O abuso de drogas, lícitas ou ilícitas, é um dos principais problemas sociais e de saúde pública do mundo, sendo assim o contato do cirurgião dentista com pacientes dependentes dessas substâncias é inevitável. Estudos sugerem que o uso de drogas aumenta as manifestações orais, como alterações do fluxo salivar, desgaste dental, cárie, doença periodontal, xerostomia e dor. Por isso, o profissional deve estar preparado para atender esses pacientes, e ter conhecimento sobre as limitações e possíveis interações, principalmente em tratamentos invasivos, seja em ambiente hospitalar com o paciente sedado ou no consultório com anestésicos locais. O objetivo deste trabalho é relatar um caso de monitoramento da pressão arterial, saturação de oxigênio e frequência cardíaca, durante um procedimento com múltiplas exodontias em uma paciente dependente química. Apesar da paciente se manter estável, foi constatado aumento da pressão diastólica no pós-operatório, podendo estar relacionado com a vasoconstrição causada pelo uso da maconha e crack, e a ação da epinefrina do anestésico. Esse aumento se relaciona com alterações no sistema simpático e parassimpático, por isso a importância de se conhecer as substâncias empregadas no procedimento e em medicamentos receitados. Conclui-se que é preciso aprimorar o conhecimento das alterações fisiológicas, químicas e neurológicas que envolvem esses pacientes, para um tratamento odontológico seguro, e quando necessário em conjunto com uma equipe multiprofissional, saber encaminhar o paciente e identificar problemas de saúde não somente bucais.
Posterior mandible region is considered a highly predicable place for primary stability during dental implant placement. Although, this region can present a significant decrease in bone density, which can lead to implant dislocation during insertion. The present case reports an unusual dislocation of dental implant in a 59 old healthy patient's mandible and a secure solution for this kind of complication. During the drilling, bone quality type IV was observed. In sequence, implant was abruptly inserted in the perforation site and dropped into the bone marrow. Panoramic radiograph showed the implant inside bone marrow, close to mandibular base. The implant was removed through the surgical site. The screw of the implant prosthesis transfer was used to reach the displaced implant. A second implant with the same dimensions as the first one, differing by the external hexagon, was inserted into the same implant site. Therefore, the authors strongly recommend the use of the presented technique prior to osteotomy on mandibular body, reserving the second in the impossibility of reaching the internal connection of the displaced implant.
This study aimed to perform a systematic review and meta-analysis to evaluate the preemptive action of the combination of corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) or both drugs singly after third molars surgery. It was performed a search on the PubMed/MEDLINE, Scopus, and Cochrane databases, according to the PRISMA criteria, with no time restrictions up to March 2020. The postoperative pain was evaluated, qualitatively, through the visual analogue scale (VAS) and the number of rescue analgesics (NRA). The edema and trismus were evaluated in a qualitative way through linear measures. Besides that, a meta-analysis of the post-operative pain (VAS) was performed. It was found 103 articles, which four articles were selected according to the inclusion and exclusion criteria. A total of 208 patients was evaluated and the combination of corticosteroids and NSAIDs showed great behavior in the preemptive action after third molars surgery for all the parameters evaluated when compared to both drugs singly. Meta-analysis about the VAS showed that the combination of drugs reduced significantly the postoperative pain when compared to the NSAIDs singly (P<0.05). It was concluded that the combination of NSAIDs and corticosteroids improved postoperative pain, edema, and trismus after third molars surgery.
O herpes-zóster é uma infecção viral causada pela reativação do vírus da varicela-zóster, que acomete geralmente a população idosa. O vírus da varicela, quando em estado dormente, se localiza nos gânglios trigeminais e quando reativado pode causar lesões no rosto e vesículas intra bucais. Esta doença pode afetar com maior prevalência pacientes imunossuprimidos e caracteriza-se por erupções maculopapulares distribuídas na região do nervo afetado, causando dores intensas, tremores e até parestesia. O diagnóstico do herpes zoster geralmente é estabelecido por meio do quadro clínico apresentado pelo paciente e o tratamento é voltado aos sintomas e à causa, optando pelo uso de medicações antivirais sistêmicas e tópicas. Este artigo relata o caso de uma paciente, do sexo feminino, leucoderma, sem problemas de saúde e tratamentos imunossupressores prévios, de 56 anos de idade, que deu entrada ao pronto socorro, tendo com queixa principal a dor extra oral em hemiface direita, com evolução rápida de três dias após exodontia.
The Peripheral Ossifying Fibroma is a benign tumor that develops from a hyperplastic tissue reaction, usually related to traumatic stimulus that are responsible for triggering inflammatory reactions of the connective tissue. Histologically, it is a nodular mass characterized by a dense connective tissue, surrounded by stratified squamous epithelium. Surgical removal in these cases is indicated, and for reconstruction of soft tissue in the region, some periodontal surgical techniques are recommended, such as free gingival grafting. Thus, the present study aims to report a clinical case submitted to the free gingival graft technique for tissue reconstruction after the surgical removal of a fibroma. A total excision of the lesion was performed, later sent to a histopathological report where it was diagnosed as Peripheral Ossifying Fibroma, after the removal of the lesion the region was left with the periosteum exposed and then the free gingival graft was performed to cover the region and promote keratinized gum augmentation. This technique proved to be efficient for reconstruction of soft tissue in the region after surgical removal of the Peripheral Ossifying Fibroma, returning aesthetics, function and periodontal health.
Background: Implantology has been restoring dentition for decades with a quality never seen before.Currently, one of the largest challenges in oral rehabilitation using dental implants is bone reconstruction after tooth extraction. Bone reconstruction can be difficult because of residual bone defects caused by endodontic lesions, root fractures, periodontal involvement, or even the surgical stage. These factors can cause a reduction in the height and width of the alveolar bone, which leads to a lack of sufficient residual bone that can be used for implant placement. Lack of this residual bone can therefore impact upon locking, primary stability, and bone preservation. Guided bone regeneration is a highly useful technique for repairing critical defects. However, it is not a simple technique. It has a straightforward concept and technique, but its execution must be performed with great accuracy to ensure a satisfactory result. Successful cases using this precise technique provide valuable tips for performing guided bone regeneration in an outpatient setting, and with the addition of exams such as the histopathological examination of the bone involved, it is possible to confirm the health and further preservation of this regeneration.Case Description: This case report aims to discuss the parameters related to guided bone regeneration.It presents an alternative approach and illustrates the main features of a successful clinical case where a lyophilized bovine bone graft was used together with a bovine cortical membrane, in a 23-year-old female patient who presented a post-extraction bone defect characterized as a four-walled defect in the upper left canine region. Bringing as a differential some histological sections confirming the stage of maturation and health of the repaired bone tissue. Conclusions:The case presented excellent results and had clinical imaging follow-up 9 years after the intervention. As observed in the histopathological examination, the bone quality, together with the vascularization of the regenerated tissue, were indicative of a good adhesion of the grafted material to the bone defect, which allowed excellent conditions for its maintenance. Demonstrating the longevity and effectiveness of the technique when properly indicated.
The installation of immediate implants after tooth extractions is becoming a common practice in the dental clinic. During this surgical procedure, complications such as the displacement of dental implants into the maxillary sinus may occur due to the close relationship between the floor of the maxillary sinus and the upper teeth. In these cases, treatment consists of removing the implant that has been displaced in order to prevent future complications such as maxillary sinusitis and oroantral fistula. The present study aims to present a clinical case in which the removal of the maxillary sinus implant was performed using the modified Caldwell-Luc Technique. The patient sought a private clinic for extraction of the left upper second molar and oral rehabilitation with implants. Even with little bone height between the floor of the maxillary sinus and the crest of the alveolar ridge, the professional opted for immediate implant installation after extraction, but when returning after 90 days, the implant had moved into the sinus. The implant was removed using the modified Caldwell-Luc technique, which consists of making a bone window in the lateral wall of the maxillary sinus, removing the fragment, replacing the bone window, and suturing the previously folded flap. Therefore, it can be concluded that the Caldwell-Luc technique benefits the closure of the bone defect, avoids fistulas and the area of fibrosis in the membrane, being an effective and viable alternative for removing implants in the maxillary sinus region.
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