would improve validity and reliability of outcome measures. With some 20 years of knowledge of evidence-based healthcare, the meager attention to these issues begins to raise ethical issues about TMJD trial conduct and clinical care.

Treatment of Chronic Mandibular Dislocations: A Comparison Between Eminectomy and Miniplates

PURPOSE Temporomandibular joint dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. The purpose of this study was to compare 2 types of treatment for chronic mandibular dislocations, eminectomy and miniplates, evaluate the results of these surgeries, and make a critical review of the literature. PATIENTS AND METHODS The sample was obtained from the records of Oswaldo Cruz Hospital (Recife, Brazil) and comprised cases submitted to chronic mandibular dislocation treatment by eminectomy and by use of miniplates between 2000 and 2006. Preoperative and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of dislocations, recurrence rate, and presence of facial nerve paralysis. RESULTS After eminectomy, the mean maximal mouth opening was 48.4 +/- 8.5 mm preoperatively and 41.3 +/- 5.0 mm postoperatively. After the use of miniplates, it was 42.75 +/- 11.53 and 45.62 +/- 8.52 mm, respectively. There was no facial nerve paralysis after either treatment. Recurrence occurred with miniplates (11.11%) but not with eminectomy. CONCLUSION Eminectomy had less chance of recurrence without creating articular damage, and with miniplates, the chance of recurrence increased because there is always the possibility of the miniplate fracturing.

Comparative study of eminectomy and use of bone miniplate in the articular eminence for the treatment of recurrent temporomandibular joint dislocation

UNLABELLED Dislocation of the temporomandibular joint occurs when the mandibular condyle exits the glenoidal cavity and remains anteriorly locked to the articular eminence. It is repetitive (recurrent dislocation), usually associated with mandibular hypermobility and inclination of the articular eminence. AIM This study intended to clinically and radiologically assess the technique of eminectomy and the use of a miniplate on the articular eminence for the treatment of recurrent dislocation of the temporomandibular joint of patients operated on at Oswaldo Cruz University Hospital from January to September 2003. STUDY DESIGN Retrospective cohort. MATERIAL AND METHOD The sample consisted of 11 patients. Eminectomy was performed on nine joints of five patients and the placement of a miniplate on the articular eminence was performed on 11 joints of six patients. Data collection was carried out through analysis of patients medical charts and new postoperative visit. RESULTS The results showed that there were no major postoperative complications with either technique. Maximum mouth opening was greater with eminectomy procedure and none of the patients operated on presented any recurrence of dislocation. CONCLUSION It is concluded that both techniques were effective in the treatment of recurrent dislocation of the temporomandibular joint.

Estudo comparativo da eminectomia e do uso de miniplaca na eminência articular para tratamento da luxacão recidivante da articulacão temporomandibular

Dislocation of the temporomandibular joint occurs when the mandibular condyle exits the glenoidal cavity and remains anteriorly locked to the articular eminence. It is repetitive (recurrent dislocation), usually associated with mandibular hypermobility and inclination of the articular eminence. AIM: This study intended to clinically and radiologically assess the technique of eminectomy and the use of a miniplate on the articular eminence for the treatment of recurrent dislocation of the temporomandibular joint of patients operated on at Oswaldo Cruz University Hospital from January to September 2003. STUDY DESIGN: Retrospective cohort. MATERIAL AND METHOD: The sample consisted of 11 patients. Eminectomy was performed on nine joints of five patients and the placement of a miniplate on the articular eminence was performed on 11 joints of six patients. Data collection was carried out through analysis of patients medical charts and new postoperative visit. RESULTS: The results showed that there were no major postoperative complications with either technique. Maximum mouth opening was greater with eminectomy procedure and none of the patients operated on presented any recurrence of dislocation. CONCLUSION: It is concluded that both techniques were effective in the treatment of recurrent dislocation of the temporomandibular joint.

Conduction velocity of the rabbit facial nerve: a noninvasive functional evaluation

The aim of this study was to evaluate standardized conduction velocity data for uninjured facial nerve and facial nerve repaired with autologous graft nerves and synthetic materials. An evaluation was made measuring the preoperative differences in the facial nerve conduction velocities on either side, and ascertaining the existence of a positive correlation between facial nerve conduction velocity and the number of axons regenerated postoperatively. In 17 rabbits, bilateral facial nerve motor action potentials were recorded pre- and postoperatively. The stimulation surface electrodes were placed on the auricular pavilion (facial nerve trunk) and the recording surface electrodes were placed on the quadratus labii inferior muscle. The facial nerves were isolated, transected and separated 10 mm apart. The gap between the two nerve ends was repaired with autologous nerve grafts and PTFE-e (polytetrafluoroethylene) or collagen tubes. The mean of maximal conduction velocity of the facial nerve was 41.10 m/s. After 15 days no nerve conduction was evoked in the evaluated group. For the period of 2 and 4 months the mean conduction velocity was approximately 50% of the normal value in the subgroups assessed. A significant correlation was observed between the conduction velocity and the number of regenerated axons. Noninvasive functional evaluation with surface electrodes can be useful for stimulating and recording muscle action potentials and for assessing the functional state of the facial nerve.

Fracture of the Atrophic Mandible: Case Series and Critical Review

PURPOSE Atrophic mandible fracture is common among elderly patients. Such fractures present management difficulties related to anatomic and physiologic alterations in this population. The purpose of this study was to evaluate the results of this type of fracture treatment and to realize a critical review of literature on the subject. PATIENTS AND METHODS The sample was obtained from records of patients of Restauração Hospital (Recife, Brazil) who underwent surgical treatment of atrophic mandible fracture between 2006 and 2009. Data, such as etiology, location, and degree of displacement of the fractures, as well as access, type of fixation used, and the presence of postoperative complications, were analyzed. RESULTS Successful bone union was achieved in 100% of cases. Complications were related to those patients treated with reconstruction plates (2.4 mm). CONCLUSIONS Open reduction and internal fixation with miniplates seem a feasible option for primary treatment of atrophic mandible fractures without comminution or loss of substance. The level of scientific evidence for the treatment of atrophic mandible fractures is low.