Medicina Oral Patologia Oral Y Cirugia Bucal最新文献

Background: Choosing analgesics after third molar surgery requires balancing efficacy with safety. This network meta-analysis (NMA) aimed to compare and rank the safety profiles, measured by adverse events (AEs) related to medication use, of various single-dose oral analgesic regimens.

Material and methods: Electronic databases were searched for randomized controlled trials (RCTs) assessing single-dose oral analgesics following third molar surgery. The primary outcome was the incidence of any AE reported before discharge. A frequentist NMA was performed to estimate relative risks (RR) and SUCRA-based probabilistic rankings. The certainty of the evidence was assessed using CINeMA.

Results: Twenty-eight RCTs involving 5306 patients were included. NSAID monotherapy demonstrated a significantly higher risk of AEs compared to other non-opioid analgesics and opioid analgesics alone. Conversely, few significant differences were found between most active drugs and placebo. Probabilistic ranking indicated that both nonsteroidal anti-inflammatory drugs (NSAIDs) and placebo had a higher probability of ranking among the least safe options. Significant global inconsistency was detected across the network, and the certainty of the evidence was generally very low to low.

Conclusions: The safety profile of single-dose analgesics in this model is complex. While pairwise comparisons and rankings suggested that NSAIDs might be associated with a higher frequency of adverse events, these findings are based on very low to low certainty evidence and likely reflect minor, transient events such as nausea. Additionally, the high incidence of events in the placebo group suggests that the nocebo effect plays a predominant role in event perception. Therefore, results regarding the comparative safety of NSAIDs should be interpreted with caution, balancing this potential risk against their superior analgesic efficacy.

Background: Biological complications such as peri-implantitis present a significant challenge to the long-term stability of dental implants, often leading to failure if left untreated. While a history of periodontitis is a known risk factor, there is a lack of real-world data quantifying the "survival extension" provided by therapeutic interventions. This study aimed to evaluate the efficacy of surgical and non-surgical "rescue" therapies in extending the lifespan of dental implants that ultimately failed.

Material and methods: A retrospective cohort analysis was conducted using the multi-institutional BigMouth dental data repository, examining patients treated between 2011 and 2022. The study identified 725 failed implants, which were stratified into two clusters: A "Rescue Therapy" group (n=130) that received active intervention (e.g., scaling, flap surgery, bone grafting) and a "No Rescue" control group (n=595) that received no intervention prior to failure. The primary outcome was time-to-failure, calculated in months. A subgroup analysis of implants surviving beyond 12 months was performed to isolate late-stage biological failures.

Results: The Rescue Therapy group demonstrated a statistically significant survival advantage over the No Rescue group. In the subgroup of implants surviving the initial osseointegration phase (>12 months), those receiving rescue therapy achieved a median survival of 91.1 months, compared to 40.9 months for untreated implants (p<0.001). This differential equates to a median "survival extension" of 50.2 months (approximately 4.2 years) attributable to active intervention. Non-smokers showed a trend toward higher utilization of rescue therapies.

Conclusions: Interventional periodontal therapy significantly extends the functional lifespan of failing dental implants compared to non-intervention. For late-stage failures, rescue therapy provides a clinically meaningful survival extension of over four years. These findings advocate for an aggressive interventional approach to manage peri-implant biological complications, delaying explantation and maintaining function.

Background: Contemporary dental implant systems are continuously evolving in terms of surface characteristics, as well as macro- and micro-design. This study evaluates the performance of recent Straumann® implants-specifically comparing Bone Level Tapered (BLT) and Bone Level Conical (BLC) designs-in relation to peri-implant bone resorption and immediate loading protocols.

Material and methods: A total of 84 BLT implants and 84 BLC implants were placed in 78 patients between 2023 and 2025 across several clinics in Spain. Radiographic and periodontal probe measurements were performed to assess crestal bone level changes at one year post-placement. This retrospective cohort study focused on primary outcomes including 1-year survival rates and the evaluation of marginal bone loss (MBL).

Results: The most significant result was the 98.8% success rate observed for BLC implants.

Conclusions: While both Straumann® tapered implants represent excellent treatment options, BLC implants demonstrated superior improvements across all evaluated parameters. Future research should focus on identifying areas for further enhancement and comparing their performance with other leading implant systems.

Background: Consistent geographical disparities in oropharyngeal cancer (OPC) mortality rates have been observed across Europe, with distinct trends emerging among men and women. This study provides a detailed subnational analysis of OPC mortality in Spain between 1999 and 2023, categorised by gender and administrative region.

Material and methods: We conducted an ecological analysis using ICD-10 C10 mortality data for all 50 Spanish provinces and the two autonomous cities (Ceuta and Melilla). Hierarchical Bayesian spatio-temporal Poisson models, fitted via INLA, were employed to decompose variance and identify gender-specific risk patterns.

Results: Gender-specific patterns were markedly distinct. Male mortality showed a strong spatial structure (88.1% of variance), with persistent high-risk clusters in Northern Spain (Asturias, A Coruña, Cantabria) and the Canary Islands. Despite a modest national decline, risk often remained stable or increased in these high-risk areas; for instance, Cantabria's relative risk (RR) peaked at 2.62 in 2023. This pattern is consistent with entrenched traditional risk factors (tobacco and alcohol use). Conversely, female mortality was dominated by a strong national temporal increase (17.2% of variance), likely reflecting a growing HPV-associated burden. Risk escalated nearly uniformly across the country, rising from RR 0.62 in 1999 to 1.54 in 2023. Localised temporal deviations were significant for men (10.2% interaction), but negligible for women (0.4%), confirming a synchronised, nationwide female trend.

Conclusions: OPC mortality dynamics demand dual intervention strategies. Deep-rooted gender disparities in the northern and island provinces suggest strengthening tobacco and alcohol control campaigns. The rapid and widespread increase in female mortality highlights the need of expanding HPV vaccination programmes nationwide.

Background: The purpose of this systematic review was to determine the risk of alveolar osteitis with the use of traditional non-steroidal anti-inflammatory analgesics (NSAIDs) and COX-2 selective inhibitors compared to placebo using data from published clinical trials.

Material and methods: Embase and Medline/PubMed databases were employed to search for clinical trials. Articles that met the inclusion criteria were assessed for risk of bias using the Cochrane tool and data on alveolar osteitis were specifically extracted. Statistical analysis was performed using Review Manager 5.3 software.

Results: The risk assessment for alveolar osteitis concerning traditional NSAIDs included 19 clinical trials (n=2888) while for COX-2 inhibitors included 13 clinical trials (n=3820). Overall statistical analysis and subgroup evaluation by medication indicated that traditional NSAIDs did not increase the risk of alveolar osteitis. On the other hand, subgroup statistical analysis for selective COX-2 inhibitors suggested that rofecoxib elevated a patient's risk of developing alveolar osteitis (n=947, I2=0%, Z=2.52, OR=1.89, 95% CI=1.15 to 3.10, p=0.01) compared with placebo. Sensitivity analysis of the rofecoxib data exhibited high statistical robustness.

Conclusions: Data indicates that rofecoxib increases the risk of alveolar osteitis in patients undergoing tooth extraction.

Background: Periodontal disease (PD) is a prevalent chronic inflammatory condition linked to cardiovascular disease, diabetes mellitus and dementia, yet it is unclear how far medical specialty guidelines translate this evidence into concrete recommendations for assessment, referral and shared care.

Objective: To map clinical practice guidelines, consensus statements and position papers that contain explicit, actionable recommendations on PD within major medical specialties.

Material and methods: A scoping review was conducted following Joanna Briggs Institute guidance and reported according to PRISMA-ScR. PubMed/MEDLINE, Scopus, Web of Science Core Collection and LILACS were searched from 2005 to 2025 using MeSH/DeCS and free-text terms for periodontal disease, guideline documents and target specialties. Records were de-duplicated, screened in Rayyan by two independent reviewers and included if they were peer-reviewed or professionally endorsed guidance for adults that contained explicit periodontal recommendations. Data were charted in a standardized matrix and synthesized descriptively by specialty.

Results: The search yielded a small corpus of eligible documents. Operational recommendations were concentrated in diabetes-periodontitis statements, with fewer detailed pathways in cardiovascular and dementia care and very limited or absent guidance in obstetrics/gynecology and rheumatology. Across documents, PD was framed as a modifiable risk or complication, but periodontal definitions, screening intervals and division of responsibilities between medical and dental providers were heterogeneous or poorly specified.

Conclusions: Few medical specialty guidelines formally integrate PD into chronic disease care. Harmonized, multidisciplinary guidance with standardized definitions, clear referral criteria and shared follow-up schedules is needed to embed periodontal health within noncommunicable disease management.

Background: Static computer-assisted implant surgery (sCAIS) allows for accurate implant placement. However, the currently available systems usually block drill irrigation, increasing the risk of overheating and tissue damage. The present in vitro study evaluates the volume of irrigation solution that passes through the guide sleeve during implant drilling with different sCAIS systems.

Material and methods: The volume of irrigation solution that passed through a designed guide sleeve was measured on a 5ml syringe. The following sCAIS systems and groups were evaluated: a sleeve-in-sleeve with drill handle system (Straumann® sCAIS system); an integrated sleeve-in-drill system (RealGuide™ Z3D sCAIS system), and an integrated sleeve-in-drill system with irrigation channels (Adin® sCAIS system). The control group had neither drill handle nor sleeve-in-drill. The first pilot drill from each system was used, and drilling was performed for 10 seconds. The experiment was repeated 10 times for each group, and a blinded investigator measured the amount of irrigation solution in ml/s. A descriptive and bivariate analysis was performed.

Results: The median volume of irrigant collected over 10 seconds was: sleeve-in-sleeve group, 0.35 (IQR: 0.04) ml/s; sleeve-in-drill group, 0.07 (IQR: 0.04) ml/s; sleeve-in-drill system with channels group, 0.46 (IQR: 0.12) ml/s; and control group, 0.54 (IQR: 0.02) ml/s. The differences between groups were statistically significant (p=0.0001), except for the Adin sCAIS® system, which was not different from the control group (p=0.085).

Conclusions: Within the limitations of the study, the volume of irrigation seems to be influenced by the design and sCAIS system used. Although all guides impeded irrigation, the Adin® sCAIS system facilitated irrigation the most.

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.