Abstract BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear. Objective this study aimed to compare the immediate effects of botulinum toxin type A (BoNT-A) injections and Acupuncture in myofascial temporomandibular disorders (TMD) patients. Methodology 54 women were divided into three groups (n=18). AC patients received four sessions of traditional acupuncture, being one session/week during 20-min. BoNT-A patients were bilaterally injected with 30U and 10U in masseter and anterior temporal muscles, respectively. Moreover, a control group received saline solution (SS) in the same muscles. Self-perceived pain was assessed by visual analog scale, while pressure pain threshold (PPT) was verified by a digital algometer. Electromyographic evaluations (EMG) of anterior temporal and masseter muscles were also measured. All variables were assessed before and 1-month after therapies. The mixed-design two-way repeated measures ANOVA and Tukey’s post-hoc tests were used for analysis, considering a=0.05. Results Self-perceived pain decreased in all groups after one month of therapy (P<.001). BoNT-A was not better than AC in pain reduction (P=0.05), but both therapies were more effective in reducing pain than SS (P<0.05). BoNT-A was the only treatment able to improve PPT values (P<0.05); however, a severe decrease of EMG activity was also found in this group, which is considered an adverse effect. Conclusion after one month of follow-up, all therapies reduced the self-perceived pain in myofascial TMD patients, but only BoNT-A enhanced PPT yet decreased EMG.

Abstract The present cross-sectional case-control study aimed to determine if there is an association between specific oral behaviors, sleep bruxism (SB), awake bruxism (AB), and painful temporomandibular joint (TMJ) clicking. Ninety individuals were dived into three groups; Group 1 (n = 30): painful TMJ clicking; Group 2 (n = 30): painless TMJ clicking; and Group 3 (n = 30): control group. The following clinical data were studied: oral behaviors (unilateral chewing, gum chewing, nail biting, foreign objects biting, leaning with jaw against the hand, and sleeping in a position that pressures the jaw), SB, AB (including the frequency in 10 days, evaluated by ecological momentary assessment), and malocclusions investigated based on clinical inspections (anterior open bite, posterior cross-bite, abnormal overbite/overjet, occlusal guidance, mediotrusive and/or laterotrusive interferences, retruded contact position to maximum intercuspation slide, missing posterior teeth). All statistical tests (Kolmogorov-Smirnov, chi-square, and one-way ANOVA) were performed with a 5% significance level. Group 1 had the highest frequency of and a significant association with leaning with jaw in the hand, sleeping position that pressures the jaw, gum chewing, nail biting, and AB (p<0.05). Gum chewing, nail biting, and AB were associated with Group 2 only when compared to Group 3 (p<0.05). No significant difference among groups was found for other behaviors (unilateral chewing and foreign objects biting), SB, and all malocclusions (p>0.05). It can be concluded that patients with painful TMJ clicking had a higher frequency of and a significant association with some specific harmful behaviors and AB.

RESUMO Objetivo: O presente estudo teve como objetivo comparar a reabsorção radicular lateral externa (RRLE) e a reabsorção radicular apical externa (RRAE) em dentes movimentados sobre o rebordo edêntulo atrófico e naqueles submetidos à movimentação ortodôntica usual. Métodos: Foram avaliados 54 pré-molares, sendo 27 deles movimentados em direção ao rebordo edêntulo (Grupo 1) e 27 (dos mesmos pacientes) não transladados, que compuseram o grupo controle (Grupo 2). A RRLE foi avaliada por meio de escores de 0 a 3, e a RRAE foi avaliada por meio de escores de 0 a 4, antes e depois do tratamento. As medidas foram comparadas por meio dos testes de Kruskal-Wallis e de Student-Newman-Keuls. Resultados: O escore da RRLE aumentou estatisticamente apenas no Grupo 1 (p< 0,05). Após o tratamento ortodôntico, observou-se que quase 56% (n = 15) dos dentes do Grupo 1 apresentaram escores 2 e 3, enquanto o Grupo 2 apresentou escores 2 e 3 em cerca de 11% (n = 3) dos dentes. O escore da RRAE aumentou em ambos os grupos após a movimentação ortodôntica; entretanto, as análises estatísticas não mostraram diferenças significativas entre os grupos (p> 0,05). Conclusões: Dentes submetidos à movimentação ortodôntica sobre rebordo edêntulo atrófico estão sujeitos a uma maior reabsorção radicular externa lateral.

ABSTRACT Objective: The present study aimed at comparing the external lateral root resorption (ELRR) and external apical root resorption (EARR) between teeth moved through the atrophic edentulous ridge and those undergoing the usual orthodontic movement. Methods: Fifty-four premolars were evaluated, where 27 of them had been moved toward the edentulous ridge (Group 1) and 27 from the same patient, had not been translated, which comprised the control group (Group 2). ELRR was evaluated by 0-3 scores and EARR was evaluated by 0-4 scores, before and after movement. Measurements were compared by Kruskal-Wallis and Student-Newman-Keuls tests. Results: ELRR increased statistically only in the Group 1 (p< 0.05). After orthodontic treatment, it was observed that almost 56% (n = 15) of teeth in Group 1 presented scores 2 and 3, while Group 2 presented scores 2 and 3 in about 11% (n= 3) of the teeth. EARR increased in both groups after orthodontic movement, however, statistically analyses showed no significant differences between groups (p> 0.05). Conclusions: Orthodontic movement into the atrophic edentulous ridge is subject to a greater lateral external root resorption.

When installing an immediate implant, you can choose between installing a temporary clinical crown, healing abutments, or to close the implant for a two-step surgical treatment. The use of customized healing abutments seals the implants and leads to individualized healing, which favors the creation of subsequent crowns. The present study aims to report a clinical case involving an immediate implant and the installation of customized healing abutments, demonstrating the results and the importance of knowledge of this technique by the dentist.

Quando feita a instalação de um implante imediato pode se optar entre a instalação de uma coroa provisória clínica, um cicatrizador ou pode se optar pelo fechamento do implante para um tratamento em duas etapas cirúrgicas. O uso de cicatrizadores personalizados sela os implantes e leva a uma cicatrização individualizada, que favorece a confecção das coroas subsequentes. O presente trabalho objetiva relatar um caso clínico envolvendo um implante imediato e a instalação de um cicatrizador personalizado, demonstrando os resultados e a importância de conhecimento dessa técnica pelo cirurgião-dentista.

RESUMO JUSTIFICATIVA E OBJETIVOS : A artrocentese e um tratamento eficaz para diminuir ou abolir a dor, aumentar a máxima distância interincisal e eliminar o derrame articular em pacientes com deslocamento de disco sem redução. O objetivo deste estudo foi expor e discutir uma nova proposta técnica de artrocentese da articulação temporomandibular aplicada no tratamento de um caso de deslocamento de disco sem redução. RELATO DO CASO : Paciente do sexo feminino, 18 anos procurou tratamento devido a dor na articulação temporomandibular e limitação da abertura da boca. A distância interincisal máxima foi de 30,28mm. A ressonância magnética confirmou o diagnóstico de deslocamento de disco sem redução com sinais de derrame articular na articulação temporomandibular direita. A artrocentese foi realizada com o bloqueio anestésico do nervo auriculotemporal, masseterino e temporal profundo posterior. Depois disso, duas agulhas foram inseridas no compartimento superior da articulação temporomandibular. Na segunda agulha foi conectado um cateter transparente e nesse uma bomba de vácuo. Clinicamente, após a artrocentese, a distância interincisal máxima aumentou para 46,25mm e não houve mais dor. Na nova ressonância magnética realizada 180 dias após, não havia mais sinais de derrame articular. CONCLUSÃO : A artrocentese da articulação temporomandibular foi eficaz no tratamento do paciente com deslocamento do disco sem redução. O aspecto dessa técnica, que é particularmente relevante para a prática clínica, foi a conexão de um cateter transparente a uma bomba de vácuo. Isso permitiu a visão da solução, sua fluidez, além de orientar o fluxo da solução utilizada para lavagem, otimizando a irrigação. No entanto, novos estudos são necessários para comparar diferentes protocolos de irrigação com e sem o uso associado de uma bomba de vácuo.

ABSTRACT BACKGROUND AND OBJECTIVES: Arthrocentesis is an effective treatment to reduce or eliminate pain, increase maximal interincisal distance, and to eliminate joint effusion in patients with disc displacement without reduction. This study aims to expose and to discuss a new technique proposal of temporomandibular joint arthrocentesis applied in the treatment of a single case of disc displacement without reduction. CASE REPORT: Female patient, 18-year-old patient sought treatment due to joint pain and mouth opening limitation. The maximal interincisal distance was 30.28mm. Magnetic resonance imaging confirmed the diagnosis of disc displacement without reduction with signs of joint effusion in the right temporomandibular joint. Temporomandibular joint arthrocentesis was performed under selective sensory nerve block of the auriculotemporal, the masseteric and posterior deep temporal nerves. Two needles were inserted in the upper compartment of the temporomandibular joint. In the second needle, a transparent catheter was connected into a vacuum pump. Clinically, after the arthrocentesis, the maximal interincisal distance increased to 46.25mm, and the patient referred no more pain. After six months, a magnetic resonance imaging was performed to observe the results, and there were no more signs of joint effusion. CONCLUSION: Temporomandibular joint arthrocentesis was an effective treatment for this patient with disc displacement without reduction. The aspect of this technique that is particularly relevant for clinical practice was the connection of a transparent catheter to a vacuum pump. In fact, it allowed the visualization of the solution fluidity, as well as guides the flow of the solution used for joint washing, optimizing the irrigation. However, new studies are necessary to compare different protocols of irrigation with and without the associated use of a vacuum pump.

Abstract Disc displacement with reduction (DDWR) is one of the most common intra-articular disorders of the temporomandibular joint (TMJ). Factors related to the etiology, progression and treatment of such condition is still a subject of discussion. This literature review aimed to address etiology, development, related factors, diagnosis, natural course, and treatment of DDWR. A non-systematic search was conducted within PubMed, Scopus, SciELO, Medline, LILACS and Science Direct using the Medical Subjective Headings (MeSH) terms “temporomandibular disorders”, “temporomandibular joint”, “disc displacement” and “disc displacement with reduction”. No time restriction was applied. Literature reviews, systematic reviews, meta-analysis and clinical trials were included. DDWR is usually asymptomatic and requires no treatment, since the TMJ structures adapt very well and painlessly to different disc positions. Yet, long-term studies have shown the favorable progression of this condition, with no pain and/or jaw locking occurring in most of the patients.

Pyogenic granuloma (PG) is a non-neoplastic proliferative lesion. This term, however, is a misconception, since it is not related to any infection, does not contain pus and it is not a true granuloma. The occurrence of recurrent PG associated with vascular lesions on the skin, such as port-wine stains, has been described in the literature. A 23 years old male patient was attended in the Federal University of Maranhão presenting a lesion with pyogenic granuloma characteristics in the buccal side of the first molar associated with port-wine stain. The diagnosis was confirmed per an excisional biopsy, along with histopathologic analysis. Due to the recurrence of the lesion after the surgical approach, intralesional corticosteroid injections was performed three times. After two-years no signs of recurrence could be observed. In conclusion, despite of the high prevalence of Pyogenic Granuloma recurrence, intralesional corticosteroid injections may be an alternative option to conventional surgical treatment.

O granuloma piogênico (GP) é um processo proliferativo não neoplásico. Este termo entretanto, é equivocado, uma vez que não está relacionado a qualquer infecção, não contém pus e não é um verdadeiro granuloma. A ocorrência do GP recorrente associado a lesões vasculares na pele, tais como manchas de vinho do porto, tem sido descrita na literatura. Paciente do gênero masculino com 23 anos de idade foi atendido na Universidade Federal do Maranhão apresentando uma lesão com características de granuloma piogênico na vestibular do primeiro molar, associada à mancha vinho do porto. O diagnóstico foi confirmado através de biopsia excisional e análise histopatológica. Devido à recorrência da lesão após a abordagem cirúrgica, injeções intralesionais de corticoides foram realizadas três vezes. Após dois anos de acompanhamento, não houve recorrência. Pode-se concluir que, apesar da alta prevalência de recorrência do granuloma piogênico, injeções intralesionais com corticoides podem ser uma alternativa ao tratamento cirúrgico convencional.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fibromialgia é uma síndrome de dor generalizada crônica, acompanhada de sintomas somáticos, representados principalmente por distúrbios do sono. Dentre os tratamentos farmacológicos, a pregabalina é o principal representante. CONTEÚDO: Foi realizada uma busca eletrônica nas bases de dados Lilacs, Pubmed/Medline, Scielo e ScienceDirect, cruzando-se os seguintes descritores em língua inglesa e portuguesa: “fibromyalgia”; “sleep disorder”, “treatment”; “pregabalin”; “medicine”; “fibromialgia”; “distúrbios do sono”, “tratamento”; “pregabalina”; “fármacos”. Foram incluídos somente artigos de revisão de literatura, revisão sistemática, meta-análise e estudos clínicos randomizados publicados no período de outubro de 1992 a maio de 2018. CONCLUSÃO: A pregabalina é eficiente e segura no manuseio dos distúrbios do sono em pacientes com fibromialgia, pois diminui o número de despertares e aumenta o tempo de duração do sono.

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia is a chronic generalized pain syndrome accompanied by somatic symptoms, mainly represented by sleep disorders. Pregabalin is the main agent among pharmacological treatments. CONTENTS: An electronic search was performed in the databases Lilacs, Pubmed/Medline, Scielo and ScienceDirect. The keywords used in English and Portuguese were “fibromyalgia”; “sleep disorder”, “treatment”; “pregabalin”; “medicine”; “fibromialgia”; “distúrbios do sono”, “tratamento”; “pregabalina”; “fármacos”. Only articles of literature review, systematic review, meta-analysis and randomized clinical studies published between October 1992 and May 2018 were included. CONCLUSION: Pregabalin is efficient and safe in the management of sleep disorders in patients with fibromyalgia because it reduces the number of awakenings and increases sleep duration.

RESUMO JUSTIFICATIVA E OBJETIVOS: As desordens inflamatórias da articulação temporomandibular apresentam alta prevalência na população. O conhecimento sobre os mediadores inflamatórios, tais como histamina, serotonina, cininas, eicosanoides, fator de ativação plaquetária, óxido nítrico, fator de necrose tumoral e interleucinas, pode contribuir para melhor entendimento dessas desordens. O presente trabalho objetivou revisar a literatura a respeito dos principais mediadores inflamatórios envolvidos nas artralgias temporomandibulares. CONTEÚDO: Foi realizada uma busca nas bases de dados LILACS, Pubmed/Medline, Scielo e Science direct, cruzando-se os seguintes descritores em língua inglesa e portuguesa: inflammation, temporomandibular joint, inflammatory mediators, inflamação, articulação temporomandibular e mediadores inflamatórios. Foram incluídos artigos de revisão de literatura, revisão sistemática, meta-análise e estudos clínicos randomizados, bem como livros com temática compatível, publicados no período de setembro de 1990 a junho de 2017. Foram excluídos casos clínicos, estudos abertos «open-label» e estudos em modelos animais. CONCLUSÃO: O conhecimento do processo inflamatório, com os diferentes mediadores e mecanismos, pode contribuir para um melhor entendimento do mesmo, possibilitando a seleção da melhor terapêutica para ser empregada clinicamente nos casos de artralgias temporomandibulares.

ABSTRACT BACKGROUND AND OBJECTIVES: Inflammatory disorders of the temporomandibular joint present a high prevalence in the population. The knowledge about inflammatory mediators, such as histamine, serotonin, kinins, eicosanoids, platelet-activating factor, nitric oxide, tumor necrosis factor and interleukins, may contrib-goupute to a better understanding of these disorders. The objective of this study was to review the literature on the major inflammatory mediators involved in temporomandibular arthralgia. CONTENTS: A search was made in the LILACS, Pubmed/Medline, Scielo and Science direct databases, crossing the following descriptors in the English and Portuguese language: inflammation, temporomandibular joint, inflammatory mediators, inflammation, temporomandibular joint and inflammatory mediators. Articles of literature review, systematic review, meta-analysis and randomized clinical trials, as well as books with compatible themes, published between September 1990 and June 2017 were included. Clinical reports, open label studies, animal model studies, were excluded. CONCLUSION: The knowledge of the inflammatory process, with the different mediators and mechanisms, can contrib-goupute to a better understanding, allowing the selection of the best therapy to be used clinically in cases of arthrogenic temporomandibular joint disorders.

Abstract Objective The objective of this retrospective study was to evaluate the impact of myofascial trigger points (MTrPs) in patients with articular disc displacement with reduction (DDWR) and to identify which clinical variables are associated with the concomitant presence of DDWR and MTrPs. Material and Methods 130 patients were selected that sought treatment due to joint pain, with ages ≥18 years, of both genders, with DDWR confirmed by magnetic resonance imaging. The sample was divided into two groups: Group 1, patients with DDWR and MTrPs (N=101); and Group 2, patients with DDWR and no MTrPs (N=29). Information on gender, age, pain duration, pain scores, and maximal interincisal distance (MID) were collected. The logistic regression model was used and the odds ratios (OR) was calculated (p<0.05). Results Group 1 presented statistically significant higher mean pain scores (p=0.007), and smaller MID (p=0.0268) than Group 2. OR were significant for the pain scores (1.429), MID (0.937) and gender (women) (2.810). Conclusions Patients with DDWR and MTrPs had increased pain scores and a MID decrease compared to patients with DDWR and no MTrPs. The variables pain scores, MID, and gender (women) showed a significant association with the concomitant presence of DDWR and MTrPs.

RESUMO JUSTIFICATIVA E OBJETIVOS: O presente estudo visou comparar os índices de ansiedade, depressão e incapacidade em pacientes com dor miofascial, com e sem o diagnóstico adicional de enxaqueca. MÉTODOS: Foram incluídos 203 pacientes da Clínica de Dor Orofacial da Universidade da Califórnia, Los Angeles, EUA, com idade acima de 18 anos, ambos os sexos, com diagnóstico primário de dor miofascial. Os pacientes também foram avaliados quanto à presença de enxaqueca, segundo os critérios da Sociedade Internacional de Cefaleias. A amostra foi dividida em dois grupos: 120 pacientes com somente dor miofascial (Grupo 1), e 83 pacientes com dor miofascial e diagnóstico adicional de enxaqueca (Grupo 2). Foram aplicados os questionários: Inventário de Ansiedade de Beck, Inventário de Depressão de Beck e Migraine Disability Assessment Questionnaire. O teste de Mann-Whitney foi utilizado para comparar os grupos a um nível de significância de 5%. RESULTADOS: Os pacientes do grupo 1 apresentaram índices de Inventário de Ansiedade de Beck de p=0,005, Inventário de Depressão de Beck de p=0,025, e número de dias perdidos e/ou prejudicados (56,4 dias) significativamente maiores que os do grupo 2. Os escores Migraine Disability Assessment Questionnaire para os grupos 1 e 2 foram, respectivamente, para o grau I de 48% e 24,1%; grau II de 9,2% e 3,6%; grau III de 8,2% e 22,9%; e, grau IV de 34,7% e 49,4%. CONCLUSÃO: Os pacientes com dor miofascial e enxaqueca apresentaram índices de ansiedade, depressão e incapacidade significativamente maiores (p<0,05), além de níveis de incapacidade moderado e grave, consideravelmente superiores em relação ao grupo de pacientes com somente dor miofascial.

ABSTRACT BACKGROUND AND OBJECTIVES: The aim of this study was to compare anxiety, depression and disability indexes in patients with myofascial pain with and without additional diagnosis of migraine. METHODS: We included 203 patients of the Orofacial Pain Clinic of the University of California, Los Angeles, USA. Patients were over 18 years of age, both genders, with a primary diagnosis of myofascial pain. The patients were also evaluated for the presence of migraine according to the criteria of the International Headache Society. The sample was divided into two groups: 120 patients with only myofascial pain (Group 1) and 83 patients with myofascial pain and with an additional diagnosis of migraine (Group 2). The Beck Anxiety Inventory, Beck Depression Inventory and Migraine Disability Assessment questionnaires were applied. The Mann-Whitney test was used to compare the groups at a significance level of 5%. RESULTS: Patients in group 1 presented significantly higher indexes in the Beck Anxiety Inventory (p=0.005), Beck Depression Inventory (p=0.025) and number of days lost and/or impaired (56.4 days) than those in group 2. The Migraine Disability Assessment Questionnaire scores for groups 1 and 2 were, respectively, 48% and 24.1% for grade I; 9.2% and 3.6% for grade II; 8.2% and 22.9% for grade III; and, 34.7% and 49.4% for grade IV. CONCLUSION: Patients with myofascial pain and migraine had significantly higher anxiety, depression and disability indexes (p<0.05), as well as moderate and severe disability levels considerably higher than those with only myofascial pain.