Palavras-chave retiradas da vers?o impressa do trabalho. / Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-09-19T20:33:45Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) anna_catharina_vieira_armond.pdf: 3140231 bytes, checksum: a3da3d5012b8c5145f53d838686f0611 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-10-09T13:25:52Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) anna_catharina_vieira_armond.pdf: 3140231 bytes, checksum: a3da3d5012b8c5145f53d838686f0611 (MD5) / Made available in DSpace on 2017-10-09T13:25:52Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) anna_catharina_vieira_armond.pdf: 3140231 bytes, checksum: a3da3d5012b8c5145f53d838686f0611 (MD5) Previous issue date: 2017 / O objetivo deste estudo foi avaliar a efic?cia da acupuntura no controle de dor, edema e trismo ap?s exodontia de terceiros molares e controle da ansiedade pr?-operat?ria comparada ? acupuntura placebo. Para isso, um ensaio cl?nico randomizado, controlado, triplo-cego, no formato boca dividida, foi realizado. Dezesseis pacientes com m?dia de idade de 22,5 (?3,45) anos foram submetidos ? remo??o dos dois terceiros molares inferiores em momentos diferentes e receberam quatro sess?es de acupuntura, uma anterior ? cirurgia e outras nos momentos 24, 48 e 72 horas ap?s. Nos momentos do baseline, 24, 48, 72 horas e 7 dias ap?s a cirurgia, foram feitas avalia??es de edema, atrav?s das medidas da face e trismo, pela abertura m?xima bucal. A dor foi avaliada pela escala visual anal?gica nos momentos 24, 48 e 72 horas e a ansiedade foi avaliada pelo question?rio STAI (State-Trate Anxiety Inventory) e pela escala visual anal?gica nos momentos baseline e antes e depois da acupuntura no dia da cirurgia. A an?lise estat?stica foi feita pelo teste T pareado e Wilcoxon. A acupuntura obteve melhor desempenho no controle de edema nos momentos 48 horas (p=0,026), 72 horas (p=0,046) e 7 dias (p=0,040) quando comparada ao placebo. N?o houve diferen?a estat?stica no controle de dor, trismo e ansiedade entre os grupos. Em conclus?o, o uso da acupuntura apresentou melhores resultados no controle de edema ap?s exodontia de terceiros molares quando comparada ? acupuntura placebo. / Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Odontologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2017. / The objective of this study was to evaluate the efficacy of acupuncture in the control of pain, edema and trismus after third molar extraction and control of preoperative anxiety compared to placebo acupuncture. Thus, a randomized, controlled, triple-blind, split-mouth clinical trial was performed Sixteen patients with a mean age of 22.5 (?3,45) underwent removal of the two lower third molars at different times and received four acupuncture sessions, one prior to surgery and others at moments 24, 48 and 72 hours after. Edema evaluations were made through the measurements of the face and trismus by maximum buccal opening at the baseline and 24, 48, 72 hours and 7 days after surgery. The pain was evaluated by the visual analogue scale at moments 24, 48 and 72 hours and the anxiety was evaluated by the STAI questionnaire and the visual analogue scale at baseline and before and after acupuncture on the day of surgery. Statistical analysis was performed using the paired T test and Wilcoxon. Acupuncture showed better performance in the control of edema at 48 hours (p=0.026), 72 hours (p=0.046) and 7 days (p=0.040) when compared to placebo. There was no statistical difference in the control of pain, trismus and anxiety between the groups. In conclusion, the use of acupuncture showed better results on edema control after third molar extraction when compared to pacebo.

Submitted by Maria Anália Conceição (marianaliaconceicao@gmail.com) on 2016-06-27T18:14:05Z No. of bitstreams: 1 Publico-NOVO-19.pdf: 3346874 bytes, checksum: 17dd5440a6491e9f9e098ed990f9a67e (MD5) / Approved for entry into archive by Maria Anália Conceição (marianaliaconceicao@gmail.com) on 2016-06-27T18:14:55Z (GMT) No. of bitstreams: 1 Publico-NOVO-19.pdf: 3346874 bytes, checksum: 17dd5440a6491e9f9e098ed990f9a67e (MD5) / Made available in DSpace on 2016-06-27T18:14:55Z (GMT). No. of bitstreams: 1 Publico-NOVO-19.pdf: 3346874 bytes, checksum: 17dd5440a6491e9f9e098ed990f9a67e (MD5) Previous issue date: 2015 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Rede Ibero-Americana de Biofabricação / Introdução: A aplicação de dexametasona em cultura de células mesenquimais induz diferenciação osteoblástica, consequentemente formação de tecidos mineralizados. A Engenharia Tecidual propõe o desenvolvimento de estratégias terapêuticas direcionadas à regeneração funcional e estrutural de tecidos biológicos. Nesse sentido, a caracterização celular in vitro é fundamental para garantir o desenvolvimento destas técnicas. Objetivo: Avaliar o efeito da dexametasona administrada como medicação pré-operatória na cultura de células primárias de polpa dental humana. Métodos: Foram utilizadas células provenientes da polpa de terceiros molares. Essas foram distribuídas em dois grupos experimentais com dois protocolos de medicação pré-operatória utilizados em rotina odontológica, onde no protocolo B, o paciente ingeria 1 comprimido de dexametasona 1hora antes à cirurgia e no A não. A avaliação da proliferação, viabilidade e diferenciação, foram pelos testes Trypan Blue, MTT, Von Kossa e Alizarin Red respectivamente, e realizadas em intervalos fixados. Análise de variância de Friedman e t test foram aplicados, fixando em 95% de confiança. Resultados: As células pertencentes ao protocolo A atingiram pico de proliferação aos 21 dias de cultura enquanto as células do protocolo B em 14. Células do protocolo A foram estatisticamente mais viáveis aos 7 e 21 dias enquanto as do protocolo B, aos 14. Na análise de Von Kossa e Alizarin Red observou-se que as células pertencentes ao protocolo B formaram nódulos de calcificação desde 7 dias de cultura enquanto no A aos 14. Conclusão: A utilização da dexametasona como medicação pré-operatória em cirurgia de terceiros molares promove diferenciação celular precocemente, quando observada in vitro. / Introduction: The use of dexamethasone in mesenchymal cell culture induces osteoblastic differentiation and, consequently, formation of mineralized tissues. Tissue Engineering proposes the development of therapeutic strategies aiming at structural and functional regeneration of biological tissues. In this sense, cell characterization in vitro is critical to ensure the development of such techniques. Objective: To evaluate the effect of dexamethasone administered as preoperative medication in primary cell culture of human dental pulp. Methods: We used cells from the third molar pulp. These cells were divided into two experimental groups, each with two preoperative medication protocols used in dental routine and differentiated by the intake of dexamethasone in one of them. The assessment of proliferation, differentiation, and viability through Trypan Blue, MTT and von Kossa, and Alizarin Red tests, respectively, were held in fixed intervals. Friedman analysis of variance and t test were applied, and confidence interval was set at 95%. Results: Protocol A cells proliferation reached its peak on day 21 while protocol B cells proliferation reached its peak on day 14. Protocol A cells were statistically more viable between days 7 and 21 whereas protocol B cells viability was higher on day 14. Von Kossa and Alizarin Red analyses showed that calcified nodules formation occurred from the seventh day of cell culture in protocol B cells and on day 14 in protocol A cells. Conclusion: The use of dexamethasone as preoperative medication in third molar surgery promotes cell differentiation earlier, when observed in vitro. / FAPESP: 07/51227-4 / FAPESP: 08/57860-3 / CNPq: 573661/2008-1

Submitted by Rúbia Gomes de Oliveira (rubiagoliveira@gmail.com) on 2018-10-04T19:18:25Z No. of bitstreams: 1 DISSERTAÇÃO - Final.pdf: 1168570 bytes, checksum: cad1e7fa9d153dc04d0ef37e6a0db0b2 (MD5) / Approved for entry into archive by Silvana Alvarez null (silvana@ict.unesp.br) on 2018-10-04T20:38:58Z (GMT) No. of bitstreams: 1 oliveira_rg_me_sjc.pdf: 1168570 bytes, checksum: cad1e7fa9d153dc04d0ef37e6a0db0b2 (MD5) / Made available in DSpace on 2018-10-04T20:38:59Z (GMT). No. of bitstreams: 1 oliveira_rg_me_sjc.pdf: 1168570 bytes, checksum: cad1e7fa9d153dc04d0ef37e6a0db0b2 (MD5) Previous issue date: 2018-08-16 / A exodontia de terceiros molares inferiores é uma prática comum nas clínicas odontológicas, porém o pós-operatório inerente a esta cirurgia apresenta dor, edema e trismo. Algumas das posições de inclusão do terceiro molar podem acarretar comprometimento periodontal nos segundos molares adjacentes. Com isso o presente trabalho buscou desenvolver através deste estudo clínico controlado, um protocolo com o laser de baixa intensidade para aplicação no pós-operatório das exodontias de terceiros molares mandibulares, de modo a minimizar os sinais e sintomas e melhorar os parâmetros periodontais dos segundos molares adjacentes. O laser empregado foi o Photon Laser III – DMC, São Carlos, SP/Brasil – como meio de condução o vermelho, com comprimento de onda 660 nm, potência útil de 30 mW, meio ativo AsGaAl. Sessenta pacientes de ambos os gêneros, com necessidade de exodontia dos terceiros molares, em classificações padrões de posição, foram randomizados em três grupos para análise – Grupo I: 10J/cm2, Grupo II: 30J/cm2 e Grupo III: Sham, e acompanhados pelo período de 6 meses. A análise do trismo e edema facial no pós-operatório e do nível clínico de inserção encontraram diferenças estatísticas significantes entre os grupos que receberam a terapia laser quando comparado ao grupo sham. Portanto, a utilização do laser de baixa intensidade como terapia adjuvante após a exodontia de terceiros molares demonstrou efetividade. Sendo que o Grupo I se destacou, após seis meses de avaliação. / The extraction of lower third molars is a common practice in dental clinics, but the postoperative period inherent to this surgery presents pain, edema and trismus. Some of the inclusion positions of the third molar can lead to periodontal involvement in the adjacent second molars. The aim of this study was to develop a low-intensity laser protocol for the post-operative treatment of mandibular third molar extractions in order to minimize the signs and symptoms and to improve the periodontal parameters of the second molars adjacent. The laser used was Photon Laser III - DMC, São Carlos, SP / Brazil - as red conduction medium, with wavelength 660 nm, useful power of 30 mW, active medium AsGaAl. Sixty patients of both genders, in need of third molar extraction in standard position classification, were randomized into three groups for analysis - Group I: 10J / cm2, Group II: 30J / cm2 and Group III: Sham, and monitored for the period of 6 months. The analysis of trismus and facial edema in the postoperative and the clinical level of insertion found significant statistical differences between the groups that received the laser therapy when compared to the sham group. Therefore, the use of the low intensity laser as an adjuvant therapy after third molar extraction was effective. As Group I stood out after six months of evaluation.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Third molar surgery is a frequent procedure in dentistry related to variable degrees of postoperative pain. In this context, non-steroidal anti-inflammatory drugs have been commonly used in studies that evaluated the efficacy of preemptive analgesia as a strategy for pain control. Thus, the aim of the present study was to evaluate the preemptive analgesic efficacy and anti-inflammatory effect of ibuprofen and etoricoxib in mandibular third molar surgery, compared with a placebo. A randomized, double-blind, placebo-controlled crossover trial was conducted with patients undergoing a surgical removal of mandibular third molars with similar pattern of bone inclusion and surgical difficult between right and left sides, requiring bone removal under local anesthesia. Eighteen eligible patients were allocated into three groups to receive 1 hour preoperatively a single dose of ibuprofen 400 mg, etoricoxib 120 mg, or placebo. Pain intensity, use of analgesic rescue medication, swelling and maximum mouth opening were evaluated. The overall median (minimum - maximum) of pain scores was different between groups (p < 0.0001): ibuprofen, 0.0 (0.0 â 5.5); etoricoxib, 0.0 (0.0 â 3.5); placebo, 1.0 (0.0 â 7.0). Etoricoxib reduced pain scores significantly in comparison with ibuprofen (p < 0.05). The pain score peak occurred 6 hours after surgery between 3 compared groups (p < 0.0001). Rescue medication was used in 83.33%, 75%, and 100% of surgical procedures receiving ibuprofen, etoricoxib, and placebo, respectively (p = 0.1967). The mean of consumed rescue medication was different between ibuprofen (1.7Â2.0), etoricoxib (0.8Â06), and placebo (1.0Â2.7) groups over the study period (p = 0.0052), and was significantly lower in etoricoxib group by comparison with the placebo group (p < 0.05). Among study periods, there was no statistically significant difference between groups in relation to median values of facial swelling (p > 0.05) and mean values of maximum mouth opening (p > 0.05). In conclusion, ibuprofen and etoricoxib significantly reduced the intensity of postoperative pain and the need for use of rescue medication compared to placebo group. Etoricoxib showed a better preemptive analgesic activity than ibuprofen. Both drugs did not exert significant anti-inflammatory effect able to reduce swelling and trismus in comparison with placebo group. / A cirurgia de terceiros molares à um procedimento frequente em Odontologia relacionado a variados graus de dor pÃs-operatÃria. Nesse contexto, drogas anti-inflamatÃrias nÃo-estereoidais tÃm sido comumente utilizadas em estudos que avaliaram a eficÃcia da analgesia preemptiva como uma estratÃgia para controle da dor. Portanto, o objetivo do presente estudo foi avaliar a eficÃcia da analgesia preemptiva e aÃÃo anti-inflamatÃria do ibuprofeno e etoricoxibe em cirurgia de terceiros molares mandibulares comparado a um placebo. Foi realizado um ensaio clÃnico randomizado, duplo-cego, placebo-controlado cruzado com pacientes submetidos a cirurgia para remoÃÃo de terceiros molares mandibulares, com padrÃes similares de inclusÃo Ãssea e dificuldade cirÃrgica entre os lados direito e esquerdo, e que requeriam remoÃÃo Ãssea sob anestesia local. Dezoito pacientes elegÃveis foram randomicamente alocados em trÃs grupos para receber 1 hora preoperatoriamente dose Ãnica de ibuprofeno 400mg, etoricoxibe 120mg, ou placebo. Intensidade de dor, uso de medicaÃÃo analgÃsica de resgate, edema e mÃxima abertura bucal foram avaliados. A mediana (mÃnimo - mÃximo) global dos escores de dor diferiu entre os grupos (p < 0,0001): ibuprofeno, 0,0 (0,0 â 5,5); etoricoxibe, 0,0 (0,0 â 3,5); placebo, 1,0 (0,0 â 7,0). Etoricoxibe reduziu os escores de dor significantemente em comparaÃÃo ao ibuprofeno (p < 0,05). O pico de dor ocorreu 6 horas apÃs a cirurgia entre os 3 grupos comparados (p < 0,0001). MedicaÃÃo de resgate foi utilizada em 83,33%, 75% e 100% dos procedimentos cirÃrgicos que receberam ibuprofeno, etoricoxibe e placebo, respectivamente (p = 0,1967). A mÃdia de medicaÃÃo de resgate consumida diferiu entre os grupos ibuprofeno (1,7Â2,0) e etoricoxibe (0,8Â0,6) e placebo (1,0Â2,7) durante todo o perÃodo de estudo (p = 0,0052), e foi significantemente menor no grupo do etoricoxibe em comparaÃÃo com o grupo placebo (p < 0,05). Entre os perÃodos de avaliaÃÃo do estudo, nÃo existiu diferenÃa estatisticamente significante dos grupos entre si em relaÃÃo à mediana dos valores de edema facial (p > 0,05) e à mÃdia dos valores de mÃxima abertura bucal (p > 0,05). Em conclusÃo, ibuprofeno e etoricoxibe reduziram significantemente a intensidade de dor pÃs-operatÃria e a necessidade do uso de medicaÃÃo de resgate comparado ao grupo placebo. Etoricoxibe mostrou melhor atividade analgÃsica preemptiva do que o ibuprofeno. Ambas as drogas nÃo exerceram efeito anti-inflamatÃrio significante capaz de reduzir edema e trismo em comparaÃÃo ao grupo placebo.

O Objetivo do presente estudo foi avaliar a relação entre ansiedade odontológica e cortisol salivar por meio de escalas e o nível de cortisol salivar em pacientes submetidos à exodontia dos terceiros molares inferiores. O estudo envolveu 15 pacientes com idade entre 18 e 29 anos, do gênero masculino e ASA I (saudável), submetidos à exodontia dos terceiros molares inferiores bilateralmente sob anestesia local. Foram coletados dados subjetivos por meio de escalas (Escala de Ansiedade Dental de Corah, Escala Visual Análoga de ansiedade e dor, Inventário de Ansiedade Traço-Estado de Spielberger, Escala Verbal e Escala Visual Numérica de ansiedade e dor) e objetivo por meio da coleta de cortisol salivar. Os dados obtidos revelaram correlação entre ansiedade odontológica e dor detectada por meio da escala visual numérica, que evidenciou diferença estatística significante na redução quando comparado os períodos de 3 minutos após a anestesia e 2 horas após o início da segunda cirurgia. O cortisol salivar no período de 2 horas após o início da primeira e segunda cirurgia expôs alteração da curva do ritmo circadiano elevando-a, contudo sem diferença estatística. As cirurgias para extração de terceiros molares inferiores foram capazes de alterar a curva do cortisol mesmo em pacientes com baixo nível de ansiedade. A experiência interfere na resposta do paciente frente à ansiedade e dor, se de forma positiva, reduzindoas de modo significante. / The objective of this study was to evaluate the relationship between dental anxiety and salivary cortisol using scales and salivary cortisol levels in patients undergoing extraction of third molars. The study involved 15 patients aged between 18 and 29 years, male and ASA I (healthy), undergoing extraction of third molars bilaterally under local anesthesia. Data were collected by means of subjective scales (Corahs Dental Anxiety Scale (DAS), Anxiety Visual Analogue Scale (VAS) of anxiety and pain, Spilberger State-trait Anxiety Inventory (STAI), Verbal Scale and Visual Numeric Scale of anxiety and pain) and objective by collecting salivary cortisol. These data revealed a correlation between dental anxiety and pain detected by visual numerical scale, showing statistically significant difference in reduction compared periods of 3 minutes after anesthesia and 2 hours after starting the second operation. The salivary cortisol within 2 hours after the onset of first and second operation curve exhibited alteration of circadian rhythm raising it, however no statistical difference. Surgeries for extraction of third molars were able to change the curve of cortisol even in patients with low anxiety levels. The experience interferes with the patient\'s response against the anxiety and pain, in a positive way, reducing them so significant.

nÃo hà / As alteraÃÃes inflamatÃrio-infecciosas pÃs-operatÃrias em cirurgias de remoÃÃo de terceiros molares estÃo muitas vezes associadas à contaminaÃÃo bacteriana do sitio cirÃrgico no perÃodo trans-operatÃrio. Desta forma, foi feito um ensaio clÃnico controlado, do tipo boca dividida, randomizado, prospectivo, duplo-cego, objetivando avaliar o efeito da administraÃÃo profilÃtica prÃ-operatÃria de amoxicilina no controle dos eventos inflamatÃrio-infecciosos associada à cirurgia para a remoÃÃo de terceiros molares. ApÃs a aplicaÃÃo dos critÃrios de inclusÃo e exclusÃo para os pacientes que buscaram atendimento na disciplina de Cirurgia Buco-Dental e Estomatologia ClÃnica do Curso de Odontologia da Universidade Federal do CearÃ, no perÃodo de janeiro a novembro de 2008, foi obtida uma amostra de 34 pacientes. Cada paciente foi controle de si prÃprio, uma vez que a padronizaÃÃo da inclusÃo dentÃria possibilitou a comparaÃÃo entre os lados da boca de um mesmo paciente, e recebeu dois procedimentos cirÃrgicos distintos e aleatoriamente escolhidos. O lado experimental foi o procedimento cirÃrgico no qual se utilizou uma dose inicial profilÃtica de 1 grama de Amoxicilina uma hora antes da realizaÃÃo do procedimento de remoÃÃo de um terceiro molar superior e inferior do mesmo lado. O lado controle foi considerado o outro procedimento realizado no qual o paciente fez uso de 02 cÃpsulas de placebo administradas da mesma forma que os do grupo experimental. A tÃcnica operatÃria foi padronizada e realizada pela mesma equipe cirÃrgica. Os parÃmetros avaliados foram dor, edema, mÃxima abertura bucal, hipertermia e achados bucais nas reavaliaÃÃes de 3, 7 e 14 dias pÃs-operatÃrios. Na anÃlise de variÃveis contÃnuas foi utilizado o teste paramÃtrico T-student para amostras independentes e na anÃlise de variÃveis categÃricas, o Teste Qui-Quadrado. Nas comparaÃÃes, utilizaram-se testes bilaterais, onde o valor do nÃvel de significÃncia adotado no presente estudo foi de &#945;= 0,05. O valor de p-valor foi considerado estatisticamente significativo quando igual ou menor que 0,05. No que se refere à ocorrÃncia geral de eventos inflamatÃrio-infecciosos entre os grupos avaliados, nÃo foram constatadas diferenÃas estatisticamente significante nas reavaliaÃÃes. Foi constatada reduÃÃo significante da sintomatologia dolorosa avaliada ao sÃtimo dia no grupo experimental em comparaÃÃo com o controle, padrÃo significativo tambÃm foi constatado ao terceiro dia pÃs-operatÃrio quanto a uma maior amplitude da abertura bucal no grupo experimental em comparaÃÃo com o controle. Nas condiÃÃes do presente estudo, pÃde-se concluir que a utilizaÃÃo da antibiÃticoterapia profilÃtica prÃ-operatÃria nÃo foi eficaz na reduÃÃo da ocorrÃncia de eventos inflamatÃrio/infecciosos (edema, hipertermia e achados bucais) nos perÃodos avaliados, com exceÃÃo da sintomatologia dolorosa e da abertura bucal respectivamente ao sÃtimo e terceiro dia pÃs-operatÃrios; e que o uso da medicaÃÃo antibiÃtica de forma sistemÃtica pode expor o paciente a um risco indesejado de resistÃncia bacteriana e efeitos adversos, relacionados ao medicamento, sem que haja uma justificativa clara para benefÃcios relacionados ao seu uso. / Post-operative inflammatory-infectious changes after the removal of third molars are often associated with bacterial contamination of the surgical site in the trans-operative period. Thus, this study aims to conduct a prospective, double-blind, placebo-controlled randomized clinical trial with split-mouth metodology, to evaluate the effect of preoperative prophylactic administration of amoxicillin in the control of infectious-inflammatory events associated with surgery for the removal of third molars. After application of inclusion and exclusion criteria for patients seeking odontological attention in the discipline of Bucco-Dental Surgery and Clinic Stomatology in the Course of Dentistry in the Universidade Federal do Cearà during the period from January to November of 2008, a sample of 34 patients was obtained. Each patient was his own control, since the standardization of dental inclusion allowed the comparison between the sides of the mouth of a patient, and received two separate surgical procedures randomly chosen. The experimental side was the surgical procedure that used an initial prophylactic dose of 1 gram of amoxicillin one hour before the procedure to remove an upper and lower third molar from one side. The control side was the other in witch the patient received placebo capsules in the same way of the experimental side. The surgical procedure was standardized and performed by the same surgical team. The parameters evaluated were pain, swelling, maximum mouth opening, hyperthermia and oral findings in revaluations after 3, 7 and 14 days of the surgery. To the analysis of continuous variables was used the parametric T-student test for independent samples and the chi-square test for the analysis of categorical variables. In comparisons, bilateral tests were used where the level of significance adopted in this study was &#945; = 0.05. The p-value was considered statistically significant when equal or less than 0.05. As regards the occurrence of general infectious-inflammatory events between the studied groups, there were no statistically significant differences in the revaluations. There was a significant reduction of painful symptoms assessed on the seventh postoperative day in the experimental group compared with the control, significant pattern was also observed on the third postoperative day on a greater magnitude of mouth opening in the experimental group compared to control. Under the conditions of this study it was concluded that the use of preoperative prophylactic antibiotic therapy was not effective in reducing the occurrence of inflammatory-infectious events (edema, hyperthermia and oral findings) in the postoperative periods evaluated, except for the painful symptoms and maximal mouth opening respectively on the seventh and third postoperative day, and that the systematic use of antibiotic medication can expose the patient to an unwanted risk of bacterial resistance adverse effects, related to the medication, without giving a clear explanation for benefits related to its use.

O objetivo do presente estudo foi avaliar a eficácia da analgesia preemptiva na cirurgia de extração de terceiros molares inclusos. Nesse estudo duplo cego, randomizado e pareado, os pacientes foram submetidos à extração de terceiros molares inferiores bilaterais em dois tempos distintos. Em uma das duas cirurgias, no pré-operatório os pacientes fizeram uso de Cetoprofeno 150 mg via oral a cada 12 horas durante dois dias antes e, após a cirurgia, continuaram a medicação por mais três dias. Em outra cirurgia, fizeram uso de um comprimido placebo no pré-operatório a cada 12 horas durante dois dias antes e, após a cirurgia, fizeram uso de Cetoprofeno 150 mg a cada 12 horas por três dias. O analgésico de resgate utilizado foi o Paracetamol 750 mg via oral. A dor pós-operatória foi avaliada por meio de Escala Visual Analógica, Escala Nominal e quantidade de consumo de analgésicos de resgate. Os resultados não mostraram diferença significante entre o controle e cetoprofeno preemptivo na redução da dor pós-operatória e no consumo de analgésicos de resgate. Concluiu-se que neste modelo experimental, a analgesia preemptiva não se mostrou eficaz na redução da dor pós-operatória. / The aim of this study was to evaluate the effectiveness of the preemptive analgesia in the third molar surgery. In this double blind study, randomized and paired, the patients were submitted to the extraction of the third molar bilateral inferiors in two distinct times. In one of the two surgeries, during the two-day preoperative the patients made useof150 mg of ketoprofenoralevery12 hours and, after the surgery, they kept taking this medication for three days. In the other surgery, a placebo pill was used in the preoperative, also every 12 hours, for two days and, after the surgery, ketoprofen 150 mg was used every 12 hours for three days. The rescue analgesic used was the paracetamol 750 mg oral. Postoperative pain was evaluated by making use of the Analogical Visual Scale, the Nominal Scale and the amount of rescue analgesic consumption. The results did not show significant difference between the control and the preemptive ketoprofen in the reduction of postoperative pain and in the rescue analgesic consumption. We can conclude that in this experimental model, the preemptive analgesia did not prove to be efficient in the reduction of postoperative pain.

Age estimation in living individuals around the legal age of 18 years remains a difficult challenge, with limited options available. In this study third molar development was used, along with the novel method of anterior inferior vertebral ring apophysis development, to assess the age of living individuals and the probability of being 18 years. For third molar development, panoramic radiographs of 705 white and 563 black South Africans were scored using a 10 stage scoring system. Vertebral apophysis development of C2, C3, and C4 of 496 white and 478 black South Africans were assessed from cephalometric radiographs, using a four-stage scoring system. Likelihood values were determined for individuals in each sex and population group being 18 years, based on developmental stages. For apophysis development, the median ages for attainment of stages 0, 1, and 2 were below the 18-year threshold for all ancestry and sex groups, while stage 3 was also below this threshold in some groups. For third molar development, black South African individuals consistently matured earlier than white South African individuals, while for most of the stages the opposite was true for apophysis development. Differences between the sexes were also noted for third molar, but not for vertebral apophysis development. These age indicators were also combined by using a generalised linear model (GLM). The combined sample comprised of 165 females and 122 males aged between 15 and 18 years. Four additional models were obtained from data sets only containing data for third molar and cervical ring apophysis development respectively. The performance of all the models were quantified and compared using the Akaike information criterion (AIC) as an estimator of the relative quality of the statistical models and the prediction error as a mean square error value. The best performance resulted from third molar development, although the vertebral data adds a component related to skeletal development which may better reflect biological reality. These results show that cervical vertebral apophysis development is a valuable, novel addition to the assessment of age in living individuals. Both these methods are easy to use and can be assessed from standard and routinely used radiographic images. The developed models need to be sex and ancestry specific, as clear differences were noted. / Thesis (PhD)--University of Pretoria, 2019. / Anatomy / PhD / Unrestricted

The retromolar foramen represents a little known anatomical variation in the posterior mandible of uncertain clinical importance. It has been the subject of limited study. Findings and conclusions of these studies have been placed under little scrutiny. Suggested clinical consequences associated with the presence of the retromolar foramen include local anaesthetic failure, local haemorrhage during surgery, perineural spread of infectious and invasive pathology, and loss of sensation in the normal distribution of the buccal nerve due to surgical intervention. Reports of the possibility of these complications seem to suggest that the retromolar foramen, canal and its associated neurovascular bundle are structures of great clinical importance. Case reports seem to have, however, only included reports of loss of gingival and buccal sensation as a consequence of third molar surgery in the presence of this anomaly. This study therefore aimed to report the prevalence of the retromolar foramen and canal in the South African population, describe its course and structure, and produce a clinical framework in which to approach the presence of the retromolar foramen. Comparisons between the present and existing studies were made and conclusions concerning the clinical importance of this structure were drawn. Inspection of a sample containing 946 mandibles was performed. Of these, 885 were regarded as suitable for inclusion. These mandibles were inspected for the presence of a retromolar foramen in which a 1 mm diameter needle could pass through without resistance. The distance from the last tooth in the arch to the retromolar foramen was also measured. Fifty of these mandibles were then randomly selected and scanned using microfocus computed tomography. Seventy mandibles were found to have at least one retromolar foramen (7.9% of the total sample). No statistically significant differences were found when the presence of the retromolar foramen was correlated with race, sex or age. The finding that sex and age played no significant role in the presence of the retromolar foramen is in agreement with available literature. Detected prevalence seemed to be heavily influenced by the method used to determine the presence of the retromolar foramen. The average distance between the second mandibular molar and the retromolar foramen was 16.83 ± 5.57 mm and the average distance between the third mandibular molar and the retromolar foramen was 10.47 ± 3.77 mm. These findings were found to be in agreement with most other reports. Fifty retromolar canals were selected at random and scanned using microfocus computed tomography. Analysis revealed four basic patterns. These were type A, a vertical canal between the inferior alveolar canal and the retromolar area of the mandible, type B, a curved canal taking a recurrent course between the inferior alveolar canal and the retromolar area, type C, a canal with an approximately horizontal path between the inferior alveolar canal and the retromolar area, and the temporal crest canal (TCC, not designated as type D to create a distinction between it and types A, B and C), a canal terminating on either side of the temporal crest. Type B was the most common presentation (68% of retromolar canals in the study), a finding contrary to that of other studies. The presence of the retromolar neurovascular bundle is of uncertain clinical importance and requires further anatomical and pharmacological study to determine its effect on local anaesthetic failure. A model in which the retromolar canal branches from the inferior alveolar canal does not seem to support a conclusion in which local anaesthetic failure may be directly attributable the presence of this anatomical variation alone. Classification of the retromolar canal is of limited clinical use and may require a revised scheme if clinical application is sought. Complications associated with the presence of the retromolar foramen are poorly documented and seem to be of little consequence. / Dissertation (MSc)--University of Pretoria, 2014. / tm2015 / Anatomy / MSc / Unrestricted

The objective of this study was to: (1) model the course of the lingual nerve (LN) in the third molar region using digitized data and (2) investigate landmarks to aid in predicting the position of LN. A MicroScribe 3-DX digitizer and Autodesk® Maya® 8.5 were used to create 3-D in-situ models of LN for seven human cadaveric specimens. Regression analysis demonstrated that an anteriorly positioned lingula is directly proportional to the vertical distance of the LN relative to the alveolar crest (p < 0.05). A superiorly positioned mylohyoid ridge was also directly proportional to the vertical distance of the LN relative to the alveolar crest (p < 0.05). The LN is positioned closer to the alveolar crest in specimens where the mylohyoid ridge is positioned superiorly (p = 0.001). This study demonstrated a novel way of quantifying the relative position of the LN using 3-D computer modeling.