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Background: This study aimed to evaluate the efficacy of ozonized water on pain, oedema and trismus after impacted third molar mandibular surgeries when compared to double distilled water. A randomized triple blind trial was conducted., Methods: Patients with third molars class II-B of Pell-Gregory were included, and surgical extraction was performed. Irrigation was done with ozonized (group 1) or double distilled water (group 2). The type of irrigation and the side to be operated were randomized. Neither the patients nor the operator or evaluator were aware of the irrigation solution. Pain, oedema and trismus were evaluated at baseline, 24-h, 48-h, 72-h and 7-days after treatment. The data were evaluated by Friedman, Wilcoxon, Mann-Whitney tests, and size effect., Results: It was included 8 men and 12 women, with a mean age of 20.9y.o. The initial pain mean was 7.94 (±12.81) (group 1) and 5.50 (±9.12) (group 2) (p > 0,05). There was a statistically significant reduction of pain, oedema and trismus in intragroup analysis (p < 0.05). There was no statistically significant difference (p > 0.05) when comparing the oedema and trismus between groups. The size effect ranged from small (0.23) to large (1.29)., Conclusions: It was concluded that ozonized water was compatible as irrigation method, not inferior to double distilled water, and had satisfactory effects on management of pain, oedema and trismus after surgical removal of the third molar., Trial Registration: This clinical trial was registered in ClinicalTrials.gov NCT03501225 on April 18, 2018.

Enamel renal syndrome (ERS) is a rare autosomal recessive disorder not fully characterized. Here we investigated ERS characteristics in 11 patients from 5 Brazilian families through clinical examination, imaging, renal ultrasonography, laboratory tests and DNA sequencing. The patients' age ranged from 6 to 25 years-old, and the presence of hypoplastic amelogenesis imperfecta, microdontia, intra-pulpal calcification, impacted posterior teeth with hyperplastic pericoronal follicles, gingival fibromatosis, ectopic calcifications on gingival and pericoronal tissues, and nephrocalcinosis were common findings to all patients. Only 4 patients showed abnormal laboratory tests (vitamin D, parathyroid hormone, phosphate, calcium). Intellectual disability and renal cysts were present in 2 patients each. Biallelic loss of function mutation in FAM20A gene, characterized by one base pair deletion in exon 11, resulting in a frameshift replacing a glutamine at codon 483 for a lysine and terminating at position 24 [NG&#95;029809.1: c.1447delG; p.(Glu483Lysfs*24)], was detected in all patients, strongly suggesting a founder effect. Our results reinforce the distinct orofacial features of ERS, which are the clue for kidney examination and genetic testing. Early diagnosis is essential to minimize the deleterious effects related to ERS. Here we report the largest series of patients with ERS in a same population, and describe, for the first time, a founder mutation for FAM20A., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

The aim of this systematic review was to evaluate the clinical evidences of the bromelain in minimizing inflammatory parameters such as pain, edema, and trismus after lower third molar surgeries. An electronic search was conducted in six databases through November 2017. The eligibility criteria included randomized and non-randomized clinical trials and/or comparative studies that used bromelain after lower third molar surgeries. The search strategy resulted in 117 articles. Following the selection process, seven studies were included in the systematic review and four in the meta-analysis. In terms of the risk of bias analysis, all the evaluated studies were classified as low or unclear risk of bias in the following criteria: selection bias, detection bias, and reporting bias. The final quantitative analysis of the variables showed that the use of bromelain resulted in greater reduction of pain levels (mean difference [MD]: -0.38; 95% confidence interval [CI; -0.66 to -0.09]), edema (MD: -0.34; 95% CI [ -0.68 to -0.01]), and trismus (MD: -2.01; 95% CI [ -3.99 to -0.02]) among the analyzed groups. The results suggest that the bromelain appears to be effective in the control of pain, edema, and trismus after lower third molar surgeries; however, further high-quality studies are needed to confirm this finding., (© 2018 John Wiley & Sons, Ltd.)

The aim of this study was to compare the effects of acupuncture and placebo acupuncture on the control of pain, oedema, and trismus following the extraction of third molars and on the control of preoperative anxiety. Sixteen patients (mean age 22.5±3.45years) each underwent four acupuncture sessions, one prior to each surgery and the others at 24, 48, and 72hours after each surgery (left and right tooth). Oedema was determined using measurements of the face and trismus was determined by maximum mouth opening at baseline and at 24, 48, 72hours and 7days following surgery. Postoperative pain was evaluated by the patients using a visual analogue scale (VAS) at 24, 48, and 72hours following surgery. Anxiety was evaluated using the State-Trait Anxiety Inventory and a VAS at baseline and before and after acupuncture prior to surgery. The statistical analysis was performed using the paired t-test and Wilcoxon test. Acupuncture showed a better performance in the control of oedema at 48hours (P=0.026), 72hours (P=0.046), and 7days (P=0.040) when compared to placebo. There was no statistically significant difference between the acupuncture and placebo groups in the control of pain, trismus, or anxiety., (Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of this meta-analysis was to determine which characteristics of mandibular third molars (MTMs) are more often associated with an increase in the prevalence/incidence of caries on the distal surface of mandibular second molars (MSMs)., Methods: Three electronic databases were analyzed: PubMed; OVID and the Virtual Health Library. Observational studies were included, and the risk of bias was assessed using The Newcastle-Ottawa Scale. The Comprehensive Meta-Analysis software program was used for meta-analysis., Results: Fifteen studies were included in this systematic review, and five were included in the meta-analysis. The distal surface of MSMs were more likely to exhibit caries in the following scenarios: when MTMs were found in the A position, rather than the C position (OR: 3.45, 95% CI: 2.28-5.22, p<0.001); when the horizontal position was compared with the vertical (OR: 8.12, 95% CI: 3.75-17.58, p<0.001) and distoangular (OR: 9.75, 95% CI: 3.49 - 27.25, p<0.001) positions; and when the mesioangular position was compared with the vertical (OR: 7.25, 95% CI: 3.48-15.10, p<0.001) and distoangular (OR: 9.54, 95% CI: 3.47 - 26.21, p<0.001) positions., Conclusion: The results of this study suggest that the presence of MTMs increases the incidence of caries on the distal surface of MSMs. Furthermore, caries on the distal surface of MSMs is more commonly associated with position A and horizontal and mesioangular mandibular molars.

Cellular neurothekeomas (CNs) are distinctive benign tumors of uncertain histogenesis, with predilection for the skin of the head and neck region. We describe the first case of multiple desmoplastic CNs (DCNs) affecting the oral cavity in a 9-year-old girl. Histopathologic evaluation showed a proliferation of spindle and epithelioid cells, forming nests and bundles, supported by exuberant fibrous stroma, as well as scattered multinucleated floret-like giant cells. The tumor cells were immunopositive for vimentin, CD63, CD56, whereas AE1/AE3, S100, CD34, α-SMA, GFAP, EMA, CD57 and NSE were negative. Ki-67 was <2%. Multiple DCNs should be considered in the differential diagnosis of oral nodular lesions.

Purpose: We aimed to compare the effect of dexamethasone, 8 mg, and diclofenac sodium, 50 mg, associated with codeine, 50 mg, on the control of pain, swelling, and trismus after extraction of impacted third molars., Materials and Methods: Fifteen healthy patients with a mean age of 22.8 years (SD, 12.62 years) received a single oral dose of either drug 1 hour before each surgical procedure (left and right teeth). At 24, 48, and 72 hours after surgery, swelling was determined by use of linear measurements on the face and trismus was determined by maximal mouth opening. Postoperative pain was self-recorded by the patients using a numerical rating scale at 24-hour intervals for a period of 72 hours. Data analysis involved descriptive statistics and Shapiro-Wilk, Wilcoxon, and paired t tests (P < .05)., Results: Dexamethasone controlled pain (P = .016) and edema (P = .08) within 48 hours better than diclofenac sodium associated with codeine. No statistically significant differences were found between drugs regarding trismus and consumption of rescue analgesics (acetaminophen)., Conclusions: The results of this study suggest that pre-emptive administration of dexamethasone, 8 mg, showed better control of pain and swelling in bilateral extractions of third impacted mandibular molars., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of the present study was to assess the periodontal condition and sensitivity of second mandibular molars after the extraction of the adjacent third molar, while also assessing the quality of life of the patients., Materials and Methods: Twenty-three healthy patients were assessed in terms of probing depth, gingival height, gingival thickness, dental sensitivity, plaque index and bleeding on probing (adjacent second mandibular molar), before the surgical procedure, as well as 60 and 180 days after the surgery. The following data were also recorded and measured: the position and size of the impacted teeth; the size of the alveoli after surgery and the quality of life of the patient., Results: Significant differences were found for probing depth and gingival height before and after 180 days. The plaque index increased significantly after surgery ( P = 0.004), as did bleeding on probing. No significant difference was found for the quality of life. The size of the third molar extracted was correlated with bleeding on probing 180 days after the surgery., Conclusion: An improvement was noted in the periodontal condition of the second mandibular molars after the extraction, based on the assessments of probing depth and gingival height. The position of the third molar affected the periodontal condition of the second mandibular molar. No alterations were recorded for dental sensitivity or the quality of life after the extraction., Competing Interests: There are no conflicts of interest.

The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars in mandibular condyle fractures. An electronic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and VHL, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 13 studies were included in the systematic review and 11 in the meta-analysis. In terms of the risk of bias analysis, six studies presented ≤6 stars in the Newcastle-Ottawa scale assessment. The presence of a mandibular third molar decreased the probability of condylar fracture (cross-sectional and case-control studies: odds ratio (OR) 0.26, 95% confidence interval (CI) 0.17-0.40, I 2 =87.8%; case-control studies: OR 0.30, 95% CI 0.16-0.58, I 2 =91.6%). The third molar positions most favourable to condylar fracture according to the Pell and Gregory classification are class A (OR 1.32, 95% CI 1.09-1.61, I 2 =0%) and class I (OR 1.37, 95% CI 1.05-1.77, I 2 =32.8%). Class B (OR 0.69, 95% CI 0.49-0.97, I 2 =56.0%) and class II (OR 0.71, 95% CI 0.57-0.87, I 2 =0%) act as protective factors for condylar fracture. The results suggest that the presence of a mandibular third molar decreases the chance of condylar fracture and that the positions of the third molar most favourable for condylar fracture are classes A and I, with classes B and II acting as protective factors., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The aim of this systematic review was to investigate the influence of the presence and position of mandibular third molars on angle fractures. An electronic search was conducted in the PubMed, Scopus, Web of Science, Cochrane Library, and VHL databases, through January 2016. The eligibility criteria included observational studies. The search strategy resulted in 704 articles. Following the selection process, 35 studies were included in the systematic review and 28 in the meta-analysis. Twenty studies presented a score of ≤6 stars in the Newcastle-Ottawa scale assessment, indicating a risk of bias in the analysis. The presence of a mandibular third molar increases the chance of an angle fracture (case-control and cross-sectional studies: odds ratio (OR) 3.83, 95% confidence interval (CI) 3.02-4.85, I 2 =83.1%; case-control studies: OR 3.27, 95% CI 2.57-4.16, I 2 =81.3%). The third molar positions most favourable to angle fracture according to the Pell and Gregory classification are class B (OR 1.44, 95% CI 1.06-1.96, I 2 =87.2%) and class II (OR 1.67, 95% CI 1.36-2.04, I 2 =72.4%). Class A (OR 0.60, 95% CI 0.45-0.81, I 2 =87.1%) and class I (OR 0.51, 95% CI 0.37-0.71, I 2 =89.4%) act as protective factors for angle fracture. The results suggest that the presence of the third molar increases the chance of angle fracture by 3.27 times and that the most favourable positions of the third molar for angle fracture are classes B and II, whilst classes A and I act as protective factors., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Aim: The aim of this systematic review and meta-analysis was to compare, in the lower third molar surgery, the osteotomy techniques with rotary instruments and piezoelectric motors., Methods: An electronic search was conducted using the following databases: Pubmed, Web of Science, and the Cochrane Oral Health Group Trials Register. Inclusion criteria were: studies in humans, randomized or nonrandomized, comparing the extraction of third molars that required osteotomy and/or odontosection with rotary instrument and osteotomy and/or odontosection with piezoelectric motor assistance. The analysis and inclusion of articles was performed by two reviewers independently. An evaluation of the quality of articles and data extraction was carried out., Results: From a total of nine hundred seventy four (974) trials, eleven articles were included in the qualitative analysis, and seven were included in the quantitative analysis. Rotary instruments were faster than the piezoelectric surgery (95 % CI 0.34 to 1.16). The piezoelectric surgery showed better results when compared with roatry instruments when trismus was assessed in 2 (95 % CI 0.65 to 1.69), 3 (95 % CI 0.63 to 1.67) and 5 (95 % CI 0.03 to 2.26) days after surgery. Seven days after surgery, there were no differences between the techniques (95 % CI (-0.022) to (-1.49))., Conclusion: The piezoelectric surgery was effective in reducing pain, swelling and trismus in third molar surgery, but the same requires greater surgical time than the rotary instruments.