稳定型咬合板用于颞下颌关节紊乱病的疗效评价

目的:研究稳定型咬合板用于颞下颌关节紊乱病治疗的症状改善情况及其咬合面磨耗特征分析。方法:对28例颞下颌关节紊乱病患者(5例男性,23例女性)运用稳定型咬合板进行治疗,分别在治疗后的1、3、6、10周复诊,观察患者症状变化情况以及咬合板上的磨耗情况并对磨耗面进行评价分析。结果:有25例(89%)患者咬合板上出现磨耗面,其中双侧向型者14例(56%),小侧向型者8例(32%),单侧向型者3例(12%)。无磨耗的3例(12%),未发现有前伸磨耗型患者。10周后患者的症状显著性改善。结论:大多数颞下颌关节紊乱病患者都有如磨牙症一类的功能异常活动,且以侧向型为主。稳定型咬合板能显著改善颞下颌关节紊乱病的临床症状。     

认知行为疗法治疗颞下颌关节紊乱病的系统评价

目的:评价认知行为疗法治疗颞下颌关节紊乱病的疗效。方法:计算机检索PubMed(1990～2009)、OV-ID(1960～2009)、EMbase(1974～2009)、Cochrane图书馆临床对照试验资料库(2009年第3期)、中国生物医学文献数据库(CBM,1978～2009),和中国期刊全文数据库(CNKI,1994～2009),收集认知行为疗法治疗颞下颌关节紊乱病的随机对照试验和半随机对照试验。由两名评价者独立评价研究质量和提取数据,对同质研究采用RevMan5.0软件进行Meta分析,对异质性研究不能进行Meta分析者,则进行描述性的定性分析。结果:共检索到相关文献323篇,评价后纳入5个研究,其中3个随机对照试验和2个半随机对照试验。质量评价结果为2个研究被评为B级,3个研究被评为为C级,纳入研究的方法学质量普遍不高。由于纳入研究存在疗程不一,随访期不一,以及对照组干预措施等临床异质性,无法用Meta分析方法合并效应量,只做了描述性的定性分析。分析结果显示CBT对TMD的治疗效果较其对照组并无明显优势,各研究随访结果也有差异,其疗效还无法确定。结论:基于目前的证据无法得出CBT治疗TMD的确切疗效。因此尚需要开展设计严谨,方法学质量更高的临床试验以获得更可靠的证据。     

Efficacy of stabilisation splint treatment on temporomandibular disorders

Summary The evidence supporting the use of stabilisation splints in the treatment of temporomandibular disorders (TMD) is scarce and a need for well‐controlled studies exists. The aim of this randomised, controlled trial study was to assess the efficacy of stabilisation splint treatment on TMD. The sample consisted of 80 consecutive referred patients who were randomly assigned to the splint group (n = 39) and the control group (n = 41). Subjects in the splint group were treated with a stabilisation splint, whereas subjects in the control group did not receive any treatment except counselling and instructions for masticatory muscle exercises which were given also to the subjects in the splint group. Outcomes were visual analogue scale (VAS) on facial pain intensity and clinical findings for TMD which were measured at baseline and after 1‐month follow‐up. The differences in change between the groups were analysed using regression models. Facial pain decreased and most of the clinical TMD findings resolved in both of the groups. The differences in changes in VAS or clinical TMD findings between the groups were not statistically significant. The findings of this study did not show that stabilisation splint treatment in combination with counselling and masticatory muscle exercises has additional benefit in relieving facial pain and increasing the mobility of the mandible than counselling and masticatory muscle exercises alone in a short time‐interval.     

Effect of Intensive Periodontal Therapy on Blood Pressure and Endothelial Microparticles in Patients With Prehypertension and Periodontitis: A Randomized Controlled Trial

Background: Although some studies show a positive association between periodontitis and blood pressure (BP) elevation, research on the effect of intensive periodontal treatment on decline in BP levels and endothelial microparticles (EMPs) without any antihypertensive management is lacking. Therefore, the present clinical trial explores whether intensive periodontal therapy would lower BP levels and EMPs of patients with prehypertension with periodontitis. Methods: From a total 107 patients, 95 underwent randomization (47 assigned to control‐treatment [CT] group and 48 assigned to intensive‐treatment [IT] group) and completed the trial. Patients received intervention for 4 consecutive weeks and were followed for 6 months. Levels of BP and EMPs were evaluated at baseline and 1, 3, and 6 months after intervention. Results: Periodontal conditions were significantly improved (P <0.05) 6 months after intensive periodontal treatment. In parallel, the primary outcomes including systolic and diastolic BP and EMPs were markedly reduced in the IT group compared with the CT group (absolute difference: 12.57 and 9.65 mm Hg and 581.59/μL, respectively; 95% confidence intervals: 10.45 to 14.69, 7.06 to 12.24, and 348.12 to 815.06, respectively; P <0.05). Reduction in BP levels and EMPs was related to improvement in probing depth (r = 0.358, 0.363, and 0.676, respectively, by the Pearson product‐moment correlation; P = 0.009, 0.008, and P <0.001, respectively). Conclusion: To the best knowledge of the authors, the present study demonstrates for the first time that intensive periodontal intervention without any antihypertensive medication therapy may be an effective means to lower levels of BP and EMPs in patients with prehypertension with periodontitis.     

The effectiveness of splint therapy in patients with temporomandibular disorders: A systematic review and meta-analysis

PURPOSE: The authors conducted a systematic review of all published randomized controlled trials in which investigators compared the effectiveness of splint therapy with that of minimal or no treatment in patients with temporomandibular disorders (TMDs). TYPES OF STUDIES REVIEWED: The authors searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials for studies published from inception of each database through August 2011. In eligible studies, investigators enrolled adult patients with TMDs and assigned them randomly to splint therapy or a control group receiving minimal or no treatment. RESULTS: Of 1,567 potentially eligible studies, 11 proved eligible and were included. Moderate-quality evidence suggests that splint therapy reduced pain in the temporomandibular joint (TMJ) area (standardized response mean = -0.93, 95 percent confidence interval [CI], -1.33 to -0.53; risk difference for having continued pain = -0.35, 95 percent CI, -0.21 to -0.46; mean change on the 100-millimeter visual analog scale = -11.5 mm, 95 percent CI, -16.5 mm to -6.6 mm). Low to very low quality of evidence showed no significant differences between the splint therapy and control groups in terms of quality of life or depression. None of the trial reports described effect on function. CONCLUSIONS: Although overall results are promising for the reduction of pain, establishing the role of splints for patients with TMDs will require large trials with stronger safeguards against bias.     

Efficacy of Varying Concentrations of Subgingivally Delivered Metformin in the Treatment of Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Metformin (MF), a second‐generation biguanide, is a commonly used oral antidiabetic drug that has been shown recently to stimulate osteoblasts and reduce alveolar bone loss. The present study aims to explore the efficacy of 0.5%, 1%, and 1.5% MF gel as a local drug delivery system in adjunct to scaling and root planing (SRP) for treatment of intrabony defects (IBDs) in patients with chronic periodontitis. Methods: A total of 118 IBDs were treated with 0.5%, 1%, or 1.5% MF gel or placebo gel. Clinical parameters (modified sulcus bleeding index, plaque index, probing depth [PD], and clinical attachment level [CAL]) were recorded at baseline, 3 months, and 6 months, whereas radiographic parameters were recorded at baseline and 6 months. IBD depth at baseline and 6 months was calculated on standardized radiographs by using the image analysis software. The mean concentration of MF in gingival crevicular fluid was estimated by reverse‐phase high‐performance liquid chromatography. Results: Mean PD reduction and mean CAL gain was found to be greater in MF groups than the placebo group at both 3 and 6 months. Furthermore, significantly greater reduction of IBD depth was found in the MF groups compared to the placebo group, with greatest reduction in 1% MF. Conclusions: The results of the present study show that local delivery of MF into the periodontal pocket stimulated significant increase in the PD reduction, CAL gain, and improved IBD depth reduction compared to placebo in adjunct to SRP. This can provide a new direction in the field of periodontal healing.     

Efficacy and Safety of Oral Premedication on Pain after Nonsurgical Root Canal Treatment: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Introduction

This review aimed to find the most effective oral premedication in reducing pain in adults after nonsurgical root canal therapy (NSRCT) using network meta-analysis.

化脓性颞下颌关节炎的特征与诊断

目的探讨化脓性颞下颌关节炎的临床特征及其早期诊断方法。方法收集我科近5年的30例化脓性颞下颌关节炎患者,对其临床症状,关节液的性质和量,关节液的组织学和细菌学表现,影像学检查,其它实验室检查及后遗症进行分析。结果患者主要为成年人(>18岁占29/30);血源性感染多见;多数(25/30)局部症状轻,全身反应不明显;关节液组织学检查见大量粒细胞,可伴纤维蛋白或纤维软骨碎片;15/30患者关节液细菌学检查见到细菌,培养出的病原菌主要为金黄色葡萄球菌和腐生葡萄球菌;后遗症轻,主要为继发性骨关节病。结论当今化脓性颞下颌关节炎表现出感染源隐匿性、症状不典型性、后遗症轻等特点;关节腔穿刺和关节液分析是其必要的诊断手段。     

Effect of Resin-based and Bioceramic Root Canal Sealers on Postoperative Pain: A Split-mouth Randomized Controlled Trial

Introduction

The aim of this study was to compare the effect of resin-based and bioceramic root canal sealers on the occurrence and intensity of postoperative pain in patients with asymptomatic apical periodontitis (AAP).

The Effect of Trypsin-Chymotrypsin on Postoperative Pain after Single Visit Endodontic Treatment: A Randomized Controlled Trial

IntroductionThe efficacy of trypsin-chymotrypsin in postoperative pain management following single-visit root canal treatment of teeth with symptomatic irreversible pulpitis was evaluated. Additionally, synergistic effects with nonsteroidal anti-inflammatory drugs and reported side effects were also investigated.MethodsThis prospective, parallel, triple-blinded phase IV randomized controlled trial included 60 patients with mandibular first molars exhibiting symptomatic irreversible pulpitis. The patients were randomly allocated using computer software to one of four treatment groups (n = 15 each), and either ibuprofen (600 mg), ambezim-G (trypsin 5mg-chymotrypsin 5 mg), a combination of both, or a placebo drug were administered postoperatively. The participants scored pain intensity at different time-intervals using a numerical scale, and passive surveillance of harm was used to detect clinical safety. Age was compared between groups using a one-way analysis of variance test. Pain scores were analyzed using the Kruskal-Wallis and Friedman's tests and, if significant, Dunn's test was used for pairwise comparisons. The chi-square test was used to compare qualitative data, and the significance level was set at P value ≤ .05.ResultsAll interventions were found to be effective in reducing postoperative pain, and no statistically significant differences were observed between the ibuprofen, trypsin-chymotrypsin, and combination groups. However, all 3 groups differed significantly from the placebo group. The safety profile of the interventions did not differ significantly.ConclusionsTrypsin-chymotrypsin exhibits comparable efficacy to nonsteroidal anti-inflammatory drugs. No synergistic effects occur when the 2 are used in combination. This is the first randomized controlled trial to assess the effects of proteolytic enzymes on postendodontic pain.Trial registrationclinicaltrials.gov, Identifier: NCT05479747     

Effect of Diclofenac Potassium Premedication on Postendodontic Pain in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Randomized Placebo-Controlled Double-Blind Trial

IntroductionThe aim of this prospective, randomized, double-blind clinical trial was to evaluate the effect of a preoperative, single, oral dose of diclofenac potassium (DFK) on postoperative pain and rescue analgesic intake in patients with symptomatic irreversible pulpitis in mandibular molars treated in 1 visit.MethodsSeventy emergency patients with moderate to severe preoperative pain randomly received either 50 mg DFK or placebo tablets 1 hour before starting endodontic treatment (n = 35 per group). Patients recorded their pain level 6, 12, 24, and 48 hours after treatment on a 170-mm Heft-Parker visual analog scale. The incidence of rescue analgesic intake was also recorded. Outcome data were statistically analyzed using Mann-Whitney U, Friedman, Wilcoxon signed rank, and chi-square tests. Binary logistic regression assessed the association of predisposing factors with postoperative pain. The significance level (α) was set at 0.05.ResultsOf the 70 patients, 68 were analyzed (n = 34 per group). Both groups had similar baseline characteristics (P > .05). DFK showed significantly less pain incidence and intensity than the placebo at 48 hours only (P < .05). A significant decrease occurred from 24 to 48 hours with DFK (P < .05), which was not recorded with the placebo (P > .05). No difference in the incidence of rescue analgesic intake was reported between groups (P > .05). Food intake timing, sex, and rescue analgesic intake were associated with postoperative pain (P < .05).ConclusionsPremedication by a single, oral dose of 50 mg DFK could be effective in reducing postendodontic pain at 48 hours after 1-visit endodontic treatment in mandibular molars with symptomatic irreversible pulpitis.     

化脓性颞下颌关节炎病原菌的分离培养和鉴定

目的 分离、培养和保存化脓性颞下颌关节炎的病原菌，了解其种类，探索合适的培养条件。方法 对近5a就诊的30例化脓性颞下颌关节炎患者，抽取关节液，进行涂片、革兰染色，分别采用血琼脂培养基、室温保存菌种培养基、乳酪消化大豆胨琼脂(TSA)和乳酪消化大豆胨肉汤(TSB)等4种培养基在需氧和厌氧条件下进行细菌培养，并对培养出的细菌进行生化鉴定。结果 关节液涂片细菌检出率为50％(15／30)，细菌培养阳性率为17％(5／30)，培养出的病原菌主要为腐生葡萄球菌和金黄色葡萄球菌，所用的培养基以TSB为佳。结论 作者成功地分离出2种病原菌，其中腐生葡萄球菌为首次发现，但检出率较低，尚需进一步完善培养技术。     

Association of stress and depression with chronic facial pain: A case-control study based on the Northern Finland 1966 Birth Cohort

Objective: The aim was to study the association between stress level and chronic facial pain, while controlling for the effect of depression on this association, during a three-year follow-up in a general population-based birth cohort.

Methods: In the general population-based Northern Finland 1966 Birth Cohort, information about stress level, depression and facial pain were collected using questionnaires at the age of 31 years. Stress level was measured using the Work Ability Index. Depression was assessed using the 13-item depression subscale in the Hopkins Symptom Checklist-25. Three years later, a subsample of 52 subjects (42 women) with chronic facial pain and 52 pain-free controls (42 women) was formed.

Results: Of the subjects having high stress level at baseline, 73.3% had chronic facial pain, and 26.7% were pain-free three years later. The univariate logistic regression analysis showed that high stress level at 31 years increased the risk for chronic facial pain (crude OR 6.1, 95%, CI 1.3–28.7) three years later. When including depression in a multivariate model, depression associated statistically significantly with chronic facial pain (adjusted OR 2.5, 95%, CI 1.0–5.8), whereas stress level did not (adjusted OR 2.3, 95%, CI 0.6–8.4).

Conclusion: High stress level is connected with increased risk for chronic facial pain. This association seems to mediate through depression.     

The Effect of Apical Positive and Negative Pressure Irrigation Methods on Postoperative Pain in Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial

Introduction

This study compared the effect of conventional needle irrigation (positive pressure) and the EndoVac system (Discus Dental, Culver City, CA) (negative pressure) on postoperative pain in mandibular molar teeth with symptomatic irreversible pulpitis.

Effect of Low-level Laser Therapy on Postoperative Pain in Molars with Symptomatic Apical Periodontitis: A Randomized Placebo-controlled Clinical Trial

Introduction

In this clinical trial, we evaluated the effect of low-level laser therapy (LLLT) on postoperative pain in mandibular molar teeth with symptomatic apical periodontitis.

Effects of Ozone Therapy on the Early Healing Period of Deepithelialized Gingival Grafts: A Randomized Placebo‐Controlled Clinical Trial

Background: This study evaluates the effects of ozone therapy (OT) on the early healing period of deepithelialized gingival grafts (DGG) placed for non‐root coverage gingival augmentation by laser Doppler flowmetry (LDF). Methods: Thirty‐three patients were assigned to study groups: 1) test: DGG + OT; or 2) control group: DGG alone. Thirty patients completed the study. Ozone was applied on DGGs placed in the recipient bed and donor site immediately after surgery and at days 1 and 3 post‐surgery. Blood perfusion in the recipient site was measured by LDF on the day of surgery and at 1, 2, 3, 6, 8, 10, and 13 days after surgery. Quality of life (assessed by the Oral Health Impact Profile‐14) and pain at donor/recipient sites (assessed by visual analog scale) were also investigated. Results: Increase in blood perfusion units in the test group was significantly higher than control group at 1, 2, 3, 6, and 8 days post‐surgery (P <0.001). Significant differences occurred between test and control groups in terms of visual analog scale values during the first week post‐surgery for both donor and recipient sites (P <0.05). The ozone‐treated group showed significantly higher quality of life than control group on postoperative day 6 (P = 0.002). Conclusions: OT enhanced blood perfusion units in the first postoperative week. This outcome is also consistent with improvement in wound healing, accompanied by an increase in quality of life and decrease in postoperative pain in the test group.