Objective: To assess the efficacy and safety of the use of midazolam as monotherapy, compared to the associated use of midazolam and hydroxyzine for minimum and moderate sedation of children in dental offices, using data obtained from clinical trials. Material and Methods: A systematic review protocol was developed and registered on PROSPERO (CR42020208633). An electronic search was carried out in Pubmed, Lilacs, Science Direct, Open Gray, Web of Science, and central Cochrane Library. No language restrictions were included. Clinical trials were carried out with children aged 0-12 years, using midazolam as monotherapy compared to the use of midazolam associated with hydroxyzine to verify the effectiveness and safety of oral sedation. The quality of the studies was individually assessed and grouped using the RoB 2 (Revised Cochrane risk-of-bias tool for randomized trials) and GRADE (Grading of Recommendations Assessment, Development and Evaluation) systems, respectively. Results: A total of 749 studies were found. After analyzing the inclusion and removal of duplicates, two studies were analyzed for the quality of evidence. Through this analysis, it was possible to verify the very low level of scientific evidence on the superiority of the efficacy and safety of the combined use of midazolam and hydroxyzine for oral sedation in children in dental offices. Conclusion: The conflicting results and limitations of the studies enabled to establish that there is insufficient evidence to support the use of these drugs combined. There is only evidence for the use of midazolam as monotherapy.
O presente estudo relata um caso de reabsorção patológica radicular em um molar decíduo tratado endodônticamente com pasta CTZ. Paciente do gênero masculino, 7 anos de idade, procurou atendimento, acompanhado por seus genitores, com a queixa principal de que o dente apresentava dor aguda. Durante a anamnese, o responsável relatou que o dente vinha apresentando dor espontânea que se intensificava durante a mastigação. Ao exame clínico não foi constatado quaisquer alterações em mucosa, gengiva e língua. Entretanto, verificou-se a presença de exposição da câmera pulpar do dente 55, sem indícios de polpa, configurando um quadro clínico de necrose. Ao realizar o exame radiográfico inicial foi possível verificar lesão de cárie extensa atingindo a região de cornos pulpares distais e raízes com comprimento maior que 1/3 e coroa do dente sucessor ainda não totalmente formada. Constatada a viabilidade da manutenção do dente 55 na cavidade oral, instituiu-se o tratamento endodôntico através da técnica LSTR com a pasta antibiótica CTZ (cloranfenicol, tetraciclina, óxido de zinco) e restauração com resina composta. O paciente foi acompanhado por um período de 3 e 12 meses após o tratamento inicial. Em ambas as visitas, a restauração se apresentou hígida e satisfatória, contudo, foi possível notar aumento da reabsorção radicular lateral e de radiolucidez na região de furca. Após constatada tal reabsorção o dente teve sua indicação para a exodontia. A pasta CTZ pode estimular o aumento da velocidade de rizólise em dentes decíduos por meio de reabsorções radiculares patológicas. Porém, estudos longitudinais precisam ser conduzidos.
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