Abstract Purpose: To evaluate bone formation through ultrastructural analysis around titanium implants in severe alloxanic uncontrolled diabetic rats, and controlled with insulin, in comparison with nondiabetic rats. Methods: Thirty-six male Wistar rats, weighing between 200 and 300 g, divided into three experimental groups: normal control group (G1), a diabetic group without treatment (G2), and a diabetic group treated with insulin (G3). The animals received titanium implants in the right femur, and osseointegration was evaluated at 7, 14, and 21 days after surgery, through ultrastructural analysis using scanning electron microscopy. Results: The ultrastructural analysis showed a dense bone structure in the G1, few empty spaces and a small number of proteoglycans; G2 presented bone matrix with a loose aspect, irregular arrangement, thin trabeculae, empty spaces and a large number of proteoglycans; G3 obtained similar results to G1, however with a higher number of proteoglycans. Conclusion: Severe diabetes caused ultrastructural changes in bone formation, and insulin therapy allowed an improvement in osseointegration, but it was not possible to reach the results obtained in the control group.

OBJECTIVE: The purpose of this study was to compare the effectiveness of trigger points injections using lidocaine 0.5% and dry needling without any kind of home-based rehabilitation program. METHODS: Sixteen patients with myofascial pain and trigger points in masticatory muscles were randomly assigned to two groups and received only one application session. The pressure pain threshold (PPT) was recorded before and after the injection: Ten minutes, 24 hours later, 7, 15, 21 and 30 days after the treatment. Visual analogue scale (VAS) was used to in all evaluation periods. RESULTS: There were no difference between groups for PPT, but for all groups the PPT during the time significantly increased when compared the before treatment. VAS showed differences between groups and during the time. The 0.5% lidocaine had the lowest VAS values when compared to dry needling, but at 30 days there were no differences among them. CONCLUSIONS: Despite the differences in VAS and considering there were no differences in PPT increases, we concluded that, in this study, both groups were able to disrupt the mechanisms of trigger point and relieve the myofascial pain symptoms.

OBJETIVO: esta revisão de literatura visa avaliar, através de literatura específica, a sensibilidade e especificidade do exame de ressonância magnética (RM) para o diagnóstico dos desarranjos internos da articulação temporomandibular (ATM). METODOLOGIA: tanto artigos que utilizaram ATM de cadáveres para comparar achados anatômicos aos achados de ressonância magnética (RM), como artigos que compararam achados clínicos com achados de RM foram utilizados. Através dos achados desses artigos, as propriedades de sensibilidade e especificidade da RM para o diagnóstico de desarranjos internos da ATM foram calculadas. Com isso, a confiabilidade e a aplicabilidade do exame de RM no diagnóstico dos desarranjos internos da ATM foram discutidas. RESULTADOS: encontrou-se sensibilidade de 90% e especificidade de 88% da RM para desarranjos internos da ATM. CONCLUSÃO: o exame de RM de ATM possui ótima sensibilidade e especificidade para o diagnóstico dos desarranjos internos da ATM. Porém, tal exame deve ser solicitado com cautela, apenas nos casos onde a imagem seja indispensável para o plano de tratamento.

OBJECTIVE: the aim of this paper is to review the literature concerning the reliability and applicability of magnetic resonance imaging (MRI) in the diagnosis of temporomandibular joint (TMJ) internal disorders. METHODS: articles that have used TMJ from cadavers to compare MRI findings with anatomic findings, as well as some papers that have compared clinical findings with MRI findings were evaluated. According to the findings identified on these articles, the MRI sensitivity and specificity properties for the TMJ internal disorders diagnosis were calculated. Then, the MRI reliability and applicability for the TMJ internal disorders diagnosis were discussed. RESULTS: 90% of sensitivity and 88% of specificity were found. CONCLUSION: the TMJ MRI presents good sensitivity and specificity for the TMJ internal disorders diagnosis. But dentists should beware and request this exam only in cases where MRI will be essential to the treatment planning.

O objetivo desse estudo foi avaliar a efetividade das placas oclusais reposicionadoras no controle de patologias intra-articulares da ATM, quando comparadas a um tratamento convencional (placa estabilizadora) e um grupo sem tratamento (controle). A amostra final constou de 52 pacientes portadores de sinais e sintomas de desordens intra-articulares da ATM, divididos, aleatoriamente em três grupos, de acordo com o procedimento empregado: grupo I (n=20), utilizou placa estabilizadora, grupo II (n=18) utilizou placa reposicionadora e grupo III (n=14), sem nenhum tratamento.Toda a amostra foi acompanhada durante um ano, sendo avaliada através de questionários anamnésicos, palpação muscular e da ATM, movimentação mandibular e detecção de sons articulares.Uma avaliação da condição oclusal também foi realizada nos diferentes períodos de exame. Os resultados demonstraram uma maior efetividade das placas reposicionadoras na redução inicial da dor relatada pelo paciente, assim como uma diminuição na sensibilidade a palpação na ATM.Todos os grupos mostraram-se semelhantes após seis meses de controle em relação aos sintomas, assim como em relação aos ruídos articulares. Os índices de palpação muscular mostraram-se melhor para todos os grupos, sendo que a oclusão também não se alterou significantemente. Baseado no acima exposto, conclui-se que a terapia de uso parcial das placas reposicionadoras constitui-se num meio efetivo de controle das patologias intra-articulares da ATM.

This study aimed at evaluating the effectiveness of partial use of anterior repositioning appliances in the management of TMJ pain and dysfunction when compared to stabilization splints and a control group in a one-year follow-up. Sample was initially constituted by 60 patients, randomly divided into three groups: I- stabilization splints, II- repositioning splints and III- no treatment. The whole sample was evaluated by means of TMJ and muscle palpation, mandibular AROM, analysis of occlusal contacts, joint sounds inspection and Visual Analogue Scale (VAS) for one year; 52 patients composed the final sample. A significant (after 15 days) improvement in pain report (VAS) and palpation index was found for group II (p<0.01). The occurrence of occlusal alterations as posterior open bite or gross interferences after the splint therapy and increased muscle tenderness were not problems in this study. Similar results in joint noises reduction were observed for the entire sample. It was concluded that controlled partial use of repositioning splints is a beneficial tool in the management of intra-articular pain and dysfunction, with no risks of irreversible occlusal changes.

Dor Orofacial é um campo da odontologia dedicado ao diagnóstico e tratamento de dores orofaciais crônicas e complexas, além d e desordens motoras. Essa especialidade odontológica tem se desenvolvido por vários anos com o objetivo de prover um melhor entendimento de um grupo de pacientes que, de alguma forma, não tinham dores de origem dentária e nem condições óbvias médicas que explicassem suas dores na face. Depois de um longo período propondo tratamentos baseados apenas no aspecto mecanicista da doença, nossa profissão percebeu a importância de entender mecanismos básicos de diagnóstico diferencial para melhor controlar esses casos. Essa mudança de mentalidade tem levado a modificações na educação em odontologia, assim como nos procedimentos clínicos executados. Historicamente considerada como um "problema de oclusão", as dores orofaciais obtiveram recentemente o reconhecimento como especialidade em nosso país. Baseado nisso, o objetivo desse artigo é discutir diferenças básicas entre os tipos mais comuns de dor orofacial, assim como ressaltar a importância do conhecimento de mecanismos de condução de dor para a formulação de um plano de tratamento efetivo.

Orofacial Pain is the field of dentistry devoted to the diagnosis and management of chronic, complex, facial pain and oromotor disorders. This specialty in dentistry has developed over a number of years out of the need for better understanding of a group of patients who somehow were not clearly suffering from dental pain disorders, but still did not seem to have a clearly defined medical problem. After a long period of treating patients based on the mechanicist aspect of the disease, our profession has realized the importance of basic knowledge and differencial diagnosis in order to proper manage these patients. This modification in the approach has caused severe changes in education as well as in clinical activities. Historically considered as a problem of occlusion, Orofacial Pain, including Temporomandibular Disorders (TMD) has recently reached the status of "Specialty" in Brazil. Therefore, this paper aims to discuss the main differences between musculoskeletal and neuropathic pain and the importance of basic knowledge to perform successful management.