The influence of electrical high-speed rotation on mandibular third molar surgeries: a prospective, randomized, split-mouth clinical and radiographic study

The aim of this split-mouth randomized clinical trial was to evaluate the clinical outcomes (operative time, edema, trismus, and pain), the immediate histological effects, the alveolar repair (2 and 4 months), and the quality of life after the extraction of impacted third molars using high-speed pneumatic and electrical rotation. Sixteen patients underwent extraction of the two mandibular third molars with a minimum interval of 15 days. On one side of the participant's mouth, high-speed pneumatic rotation was used (Control Group-CG) while for the other side, high-speed electrical rotation was used (Study Group-SG). Statistical analysis included ANOVA repeated measures and Pearson correlations. SG group showed: shorter operative time (p = 0.019), less pain (p = 0.034), swelling (p < 0.001) and trismus (p = 0.025) on the 1st postoperative day; less pain (p = 0.034) and trismus (p = 0.010) on the 3rd postoperative day; less trismus (p = 0.032) on the 7th postoperative day; and better quality of life (p = 0.007). No differences were observed for peripheral bone damage or bone density of alveolar repair at 2 and 4 months between groups. Electric high-speed rotation provided better postoperative clinical parameters of pain, edema and trismus when compared with pneumatic high-speed rotation for mandibular third molar surgery.Trial registration: Brazilian Registry of Clinical Trials registration number RBR-4xyqhqm ( https://ensaiosclinicos.gov.br/rg/RBR-4xyqhqm ).

Successful Osseointegrated Implants in Hypertensive Patients: Retrospective Clinical Study

PURPOSE

The aim of this study was to investigate the association of hypertension and antihypertensive drugs with the failure of osseointegrated dental implants.

MATERIALS AND METHODS

This study conformed to STROBE Guidelines regarding retrospective studies. Data from 602 medical records of patients who received rehabilitation treatment with osseointegrated implants between 2000 and 2017, completed at least 6 months before the study, were analyzed. Data on age, sex, presence or absence of hypertension, use or not of antihypertensive drugs, number of placed and lost implants, and type of prosthetic rehabilitation were collected. Statistical chi-square tests and the Fisher exact test were used to analyze the variables with implant loss, using a significance level of P < .05.

RESULTS

One thousand eight hundred eighty-seven implants were placed with a success rate of 97.51% (47 implants lost in 41 patients). Of the 602 patients, 71.43% (432) were normotensive and 28.36% (171) were hypertensive. The success rate of implants in the normotensive group was 93.28%, and in the hypertensive group, it was 92.99%, with no statistical difference between the groups (P = .958). Of these patients, the success rate among the hypertensive group was similar for medication users (92.5%) and for nonusers (94.1%), with no statistically significant difference (P = .939).

CONCLUSION

The presence of hypertension, as well as the use of antihypertensives, could not be associated with the failure of osseointegrated implants.

Mandibular Reconstruction with Iliac Crest Graft Associated with L-PRF and Hyperbaric Oxygen Therapy: A Case Report

Maxillofacial reconstructions with free grafts have become a routine reality for plastic surgeons and maxillofacial surgeons in the last decade. This condition usually occurs after radical treatment of benign or malignant pathologies of the stomatognathic complex, through en bloc resections with a safety margin to reduce the chances of recurrence of the pathology. One of the great challenges faced by surgical teams is no longer just in relation to the technique used for planning, but the predictability and maintenance of the graft performed in the face of systemic changes that can compromise the success of the graft, such as diabetes mellitus. Several aspects have been explored in recent years, such as the use of ozone, synthetic membranes, formation of Leukocyte and Platelet Rich Fibrin (L-PRF) and hyperbaric therapy in the quest to maximize the chances of graft success, reducing the chances of infection and bone resorption mainly through osteoinductive and osteogenic stimuli, which are not characteristics present in a metabolic dysfunction such as diabetes. Another important data for these types of surgery is the bone quality offered by the donor bed, because in maxillofacial reconstructions, a balance in the amount of corticalized bone and medullary bone is important, which leads us to characteristics such as the best donor bed for these surgical reconstructions in the iliac crest region. Here the authors present a case of 64 years old male hypertensive patient with h/o diabetes mellitus, managed by a mandibular reconstruction surgery with iliac crest graft associated with L-PRF and hyperbaric oxygen therapy after extensive resection of a benign mandibular tumour in a patient with diabetes mellitus.

Surgery first approach in orthognathic surgery - Considerations and clinical case report

The Rationale:

The surgery first approach is a safe and stable procedure for the correction of dentofacial deformities that requires little orthodontic correction, leading to a faster return of functions.

Patient Concerns:

Patient with facial discrepancies seeks treatment that returns function and aesthetics, requiring a less prolonged treatment with adequate results.

Diagnosis:

Clinical, facial, and radiological image analysis was used for diagnosis and treatment plan.

Treatment:

Surgery first approach was performed in a patient with facial pattern II dolichocephalic, vertical maxillary excess, mandibular growth deficiency, aesthetic, and functional complaints, with the completion of the orthodontic treatment in 15 months.

Outcomes:

Follow-up of 36 months showed no evidence of recurrence of the initial condition and occlusal stability was maintained. The patient had no more functional and aesthetic complaints.

Take-away Lessons:

Aesthetic and functional improvements were observed more rapidly due to the correction of the skeletal deformity, with improvement in behavior and self-esteem.