MedNEXT Journal of Medical and Health Sciences

Historical analysis of the cost of acquiring a coronary stent and feasibility of the new ministry of health ordinance: a retrospective observational longitudinal study

Sat, 18 Nov 2023 00:00:00 +0000

Introduction: According to the World Health Organization (WHO), cardiovascular diseases (CVD) are the leading cause of death in the world. It is estimated that 17.7 million people died from CVD in 2015. According to data from DATASUS, in 2008, 44,138 coronary angioplasties were performed with or without stents. In 2016, 79,997 angioplasties were performed. The cost of orthoses, stents, and special materials for hospitals impacts the financial balance of the single health system (SUS). Objective: It was to carry out a cost analysis of stents for angioplasty from the perspective of the Brazilian Unified Health System. Methods: The present study followed a retrospective longitudinal observational model (STROBE). Data on stents about the years 2020 and 2021 and the cost assessment were carried out by searching the intra-hospital financial database of Santa Casa in the city of Jaú, São Paulo, Brazil, and the SUS table. The research was in the field of incomplete economic evaluation (cost analysis and brands of stents) through macro-costing of stent supply. The variables were presented as percentages, mean, and standard deviation. Comparisons of variables were performed using the Kruskal-Wallis test, with p<0.05, and Tukey analysis (ANOVA-One-Way) with p>0.05 with a statistical difference. Predictive logistic regression analysis was performed to better understand the trend in stent costs each year, with a significant p<0.05. Results: After analyzing the intra-hospital financial data and the SUS table, they showed a significant increase in the transfer value of stents from 2020 to 2021, with average values in reais of R$1,399 to R$2,478, respectively. This difference of R$1,079.00 can be justified by the period of the COVID-19 pandemic, as well as the increase in demand for stents. Conclusion: Lower average values for stent costs were observed in 2020 and 2021 compared to other stent values that were published in studies covering the same periods. However, the average cost of stents in this study in 2021 showed significantly higher values compared to 2020, which further burdened the budget of the Unified Health System. The future perspective is that a greater transfer of funds from the Federal Government for the Unified Health System, as well as a reduction in the cost prices of stents by manufacturers and suppliers in the post-COVID-19 period, to obtain a balance in public spending. Furthermore, it is expected that drug-eluting stents will be more widely used in the Unified Health System. Furthermore, it is necessary to establish public policies to standardize stent prices.

Major clinical evidence of calorie restriction and intermittent fasting on skin health: a systematic review

Fri, 10 Nov 2023 00:00:00 +0000

Introduction: Combined skin diseases represent the fourth leading cause of non-fatal disability worldwide. In 2013, it was estimated that skin diseases represented almost 2.0% of the total global burden of disease. Different fasting models have been studied in an attempt to understand the effect of fasting on skin structure and function. Objective: It was to present the main scientific evidence of the effects of calorie restrictions and intermittent fasting on skin health. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to September 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 119 articles were found, and 26 articles were evaluated in full, and 23 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=64.7%>50%. It was concluded that although calorie restriction is the most effective intervention to prolong the life of organisms and prevent age-related diseases, its effects on aging and skin diseases can be significant. Dietary lifestyles can affect epithelial lineages such as the skin and intestine. The impact of Ramadan fasting on skin health can be compared with the effect of other types of fasting, including periodic dieting, calorie restriction, dietary restriction, dietary manipulation, and intermittent, short-term, and prolonged fasting. However, despite the scarcity of studies on the topic, no serious health risks have been reported and, therefore, patients who wish to fast should be warned about the importance of continuing their treatment and the administration of transdermal/topical medications.

State of the art of orofacial harmonization: a review

Wed, 08 Nov 2023 00:00:00 +0000

Nowadays, a harmonious smile depends on several factors ranging from the aesthetic to the functional, but it is known that a smile opens doors and is also known as a business card for anyone. The present study aims to discuss the issue of orofacial harmonization nowadays, the existing indications, and the contraindications of this treatment modality, through a literature review. This study is a systematic literature review and for its realization, a bibliographical survey of articles in the main internet databases was carried out. It is worth remembering that, like any procedure, it is necessary to carry out an evaluation, to plan well how the procedure will be carried out, to know the indications, the contraindications, the places that can be applied, the way to dilute the product, when using botulinum toxin. However, this study made it possible to understand that orofacial harmonization, in addition to being an aesthetic procedure, has characteristics that are linked to the question of the biomechanics of the smile, forgetting the question of the person's self-esteem.

Major clinical outcomes of metabolism and sports physiology: a systematic review

Sat, 04 Nov 2023 00:00:00 +0000

Introduction: In the sports medicine setting, many of the established positive health benefits of exercise have been documented by historic discoveries in the field of exercise physiology. Mitochondrial function is critical in regulating all three of the classic physiological factors that limit endurance performance. Objective: It was to carry out a systematic review to present the main information on exercise physiology in the light of mitochondrial redox activities in sports performance, as well as the guidelines of sports medicine in this regard. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from August to September 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles dated from 2008 to 2023. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 200 articles were found, and of the 77 articles were evaluated in full and 32 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 37 studies with a high risk of bias and 78 studies that did not meet GRADE. It was concluded that sports physicians may seek to use an increasing number of non-invasive techniques to study muscle metabolic functioning, answering how mitochondrial networks interact with O2 kinetics, how to remodel mitochondrial networks to increase performance, and how training affects the interaction between glycogen/lipid storage site and mitochondrial networks. Physiological and psychological demands during training and competition generate fatigue and reduce an athlete's sport-specific performance capacity. The magnitude of this decrease depends on several characteristics of the exercise stimulus, such as type, duration, and intensity, as well as on individual characteristics, such as physical conditioning, profile, and fatigue resistance. Recent evidence suggests that exercise-induced reactive species are essential upstream signals for the activation of redox-sensitive transcription factors and the induction of exercise-associated gene expression. Free radicals and oxidative stress are increasingly included in major reviews of exercise physiology as regulators of responses and adaptations.

Sotos syndrome: a case report

Mon, 30 Oct 2023 00:00:00 +0000

Background and Objective: This clinical case study analyzed the characteristics of Sotos syndrome. Since it is a rare syndrome and is related to the occurrence of behavioral disorders. Health professionals who work with this population were informed so that this condition is recognized, enabling appropriate treatment and consequently a good quality of life. This study was analyzed and approved by the Research Ethics Committee according to the reasoned opinion number, under number 6,089,691, and the patient's consent was obtained through the Free and Informed Consent Form. Final Considerations: Sotos Syndrome should be considered when the patient presents macrocrania, growth acceleration, and behavioral changes associated with varying degrees of delay. The diagnosis is clinical, but complementary tests help, as they rule out other possible causes for such an association of symptoms since there is no specific test for the syndrome to date. The treatment of these patients must be individualized, using pharmacological and non-pharmacological strategies according to the needs of the moment. Clinical follow-up is always necessary, due to complications that may arise.

Major clinical findings on the safety and effectiveness of ozone therapy in endodontic treatment: a concise systematic review

Sat, 28 Oct 2023 00:00:00 +0000

Introduction: In the scenario of endodontic diseases, microorganisms, and their byproducts are the main causes of pulpal and periradicular diseases. Sodium hypochlorite (NaOCl) is the most commonly used root canal irrigant. Ozone (O₃) therapy has been investigated to reduce or eliminate the microbiota load within the root canal system, improving endodontic results. Objective: It was to highlight the main clinical findings of the safety and effectiveness of ozone therapy in endodontic treatment. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from July to September 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 87 articles were found, and 23 articles were evaluated in full and 14 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 18 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=47.7%<50%. It was concluded that ozone has been accumulating scientific evidence regarding its success in endodontic treatment, more specifically in the decontamination of root canals and activation of regenerative processes. Ozone therapy is a minimally invasive treatment method, without discomfort or pain. It also minimizes the patient's anxiety and stress level, as it reduces the duration of treatment. The beneficial role of ozone in treating different oral and dental conditions is still limited. There are possible side effects during intraoral application, as it can reach the upper respiratory tract.

Development of mouth cancer associated with deleterious habits such as etilism and tabagism: a review

Mon, 23 Oct 2023 00:00:00 +0000

Oral cancer is a multifactorial disease resulting from changes in the DNA of cells present in the oral cavity, altering their natural structure and consequently causing a mutation in the Deoxyribonucleic Acid chain. Several extrinsic factors can cause oxidation of the DNA chain, such as smoking, alcoholism, human papillomavirus (HPV) virus infection, and a diet poor in antioxidants present in fruits and vegetables in general. The association of more than one factor can further increase the chances of developing this pathology. The objective of this study was to search the literature for articles that report an association between harmful habits, such as smoking, alcohol consumption, and HPV virus infection, with the risk of developing oral cancer. The articles used were extracted from online databases, such as PubMed, Scielo, and Google Scholar to gather research on the topic in question.

A review of the major considerations and predictors of osseointegrated implants

Gustavo Fabri Maschio, Elias Naim Kassis — Wed, 11 Oct 2023 00:00:00 +0000

The most common bone disorder found by implant dentists is osteoporosis, which is a systemic skeletal disorder associated with aging, which is characterized by loss of bone mass, making bones fragile and more susceptible to fractures. The World Health Organisation has defined osteoporosis as a bone mineral density level greater than 2.5 standard deviations below the mean of young normal women. After 60 years of age, a third of the population have this disorder, it occurs twice as often in women than in men. It is estimated that 1.3 million fractures and 133,000 hip fractures occur every year as a result of osteoporosis. This study aimed to discuss aspects of the pharmacological action of Bisphosphonates (BP) and their influence on bone tissue when associated with treatment with dental implants. There are several types of treatments which prevent or prevent the progression of osteoporosis. So, BP, such as alendronate, are inhibitor of bone resorption. Act as controlling the development of osteoporosis by increasing the process of bone density and decreasing its reabsorption, often acting as supporting the process of osseointegration of dental implants.

Main clinical and surgical outcomes of crossbite treatment: a concise systematic review

Mon, 09 Oct 2023 00:00:00 +0000

Introduction: In the crossbite scenario, the prevalence of malocclusion is 56%, with 10% of crossbites in the primary dentition, 11% in the mixed dentition, and 5% in the permanent dentition. The etiology is multifactorial and early diagnosis of crossbite is essential to reduce the risk of dental, alveolar, and skeletal malocclusions. In this sense, malocclusions are a disorder that is increasingly present in the population. Objective: It was to carry out a concise systematic review of the main considerations of crossbite and malocclusions. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from June to September 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total 117 articles were found, and 22 articles were evaluated in full and 13 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 7 studies with a high risk of bias and 43 studies that did not meet GRADE. Early bite correction will provide benefits, restoring the normal redirection of the eruption of permanent teeth, providing correction of asymmetries in condylar positioning, and favoring ideal occlusion. Furthermore, early expansion with a removable expansion plate is a successful method for correcting crossbites and increasing intermolar width in the early phase of mixed dentition. Results remain stable until comprehensive treatment of the permanent dentition begins. Rapid maxillary expansion is a resource of great value to the orthodontist that can be used to treat maxillary transverse deficiencies.

Major deleterious oral habits: a brief systematic review

Tue, 26 Sep 2023 00:00:00 +0000

Introduction: The deleterious habits in children, in the deciduous dentition phase, seem to be present in more than half of the child population, reaching rates greater than 90%, depending on the population studied, and dentofacial alterations may already be present in half of these individuals. Early identification is essential so that malocclusions, which are more difficult to treat, do not set in. Objective: It was to carry out a brief systematic review to highlight deleterious oral habits, as well as to point out their main predictors and treatments. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from April to June 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 87 articles were found. A total of 32 articles were evaluated in full and 16 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 6 studies with a high risk of bias and 43 studies that did not meet GRADE. Since pediatric follow-up is more frequent than consultations with the pediatric dentist, the early identification of deleterious habits by physicians is of fundamental importance in referring these patients to dental treatment that diagnoses and removes these habits, before difficult-to-resolve malocclusions get settled. Preventive measures should also be taken, guiding parents so that deleterious oral habits do not take hold, such as a minimum period of six months of breastfeeding, finger sucking should be replaced by an orthodontic pacifier, the bottle should have an orthodontic spout, removing the habit of pacifier and bottle until the age of three. There is an association between deleterious habits and different types of malocclusions in different planes of space, with atypical swallowing being a habit that must be diagnosed early.

What factors contribute to behaviour-related stigma among men who have sex with men in Western Province - Sri Lanka

T. S. Mekala Fernando, H. M. J. P Vidanapathirana — Tue, 24 Oct 2023 00:00:00 +0000

Introduction: Men who have sex with men (MSM) are one of the key population groups who have a high risk of transmitting and acquiring HIV. They are being stigmatized due to their behavior. Therefore, it is of prime importance to identify those correlates of stigma among MSM to take measures to minimize them. Objective: To determine the correlates of behavior-related stigma among MSM in Western Province, Sri Lanka. Methods: A cross-sectional study with an analytical component was conducted among MSM in the Western province, of Sri Lanka. The sample size was 564. Participants were recruited using respondent-driven sampling. Data collection was done using two interviewer-administered questionnaires, the “Behavior related stigma Scale”, a tool developed and validated by the investigators was used to assess the level of stigma, and a separate questionnaire to assess the correlates of stigma which was also developed by the investigators. Correlates of behavior-related stigma among MSM were determined by multivariate analysis using an adjusted Odd’s ratio. Results: Advancing age (>29 years) (p= 0.01), being educated up to grade 10 (p = 0.039), family and friends considering homosexuality as a psychiatric disease (p – 0.018), the experience of sexual abuse in childhood (p <0.001), the experience of nonverbal harassment from relatives (p <0.001), being arrested by police during lifetime (p<0.001), not carrying condoms as they were not supplied (p=0.007) were positively associated statistical significance with a high level of behavior related stigma among MSM. Being educated regarding HIV/AIDS from the health sector and media were negatively associated. Conclusions: There are modifiable factors associated with behavior-related stigma among MSM. Awareness programs should be conducted for the public to sensitize them regarding same-sex behavior, thus minimizing harassment from society.

Ramsay hunt syndrome: a case report

Wed, 13 Sep 2023 00:00:00 +0000

Ramsay Hunt syndrome, known as Herpes zoster oticus, is a rare neurological condition due to the reactivation of the varicella-zoster virus (VZV) in the geniculate ganglion of the seventh cranial nerve. The triad is composed of vesicula-pustule-crusted lesions in the ear and external auditory canal, lagophthalmos, and ipsilateral paralysis. Diagnosis is clinical and drug treatment is with antivirals and corticosteroids. The objective of this work is to report a case of Ramsay Hunt Syndrome and reinforce the importance of early diagnosis to minimize neurological damage. Final considerations: It is important to highlight that although the triad findings appeared late, this did not affect the diagnosis and treatment of the patient, who today presents a significant improvement in symptoms and quality of life.

Major clinical findings of bone regeneration in implant dentistry: a systematic review

Wed, 16 Aug 2023 00:00:00 +0000

Introduction: Over the past three decades, the number of dental implant procedures has been around one million dental implants per year. The development of biomaterials for use in clinical dentistry is a powerful therapeutic instrument in the correction of bone defects. Objective: It was to carry out a concise systematic review of bone regeneration processes using biomaterials and the main molecular and cellular constituents for implant dentistry. Methods: The survey was carried out from May to July 2023 in the Scopus, PubMed, Science Direct, and Scielo databases, using older scientific articles with a gold standard reference up to 2023. The quality of the studies was based on the GRADE instrument and the risk of bias by the Cochrane instrument. Results and Conclusion: It was found 162 studies that underwent eligibility analysis. The final sample had 31 eligible studies that were described in the systematic review. Most studies showed homogeneity in their results, with I² =24.9% <25%. Due to bone regeneration and biological barriers in graft surgeries, there has been a technological growth of these materials as they point to potential tools for treating bone loss. The greater potential of guided bone regeneration was associated with the graft material due to the higher grade of vital bone and the lower percentage of residual graft particles. All studied bone substitute materials resulted in efficient bone formation for dental implants and alveolar ridge preservation procedures. It was concluded that bioengineering and cell therapy work together for regenerative dentistry, favoring and improving biological conditions to accelerate tissue repair and regeneration and, thus, naturally maintaining tissue homeostasis. This condition is maintained because the required cellular elements are provided, the cell proliferation and differentiation factors, and supramolecular structures that guarantee the functional stereochemical organization of the generated tissues and their systemic integration.

Relationship between periodontal disease in pregnant women and premature birth: a comprehensive review

Tue, 08 Aug 2023 00:00:00 +0000

Initially, it should be noted that the birth of premature babies constitutes the fundamental cause of morbidity and mortality and morbidity soon after birth. There are several factors that imply risks and are directly related to its development, such as the use of psychoactive substances, infections of the genito-urinary tract and tobacco. smoke and other infections at a distance. Periodontal disease is considered an independent risk factor for premature low birth weight babies, which places active periodontal disease as an independent risk factor for the birth of premature and low birth weight babies. In this perspective, the objective of this work is to analyze periodontal disease as a risk factor for prematurely born babies. The methodology used in the development of the work is the literature review, with the use of articles from reference periodicals for the theme. It can be stated that in cases of periodontal disease, inflammatory stimuli can induce hyperirritability of the uterine smooth muscle, causing contraction of the uterus and cervical dilation, triggering premature birth. By constituting a chronic infection, it can influence the occurrence of premature birth indirectly or directly. However, it is important to understand that the treatment of periodontal disease is effective, reducing the incidence of premature birth.

Major approaches to laser therapy in regenerative processes in bucco-maxillo-facial bone defects: a concise systematic review

Fri, 04 Aug 2023 00:00:00 +0000

Introduction: In the context of oral and bucco maxillo regenerative processes, bone defects are caused by trauma, surgery, tumor, congenital disease, and other pathological factors. Low-level laser therapy (LLLT) can regulate cellular functions by affecting cell growth and cytokine secretion, thereby exerting a variety of biological effects. Objective: It was to carry out a concise systematic review of the main stimulatory and regenerative effects of laser therapy on bone formation processes in maxillary oral surgery for bone defects. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to March 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 1993 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed accordingly, according to the Cochrane instrument. Results and Conclusion: A total of 114 articles were found, 48 articles were evaluated and 29 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 16 studies with a high risk of bias and 40 studies that did not meet GRADE. It was concluded that there is scientific evidence of the positive effect of low-intensity laser energy on bone regeneration within a certain relationship between dose and output power. The low-intensity laser stimulates cellular metabolism, increasing protein synthesis and subsequent bone regeneration. A high dose combined with low potency or a low dose combined with high potency appears to produce a positive effect.

Major clinical evidence of the optimization of the use of CO2 fractional ablative laser with cells and molecules: a systematic review

Fernanda Soubhia Liedtke, Samadhi Wishwanath Rajapaksa — Sun, 23 Jul 2023 00:00:00 +0000

Introduction: Ablative fractional CO₂ laser skin resurfacing describes the process of removing the superficial epidermal and dermal layers of the skin to reduce the cutaneous signs of photoaging. The clinical efficacy and safety of exosomes, adipose tissue stem cells, platelet-rich plasma, and resveratrol as adjuvant therapy after ablative fractional CO₂ laser application are evidenced by the world literature. Objective: It was to carry out a systematic review to list the main clinical outcomes of the use of fractional ablative CO₂ laser, with or without associated techniques, for facial aesthetic treatment. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from April to May 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 86 articles were found. A total of 32 articles were fully evaluated and 17 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies at high risk of bias and 37 studies that did not meet the GRADE. It was concluded that ablative fractional CO₂ laser offers a safe and effective treatment for disfiguring facial scars. It was shown that the improvement in the appearance and quality of the scar was significant for the patient, with a significant impact on the patient's quality of life. Based on these findings, we suggest including ablative fractional CO₂ laser in the concept of facial scar treatment. The results demonstrate that the ablative fractional CO₂ laser of low fluence and low density is a safe and efficient option for the photorejuvenation of the face. Repeated application of ablative fractional CO₂ laser to skin with melasma can result in lasting improvement due to its destructive effect on melanocytes. Furthermore, the combined use of exosome gel with CO₂ laser resurfacing would provide synergistic effects on both the efficacy and safety of atrophic acne scarring treatments. ADSC-CM with CO₂ resurfacing is a good combination therapy for the treatment of atrophic acne scars and skin rejuvenation. The combined use of ablative fractional CO₂ laser and PRP obtained better results. Resveratrol can improve photoaging alone and add efficacy to fractional ablative laser treatment and decrease the adverse effects induced by fractional ablative laser.

Outcomes of clinical studies of periapical procedures (parendodontic surgery): a systematic review

Fri, 21 Jul 2023 00:00:00 +0000

Introduction: The attempt to contain microbial proliferation does not prove to be viable or solvable through coronary access, periapical or parendodontic surgery is indicated as a therapeutic complement. Periapical surgery is intended to provide healing to periradicular tissues, generating rehabilitation of dental function, which is indicated in cases such as retro filling and periradicular tissue repair. Objective: It was to carry out a systematic review to elucidate the main approaches to apical and periapical lesions and other complications through evidence from clinical studies of endodontic surgery. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from April to June 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 127 articles were found, and 47 articles were evaluated in full and 18 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 13 studies with a high risk of bias and 21 studies that did not meet GRADE. Periapical surgery (parendodontic) is indicated in cases of persistent chronic periapical inflammation, with extensive apical radiolucent areas, restricted coronal access to the root apex, due to insufficient retrograde sealing or root pins that cannot be removed, perforation and fracture of the apical third of the root, in addition to pulpal calcifications in the root third, etc. Increasingly used to repair problems that were not resolved through conventional endodontic treatment and endodontic retreatment, parendodontic surgery with retro-preparation and retro-filling, using appropriate materials and techniques, was efficient for removing the etiological agent and obtaining periapical health. Paraendodontic surgery is an effective and conservative treatment option concerning tooth extractions, and when performed correctly, with the aid of good materials such as MTA, it brings satisfactory results.

Major evidence and guidelines for antibiotic therapy in implant dentistry: a systematic review

Fri, 21 Jul 2023 00:00:00 +0000

Introduction: Dentistry was favored by the discovery of osseointegration, which has become important in the treatment of partially and edentulous patients. Initially, osseointegration was used only to treat edentulous patients in the maxilla and mandible, using a single type of implant, prosthetic abutment, and rehabilitation protocol. However, as the applications of osseointegration evolved, complications also increased, which became more numerous and are no longer the result of surgical and mechanical problems of the components of a single care protocol, requiring more research, studies, and care. In this scenario, the use of antibiotics in implantology is very common and the abuse of antibiotics is more and more frequent. The rational use of antibiotics in the oral implantology process needs the support of evidence-based medicine. The prophylactic use of antibiotics in dental implantology was reviewed in the present study, including the summary of different risks of infection, such as peri-implantitis and maxillary sinusitis after lifting the maxillary sinus floor. Objective: To carry out a systematic review of the literature on the real effects of antibiotic therapy on implantology, especially in the pre-procedure phase. The present study was based on studies of guidelines, with emphasis on the German directive. Main findings and conclusion: The current evidence of antibiotic prophylaxis from oral and maxillofacial surgery was summarized by the planned German S3 guideline “antibiotic prophylaxis in surgery”. Perioperative prophylactic antibiotics can reduce SSI in major procedures, such as head and neck cancer surgery, and prophylaxis is only beneficial for 24 hours. In orthognathic surgery, preoperative antibiotics can reduce SSI with good quality evidence, but it benefits prolonged therapy, and which regimen is most effective remains uncertain. In traumatology, perioperative antibiotic prophylaxis for mandibular fractures and Lefort-1/2 can reduce the SSI, but antibiotic regimens should not be prolonged in the postoperative period by 24 hours. For dentoalveolar surgery, the evidence is more ambivalent. For dental implants, perioperative antibiotics as single injection prophylaxis before placement can reduce dental implant failure, but not SSI. For the removal of third molars, antibiotic therapy in the perioperative period is of uncertain benefit for healthy patients, but it was not possible to obtain evidence to evaluate antibiotic therapy for patients with pre-existing conditions.

Guided bone regeneration in implant dentistry: a systematic review

Wed, 12 Jul 2023 00:00:00 +0000

Introduction: The rehabilitation of the dental arch with osseointegrated implants makes it possible to improve the quality of life of patients. Guided bone regeneration (GBR) has been applied to replace lost bone to allow the implant to be fully integrated and maintained during functional loading. GBR is considered one of the most commonly applied methods to reconstruct alveolar bone and to treat peri-implant bone deficiencies. Objective: It was to develop a systematic review to highlight the main approaches of guided surgery to promote bone regeneration in implant dentistry. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from March to May 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 1977 (Golden pattern - Bra°nemark et al. ) to 2023. Results and Conclusion: A total of 117 articles were found, 38 articles were evaluated and 28 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 15 studies that did not meet GRADE. It was concluded that the application of a membrane to prevent nonosteogenic tissues from interfering with bone regeneration is a fundamental principle. Membrane properties and biological outcomes drive bone regeneration in membrane-covered defects. Barrier membranes play the role of preventing the invasion of soft tissue by exiting the mucosa and creating an underlying space to support bone growth. Collagen membranes have excellent biological properties and bone regeneration results. While collagen membranes do not provide sufficient mechanical protection of the covered bone defect, titanium-reinforced membranes, and non-resorbable membranes need to be removed in a second surgery.

Intramuscular use of pmma microspheres for treating calf poliomyelitis atrophy: a case report

Mon, 10 Jul 2023 00:00:00 +0000

Introduction: One of the sequelae of poliomyelitis is muscle atrophy, which presents with decreased muscle mass, especially in the lower limbs. Besides functional treatment, it is important to consider aesthetic treatment to correct muscle asymmetry because this condition negatively affects the quality of life. Case description: In this report, we describe the case of a female patient with muscle atrophy in the left calf due to poliomyelitis sequelae who was treated with intramuscular implantation of polymethylmethacrylate (PMMA) microspheres. Results: Obtained an increase of 7 cm in the circumference of the left calf after the end of the treatment. Conclusion: The result obtained with the intramuscular filling was effective in treating calf muscle asymmetry.

Major outcomes of dental implants in oncological patients: a concise systematic review

Mon, 26 Jun 2023 00:00:00 +0000

Introduction: The etiology of oral cancer is multifactorial resulting from several factors that predispose to the development of this pathology. The rehabilitation of oral functions after jaw surgery in patients with oral cancer is a goal that is often difficult to achieve. Dental implants offer a mechanism to provide stability to prostheses. Objective: This study aimed to present the main outcomes of dental implants in cancer patients. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to May 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 2013 to 2023. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 118 articles were found, 34 articles were evaluated in full and 14 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 32 studies with a high risk of bias and 32 studies that did not meet GRADE. It was concluded that implants inserted into irradiated bone showed significantly lower survival. Head and neck radiotherapy has always been considered a risk factor for rehabilitation with dental implants. However, recent data suggest that the overall 5-year implant survival in irradiated patients may be greater than 90%.

Key clinical considerations and updates on the techniques for successful zygomatic implant: a systematic review

Sun, 25 Jun 2023 00:00:00 +0000

Introduction: In the context of implant dentistry, what represents a great burden in the aesthetic recovery of patients who have suffered dentoalveolar trauma is the lack of bone in the alveolar crest, compromising the quality of life due to tooth loss. Objective: Performed a systematic review to present key clinical considerations and updates on the best techniques for successful zygomatic implantation. Methods:The systematic review rules of the PRISMA Platform were followed. The research was carried out from February to May 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion:A total of 128 articles were found, 54 articles were evaluated in full and 34 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 32 studies that did not meet GRADE. Zygomatic implants can be placed with good precision. The application of these newly designed 3D-printed surgical guides results in the predictable placement of zygomatic implants and offers the possibility of immediate prosthetic rehabilitation. Preliminary data from one year after loading suggest that immediately loaded zygomatic implants were associated with statistically significantly fewer prosthetic failures. Also, zygomatic implants proved to be a better rehabilitation modality for severely atrophic jaws.

Dental implant and aesthetics: a systematic review

Sat, 24 Jun 2023 00:00:00 +0000

Introduction: Besides the aspects of oral physiological functions, visual appearance and aesthetics have been addressed as an important factors in this type of therapy. In restorative dentistry, a pleasant aesthetic has been described as a blending of natural dentition and prosthetic elements, in addition to the identification, adaptation, and correct conditioning of these elements with the marginal and peripheral tissues. Objective: The present study aimed to present the main factors supporting aesthetic excellence before and after the rehabilitation of former regions' use of dental implants. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to May 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 1985 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 98 articles were found, 38 articles were evaluated in full and 31 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies with a high risk of bias and 30 studies that did not meet GRADE. It is important to know the biological structures of the soft and hard tissues around an osseointegrated dental implant (peri-implant referred to as peri-implant phenotype), in the context of peri-implant esthetic complications. Aesthetics has become a primary factor in the patient's expectations, and the duty of the surgeon's professional knowledge of the fundamental aspects in achieving this aspect of a correct treatment plan to meet the appropriate restorative and surgical protocols, thus being able to achieve satisfactory results is required. It notes that all efforts should be aimed at the final result.

Access to the upper third of the face: a literary review of indications, techniques, and intercurrences

Lucas Soares Rezende, Marcelo Alves de Sena Sobrinho, Igor Mariotto Beneti — Sat, 24 Jun 2023 00:00:00 +0000

Due to its location, anatomy, and projection in the upper third of the face, the frontal bone is frequently affected by trauma of different intensities that result in fractures. Access to the upper third of the face for the correct reduction and stabilization of the trauma requires an extensive approach. The main alternatives for correct exposure are coronal and transcutaneous incisions. The coronal incision is the incision of choice, as it allows us to adequately approach important structures related to fractures of the frontal bone. The transcutaneous incisions, these incisions comprise the region of the eyebrow, upper eyelid, eyebrow, and gull-wing incision and, when present, lacerations in the soft tissue of the trauma itself can be used as access to the fractures. The present work aimed to describe, through a literature review, the accesses to the upper third of the face, as well as to report the techniques and intercurrences. Even though it is the main choice for coronal access, it can cause alopecia, loss of sensitivity, compromised aesthetics, muscle depression, possible need for postoperative blood transfusion, facial nerve deficit, and supratrochlear deficit, among others. The alternatives are transcutaneous incisions, these incisions include the region of the eyebrow, upper eyelid, eyebrow, and gull-wing incision and, when present, lacerations in the soft tissue of the trauma itself can be used as access to the fractures. It was concluded that although coronal access is the main choice, the choice of incision depends on the location of the fracture, the presence of laceration, its extension, its relationship with other fractures, and surgeon preference, in addition to aesthetic factors.

Becker's Nevus Syndrome - gluteal muscle asymmetry treatment with polymethylmethacrylate implant - a case report

Fri, 16 Jun 2023 00:00:00 +0000

Becker's nevus syndrome presents with a hyperchromic spot often trunk located, associated with hypertrichosis and maxillofacial or skeletal and muscle alterations. This study reports the case of a male patient who had Becker's nevus syndrome in the left gluteal region, who underwent intramuscular PMMA microspheres implantation for muscle volume symmetrization

Major considerations of the biological mechanisms of bone regeneration through mesenchymal stem cells, exosomes, and microRNAs in the scenario of bucco-maxillo-facial surgery: a systematic review

Álvaro Augusto de Mello, Elias Naim Kassis — Thu, 15 Jun 2023 00:00:00 +0000

Introduction: In the context of bucco-maxillo facial surgery, the development of biomaterials for use in clinical dentistry in recent years has represented a powerful therapeutic instrument in the correction of bone defects. Adult tissue stem cells (mesenchymal stem cells) mediate homeostasis and regeneration of tissues and organs. Growing evidence suggests that metabolism during quiescence, activation, and differentiation may vary between tissues, integrating signaling cues and metabolic inputs with the release of exosomes and microRNAs as important metabolic messengers. Objective: It was to carry out a systematic review to present the main considerations and scientific evidence of the cellular and molecular mechanisms of bone formation or regeneration through mesenchymal stem cells, exosomes, and microRNAs in the scenario of bucco-maxillo-facial surgery with bone graft or biomaterials. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from March to May 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, with articles dated 2001 (gold standard) through 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed accordingly, according to the Cochrane instrument. Results and Conclusion: A total of 145 articles were found, 45 articles were evaluated and 34 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 30 studies with a high risk of bias and 15 studies that did not meet GRADE. The greater potential of guided bone regeneration was associated with the graft material due to the higher grade of vital bone and the lower percentage of residual graft particles. Inorganic bovine bone and porcine bone minerals combined with autogenous maxillary cortical bone showed similar biological and radiological characteristics in terms of biomaterial resorption, osteoconduction, and osteogenesis when used for maxillary sinus floor augmentation. In this regard, three fundamental parameters in bone tissue engineering that determine the capacity for osteoinduction were evidenced, such as the presence of soluble osteoinductive signals, the viability of undifferentiated mesenchymal stem cells, having the ability to differentiate into bone-forming cells and production of adequate extracellular matrix. The exosomes that contain proteins, mRNAs, microRNAs, and DNAs stand out. Exosomes change the biochemical characteristics of recipient cells through the delivery of biomolecules and play a role in cell communication. Evidence suggests that exosomes derived from mesenchymal stem cells exhibit functions similar to mesenchymal stem cells with low immunogenicity and without tumorization.

Major clinical approaches of prefabricated and customized prostheses for the temporomandibular joint: a systematic review

Thu, 15 Jun 2023 00:00:00 +0000

Introduction: The temporomandibular joint (TMJ) is composed of dense fibrocartilage formed between the mandibular condyle and the temporal bone. The high collagen content of this disc provides great rigidity and durability. Osteoarthritis-like degenerative joint disease belonging to temporomandibular disorder (TMD) is a destruction of bone and cartilage with a consequent inflammation that enhances tissue destruction. As a treatment, the implantation of a total alloplastic TMJ prosthesis is an innovative approach to the treatment of TMD. There are two types of prefabricated (stock) and custom computer-aided design/computer-aided manufacturing (CAD/CAM) systems. Objective: The present study aimed to carry out a concise systematic review of the major clinical approaches of prefabricated and customized prostheses for the temporomandibular joint. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to May 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 2018 to 2023. Results and Conclusion: A total of 107 articles were found, 34 articles were evaluated and 19 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 21 studies with a high risk of bias and 15 studies that did not meet GRADE. It was concluded that the clinical results of the stock and CAD/CAM prostheses suggested major improvements in mouth opening and reduced pain as a result of the rehabilitation of temporomandibular joint function. The results showed comparable data for the two types of prosthesis design at 6 months postoperatively. Thus, both temporomandibular joint and custom implants work well despite the additional advantages of custom prostheses, along with increasing access to digital technology, which may result in custom devices dominating the market in total temporomandibular joint replacement systems.

Clinical evidence of bio-stimulators for cervicofacial liposculpture: a systematic review

Thu, 08 Jun 2023 00:00:00 +0000

Introduction: In the liposculpture scenario, and at the cellular and molecular level, tissue engineering has numerous advantages that meet the needs of the injured tissue or organ for the regeneration process or fillings and contours. Biological microenvironments enable cell recognition and signaling cascades for neovascularization and stabilization of fat grafting. Objective: A concise systematic review was carried out on the use of potential biostimulators (cells and molecules) and the biochemical and physiological mechanisms that can contribute to the successful process of cervicofacial liposculpture, to promote neovascularization and stabilization of fat grafting or fat reduction. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from February to April 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 96 articles were found. A total of 36 articles were fully evaluated and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 11 studies at high risk of bias and 37 studies that did not meet the GRADE. The present study showed that the use of potential bio stimulators such as stromal vascular fraction cells and mesenchymal stem cells from adipose tissue, exosomes, microRNA, and PRP, as well as the molecules secreted by these cells, can contribute to the successful process of cervicofacial liposculpture, to promote neovascularization and stabilization of fat grafting or fat reduction. Furthermore, studies have shown that the use of adipose tissue plus PRP led to the presence of more pronounced inflammatory infiltrates and greater vascular reactivity, increased vascular permeability, and certain reactivity of the nervous component, noting that the addition of 20% PRP activated with calcium to adipose tissue grafts can enhance the results of regenerative and aesthetic facial surgeries.

Temporomandibular joint and complications in the dental implant: a systematic review

Mon, 05 Jun 2023 00:00:00 +0000

Introduction: Surgical procedures in the oral cavity and maxillofacial complex are used to remove pathologies and infections, restore function, optimize occlusal relationships, and prosthetically replace teeth and temporomandibular joints. Objective: It was to present, through a systematic review, the main clinical outcomes of the treatment of the temporomandibular joint in the scenario of dental implants and complications. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to May 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 2018 to 2023. Results and Conclusion: A total of 107 articles were found, 37 articles were evaluated and 19 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 24 studies that did not meet GRADE. It was concluded that for the entire gear of the temporomandibular joint to work efficiently, occlusion, joint, musculature, ligaments, and psychological factors must be in complete harmony. Clinical studies have shown that factors associated with implant placement, such as the long duration of surgical procedures, may represent risk factors for temporomandibular disorders.

Stuve-wiedemann syndrome in a child: a case report

Mon, 05 Jun 2023 00:00:00 +0000

Introduction: Stüve-Wiedemann Syndrome was first described in 1971. However, this disease was considered a single entity only a few years later. The syndrome is now known to be an autosomal recessive disorder in which the patient has dysautonomia, bone dysplasia and respiratory distress and eating disorder. Objective: To report the case of a girl with Stuve-Wiedemann Syndrome. Case Description: A 7-year-old female SSG patient presented, at birth, with early neonatal sepsis, septic shock, pneumonia, respiratory acidosis, jaundice without the need for phototherapy, food intolerance, anemia, seizures, interstitial pulmonary edema, myositis and osteomyelitis of the right humerus. After 11 months of follow-up, she was referred to a maternal-fetal clinic for genetic testing to investigate the symptoms. The patient was diagnosed with Stüve-Wiedemann Syndrome. Final Considerations: This disease is considered a primary congenital bone dysplasia, characterized by skeletal and joint changes, bowing of the long bones, episodic hyperthermia, periodic respiratory infections, eating disorders and high mortality. These were facts found in the case of the child presented here. On the other hand, this disease can manifest other symptoms such as fissured tongue and episodes of hyperhidrosis, but it was not found in our patient's case. Rare diseases of genetic origin have a high negative impact on patients' quality of life. However, with the practice of physical activity, patients can have a healthy diet. Swimming practice by SSG presents itself as an extremely important activity for the physical and psychological development of this child, contributing to the improvement of her quality of life.