Tácio Pinheiro Bezerra

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.

Prophylaxis versus placebo treatment for infective and inflammatory complications of surgical third molar removal: a split-mouth, double-blind, controlled, clinical trial with amoxicillin (500 mg).

fi b a f Although there are many conflicting reports regarding third molar removal, few studies investigating the impact of prophylactic or therapeutic antibiotic administration on the control of postoperative infection have been published. With estimated infection rates associated with dentoalveolar surgery ranging from 1% to 25%, controversy regarding the use of antibitics for this type of procedure is increasing, although entoalveolar surgery is considered potentially conaminated. The lack of detailed information leads to he use of antibiotics in the absence of a precise ndication. In extreme cases, patients may lack con-

A New Approach for Reconstruction of a Severely Atrophic Mandible

PURPOSE The purpose of this study is to report a case of a patient with a severely atrophic mandible (less than 5 mm) who was treated without bone graft using short implants and internal rigid fixation. PATIENT AND METHODS A 61-year-old woman was referred to a private clinic in the city of Recife (Brazil) with a severely resorbed mandible (less than 5 mm). The patient reported a history of nearly 15 years of complete edentulism and consecutive treatment failures. Cone beam tomography was performed and severe atrophy was confirmed, revealing total bilateral exposed inferior alveolar nerves. There was a high risk of pathologic mandible fracture, since bone density in critical areas was very low. Treatment of choice was the placement of 4 Shorty (3.75 x 5.5 mm) implants (Nobel Biocare, Göteborg, Sweden) at the symphysis for immediate functional reasons and a 2.0-mm large profile Unilock bone plate (Synthes Maxillofacial, Paoli, PA) to reinforce the mandible. A rapid prototype model was made to help precontour the plate, enabling the insertion of the plate through the transoral approach. RESULTS A week after surgery, a Brånemark prosthesis protocol was performed and the patient was satisfied with the result. At 29 months after surgery, the patient was still satisfied and had excellent function without complications. CONCLUSIONS Because of the reported advances in implantology and internal rigid fixation, more patients would be able to improve their severe dental condition without the use of more invasive techniques.

Giant salivary calculus of the submandibular gland

A54-year-old woman was seen at our department with a painless swelling on the right submandibular region that had lasted for 4 months. Physical examination revealed a hard elongated mass along the right Wharton’s duct and a reduced salivary flow. An occlusal radiograph showed a radiopaque, cylindrical, and elongated sialolith inside Wharton’s duct. It was carefully dissected with the patient under local anesthesia and a yellow 2.5-cm long specimen was obtained (Fig 1). The submandibular salivary gland was preserved. This procedure was approved by Institutional Review Boards, and the subject gave informed consent to the work. Microscopic analysis confirmed the initial diagnosis. The patient was reassessed 15 days after surgery for the evaluation. At that time, the right submandibular gland was found to be normal and a clear salivary flow could be observed. One year after the surgical procedure, the patient shows no signs or symptoms of xerostomia, and salivary flow is normal.

Do erupted third molars weaken the mandibular angle after trauma to the chin region? A 3D finite element study.

It has been suggested that third molars increase mandibular fragility because they do not contribute to its strength. For ethical reasons, a human study design that would permit the elucidation of this interference is not possible. This study evaluated the impact of the presence of erupted third molars on the mandibular angle of resistance when submitted to trauma. A three-dimensional (3D) mandibular model was obtained through finite element methodology using computed tomography (CT) with the geometry and mechanical properties to reproduce a normal mandibular structure. Human mandibles with no, one or two erupted third molars were evaluated. Whenever the third molar was present there was a greater concentration of tensions around the cervical part of its alveolus. Approximated Von Mises equivalent stress of the third molar region was 107.035 MPa in the mandible with teeth and 64.6948 MPa in the mandible without teeth. In the condylar region it was 151.65 MPa when the third molar was present and 184.496 MPa when it was absent. The digital models created proved that the mandibular angle becomes more fragile in the presence of third molars. When they are absent the energy concentrates on the lateral e posterior aspect of the condylar neck.

Comparative efficacy of nimesulide and ketoprofen on inflammatory events in third molar surgery: a split-mouth, prospective, randomized, double-blind study.

This study aimed to compare the effect of nimesulide and ketoprofen on inflammatory parameters related to the surgical removal of third molars. A split-mouth, prospective, randomized, double-blind study was conducted in patients undergoing removal of four third molars. Eighteen eligible patients were allocated to one of two groups to receive treatment two times a day with either ketoprofen 100 mg or nimesulide 100 mg for a period of 3 days. The rescue medication intake (number) and pain intensity were evaluated at 6, 12, 24, and 48 h, and at 7 days postoperatively. Swelling and maximum mouth opening were evaluated at 24 h, 72 h, and 7 days postoperatively. The peak pain score occurred at 6h after surgery in the nimesulide group and at 12h in the ketoprofen group. There was no statistically significant difference between the groups, although pain relief was observed after 48 h in the nimesulide group and after 7 days in the ketoprofen group. For each group, there was a statically significant difference in pain scores among the studied periods (P<0.0001). None of the patients required rescue medication. There was a statistically significant difference in maximum mouth opening between the preoperative and postoperative periods (P<0.0001). Ketoprofen and nimesulide were effective at controlling pain, swelling, and trismus after the surgical removal of third molars.

Rare hybrid odontogenic tumor in a 2-year-old child.

Hybrid odontogenic tumors are rare conditions that can affect the oral maxillofacial region and usually occur in adults as an asymptomatic swelling. Hybrid odontogenic tumors exclusively involving adenomatoid odontogenic tumor (AOT) and calcifying cystic odontogenic tumor (CCOT) are rare, with only 4 reported cases. In addition, there are only few studies describing the presence of abortive enamel in AOT and, to our knowledge, CCOT was not present in any of them. We described a rare case of AOT associated with CCOT and abortive enamel formation in a 2-year-old child, a condition not well described in the international literature. Secretory cell activity was assessed by periodic acid-Schiff and Congo red stains.

Correlation between radiographic signs of third molar proximity with inferior alveolar nerve and postoperative occurrence of neurosensory disorders: A prospective, double-blind study

PURPOSE To evaluate the interference of radiographic factors in the appearance of sensory deficit related to inferior alveolar nerve (IAN) after third molars (3Ms) removal. METHODS A prospective, double-blind, observational, unicentric study was performed with 126 patients submitted to a surgical procedure of lower 3Ms removal in the period from March to October/2011. Collected data included gender, age, eruption stage of 3Ms, position/angle of 3Ms (Pell-Gregory and Winter classifications, respectively), presence/absence of radiographic signs of 3Ms proximity with the inferior alveolar canal and surgical technique. Occurrence evaluation of the IAN injury was performed on the seventh postoperative day through pin-prick, two-point discrimination and brush directional stroke tests. RESULTS Predominant radiographic signs were: narrowing of the inferior alveolar canal (68.25%), darkening of root (46.82%) and diversion of the canal (31%). None of the patients presented sensory loss. Sixty-one (48.41%) of the cases had at least one or two radiographic signs of proximity with NAI. Forty-seven (37.3%) had 3 or more signs, and 18 (14.29%) did not have any radiographic signs of proximity to mandibular canal. CONCLUSION There was not a positive correlation between presence of radiographic signs of 3Ms with IAN proximity and postoperative neurosensory disorders occurrence.

Extensive oral lesion colonized with 601 myiasis larvae

Myiasis is a type of infection caused by the larvae of flying insects. This paper reports a case of a 72-year-old Caucasian man who was referred to the Infectology Department of Oswaldo Cruz University Hospital (Pernambuco – Brazil) for urgent treatment as he was malnourished and dehydrated. He had a facial and buccal lesion colonized with larvae and was extremely debilitated. The surgical and clinical treatment indicated at the first moment was the surgical removal of the larvae. But, after two days, some larvae were still present and therefore 12 mg of ivermectin was administered. At the end of the treatment, 601 larvae had been removed and the therapeutics established were suitable.

Surgical approach to pleomorphic adenomas arising in the palate: a 10-year retrospective study in a Brazilian population

Salivary  gland  tumors  represent  an  important  group  of  neoplasms  characterized  by a great  diversity  of  types and  morphological  variants.  Pleomorphic  adenoma  is  the  most  common  benign  tumor  occurring  in  the  major and  minor  salivary  glands.  The  majority  of  case  series  described  in  the  literature  refers  to  epidemiological  data of  major  and  minor  salivary  gland  tumors,  generally  being  of  a  benign  or  malignant  nature.  Studies  reporting exclusively  surgical  treatment  experience  with  pleomorphic  adenomas  of  the  palate  are  scarce.  Therefore,  the aim  of  this  study  was  to  report  data  on  the  treatment  experience  with  surgical  removal  of  pleomorphic  adenoma of  the  palate  together  with  to  nearby  mucosal  lining  with  or  without  ostectomy. Clinical  records  of  all  patients diagnosed  with  pleomorphic  adenoma  of  the  palate  seen  at  Brazilian  public  service  dental  clinic  (Oral  and  Ma xillofacial  Surgery  Division)  and  at  a  private  clinic  between  March  1999  and  November  2010  were  reviewed. The  analysis  of  the  biopsied  specimens  yielded  10  cases  during  the  10-year  period.  Of  all  the  patients  8  were women,  with  mean  age  39  years.  The  most  common  main  complaint  was  asymptomatic  increase  in  volume  (n  = 9),  with  mean  tumor  size  2.1  cm.  Most  patients  (n  =  8)  underwent  excision  of  tumor  and  mucosal  lining.  One patient  underwent  bone  ostectomy  and  in  another,  the  tumor  regressed  after  incisional  biopsy. The  mean  follow -up  was  26,8  months  (12-42  months)  with  no  recurrences,  and  the  main  complication  was  local  discomfort  and dysphonia  (n  =  2).  In  summary,  surgical  excision  of  the  tumor  and  mucosal  lining,  with  or  without  ostectomy, was  shown  to  be  an  effective  treatment  modality  for  pleomorphic  adenomas  of  the  palate.