Late hyaluronidase injection in local anesthesia : morphofunctional evaluation in rat sciatic nerve block

Introduction: Despite the enhancing effects of hyaluronidase (HYAL) over duration of anesthesia, this enzyme could cause adverse effects when injected concomitantly with local anesthetics in dental blocks. Objective: This study aimed to assess the tissue alterations caused by a local anesthetic protocol consisting of a late HYAL injection and confirm its functional effectiveness. Materials and Methods: The protocol efficacy was proved by evaluating sensory and motor functions in rats. The sciatic nerve was blocked with 2% lidocaine (LID) with epinephrine (n = 25). Thirty minutes later, 75 TRU/ml HYAL was injected into the same site (experimental group, LID/HYAL). One week later, this protocol was repeated in the contralateral hindlimb, injecting only HYAL’s vehicle (control group, LID/vehicle [LID/V]). To observe the integrity of the local tissues, histological specimens were obtained 1, 24, 48, and 72 h after treatment with LID/HYAL or LID/V (n = 16 each) and stained with hematoxylin/eosin and picrosirius red. Results: Local inflammation was similar in both groups. The integrity of the nerve fibers was preserved, in spite of some inflammation‑associated injuries in the surrounding tissues. The reversible tissue disorganization caused by HYAL, probably facilitated the diffusion of the residual anesthetic to the nerve, resulting in a prolonged anesthetic effect (P < 0.05). Conclusions: No irreversible morphological alterations are caused by the administration of HYAL prior the end of the LID‑induced block. Moreover, this protocol prolongs LID’s anesthetic effect

Photobiomodulation and myofascial temporomandibular disorder : systematic review and meta-analysis followed by cost-effectiveness analysis

Photobiomodulation (PBM) is a non-invasive and non-pharmacological treatment, which, has shown beneficial results in the treatment of temporomandibular disorders (TMD) related pain. This systematic review and meta-analysis study aimed to evaluate the eff

Microleakage of “bulk-fill” composite resin for class II restorations pretreated with CO2 laser in deciduous molars: an in vitro study

Introduction: Microleakage has been reported to cause dentin hypersensitivity because of the passage of bacteria and their products through the restoration-tooth interface and is one of the main reasons for replacement of restorations. CO2 laser can be used for treatment of dentin hypersensitivity. Thus, this study aimed to evaluate in vitro the microleakage in composite restorations following surface pretreatment with acid etching and CO2 laser.Methods: Twelve human caries-free primary molars were selected. Class II cavities were prepared on occlusal mesial and occlusal distal surfaces. Specimens were randomly divided into four groups (n = 6): Group 1 (G1) – 37% phosphoric acid gel etching + Beautiful-Bulk Restorative – Giomer (Shofu Inc); Group 2 (G2) – 37% phosphoric acid gel etching + SDR Bulk-Fill Flow (Dentsply); Group 3 (G3) – CO2 laser irradiation + Beautiful-Bulk Restorative – Giomer (Shofu Inc); Group 4 (G4) – CO2 laser irradiation + SDR Bulk-Fill Flow (Dentsply). Surfaces were restored with bonding agent (Natural Bond DE, DFL). Specimens were cut longitudinally and immersed in 0.5% methylene blue solution for 4 hours. Microleakage scores were assessed under a magnifying glass at x3,5 and qualitatively analyzed by scanning electron microscope (SEM). Data were analyzed using nonparametric Wilcoxon test (P &lt; 0.05).Results: Scores prevailed between 0 and 2, however, no statistically significant difference was found among the groups (P = 0.05).Conclusion: It could be concluded that all composite resins bulk fill did not show significant difference among them regarding microleakage using either CO2 laser or 37% phosphoric acid etching.  

Photobiomodulation for the Treatment of Primary Headache: Systematic Review of Randomized Clinical Trials.

peer reviewedThe purpose of this study was to evaluate the efficacy and safety of photobiomodulation as an adjuvant treatment for primary headache. A systematic review of randomized clinical trials was performed. For such, electronic searches were performed in the MEDLINE, Embase, Cochrane Library, LILACS, PEDro, PsycInfo, Clinicaltrials.gov., and WHO/ICTRP databases, with no restrictions imposed regarding language or year of publication. We included studies that assessed any photobiomodulation therapy as an adjuvant treatment for primary headache compared to sham treatment, no treatment, or another intervention. The methodological assessment was conducted using the Cochrane Risk of Bias tool. The certainty of the evidence was classified using the GRADE approach. Four randomized clinical trials were included. Most of the included studies had an overall high risk of bias. Compared to sham treatment, photobiomodulation had a clinically important effect on pain in individuals with primary headache. Despite the benefits reported for other outcomes, the estimates were imprecise, and the certainty of the evidence was graded as low. These findings are considered insufficient to support the use of photobiomodulation in the treatment of primary headache. Randomized clinical trials, with higher methodological quality, are needed to enhance the reliability of the estimated effects

Effect of Photobiomodulation Combined with Physiotherapy on Functional Performance in Children with Myelomeningo-Cele-Randomized, Blind, Clinical Trial.

peer reviewed[en] BACKGROUND: This study aimed to evaluate the electrical activity of the rectus femoris, tibialis anterior, and lateral gastrocnemius muscles during the sit-to-stand task and functional mobility after a neurofunctional physiotherapy protocol associated with PBM. METHODS: Twenty-five children were randomly allocated to either Active PBM + physiotherapy (n = 13) or PBM sham + physiotherapy (n = 12). PBM was carried out with a LED device (850 nm, 25 J, 50 s per point and 200 mW) at four points over the area with absence of a spiny process. Both groups completed a twelve-week supervised program with two weekly 45-60 min sessions. Pre-training and post-training assessments involved the Pediatric Evaluation of Disability Inventory (PEDI). Muscle activity was assessed using portable electromyography (BTS Engineering) and the electrodes were positioned on the lateral gastrocnemius, anterior tibialis, and rectus femoris muscles. The RMS data were recorded and analyzed. RESULTS: After 24 sessions of the treatment protocol, improvements were found in the PEDI score. The participants presented greater independence in performing the tasks, requiring less assistance from their caregivers. More significant electrical activity was found in the three muscles evaluated between the rest period and execution of the sit-to-stand tasks, both in the more compromised or less compromised lower limbs. CONCLUSION: Neurofunctional physiotherapy with or without PBM improved functional mobility and electrical muscle activity in children with myelomeningocele

Functional and histological analysis of hyaluronidase use during local anesthesia of the rat sciatic nerve

O uso concomitante da enzima hialuronidase (H) ao anestésico local (AL) é muito utilizado para melhorar a eficácia anestésica em oftalmologia; em odontologia, no entanto, não mostrou vantagens. Um novo protocolo foi testado com o objetivo de prolongar a anestesia local sem a realização de complementação anestésica. Esta possibilidade seria especialmente interessante para pacientes que apresentam restrição de dose máxima recomendada de AL ou vasoconstritor (ex. cardiopatas). Utilizou-se cloridrato de lidocaína 2% com epinefrina para bloqueio sensitivo, motor e proprioceptivo no nervo ciático em ratos (Truant,1958). Hialuronidase 75 UTR (unidade de turbidade reduzida) foi injetada no mesmo local 30 minutos após o início da analgesia (antes do término do efeito anestésico), utilizando-se a pata contralateral como controle (injeção de solução anestésica e veículo da hialuronidase solvente). A duração do bloqueio sensitivo foi avaliada através da ausência do reflexo de retirada da pata, utilizando-se um analgesímetro. O bloqueio motor foi avaliado pela duração da claudicação e da ausência do reflexo de estiramento da pata, enquanto o bloqueio proprioceptivo foi avaliado pela perda dos reflexos de salto e do reposicionamento da pata (Thalhammer et al., 1995). Foi também estudada a alteração tecidual induzida pela hialuronidase nos períodos de 1 h, 24 h, 48 h e 72 h pós-injeção. Foram avaliados os grupos: (1) falso operado (Sham); (2) AL +H; (3) AL+ solvente (Solv) e (4) Solv+Solv. Concluiu-se que a hialuronidase prolonga a duração de ação anestésica local quando injetada isoladamente antes da regressão do bloqueio de condução do nervo ciático de rato. Em todos os grupos analisados, exceto o grupo falso-operado, observou-se reação inflamatória após as injeções. Esta inflamação foi mais acentuada no grupo hialuronidase, que mostrava sinais de regressão após 72 horas. É possível que o mecanismo de ação da hialuronidase envolva a desorganização do tecido conjuntivo na região da injeção, facilitando a difusão da solução anestésica residual até o nervo.The concomitant use of the enzyme hyaluronidase (H) and local anesthetics (LA) is widely employed in ophthalmology in order to improve the effectiveness of anesthesia; in dentistry, however, this association did not seem advantageous. A new protocol was tested with the aim of drawing out local anesthesia without supplementary anesthesia. This possibility is especially interesting for patients with restriction of maximum recommended dose of LA or vasoconstrictor due to pathological conditions (e.g. heart disease). We used 2% lidocaine hydrochloride with epinephrine for sensitive, motor and proprioceptive blockade of the sciatic nerve in rats (Truant, 1958). Hyaluronidase 75 UTR was injected 30 minutes after the beginning of the anesthesia (before the recovery of the sensory function), using the contralateral limb as control (injection of LA plus the H vehicle solvent). The duration of the sensitive blockade was evaluated through the absence of the paw withdrawal reflex, using an analgesymeter. The motor blockade was evaluated by the duration of claudication (complete absence of extensor postural thrust) and by the absence of the paw stretching reflex, while the proprioceptive blockade was evaluated by the absence of hopping and tactile placing response (Thalhammer et al., 1995). Histological changes induced by H were analyzed 1h, 24h, 48h, and 72 h after the injection in the following groups: (1) Sham; (2) LA + H; (3) LA + H solvent (solv) and (4) Solv + Solv. We concluded that H draws out local anesthesia when injected before the recovery of the sciatic nerve blockade in the rat. In all groups studied, with the exception of the Sham, there was an inflammatory reaction after the injections. Inflammation was more intense after H injection, showing signs of regression after 72 hours. It is possible that the mechanism of action of H involves disorganization of the connective tissue, thus facilitating the diffusion of the residual anesthetic solution to the nerve

Evaluation of duration of anaesthesic action influenced by plain hyaluronidase in pterigomandibular block

A associação do anestésico local (AL) com hialuronidase é muito utilizada em oftalmologia melhorando a eficácia anestésica. Foi demonstrado que uma fração muito pequena das moléculas de AL injetadas atingem o feixe nervoso e o restante se difunde para os tecidos ao redor. O objetivo deste estudo foi verificar se a hialuronidase 75 UTR é capaz de prolongar a duração de ação anestésica quando injetada antes da regressão do efeito AL. Foram realizadas 40 cirurgias de terceiros molares inferiores bilaterais e simétricos, pelo mesmo operador, utilizando-se mepivacaína 2% com epinefrina para bloqueio pterigomandibular, em 20 pacientes saudáveis. Para cada cirurgia foi injetada aos 40 minutos, hialuronidase ou placebo, de modo duplo-cego. Utilizou-se estímulo elétrico na polpa para a avaliação da anestesia pulpar e estímulo mecânico (picada) na gengiva. Os testes foram feitos no pré-molar inferior, colateral à cirurgia. Em ambos tecidos avaliados, a duração da anestesia com hialuronidase foi maior (p<0,01) do que com o placebo. Indiretamente, estes resultados são um indício de que a hialuronidase redireciona as moléculas de AL para a fibra nervosa, prolongando o tempo de bloqueio nervoso. Nestas condições experimentais, pode-se concluir que, a hialuronidase prolonga a duração de ação anestésica local.The association of local anaesthetic (LA) with hyaluronidase is widely used in ophthalmic anaesthesia improving its efficacy. It was demonstrated that a fraction of molecules of the LA applied reached the nerve and the others spreads out to the tissues around. Our purpose was to verify if hyaluronidase (75 TRU) is able to prolong the duration of anaesthesic action when it was injected immediately before the end of pulpal anesthesia. It was realized 40 bilateral and symmetrical third inferior molar surgeries by the same operator, with 2% mepivacaine with epinephrine to block inferior alveolar nerve , in 20 healthy patients. In each surgeries was injected at 40 minutes hyaluronidase or placebo, in a double blinded manner. It was used electrical stimulus to evaluate pulpal anesthesia, and was done mechanical stimulus (pick) to evaluated gingival anaesthesia. The tests were done in the inferior premolar, collateral side to the surgery. In both tissues, the duration of action with hyaluronidase was longer (p<0.01) than placebo. Indirectly, these outcomes indicate that hyaluronidase redirects the molecules of LA to the nervous fiber. Regarding these experimental conditions, it is possible to conclude that hyaluronidase induce long-term local anesthesia