Marcelo Munhóes Romano

Clinical and surgical evaluation of the indication of postoperative antibiotic prescription in third molar surgery.

OBJECTIVE The aim of this study was to evaluate the need for antibiotic prescription in third molar surgery. STUDY DESIGN A double-blind randomized study was carried out with 71 patients from CODONT (Dentistry Center of the Police of São Paulo). Amoxicillin, clindamycin, or no medication was administered for 7 days immediately after surgery. The participants evaluated the presence of pain, edema, interincisal distance (ID), presence of infection, Pell and Gregory classification, rescue analgesia, osteotomy, and odontosection. RESULTS There was no difference (P < .05) between antibiotics and control over the surgery duration, dose, visual analog scale (VAS), ID, and edema, yet significant differences were seen over time for VAS, edema, and ID. CONCLUSIONS Antibiotic prescription should not be indicated in all clinical conditions, yet it is necessary to correctly evaluate factors such as systemic condition of the patient, skill of the operator, and contamination of the surgical environment.

Comparison of the fracture torque of different Brazilian mini-implants

This study evaluated fracture torque by torsion, in relation to the length and diameter of orthodontic mini-implants, to demonstrate their viability for clinical and experimental use based on the torque recommended by the manufacturers. The fractures at the moment of insertion, whose incidence in the literature is around 4%, are principally due to excessive force and the inability of the implant to resist rotational forces. Thirty orthodontic mini-implants of three commercial brands available in Brazil (Neodent 1.6 x 9 mm, Dentoflex 1.6 x 9 mm and Kopp 1.6 x 9 mm) were attached to a device made specifically for this research, leaving the mini-implants with sufficient stability. The miniimplants were submitted to torsion torque, using a digital torque wrench, until their breaking point. The values obtained with the test were submitted to analysis of variance and the Tukey test. The mean values of mini-implant ruptures were 26 N.cm for group A (Dentoflex), 25.4 N. cm for group B (Kopp) and 32.8 N.cm for group C (Neodent). From the Tukey test we could observe that the relationships between the means of the Dentoflex and Neodent groups, and between the Kopp and Neodent groups, were significant. Between the Dentoflex and Kopp groups, significance was nonexistent. All the values found in our research for fracture torque were higher than the limits recommended by the manufacturers for clinical use in orthodontics. The highest values were found in the Neodent group.

A study of effectiveness of midazolam sedation for prevention of myocardial arrhythmias in endosseous implant placement

PURPOSE The study aimed to assess electrocardiographic alterations during oral implant placement surgeries under local anesthesia (lidocaine chlorhydrate with epinephrine), using 15 mg of midazolam as an anxiolytic premedication. MATERIAL AND METHODS The study randomly selected 20 patients, aged 21-50 years old, requiring bilateral mandibular dental implants. Each patient was assessed using placebo on one side and midazolam on the contralateral side, with random, double-blinded distribution. The electrocardiogram recorded 12 static leads every 2 min, while D2 derivations were recorded continuously. RESULTS No statistically significant differences were observed between the placebo and midazolam when analyzing the morphological behavior of the electrocardiographic wave and the presence of arrhythmias during the experiment. However, under sedation, assessment of the behavior of electrocardiographic parameters during different stages of the procedure revealed statistically significant differences (P<0.05) for heart rate, P-wave amplitude and duration of the RR and QTc intervals. The arrhythmias detected were considered low risk for patients without systemic alterations and were observed in 53.3% of patients. The most frequently occurring alterations were tachycardia, bradycardia, supraventricular and ventricular extrasystoles and blocked atrial extrasystole, which were similar for both placebo and midazolam, with the greatest incidence during the initial, incision and bone drilling stages. CONCLUSION The use of 15 mg of midazolam made no difference compared with the placebo. The use of 15 mg of midazolam did not show an advantage in the incidence of arrhythmias The anxiolytic premedication does not prevent myocardial arrhythmias in endosseous implant placement. The clinical significance of the arrhythmias may not represent serious risks.

Behavioral and physiological changes in children with Down syndrome using mechanical and chemomechanical (Carisolv™) caries removal methods

This study compared behavioral and physiological changes during caries removal in children with Down syndrome when using a chemomechanical caries removal technique (Carisolv) and a conventional method of caries removal. Twenty children (ASA class 1) between 5 and 12 years of age participated in the study; 10 subjects had Down syndrome and 10 were healthy controls. The behavioral and physiological assessments were carried out during five stages of dental treatment: (1) 5 minutes before local anesthesia; (2) during local anesthesia; (3) during caries removal; (4) immediately after restoration; and (5) 5 minutes after the end of the treatment. The caries removal step resulted in the greatest behavioral and physiological changes. Except for oxygen saturation, statistically significant differences in heart rate (p<0.05) were recorded between children with Down syndrome and the control children.

Oral manifestations and rehabilitation in Fraser syndrome: A case report: ORAL MANIFESTATIONS AND REHABILITATION

Fraser syndrome (FS) is a rare recessive autosomal genetic disorder characterized by multisystemic malformations typically comprising cryptophthalmos, syndactyly, and renal defects. We report the case of a 16-year-old patient who exhibited facial asymmetry, short roots, hypodontia, and malocclusion. Oral rehabilitation included orthodontics, exodontia, and osseointegrated dental implants to improve the patients self-esteem and eating function. We suggest short roots and hypodontia assessment in patients with FS.

Impact of aggressive periodontitis and chronic periodontitis on oral health-related quality of life

The purpose of this cross-sectional study was to investigate the effect of different forms of periodontal diseases on Oral Health-Related Quality of Life (OHRQoL). Fifty-two patients with Aggressive Periodontitis (AP) or Chronic Periodontitis (CP) were included: nine patients with Localized Aggressive Periodontitis (LAP), thirty-three patients with Generalized Aggressive Periodontitis (GAP) and ten patients with Generalized Chronic Periodontitis (GCP). Oral Health Impact Profile questionnaires (OHIP-14) were distributed after a clinical examination that measured the following periodontal parameters: tooth loss, bleeding on probing (BoP), probing depth (PD), gingival recession (REC) and clinical attachment level (CAL). The global OHIP-14 score means were 10.6 for LAP, 16.5 for GAP, and 17.5 for GCP. A statistically significant difference (p < 0.01) was observed between the LAP group and the other two groups. There was significantly less bleeding and recession in the LAP group than in the patients with the generalized forms of periodontitis. LAP, GAP and GCP have an impact on patient quality of life when measured using the OHIP-14. Patients with GAP and GCP had poorer OHRQoL than LAP patients.

Histological and Radiological Analyses of a Maxillary Sinus Lift with Extensive Drilling of the Schneider Membrane Using Xenogeneic Bone

The objective of this study is to report a clinical case of maxillary sinus with lyophilized, xenogeneic graft, in which, despite a large perforation of the sinus membrane, the surgery was not aborted and the results of histological examinations indicate bone neoformation in the surgical area. Results. This case showed that the biomaterials evaluated in this study and the procedure used to place them proved to be biocompatible and presented high osteogenic potential, leading to a successful surgery and osseointegration implant. Conclusion. Positioning Schneiders membrane and filling it with the graft biomaterial helped to achieve the desired osteoconduction and proliferation of bone cells even though the patient had a large perforation of the sinus membrane.

Simplifying the implant treatment plan for an elderly patient.

I n the search for a better lifestyle and increased life expectancy, more and more elderly are seeking dental treatment. However, many of these patients present systemic compromise that could affect the success and maintenance of the proposed therapy. In such cases, simple proposals, such as partial removable prostheses (PRPs), must be used. PRPs are widely used, especially when conditions for rehabilitation with a fixed prosthesis attached to implants are not favorable. In one study, 10 patients were rehabilitated with inferior PRPs supported by implants in the posterior region; results show increased satisfaction in all patients, minimal wear of the component, absence of excessive bone loss, and periodontal health after 1 year of rehabilitation. Literature describing the combination of PPRs and implants is scarce and is based mainly on clinical reports of posterior implants for distal extension with PRPs. In this case, rehabilitation with fixed prostheses and implants was proposed to the patient, who required surgically guided bone regeneration through subantral graft or PRPs, but the patient declined both proposals. Following this, rehabilitation with implants in conjunction with PRP was planned and proposed to avoid subjecting the patient to sinus lifting surgery and to preserve the remaining tooth and the residual ridge; however, the team explained that greater load would be generated on these if they received only PRPs.