No description available.

No description available.

Magister Chirurgiae Dentium - MChD / Aim: The aim of the study was to investigate whether a correlation exists between the intra- operative position of the Inferior Alveolar Nerve (IAN) and the nerve position as noted on a pre-operative Cone Beam Computer Tomography (CBCT) scan in patients requiring Bilateral Sagittal Split Osteotomy (BSSO) of the mandible. Introduction: The BSSO of the mandible is of fundamental importance in the correction of dental facial deformities. The main post-operative complication of a BSSO of the mandible is Neurosensory Impairment (NSI). To avoid possible NSI it is important to have as much pre- operative information as possible. In this regard, pre-operative CBCT scans can provide the surgeon with an important assessment of the mandibular canal. This information on the buccolingual, superior and inferior position of the canal, especially in the region of the planned osteotomy, could help the surgical team to avoid IAN injury. Materials and Methods: This study correlates the pre-operative position of the IAN as indicated on a CBCT scan with the intra-operative IAN position in patients requiring BSSO of the mandible. Ten standardised cases were included in a prospective case series where twenty mandibular sides were assessed. Results: The variables assessed in this study were location of the nerve, age, sex, type of movement and side of mandible operated on. It was found that only the distance between the Inferior Alveolar Canal (IAC) and the lower border of the mandible are predictive of whether the IAN will be attached to - or free from - the proximal segment of the mandible. Conclusion: From the study it can be concluded that a CBCT scan is a useful and reliable modality in the pre-operative evaluation of patients undergoing BSSO especially with regard to the assessment and mapping of the mandibular canal.

INTRODUCTION: The mental foramen region is important in dental implant placement as it serves as essential neurovascular bed. Despite the belief that the interforaminal area is a safe area for implant placement, a detailed anatomical examination should be done before surgery to prevent injury to the nerve. The inferior alveolar nerve runs outward, upward and backward to the mental foramen and forms the anterior loop of the mental nerve. The anterior loop is the most mesial point of the mental foramen. Methods to determine the extension of the anterior loop include surgical cadaver dissections, panoramic films of markers in dried skulls and cadaver mandibles, panoramic films of patients, periapical radiographs and CT scans of patients. These different methods and dissimilar diagnostic techniques have led to diverse results. The aim of this study was to measure the extension of the anterior loop of the mental foramen by using cone-beam computed tomography (CBCT). METHODS: Randomly selected sagittal, axial, and coronal CBCT images of the maxillofacial region of 100 patients (50 males, and 50 females) aged between 18-80 were retrospectively screened to determine the extension of the anterior loop. Categorized into (1) younger males, (2) younger females aged (18-44), (3) older males, and (4) older females aged (45-80). Four groups based on dental status were added (1) fully edentulous males, (2) fully edentulous females, (3) dentated males, and (4) dentated females. Measurement tools provided by the software were used to determine the extension of the mental loop. Data was collected for statistical analysis to determine the association between CBCT findings and the patient's gender, age, and dentate status.  RESULTS: In this study, 50 male, and 50 female patients were included for anterior loop measurements. The median age of the sample population was 45 [range 33 to 59]. The mean anterior loop measurements for right and left side were 1.36 mm (0.80 SD) and 1.37 mm (0.79 SD) respectively. Eighty percent of our study participants were dentate and 20% were fully edentulous. Discussion Prior to implant placement proper planning is necessary to avoid misplacement of dental fixtures and injury to the mental nerve. The anterior loop is one of the crucial anatomical structures that clinicians have to consider during the planning. CBCT proved to be the most reliable method of examining the maxillofacial region. No correlation was found between age, gender, and dentate status with changes in the anterior loop measurements. Even though there was no statistical difference among the groups, but there were variations in the anterior loop measurements. In some of the individual cases the anterior loop was 0 mm in one side and 2.5 mm on the other side. This is a big measurement variation of a clinical significance when it comes to implant placement. Looking to the results among groups statistically doesn’t give us the real measurement of the anterior loop. Instead every case should be examined individually to identify the extension of the anterior loop in both sides, even if it was not detected in one of the sides. CONCLUSION: An implant placed in proximity to mental foramen requires planning to avoid complications or nerve injury. Because of possible variations in the anterior loop measurements should be done for each individual case. CBCT is the imaging method of choice to assess the anterior loop.

No description available.

Neste estudo, randomizado, duplo cego, avaliamos a eficácia anestésica em quarenta e dois pacientes, do Setor de Urgência da Faculdade de Odontologia da Universidade de São Paulo, com pulpite irreversível, que receberam mepivacaína 2% (n=21) ou lidocaína 2% (n=21) associadas à epinefrina 1:100.000 para bloqueio do nervo alveolar inferior (BNAI). O sinal subjetivo de anestesia do lábio e língua, a presença de anestesia pulpar e ausência de dor durante o procedimento de pulpectomia foram avaliados, respectivamente, por indagação ao paciente, pelo testador elétrico pulpar (TEP) e pela escala de dor verbal (VAS). Pela técnica pterigomandibular indireta das três posições, foi injetado primeiramente um tubete (1,8mL), e depois de 10 minutos, foi testada a anestesia pulpar (AP), pelo TEP, por duas leituras negativas ao estímulo máximo (80A) do aparelho. Quando não instalada a AP, um segundo tubete (mais 1,8mL) era reinjetado. Confirmada a anestesia pulpar, iniciava-se a pulpectomia. O sucesso do BNAI foi definido como a capacidade de acessar a câmara pulpar e a realização da pulpectomia sem relato de dor (VAS) pelo paciente (escore 0 ou 1), enquanto o insucesso foi caracterizado pelo incomodo/dor (escore 2 ou 3), que impedisse a continuação. Nesse caso, um terceiro e último tubete foi dado por técnicas complementares (intraligamentar ou intrapulpar) para finalizar o procedimento. Na análise estatística utilizou-se o teste Exato de Fisher e ANOVA com nível de significância fixado em 5%. Obtivemos que no grupo Mepivacaína com 1,8mL, a taxa de anestesia pulpar (AP) foi de 52% (11/21), e sucesso no BNAI de 55% (6/11); a injeção de mais 1,8mL (2º tubete) aumentou a AP para 86% (18/21) e o sucesso no BNAI para 55% (10*/18). No Grupo Lidocaína, com 1.8mL, a taxa da AP foi de 33% (7/21), o BNAI foi de 0%; com mais 1,8mL (2º tubete), a AP aumentou para 67% (14/21) e sucesso no BNAI para 14% (2*/14) (*com diferença estatística onde p0,05). A mepivacaína com volume menor proporcionou, clinicamente, maior índice de anestesia pulpar e sucesso do BNAI (pulpectomia total), e permitiu chegar mais próximo da polpa quando comparada a lidocaína. Concluímos que a mepivacaína obteve melhores resultados no sucesso do BNAI para a realização da pulpectomia em molares inferiores com pulpite irreversível. / The aim of this, double blind randomized study, was to evaluate the anesthetic efficacy of inferior alveolar nerve block (IANB) using 2% mepivacaine and 2% lidocaine both associated with adrenaline 1:100,000 in molars with irreversible pulpitis. The sample of these study consisted of forty-two healthy patients diagnosed with irreversible pulpitis actively experiencing pain. For blocking the IAN was established the following protocol: injection of one cartridge (1.8 mL) by the technique pterigomandibular of three indirect positions, expected 10 minutes and electric pulp test (EPT) Vitality Scanner®-SybronEndo, USA was accomplishment. If tooth sensitivity pain persisted another cartridge (plus 1.8 mL) was given by the same technique and the same methodology was performed. The pulpectomy was continued after the confirmation of pulpal anesthesia, which was established as the lack of response at maximum stimulation (80A) of EPT. In cases where the patient reported pain during pulpectomy even confirmed the blockage, a third cartridge was given by complementary techniques (intraligamentary or intrapulpal) to complete the endodontic procedure. The anesthetic efficacy in IANB was established when the pulpectomy was performed without report of pain and without complementation. For analysis and comparison of results we used the Fisher exact statistical test and ANOVA with significance level set at 5%. Regarding the effectiveness of the anesthetic with 1,8 mL mepivacaine, determined pulpar anesthesia (PA) was 52% (11/21), and success in IANB (pulpectomy) 55% (6/11), the most injection of 1,8 mL, increased 86% (18/21) for AP and success in IANB to 55% (10*/18). In the lidocaine group, with 1.8mL, AP rate was 33% (7/21), the IANB was 0%, with a further 1.8 mL (cartridge 2) the AP increased to 67% (14/21) and success was to IANB 14 % (2*/14), (*statistically difference p 0.05). Mepivacaine with smaller volume clinically provided a higher rate of pulpal anesthesia and most successful of IANB (pulpectomy total), allowing to reach nearest dental pulp than lidocaine. Concluded that mepivacaine performed better in success of IANB (pulpectomy) that lidocaine in molars with irreversible pulpitis

Background: Several studies have suggested that the likelihood of paraesthesia may depend on the local anaesthetic (LA) used. The purpose of this study was to analyze reports of paraesthesia among dental LAs used in the U.S. Methods: Reports of paraesthesia involving LAs between November 1997 through August 2008 were obtained from the U.S. Food and Drug Administration Adverse Event Reporting System. Chi-Square analysis compared expected frequencies, based on U.S. LA sales data, to observed reports of oral paraesthesia. Results: During the study period 248 cases of paraesthesia following dental procedures were reported. Most (94.5%) cases involved mandibular nerve block. The lingual nerve was affected in 89.0% of cases. Reports involving 4%-prilocaine and 4%-articaine were 7.3-times and 3.6-times, respectively, greater than expected (χ2, p<0.0001) based on LA usage by U.S. dentists. Conclusions: Consistent with previous reports, these data suggest that paraesthesia is more common following use of 4% LA formulations.

Background: Several studies have suggested that the likelihood of paraesthesia may depend on the local anaesthetic (LA) used. The purpose of this study was to analyze reports of paraesthesia among dental LAs used in the U.S. Methods: Reports of paraesthesia involving LAs between November 1997 through August 2008 were obtained from the U.S. Food and Drug Administration Adverse Event Reporting System. Chi-Square analysis compared expected frequencies, based on U.S. LA sales data, to observed reports of oral paraesthesia. Results: During the study period 248 cases of paraesthesia following dental procedures were reported. Most (94.5%) cases involved mandibular nerve block. The lingual nerve was affected in 89.0% of cases. Reports involving 4%-prilocaine and 4%-articaine were 7.3-times and 3.6-times, respectively, greater than expected (χ2, p<0.0001) based on LA usage by U.S. dentists. Conclusions: Consistent with previous reports, these data suggest that paraesthesia is more common following use of 4% LA formulations.

Problem: Third molar removal in sagittal split osteotomies(SSOs) is recommended by some authors at least 6 months preoperatively to prevent unfavorable fractures. Others authors suggest concomitant removal. The purpose of this study was to investigate the effect of third molars during SSOs. Methods: A prospective study of 677 SSOs was conducted. GroupI consisted of 331 SSOs and third molar removal. GroupII consisted of 346 SSOs without third molar. Intraoperative and postoperative evaluations were recorded. Results: The overall rate of unfavorable fractures was 3.1%, with incidences of 2.4% in GroupI, compared to 3.8% in GroupII(P=0.3). The rate of IAN entrapment was lower in GroupI(37.2%) than in GroupII(46.5%;P=0.01). Third molars increased procedural time by 1.7 minutes. Neurosensory deficits were higher in GroupII. Conclusion: Removal of third molars during SSOs is not associated with increased incidence of unfavorable fractures. Their presence decreases IAN entrapment, improve neurosensory recovery, but slightly increases operating time.

Neste estudo, randomizado, duplo cego, avaliamos a eficácia anestésica em quarenta e dois pacientes, do Setor de Urgência da Faculdade de Odontologia da Universidade de São Paulo, com pulpite irreversível, que receberam mepivacaína 2% (n=21) ou lidocaína 2% (n=21) associadas à epinefrina 1:100.000 para bloqueio do nervo alveolar inferior (BNAI). O sinal subjetivo de anestesia do lábio e língua, a presença de anestesia pulpar e ausência de dor durante o procedimento de pulpectomia foram avaliados, respectivamente, por indagação ao paciente, pelo testador elétrico pulpar (TEP) e pela escala de dor verbal (VAS). Pela técnica pterigomandibular indireta das três posições, foi injetado primeiramente um tubete (1,8mL), e depois de 10 minutos, foi testada a anestesia pulpar (AP), pelo TEP, por duas leituras negativas ao estímulo máximo (80A) do aparelho. Quando não instalada a AP, um segundo tubete (mais 1,8mL) era reinjetado. Confirmada a anestesia pulpar, iniciava-se a pulpectomia. O sucesso do BNAI foi definido como a capacidade de acessar a câmara pulpar e a realização da pulpectomia sem relato de dor (VAS) pelo paciente (escore 0 ou 1), enquanto o insucesso foi caracterizado pelo incomodo/dor (escore 2 ou 3), que impedisse a continuação. Nesse caso, um terceiro e último tubete foi dado por técnicas complementares (intraligamentar ou intrapulpar) para finalizar o procedimento. Na análise estatística utilizou-se o teste Exato de Fisher e ANOVA com nível de significância fixado em 5%. Obtivemos que no grupo Mepivacaína com 1,8mL, a taxa de anestesia pulpar (AP) foi de 52% (11/21), e sucesso no BNAI de 55% (6/11); a injeção de mais 1,8mL (2º tubete) aumentou a AP para 86% (18/21) e o sucesso no BNAI para 55% (10*/18). No Grupo Lidocaína, com 1.8mL, a taxa da AP foi de 33% (7/21), o BNAI foi de 0%; com mais 1,8mL (2º tubete), a AP aumentou para 67% (14/21) e sucesso no BNAI para 14% (2*/14) (*com diferença estatística onde p0,05). A mepivacaína com volume menor proporcionou, clinicamente, maior índice de anestesia pulpar e sucesso do BNAI (pulpectomia total), e permitiu chegar mais próximo da polpa quando comparada a lidocaína. Concluímos que a mepivacaína obteve melhores resultados no sucesso do BNAI para a realização da pulpectomia em molares inferiores com pulpite irreversível. / The aim of this, double blind randomized study, was to evaluate the anesthetic efficacy of inferior alveolar nerve block (IANB) using 2% mepivacaine and 2% lidocaine both associated with adrenaline 1:100,000 in molars with irreversible pulpitis. The sample of these study consisted of forty-two healthy patients diagnosed with irreversible pulpitis actively experiencing pain. For blocking the IAN was established the following protocol: injection of one cartridge (1.8 mL) by the technique pterigomandibular of three indirect positions, expected 10 minutes and electric pulp test (EPT) Vitality Scanner®-SybronEndo, USA was accomplishment. If tooth sensitivity pain persisted another cartridge (plus 1.8 mL) was given by the same technique and the same methodology was performed. The pulpectomy was continued after the confirmation of pulpal anesthesia, which was established as the lack of response at maximum stimulation (80A) of EPT. In cases where the patient reported pain during pulpectomy even confirmed the blockage, a third cartridge was given by complementary techniques (intraligamentary or intrapulpal) to complete the endodontic procedure. The anesthetic efficacy in IANB was established when the pulpectomy was performed without report of pain and without complementation. For analysis and comparison of results we used the Fisher exact statistical test and ANOVA with significance level set at 5%. Regarding the effectiveness of the anesthetic with 1,8 mL mepivacaine, determined pulpar anesthesia (PA) was 52% (11/21), and success in IANB (pulpectomy) 55% (6/11), the most injection of 1,8 mL, increased 86% (18/21) for AP and success in IANB to 55% (10*/18). In the lidocaine group, with 1.8mL, AP rate was 33% (7/21), the IANB was 0%, with a further 1.8 mL (cartridge 2) the AP increased to 67% (14/21) and success was to IANB 14 % (2*/14), (*statistically difference p 0.05). Mepivacaine with smaller volume clinically provided a higher rate of pulpal anesthesia and most successful of IANB (pulpectomy total), allowing to reach nearest dental pulp than lidocaine. Concluded that mepivacaine performed better in success of IANB (pulpectomy) that lidocaine in molars with irreversible pulpitis