Evaluation of bone texture imaging parameters on panoramic radiographs of patients with Sheehan's syndrome: a STROBE-compliant case-control study

Sheehan's syndrome (SHS) is a rare condition related to the risk of osteoporosis and evaluation of bone texture imaging features on panoramic radiographs would be suitable for this condition, which was the aim of the present study. Fractal dimension, lacunarity, and trabecular morphologic aspects were significantly altered in these patients.

INTRODUCTION

SHS is an important public health problem particularly in developing countries. It is characterized as postpartum hypopituitarism secondary to obstetric complications-related ischemic pituitary necrosis that shows significant systemic metabolic repercussions. Thus, this study aimed to evaluate bone texture parameters in digital panoramic radiographs of patients with SHS.

METHODS

A case-control study was conducted with 30 SHS patients from an Endocrinology and Diabetology Service of reference in Brazil, and 30 age- and sex-matched healthy controls. A custom computer program measured fractal dimension, lacunarity, and some morphologic features in the following mandibular regions of interest (50 × 50 pixels): below the mental foramen (F1), between the first and second molars (M1), and at the center of the mandibular ramus (R1).

RESULTS

The fractal analysis showed a statistically significant difference between the studied groups in all regions of interest. The fractal dimension in F1 (p = 0.016), M1 (p = 0.043), and R1 (p = 0.028) was significantly lower in SHS group, as well as lacunarity in R1 (p = 0.008). Additionally, several morphologic features were statistically significant in the SHS group (p < 0.05).

CONCLUSION

Therefore, individuals with SHS showed altered imaging texture parameters on panoramic radiographs, which reflect a smaller spatial organization of the bone trabeculae and, possibly, a state of reduced mineral bone density.

Implicações da Adição de Própolis nas Propriedades Físico-Mecânicas do Cimento de Ionômero de Vidro

O objetivo do presente trabalho foi realizar uma revisão da literatura sobre as propriedades físico-mecânicas do cimento de ionômero de vidro (CIV) adicionado de própolis. Para essa finalidade, foi efetuada busca no banco de dados Medline/Pubmed, utilizando os descritores “propolis”, “glass ionomer cements” e “dental materials”, na língua inglesa, no período de 2009 a 2017. Foi encontrado um total de 7 artigos, dos quais foram selecionados 6 após leitura de títulos e resumos, considerando o idioma, o período e o grau de envolvimento do artigo com o tema em questão como critérios de inclusão/exclusão. Como resultados, verificou-se que, embora os estudos apontem melhora dos efeitos antimicrobianos a partir da associação entre a própolis e o CIV, seus efeitos sobre as propriedades físico-mecânicas do cimento ainda não são totalmente conhecidos. Nos artigos selecionados foram avaliadas propriedades como resistência à compressão, solubilidade e sorção de água, com alguns resultados controversos. Tendo em vista que o cimento de ionômero de vidro é um material muito útil e versátil na Odontologia e que a própolis tem sido cada vez mais adicionada a ele    em situações como no tratamento restaurador atraumático e na cimentação de bandas ortodônticas a fim de potencializar a ação antimicrobiana dos CIVs, ainda são necessárias pesquisas adicionais para melhor compreensão dessas peculiaridades.Palavras-chave: Propolis. Glass Ionomer Cements. Dental Materials.

Aplicabilidade de Óleos Essenciais em Materiais Dentários: uma Revisão de Literatura

O objetivo do presente trabalho foi realizar uma revisão de literatura sobre as propriedades terapêuticas dos óleos essenciais (OEs) em Odontologia visando sua aplicabilidade em materiais dentários com ação antimicrobiana. Para tanto, foi realizada uma pesquisa nas bases de dados eletrônicas MEDLINE e BVS, utilizando os descritores Oils, Volatile, Dental Materials e Anti-Infective Agents em português e inglês. Foram encontrados 51 artigos publicados no período de 2007 a 2017 e 15 foram selecionados através de leitura de títulos e resumos, excluindo-se relatos de casos. Durante a análise dos artigos, destacaram-se os OEs de Lippia sidoides, timol, carvacrol e Rosmarinus officinalis que, além de serem de fácil obtenção, apresentaram atividade antibacteriana e antifúngica significativa contra S. Mutans, C. Albicans e E. Faecalis. Essas propriedades apresentadas pelos OEs propiciaram potenciais aplicabilidades em dentifrícios, enxaguatórios bucais, condicionadores de tecido, aplicações intracanal, adesivos e vernizes conferindo-lhes características antimicrobianas importantes no controle dos patógenos orais agindo de forma versátil em diferentes sítios a depender do local de aplicação do material. Importante destacar que a validação científica, clínica e comercial da atividade terapêutica dos OEs em materiais dentários são essenciais para possibilitar avanços na odontologia preventiva e restauradora, possibilitando, alternativas naturais, com poucos efeitos colaterais e que possam melhorar a qualidade de vida dos pacientes.Palavras-chave: Oils. Volatile. Dental Materials. Anti-Infective Agents.

Efeito Antibacteriano do Carvacrol e Timol nos Materiais Dentários: uma Revisão de Literatura

O objetivo desta revisão é descrever a atividade antimicrobiana dos Óleos Essenciais (OE’s) carvacrol e timol e suas aplicações  nos materiais dentários.Foi realizada uma revisão de literatura, utilizando-se as bases de dados “Medline”, “Lilacs” e “SciELO”, os descritores “Anti-infecciosos”, “Thymol”, “Oils, Volatile”, tendo sido encontrados 571 artigos e selecionados 25 publicados entre 2007 e 2017, escritos em inglês, português e/ou espanhol. Relatos de casos foram excluídos. As pesquisas com materiais dentários contendo produtos naturais aumentaram devido à busca por novas substâncias com maior atividade farmacológica, menor toxicidade e maior biocompatibilidade. Dentre os estudos levantados, os OE’s carvacrol e timol se mostraram mais prevalentes. A atividade antibacteriana destes compostos pode ocorrer pela desestabilização da parede celular, aumento da permeabilidade da membrana citoplasmática e pela alteração de vários sistemas enzimáticos, incluindo aqueles envolvidos na produção de energia celular e na síntese de componentes estruturais. Entre as possibilidades de aplicações, estes OE’s foram empregados em soluções irrigadoras para canais radiculares, dentifrícios, exaguatórios bucais e vernizes, demonstrando eficácia antibacteriana. Portanto, estudos desses produtos naturais na odontologia são realizados, visando à obtenção de materiais dentários com agentes antimicrobianos que possibilitem a prevenção e tratamento de doenças bucais, com poucos efeitos colaterais indesejáveis e fácil acesso à população.Palavras-chave: Anti-Infecciosos. Thymol. Oils. Volatile.

Plasma mepivacaine concentrations in patients undergoing third molar surgery

BACKGROUND

Local anaesthetic-related systemic toxicity mainly results from elevated plasma concentrations of these drugs. We hypothesized that intraoral injection of submaximal doses of mepivacaine does not lead to toxic levels of this drug in blood. This study evaluated the plasma levels of mepivacaine in third molars surgeries.

METHODS

Twenty-one patients were randomly assigned into two groups: group I (two unilateral third molars; submaximal dose of mepivacaine 108 mg with epinephrine 54 μg) and group II (four third molars; submaximal dose of mepivacaine 216 mg with epinephrine 108 μg). Blood samples were collected before anaesthesia, and 5, 10, 15, 20, 30, 40, 60, 90 and 120 min after anaesthesia.

RESULTS

Individual peak plasma concentrations ranged 0.77-8.31 μg/mL (group I) and from 2.36-7.72 μg/mL (group II). An increase in the average dose of mepivacaine from 1.88 ± 0.12 mg/kg (group I) to 3.35 ± 0.17 mg/kg (group II) increased the mean mepivacaine peak plasma levels from 2.33 ± 0.58 to 4.01 ± 0.69 μg/mL, respectively. Four patients obtained plasma levels of mepivacaine above the threshold for toxicity (5 μg/mL).

CONCLUSIONS

Toxic levels of mepivacaine are possible, even when a submaximal dose is used. A twofold increase in the dose of mepivacaine caused the mean peak plasma concentration to increase proportionally, indicating that they may be predicted based on the relation of dose per bodyweight.

A split-mouth, randomized, triple-blind, placebo-controlled study to analyze the pre-emptive effect of etoricoxib 120 mg on inflammatory events following removal of unerupted mandibular third molars

Pain after third molar extraction has been considered the most suitable pharmaceutical model to evaluate acute pain. This study aimed to evaluate the pre-emptive analgesic/anti-inflammatory efficacy of etoricoxib 120 mg following mandibular third molar surgery. A split-mouth, randomized, triple-blind, placebo-controlled study was conducted with patients undergoing the surgical removal of mandibular third molars. All volunteers were allocated randomly to receive either etoricoxib 120 mg or placebo 1h preoperatively, and inflammatory events were evaluated. An estimated sample of 18 surgical units per group was required based on a pilot study (95% confidence level and 80% statistical power). Rescue medication was analyzed by Kaplan-Meier method through log-rank Mantel-Cox test and Pearson linear correlation (P<0.05). Pre-emptive etoricoxib reduced postoperative pain scores significantly in comparison to placebo (P<0.001), with a pain score peak at 6h after surgery (P<0.001). The mean rescue medication consumption was lower in the etoricoxib group compared to the placebo group over the study period (P<0.05). There was no statistically significant difference between groups related to swelling and trismus. The pre-emptive administration of etoricoxib 120 mg significantly reduced the postoperative pain intensity and the need for rescue medication, but did not reduce swelling or trismus.

Enamel and dentin mineralization in familial hypophosphatemic rickets: a micro-CT study

OBJECTIVES

The aim of the present study was to analyse the mineralization pattern of enamel and dentin in patients affected by X-linked hypophosphatemic rickets (XLHR) using micro-CT (µCT), and to associate enamel and dentin mineralization in primary and permanent teeth with tooth position, gender and the presence/absence of this disease.

METHODS

19 teeth were collected from 5 individuals from the same family, 1 non-affected by XLHR and 4 affected by XLHR. Gender, age, tooth position (anterior/posterior) and tooth type (deciduous/permanent) were recorded for each patient. Following collection, teeth were placed in 0.1% thymol solution until µCT scan. Projection images were reconstructed and analysed. A plot profile describing the greyscale distance relationship in µCT images was achieved through a line bisecting each tooth in a region with the presence of enamel and dentin. The enamel and dentin mineralization densities were measured and compared. Univariate ANOVA and post hoc Tukey tests were used for all comparisons.

RESULTS

Teeth of all affected patients presented dentin with a different mineralization pattern compared with the teeth of healthy patients with dentin defects observed next to the pulp chambers. Highly significant differences were found for gray values between anterior and posterior teeth (p < 0.05), affected and non-affected (p < 0.05), as well as when position and disease status were considered (p < 0.05).

CONCLUSIONS

In conclusion, the mineralization patterns of dentin differed when comparing teeth from patients with and without FHR, mainly next to pulp chambers where areas with porosity and consequently lower mineral density and dentin defects were found.

[Fibrous dysplasia of the skull: neurologic manifestations]

The neurological manifestations of eight patients with osseous fibrous dysplasia of skull were retrospectively studied. In this series, the frontal bone was involved in 75% of the patients, the sphenoid or temporal bones in 37.5%, and the parietal in 25%. It was observed that cranial deformities occurred in all but one case, headache was present in 87.5% of the patients, visual disturbances in 50%, proptosis in 25%, and auditive symptoms in 12.5%. Six out of the eight patients were operated on: three of the four who presented progressive visual loss had postoperative improvement. In their follow up, none presented, until now, evidence of recurrence or worsening of symptoms, confirming the benign nature of fibrous dysplasia.

Spontaneous umbilical fistula from ventriculoperitoneal shunt drainage. Report of two cases

Two cases of spontaneous fluid fistula through the umbilicus connected with the drainage from a ventriculoperitoneal shunt are described. In neither case was it necessary to remove the shunt.