Preemptive use of intravenous ibuprofen to reduce postoperative pain after lower third molar surgery: a systematic review of randomized controlled trials

This study aimed to systematically review the literature to assess the effect of preemptive intravenous ibuprofen on pain reduction after lower third molar surgery. Nine databases (PubMed, Scopus, LILACS, SciELO, Embase, Web of Science, Cochrane, Open Gray, and Open Thesis) were used as sources of research, including “grey literature.” The protocol was registered in PROSPERO. Only randomized clinical trials evaluating the effects of preemptive intravenous ibuprofen on pain during and immediately after the extraction of lower third molars were included, without restrictions of year and language. Two reviewers independently performed the study selection, data extraction, and assessment of the risk of bias. The “Joanna Briggs Institute for Randomized Controlled Trials” tool was used to assess the risk of bias. Each study was categorized according to the percentage of positive responses to the questions corresponding to the assessment instrument. The results were measured narratively/descriptively. The initial search resulted in 3,257 records, of which only three studies (n=150 participants) met the eligibility criteria and were included in the qualitative analysis. All studies were published in 2019. The risk of bias ranged from low to moderate. Two studies found significant pain reduction within 48 h after the procedure. In conclusion, the use of preemptive intravenous ibuprofen for extracting third molars reduces pain and analgesic consumption after the surgical procedure

Effect of botulinum toxin A treatment on quality of life of patients with bruxism and orofacial pain

Introduction: Bruxism is defined as a parafunctional chewing activity, characterized by the clenching and / or grinding of teeth, which occurs both during sleep and during waking moments. Botulinum toxin type A presents itself as a therapeutic adjuvant to mitigate some symptoms caused by bruxism, due to the fact that it is a potent and specific myorelaxant, as it promotes the relaxation of the masticatory muscles. Method: Thirty female patients, aged between 18 and 40 years, who had bruxism and orofacial pain were selected. After careful anamnesis, the patients answered `a Visual Analogue Scale (VAS) to measure orofacial pain and another for quality of life. A randomization in two groups was performed: a control group (n = 15), where 0.05 ml of sterile saline solution were applied to the anterior bundle of the Temporal muscle and 0.2 ml to each masseter muscle; and an experimental group (n = 15), where 20 Units of Botulinum Toxin A (Botox®) were applied to each Masseter muscle and 05 Units to each Temporal muscle, in its most anterior bundle. All applications were performed on the same day by a previously calibrated operator. The patients returned for reevaluation after 30, 60, 90, 120, 150 and 180 days. In those times, patients. Results: In periods of 30, 60 and 90 days, a decrease in electromyographic activity was observed in the Botox group (p <0.001). When comparing pain and quality of life, a statistically significant difference was observed (p <0.001). Regarding quality of life, a significant difference was observed in the analyzed interval (p = 0.021). In the Botox group, considering the same evaluation interval regarding the comparison of pain and quality of life, there was a significant difference, respectively (p <0.001) and (p <0.001). When assessing the quality of life criterion between groups over time, a significant difference was observed in time 90 (p = 0.041), observing an improvement in quality of life in the Botox group. Conclusion: The application of intramuscular Botulinum Toxin type A in patients with bruxism and orofacial pain, proved to be an effective method, with regard to masseter muscle hyperactivity, in patients with bruxism, improving the quality of life of patients.Tese (Doutorado)bruxismo é definido como uma atividade mastigatória parafuncional, caracterizado pelo apertamento e/ou ranger de dentes, que ocorre tanto durante o sono como em momentos de vigília. A toxina botulínica tipo A apresenta-se como coadjuvante terapêutico para atenuar alguns sintomas causados pelo bruxismo, devido ao fato de ser um miorrelaxante potente e específico, pois promove o relaxamento dos músculos mastigatórios. Método: Foram selecionados trinta pacientes do sexo feminino, com idade entre 18 e 40 anos, que apresentavam bruxismo e dores orofaciais. Após criteriosa anamnese, as pacientes responderam `a uma Escala Visual Analógica EVA) para mensurar a dor orofacial e outra para a qualidade de vida. Uma randomização em dois grupos foi realizada: um grupo controle (n=15), onde foram aplicados 0,05ml de soro fisiológico estéril no feixe anterior do músculo Temporal e 0,2ml em cada músculo masseter; e um grupo experimental (n=15), onde foram aplicadas 20 Unidades de Toxina Botulínica A (Botox®) em cada músculo Masseter e 05 Unidades em cada músculo Temporal, no seu feixe mais anterior. Todas as aplicações foram realizadas no mesmo dia por um operador previamente calibrado. As pacientes retornaram para reavaliação após 30, 60, 90, 120, 150 e 180 dias. Nesses tempos, as pacientes foram novamente submetidas à aplicação de EVA para dor e qualidade de vida; avaliação da força de carga e eletromiografia. Resultados: Nos períodos 30, 60 e 90 dias observou-se uma diminuição da atividade eletromiografica no grupo Botox (p<0.001). Na equiparação de dor e qualidade de vida foi observada uma diferença estatisticamente significativa (p<0.001). Com relação `a qualidade de vida foi observada diferença significativa no intervalo analisado (p=0.021). No grupo Botox considerando o mesmo intervalo avaliativo no que tange a comparação de dor e qualidade de vida, houve uma diferença significativa respectivamente (p<0.001) e (p<0.001). Quando avaliado o critério qualidade de vida entre os 10grupos ao longo do tempo, foi observada no tempo 90 uma diferença significativa (p=0.041), observando melhora da qualidade de vida no grupo Botox. Conclusão: A aplicação de Toxina Botulínica tipo A intramuscular nos pacientes com bruxismo e dor orofacial, mostrou-se um método eficaz, no que se refere à hiperatividade do músculo masseter, um pacientes com bruxismo, melhorando a qualidade da vida dos pacientes.2022-06-0

Extra-buccal surgical access for canine removal included in mandibular symphysis: case report

ABSTRACT Included teeth are all the dental elements that arrive the normal time of its eruption, remains immersed within the tissues. Usually found when missing a tooth, or on routine radiographic examinations. In the presence of included teeth, it is necessary to define the best treatment approach, whether it is surgical, through exodontia, or by orthodontic tracings. Inclusive canines, in the symphysis region and near the base of the mandible, are rare and make the use of orthodontic traction techniques contraindicated. Presence of teeth in the intraosseous ectopic position can cause injuries, such as alveolodentary ankylosis, calcium metamorphosis of the pulp and aseptic pulp necrosis, among others. Anamnesis, physical examination (intra- and extraoral) and radiographic examinations such as panoramic, periapical, computed tomography, and occlusal radiographs should be performed to make the diagnosis adequate. In general, the success of the treatment depends on the age of the patient and the position of the canines at the time of the surgical procedure. The objective of this work is the extraction of a lower canine with extra-oral access in an outpatient clinical setting under local anesthesia