2018 Apr-Jun; Vol 9, No 2
Different Dosages of Corticosteroid and Routes of Administration in Mandibular Third Molar Surgery: a Systematic Review
J Oral Maxillofac Res 2018;9(2):e1
Objectives: The objective of the present systematic review was to test the hypothesis of no difference in facial swelling, pain and trismus after surgical removal of mandibular third molar with different dosages of corticosteroids and administration routes.
Material and Methods: A MEDLINE (PubMed), Embase database and Cochrane Library search in combination with a hand-search of relevant journals was conducted by including randomized controlled trials published in English until 1st December 2017.
Results: Seven studies fulfilled the inclusion criteria. Considerable variation in the included studies prevented meta-analysis from being performed. Preoperative submucosal injection of corticosteroids significantly diminishes facial swelling, pain and trismus compared with placebo. However, different dosages of corticosteroid and administration routes reveal contrary results indicating that administration of a higher dosage of corticosteroids do not necessarily cause a further decrease in facial swelling, pain and trismus.
Conclusions: Consequently, the optimal dosage of corticosteroids and administration route for diminishing postsurgical morbidity and improve quality of life after surgical removal of mandibular third molar is presently unknown. Therefore, further well-designed randomized clinical trials including a standardised protocol, patient-reported outcome measures and three-dimensional analysis of facial swelling is needed.
Keywords: corticosteroids; dentistry; edema; molar; pain; trismus.
Prosthetic Rehabilitation of the Partially Edentulous Atrophic Posterior Mandible with Short Implants (≤ 8 mm) Compared with the Sandwich Osteotomy and Delayed Placement of Standard Length Implants (> 8 mm): a Systematic Review
J Oral Maxillofac Res 2018;9(2):e2
Objectives: Test the hypothesis of no difference in prosthetic rehabilitation of the partially edentulous atrophic posterior mandible with short implants (≤ 8 mm) compared with the sandwich osteotomy and delayed placement of standard lengths implants (> 8 mm).
Material and Methods: A MEDLINE (PubMed), Embase and Cochrane library search in combination with a hand-search was conducted by including studies published in English. No year of publication restriction was applied.
Results: Six randomized controlled trials characterized by low or moderate risk of bias fulfilled the inclusion criteria. There were no statistically significant differences (P > 0.05) in the survival rate of suprastructures and implants between the two treatment modalities after one year. Sandwich osteotomy and delayed implant placement demonstrated statistically significant higher long-term peri-implant marginal bone loss as well as biological and technical complications compared with short implants
(P < 0.0001). Moreover, patients significantly favoured prosthetic rehabilitation with short implants (P < 0.0001).
Conclusions: Short implants and the sandwich osteotomy with delayed placement of standard length implants appear to result in predictable outcomes in terms of high survival rate of suprastructures and implants after prosthetic rehabilitation of the partially edentulous atrophic posterior mandible. However, further long-term randomized controlled trials assessing donor site morbidity, an economic perspective, professional and patient-related outcome measures with the two treatment modalities are needed before definite conclusions can be provided about the beneficial use of short implants for prosthetic rehabilitation of the partially edentulous atrophic posterior mandible compared with the sandwich osteotomy and delayed placement of standard length implants.
Keywords: dental implants; dental prosthesis; oral surgical procedures; randomized controlled trial; review.
Use of Autologous Stem Cells for the Regeneration of Periodontal Defects in Animal Studies: a Systematic Review and Meta-Analysis
J Oral Maxillofac Res 2018;9(2):e3
Objectives: To overview preclinical animal trials and quantify the effect size that stem cell therapy has on the regeneration of periodontal tissue complex.
Material and Methods: A systematic MEDLINE (PubMed) online library search was conducted for preclinical animal studies in vivo, using autologous periodontal ligament, dental pulp, cementum, alveolar periosteal, gingival margin or adipose stem cell types for periodontal tissue complex regeneration purposes. Studies had to be published between 2007.09.01 and 2017.09.01 in the English language.
Results: Online library search yielded 2099 results. After the title, abstract and full-text screening ten studies fit inclusion criteria and were pooled into meta-analysis. Overall the stem cell regenerative therapy had a statistically significant positive influence on the periodontal tissue regeneration when compared to the control groups. The biggest influence was made to the regeneration of cementum (standardised mean difference [SMD] 2.25 [95% confidence interval (CI) = 1.31 to 3.2]) while the smallest influence was made to the alveolar bone (SMD 1.47 [95% CI = 0.7 to 2.25]) the effect size for periodontal ligament regeneration was (SMD 1.8 [95% CI = 1 to 2.59]). Subgroup analysis showed statistically significant (P < 0.05) differences between different cell types in the alveolar bone and cementum regeneration groups and in alveolar bone group in relation to scaffold materials.
Conclusions: Stem cell therapy has a positive impact on periodontal tissue complex regeneration. Such therapy has the biggest influence on cementum regeneration meanwhile alveolar bone regeneration is influenced by the least amount. However more and less diverse preclinical studies are needed to have a greater statistical power in future meta-analyses.
Keywords: mesenchymal stromal cells; periodontal diseases; stem cells; tissue engineering.
Diffusion-Weighted Magnetic Resonance Imaging in Maxillary Sinuses Inflammatory Diseases: Report of Three Cases and Literature Review
J Oral Maxillofac Res 2018;9(2):e4
Background: Magnetic resonance imaging is considered a preferable imaging examination in the diagnosis of inflammatory maxillary sinus disease and can provide precise sinonasal characterization. Diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient are complementary magnetic resonance imaging tools that can be applied to the differentiation of sinus diseases. In this report, 3 cases of inflammatory maxillary sinus diseases imaging findings considering diffusion-weighted magnetic resonance imaging features were described. Additionally, a literature review considering the use of diffusion-weighted magnetic resonance imaging in inflammatory lesions is provided.
Methods: The cases reported were: presence of air-fluid levels, mucosal thickening and a mucous retention cyst. Conventional magnetic resonance imaging and apparent diffusion coefficient (ADC) maps, with ADC values were demonstrated. In the literature review, the studies considering inflammatory lesions were detailed, as well as ADC values established by investigators.
Results: ADC values for presence of air-fluid levels, mucosal thickening and mucous retention cyst were respectively: 1.99 x 10-3 mm2/s; 1.83 x 10-3 mm2/s; 2.05 x 10-3 mm2/s.
Conclusions: It was observed that apparent diffusion coefficient values from the inflammatory lesions described in this report were different and apparent diffusion coefficient may be useful in the differentiation of these maxillary sinus alterations. Further larger sample investigations considering apparent diffusion coefficient values focusing in inflammatory lesions are recommended. The lack of studies considering the use of diffusion-weighted magnetic resonance imaging on inflammatory diseases diagnostic was the major limitation to the literature review.
Keywords: magnetic resonance imaging; paranasal sinuses; inflammatory disease; maxillary sinus.
Non-surgical Treatment of Condylar Fracture in an 11-Year-Old Patient: a Case Report
J Oral Maxillofac Res 2018;9(2):e5
Background: Mandibular condylar fractures commonly occur after trauma and account for 25 to 35% of all mandibular fractures; its appropriate therapy still remains a point of controversy in children. The purpose of this paper is to describe the treatment of an 11-years-old male patient affected by neck-condylar fracture as result of trauma in evolutive age.
Methods: No surgical treatment was performed. A functional therapy was applied with a jaw splint. A closed treatment for mandibular condyle fractures was preferred because the amount of condylar displacement wasn’t considerable.
Results: The early treatment with functional therapy generated a functional adaptation of the condyle in the glenoid fossa and a normal mandibular function. After a 12-month follow-up the fracture resolution and an optimal condylar position were recorded.
Conclusions: The current case report and literature review showed that non-surgical therapy of neck-condylar fracture in a child with lower resin splint can restore mandibular movements and aesthetics. Facial growth after one year treatment resulted normal. A conservative treatment may be appropriate for children in selected cases with minimally displaced condyle.
Keywords: jaw fractures; mandibular fractures; traumatic dental occlusion.