Medicina Oral Patologia Oral Y Cirugia Bucal最新文献

Background: Pain management in dentistry, particularly in procedures such as mandibular third molar surgery, poses a significant challenge due to the transient efficacy of traditional local anesthetics. To address this, adjunctive therapies such as dexamethasone have been explored to prolong anesthesia and alleviate postoperative pain. However, the efficacy and safety of this approach in mandibular third molar surgery remain underexplored.

Material and methods: This study assessed the efficacy and safety of combining articaine with perineural dexamethasone for inferior alveolar nerve block in patients undergoing mandibular third molar extraction. Sixty patients aged 18-35 years were enrolled and randomly assigned to three groups receiving different anesthesia protocols. Anesthesia duration, postoperative pain scores, and adverse events were evaluated.

Results: The incorporation of dexamethasone into articaine-based anesthesia significantly prolonged the duration of analgesia compared to articaine alone, underscoring its potential as an effective adjunctive therapy. While no significant differences were observed in the duration of operation, analgesic consumption, or incidence of adverse events among the groups, trends favoring the articaine-dexamethasone cohorts were noted in postoperative pain scores.

Conclusions: Combining articaine with perineural dexamethasone for inferior alveolar nerve block prolongs postoperative analgesia in mandibular third molar surgery. While additional research using larger sample sizes and longer follow-up durations is needed, these findings imply that this combination could be beneficial for improving pain management during oral surgery.

Background: Diabetes mellitus (DM) is a common metabolic disorder, and persistent hyperglycemia may impair oral health through various immunological and inflammatory mechanisms, particularly by influencing the onset and healing of apical periodontitis (AP). This systematic review and meta-analysis aimed to evaluate whether poor glycemic control (PGC) is associated with the presence and progression of AP.

Material and methods: This study was conducted in accordance with the PRISMA 2020 guidelines. A comprehensive search of PubMed, Embase, Google Scholar, and Scopus was performed to identify relevant English-language studies published up to June 2025. Cross-sectional and longitudinal studies examining the association between glycemic control status-defined by glycated hemoglobin (HbA1c) levels-and AP-related outcomes were included. Data were synthesized using RevMan 5.3 software to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity and publication bias were also assessed.

Results: A total of 18 studies comprising approximately 51,070 patients were included. The relationship between PGC and AP was examined across three domains: AP prevalence, the persistence of apical periodontitis in root-filled teeth (AP-RFT), and alterations in local or systemic immune responses. Meta-analysis of AP prevalence (6 studies) revealed that individuals with PGC had a significantly increased risk of developing AP compared to controls (OR=2.38, 95% CI: 1.98-2.86, P<0.00001). Furthermore, meta-analysis of AP-RFT persistence (8 studies) showed that patients with PGC had a significantly higher risk of AP-RFT (OR=2.74, 95% CI: 2.03-3.70, P<0.0001). Several studies also reported elevated levels of inflammatory cytokines and bacterial load in patients with PGC.

Discussion: PGC appears to negatively influence both the development and healing of AP, possibly through immune-inflammatory pathways.

Conclusions: PGC is closely associated with the occurrence of AP and the failure of periapical healing following endodontic treatment. PGC may aggravate periapical tissue damage and inflammation through proinflammatory immune pathways. Clinicians should consider comprehensive evaluation and individualized management of DM patients during endodontic therapy to improve treatment outcomes and oral health.

Background: This study evaluated the efficacy of a single 15 mg preoperative sublingual dose of melatonin in reducing anxiety as the primary outcome, and its effects on psychomotor performance, postoperative sleep quality, and early post-traumatic stress symptoms as secondary outcomes in patients undergoing mandibular third molar surgery.

Material and methods: Forty-eight patients were randomly allocated to receive either melatonin (n=24) or an identical placebo (n=24) sublingually 45 minutes before surgery. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI) and a Visual Analog Scale for Anxiety (VAS-A) at baseline, 45 minutes post-medication, and post-surgery. Intraoperative anxiety was measured with the surgeon-rated Interval Scale of Anxiety Response (ISAR). Psychomotor performance was evaluated with the Digit Symbol Substitution Test (DSST) at baseline and 45 minutes post-medication. Sleep quality was recorded via a patient diary for three postoperative nights, and post-traumatic stress symptoms were screened one week post-surgery using the Impact of Event Scale-Revised (IES-R).

Results: After adjusting for baseline scores using ANCOVA and GLM, no significant effect of melatonin was observed on state anxiety at any time point. Regarding secondary outcomes, no significant differences were observed in psychomotor performance, intraoperative anxiety from the surgeon's perspective (ISAR), postoperative sleep quality across the three nights, or early post-traumatic stress symptoms. The intervention was well tolerated, with no adverse events reported.

Conclusions: A single 15 mg preoperative dose of sublingual melatonin did not demonstrate any significant benefit over placebo in reducing perioperative anxiety, improving psychomotor performance, enhancing postoperative sleep quality, or preventing early post-traumatic stress symptoms in patients undergoing mandibular third molar surgery.

Background: Donor site selection for bone tissue reconstruction in head and neck surgery has remained a matter of debate since the advent of microsurgical techniques. Both the fibula and the deep circumflex iliac artery (DCIA) free flaps offer specific advantages but also present distinct morbidity profiles that must be considered to provide optimized and personalized reconstructive treatment for each patient.

Material and methods: A retrospective morbidity analysis was conducted on 66 osseous free flaps (fibula and DCIA) used for head and neck reconstructive surgery at Ramón y Cajal University Hospital over a 6-year period (2018-2024). Surgical variables, as well as local and systemic complications, were analyzed.

Results: Reconstruction with the DCIA free flap was associated with a threefold higher risk of developing systemic infections not related to surgical site (47.37% vs. 21.28%; OR=3.33; 95% CI=1.07-10.41) compared with the fibula free flap. No statistically significant differences were observed between the two groups regarding free flap failure, surgical site infections, postoperative bleeding, microvascular complications, or donor site morbidity.

Conclusions: the DCIA free flap may be associated with a higher risk of systemic infections. Therefore, for patients with predisposing factors for systemic infections, the fibula free flap might represent a safer donor site. These findings could help refine donor site selection and improve individualized planning in head and neck reconstructive surgery.

Background: Alveolar ridge preservation (ARP) is critical for implant dentistry outcomes, yet current graft material selection lacks standardized intrabony root volume benchmarks. This study aimed to establish baseline data for intrabony root volumes of adult teeth using CBCT.

Material and methods: This single-center cross-sectional study included 100 adults (50 males, 50 females) with complete natural dentition. CBCT-derived intrabony root volumes were measured for 10 target tooth positions using Mimics software. Volumetric data were analyzed for differences across tooth positions, jaw locations, and genders using parametric or nonparametric tests.

Results: Intrabony root volumes varied by tooth position (first molar, first premolar, canine, lateral incisor, central incisor), with the largest volumes in upper first molars and smallest in lower central incisors. The intrabony root volumes of all target maxillary tooth positions were significantly higher than those of their mandibular homonymous counterparts (all P<0.01). Males exhibited significantly larger intrabony root volumes than females across all tooth positions (P<0.001).

Conclusions: This exploratory study preliminarily establishes comprehensive reference data for adult intrabony root volumes across tooth positions, jaw locations, and genders, which may inform the development of tailored bone substitutes to address clinical limitations in graft volume estimation.

Background: Periodontal disease is among the most prevalent oral conditions worldwide. Psychological disorders, typically diagnosed during the first two decades of life, have gained greater importance in recent years. Although the relationship between both conditions has been briefly studied, findings remain inconsistent. The objective of this systematic review is to analyze the involvement of psychological disorders on the development and progression of gingivitis and periodontitis.

Material and methods: This systematic review followed PRISMA guidelines and was registered in the PROSPERO (CRD420250651846). Searches were performed in PubMed, Scopus, Embase, and Cochrane Library using the equation: "(periodontal disease) AND ((adolescents) OR (teenager)) AND (psychological disorder)". Studies conducted in animals, adults, or with unrelated disorders were excluded Results: A total of 17 articles met the inclusion criteria. Adolescents with psychological disorders consistently showed poorer levels of periodontal health compared to controls, sharing several common risk factors among the pathologies.

Conclusions: The general trend reflects a greater predisposition and prevalence of periodontal pathology symptoms in subjects with psychological disorder. Despite que promising findings, further research using standardized methodologies is required.

Background: Mechanical decontamination of biofilm, or implantoplasty, is a commonly employed technique for managing peri-implantitis. However, the inflammatory response and in vivo behavior of tita-nium (Ti) particles released during this procedure remain underexplored. This study aimed to evaluate the cytotoxic, inflammatory, and osteogenic effects of Ti particles released during im-plantoplasty, as well as their in vivo behavior Material and Methods: Titanium particles were generated by following a standardized protocol using drills on 150 commercially pure Ti implants. Cytotoxicity thresholds were determined using THP-1 macrophages and bone marrow-derived mesenchymal stem cells (BM-MSCs). These cells were subsequently cultured with Ti particle-conditioned medium, and inflammatory responses were analyzed using RT-qPCR for markers such as CCR7, TNF-?, IL-1? (pro-inflammatory), and CD206, TGF-?, IL-10 (anti-inflammatory). Cytokine levels were quantified using ELISA. Osteogenic responses in BM-MSCs were assessed by analyzing Runx2, alkaline phosphatase (ALP), and osteocalcin (OC) expression, and ALP activity was measured colorimetrically. In vivo, Ti particles were introduced into mandibular defects in 30 Wistar rats, with histological analysis performed 20 days post-implantation Results: Ti particles elicited a pro-inflammatory response in macrophages, with increased expression of TNF-? and reduced expression of TGF-? and CD206. Cytokine analysis confirmed elevated IL-1? and reduced IL-10 levels. No significant changes in ALP activity were observed.

Conclusions: Titanium particles released during implantoplasty induce pro-inflammatory responses.

Background: Photobiomodulation (PBM) has shown promise for managing nerve paraesthesia. This trial assessed the efficacy of an 810-nm diode laser on deep-mechanical, superficial-mechanical and thermal sensitivity for inferior alveolar nerve paresthesia after implant surgery.

Material and methods: Twenty-four adults with recent implant-related paraesthesia were randomly assigned, in a parallel design, to an intervention or control group; both groups received routine vitamin-B supplementation. The intervention group underwent eight diode-laser sessions (200 mW power and 6 J/cm2 energy density) over four weeks, directed at peri-implant mucosa and adjacent cheek skin. The control group attended identical sessions with an inactive laser. Blinded examiners recorded visual-analogue-scale (VAS) scores for the Clamp (deep mechanical), Swab (light mechanical) and Ice (thermal) tests at baseline and at two and four weeks after the final session. Data were analysed with the Shapiro-Wilk test, independent-samples t-test and Friedman test (α=0.05).

Results: All twenty-four randomised participants (mean age 51±7 years) completed follow-up. Baseline VAS scores did not differ between groups (p>0.44). Although both groups improved over time, the VAS scores for paresthesia reductions in the PBM group were significantly greater than those in the control group at both follow-ups for all three tests (all p<0.001). No adverse events were reported.

Conclusions: Eight sessions of 810-nm PBM produced faster and more pronounced sensory recovery than sham treatment in patients with implant-related paraesthesia.

Background: This randomized clinical trial was designed to evaluate the postoperative analgesic efficacy of ibuprofen compared to meloxicam in patients undergoing third molar extraction.

Material and methods: Sixty-eight patients who had been indicated for the extraction of both a maxillary (semi-erupted or fully erupted crown) and mandibular third molar (Class I, Position A, and Class I, Position B, according to Pell and Gregory's classification) were randomly assigned to receive either meloxicam (7.5 mg every 12 hours, n = 34) or ibuprofen (400 mg every 8 hours, n = 34) following a single surgical procedure. Postoperative pain intensity was assessed using a Visual Analog Scale (VAS). All outcome measures were recorded during the first seven consecutive postoperative hours, and subsequently at 24, 48, and 72 hours. Addition, the presence or absence of adverse effects was recorded.

Results: In this clinical trial, a total of 68 patients (mean age 24.7 years) completed the study in this clinical trial, and no patients were lost to follow-up. The results showed lower pain intensity in the ibuprofen-treated group at all evaluated time points, except at 72 hours; however, statistically significant differences were observed only at the 2-hour mark (p < 0.05). Both groups exhibited a sustained decrease in pain from 24 hours postoperatively onward (VAS < 2). Only two cases of mild dizziness were reported in the ibuprofen group.

Conclusions: These findings suggest that both therapeutic regimens are effective and well-tolerated options for postoperative pain management in third molar extraction.

Background: This study aimed to evaluate the biomechanical behavior of five different fixation methods used in bilateral sagittal split osteotomy (BSSO), focusing on their performance with miniplates and monocortical screws during 10-mm advancement and 20º counterclockwise rotation of the occlusal plane.

Material and methods: A three-dimensional model of a human mandible, derived from computerized tomography scans and including all teeth except the third molars, was utilized. The BSSO procedure was simulated using SolidWorks 2017 CAD software (Dassault Systemes, SolidWorks Corp, USA) according to the techniques outlined by Epker. Five fixation models were tested: Model M1, one straight 4-hole miniplate with four monocortical screws; Model M2, two straight 4-hole miniplates with eight monocortical screws; Model M3, one 10-hole double miniplate with two bridges and ten monocortical screws; Model M4, one 8-hole 20º angled double miniplate with two bridges and eight monocortical screws; and Model M5, one semi-curved 6-hole miniplate with six monocortical screws. Each model was subjected to two loading patterns: 100 N posteriorly and 50 N anteriorly. The biomechanical performance was analyzed qualitatively and quantitatively, focusing on the bone, screws, and plates.

Results: Models M1 and M3 exhibited the poorest biomechanical stability; Model M2 demonstrated the highest stability; and Model M5 showed the best load distribution.

Conclusions: A model using two straight 4-hole plates offers more stable osteosynthesis, whereas a semi-curved plate with six nonlinear screws ensures effective load distribution with reduced stress concentration.