Elizangela Bertoli

Persistent Pain and Neurosensory Disturbance After Dental Implant Surgery: Prevention and Treatment

Nerve trauma caused by dental implant placement is associated with altered sensation and chronic pain. Complete or partial loss of sensation is often reported by patients who have experienced nerve trauma during implant surgery. Some patients report persistent pain and neurosurgery disturbance long after the normal healing time has passed. In addition, neuropathic pain is reported after implant surgery. Practitioners who place dental implants must be familiar with the differential diagnosis, prevention, and management of neuropathic pain. This article provides insights into the prevention and management of neurosensory deficits and chronic persistent neuropathic pain and considerations for patient referral.

Smoking and Posttraumatic Stress Disorder Symptomatology in Orofacial Pain

To explore the impact of interactions between smoking and symptoms of posttraumatic stress disorder (PTSD) on pain intensity, psychological distress, and pain-related functioning in patients with orofacial pain, a retrospective review was conducted of data obtained during evaluations of 610 new patients with a temporomandibular disorder who also reported a history of a traumatic event. Pain-related outcomes included measures of pain intensity, psychological distress, and pain-related functioning. Main effects of smoking status and PTSD symptom severity on pain-related outcomes were evaluated with linear regression analyses. Further analyses tested interactions between smoking status and PTSD symptom severity on pain-related outcomes. PTSD symptom severity and smoking predicted worse pain-related outcomes. Interaction analyses between PTSD symptom severity and smoking status revealed that smoking attenuated the impact of PTSD symptom severity on affective distress, although this effect was not found at high levels of PTSD symptom severity. No other significant interactions were found, but the present results identifying smoking as an ineffective coping mechanism and the likely role of inaccurate outcome expectancies support the importance of smoking cessation efforts in patients with orofacial pain. Smoking is a maladaptive mechanism for coping with pain that carries significant health- and pain-related risks while failing to fulfill smokers’ expectations of affect regulation, particularly among persons with orofacial pain who also have high levels of PTSD symptom severity. Addressing smoking cessation is a critical component of comprehensive treatment. Further research is needed to develop more effective ways to help patients with pain and/or PTSD to replace smoking with more effective coping strategies.

Short-Lasting Unilateral Neuralgiform Headache with Conjunctival Injection and Tearing Secondary to Head and Neck Trauma: Literature Review and Case Report.

This article reports a case of secondary short-lasting unilateral neuralgiform headache with conjunctival injection and tearing following head and neck trauma due to a violent assault. Following the incident, the patient began experiencing 4 to 30 shooting/sharp pain attacks per day in the left anterior temporal and supraorbital areas, with an intensity of 10/10 on a numeric rating scale. Each attack lasted between 10 and 60 seconds. These attacks were accompanied by ipsilateral conjunctival injection, tearing, ptosis of the left eye, blurry vision, and occasional rhinorrhea. Significant improvements in sleep, autonomic symptoms, and pain were observed with a combination of melatonin 10 mg per day, gabapentin 300 mg twice daily, physical therapy, and psychotherapy. This case highlights the relevance of a multidisciplinary approach in the treatment of challenging cases when there is evidence of more than one contributing factor, with the aim of reducing pain and improving the patients quality of life.

A systematic review of studies comparing conventional complete denture and implant retained overdenture

PURPOSE Several studies reported better outcomes when restoring edentulous mandible with unsplinted IODs compared to CCDs; however, it is not clear if these outcomes remain when the full literature is considered. The aim of this systematic review is to compare conventional complete dentures (CCDs) to unsplinted implant-retained overdentures (IODs) with regard to efficacy, satisfaction and quality of life. STUDY SELECTION The main question addressed was: How do CCDs compare to unsplinted IODs with regard to efficacy, satisfaction and quality of life? Three databases were electronically searched to identify articles comparing CCD to unsplinted IOD. Twenty-six articles were selected and reviewed in full. Of these selected articles, twenty-five compared CCDs restoring function in both arches to a maxillary CCD opposing a mandibular IOD retained by two unsplinted implants. Only one articles compared a maxillary CCDs to a maxillary IOD. RESULTS Outcome measures varied among the studies, including the Oral Health Impact Profile (OHIP), visual analogue scales (VAS), and masticatory performance tests. Overall, IODs were associated with significantly better patients masticatory performance and quality of life as indicated by Oral Health as Related to Quality of Life (OHRQoL). Mandibular unsplinted IODs were more likely than CCDs to be associated with improved OHRQoL for edentulous patients and were associated with significantly higher ratings of overall satisfaction, comfort, stability, ability to speak and ability to chew. CONCLUSIONS Results of this systematic review indicate the superiority of IODs retained by two unsplinted mandibular implants when compared to CCDs with regards to efficacy, satisfaction and quality of life.