Analysis of factors that influence quality of life of individuals undergoing treatment for mandibular fractures: A systematic review and meta-analysis

OBJECTIVE

To address the factors that affect the quality of life (QoL) of individuals undergoing treatment for mandibular fractures.

STUDY DESIGN

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the search strategy was constructed according to the Populations, Interventions, Comparison, Outcomes, and Study Design principle in the following databases: PubMed, Web of Science, Scopus, and EMBASE. Risk of bias assessment was performed with Risk Of Bias In Non-randomized Studies of Interventions and Cochrane Risk of Bias tool for randomized trials 2.

RESULTS

Nineteen studies were included: 15 observational and 4 clinical trials. Mean age ranged from 28 to 39 years, with a higher proportion of males. The condyle was the main fracture location and traffic accident was the fracture cause. Treatment approaches were mostly open reduction (89.4%) and maxillomandibular fixation (63%). QoL measurements varied considerably with the General Oral Health Assessment Index (31.5%) and Oral Health Impact Profile-14 (21%) as the main instruments. Meta-analysis showed that open reduction and maxillomandibular fixation did not present significant differences to QoL (P = .39), but significant differences were observed with time (P < .00001). Other factors affected QoL, such as mental health, pain, socializing, appearance, and eating difficulties.

CONCLUSIONS

Several factors, apart from the treatment approach, mentioned in this review seemed to affect the QoL of patients with mandibular trauma. Treatment choice should be based on well-stablished clinical criteria and on all other factors mentioned here.

Effects of osteoporosis on alveolar bone repair after tooth extraction: A systematic review of preclinical studies

OBJECTIVE

This systematic review aimed to address whether the alveolar socket repair after a tooth extraction is impacted by an osteoporotic phenotype and propose methodological observations.

DESIGN

A search strategy in MEDLINE/PubMed, EMBASE, Web of Science, and Scopus databases was performed. Quality assessment was carried out through the SYRCLE Risk of Bias tool.

RESULTS

Out of the 1147 potentially relevant records, 25 met the inclusion criteria. Most of the studies were performed in rats, and ovariectomy (OVX) was the most frequent osteoporosis induction method. Histomorphometry, micro-computed tomography (microCT), and immunohistochemistry were the main bone repair evaluation methods. Most of the included studies (88 %) presented negative impacts of osteoporosis on the alveolar socket repair. Only three studies (12 %) showed no statistical differences among groups. Overall, most of the quality assessment categories presented a high percentage of unclear risk of bias due to insufficient information in the studies.

CONCLUSIONS

The results indicated that an osteoporotic phenotype seems to impair alveolar socket repair after tooth extraction. However, there is still a lack of information and standardization. Therefore, further studies should consider the proposed methodological aspects regarding animal characteristics, OVX associated with a low calcium diet, waiting 8 weeks to osteoporosis induction, maxillary molars as the best option for tooth extraction, confirming and reporting OVX and osteoporosis success, and an appropriate method of repair analysis.

HOSPITAL INTERVENTION IN SEVERE SINUS INFECTION AFTER BONE GRAFT

This study presents the case of a patient who required antrostomy under general anesthesia to treat a sinus lift complication. The patient was a 43-year-old woman with no systemic abnormalities, who underwent maxillary sinus lift surgery associated with mineralized bovine bone graft. The Schneiderian membrane was perforated during the procedure and the rupture was treated with collagen membranes to close the wound and contain the biomaterial, preventing its dispersion. The patient developed a maxillary sinus infection seven days after the surgery. This infection was initially treated with 875 mg of amoxicillin combined with 125 mg of clavulanic acid. Although the initial infection did not worsen, the patient developed maxillary sinusitis. Thirty days after the onset of the initial infection, the patient underwent an intraoral surgery under local anesthesia to remove the biomaterial and clean the sinus cavity. Despite this procedure, maxillary ostial patency was still compromised and antrostomy was performed endoscopically in a hospital setting under general anesthesia. This procedure resolved the sinus infection. Then, 12 months after hospitalization, the patient was treated with another sinus graft surgery without postoperative complications. The treatment of sinus infections due to graft surgery may require early and active intervention with antibiotics, graft removal, and antrostomy to prevent major complications.

Magnetic Field Effects on Bone Repair after Calcium Phosphate Cement Implants: Histometric and Biochemistry Evaluation

OBJECTIVE

This work evaluated histologic and biochemically the effect of magnetic field buried in bone repair after autogenous bone graft and calcium phosphate cement implants.

METHODOLOGY

Bone defects with 5,0 mm of diameter in the cranium of Wistar mice were used to analyse. These mice were submitted to different interventions: autogenous bone graft and calcium phosphate cement implants, both with and without magnetic stimulation. Longitudinal and transversal histometric and biochemistry analysis were made in times of 15, 30 and 60 post-operative days.

RESULTS

The histometric transversal analysis did not show significant differences in the bone repair between groups. Longitudinally, significant difference were found in the quantity of neoformed bone between the times 15 and 60 post-operative days in the autogenous bone graft group under magnetic stimulation. The alkaline phosphatase enzyme presented a higher activity in 30 post-operative days and the groups under magnetic stimulation presented reduced enzymatic activity in comparison to the other groups.

CONCLUSION

The permanent and static magnetic field promoted significant differences in the neoformed bone in the groups autogenous bone graft.

Tomographic Analysis of the Impact of Mandibular Advancement Surgery on Increased Airway Volume

PURPOSE

This study aimed to quantify, using cone-beam computed tomography (CBCT) in patients who underwent a mandibular advancement surgery associated with genioplasty, three-dimensional changes in airway space and to evaluate whether these changes differ between men and women.

MATERIALS AND METHODS

Preoperative and 8-month postoperative CBCT scans of 38 patients aged 18-45 years of either sex and any ethnicity who underwent mandibular advancement surgery associated with genioplasty were analyzed using the Xoran software (Xoran Technologies, Ann Arbor, MI, USA). The linear distances gonion-gnathion (Go-Gn) and condylion-menton (Co-Me) were obtained. Airway volume was measured using the Dolphin Imaging software, version 11.0. Then, data were tabulated and analyzed using Student's t-test.

RESULTS

Mean patient age was 30.3 years; 39.47% were men and 60.63% were women. The mean Go-Gn distance was 72.05 mm before surgery and 78.56 mm after surgery, with a mean gain of 6.51 mm. The mean Co-Me distance was 113.47 mm before surgery and 119.89 mm after surgery, with a mean increase of 6.42 mm. Both differences were statistically significant. The mean volume of airway space was 17,272.92 mm3 before surgery and 24,173.74 mm3 after surgery, with a statistically significant mean increase of 6900.82 mm3. There was no statistically significant difference in mean volumetric gain between men (7566.69 mm3) and women (7456.69 mm3).

CONCLUSION

Mandibular advancement surgery results in significant increase of airway space, and there is no difference in airway volume between men and women.

Salivary flow rate, buffer capacity, and urea concentration in adolescents with type 1 diabetes mellitus

BACKGROUND

The objective of the study was to analyze salivary flow rate, urea concentration, and buffer capacity in adolescents with type 1 diabetes mellitus (type 1 DM) in two different stages.

METHODS

This study was performed on adolescents (14-19 years), allocated between two groups: type 1 DM group comprised 32 adolescents with type 1 DM, and non-type 1 DM group comprised 32 nondiabetics. The adolescents in type 1 DM group were evaluated at a baseline (T0) and after 15 months (T1), and those in non-type 1 DM group were only evaluated at T0. Diabetic status was determined by glycosylated hemoglobin (GHb) and capillary glucose tests. Measurement of salivary flow was performed by means of stimulated saliva (SSFR) collection. The buffer capacity (BC) was determined, and analysis of urea salivary concentration was performed using the colorimetric method.

RESULTS

At T0, there were significant differences between diabetics and nondiabetics for SSFR and BC (p<0.05). In diabetics, SSFR was 0.790 mL/min in T0 and 0.881 mL/min in T1 (p>0.05). BC at T0 was 4.8, and at T1, it was 3.9 (p=0.000). Urea concentration mean value had a significant decrease at T1 (28.13) compared with T0 (34.88) (p=0.013). There was a negative correlation between SSFR and urea salivary concentration at both T0 (r=-0.426, p≤0.05) and T1 (r=-0.601, p≤0.01).

CONCLUSIONS

In adolescents with type 1 DM, hyposalivation at T0 was associated with an increase in urea salivary concentration. At T1, hyposalivation was associated with a reduction in BC, and an increase in salivary urea.

Clinical management of angioneurotic oedema patient post-orthognathic surgery

Angioneurotic oedema is an acute swelling involving the submucosal or subcutaneous tissues; it is most often located in the oral and maxillofacial region, which can result in upper airway obstruction. Its aetiology is frequently associated with immunoglobulin-mediated hypersensitivity reactions that elicit a heightened inflammatory response. The objective of this study was to report the case of a patient who developed an episode of angioneurotic oedema following combined orthognathic surgery. Pharmacological and nonpharmacological interventions used in the treatment of this important clinical condition are described and discussed.

In vivo and in vitro effects of homocysteine on Na+,K+‐ATPase activity in parietal, prefrontal and cingulate cortex of young rats

In the present study we determined the effect of chronic administration of homocysteine on Na+,K+-ATPase activity in synaptic membranes from parietal, prefrontal and cingulate cortex of young rats. We also studied the in vitro effect of homocysteine on this enzyme activity and on some oxidative stress parameters, namely thiobarbituric acid-reactive substances (TBA-RS) and total radical-trapping antioxidant potential (TRAP) in the same cerebral structures. For the in vivo studies, we induced elevated levels of homocysteine in blood (500 microM), comparable to those of human homocystinuria, and in brain (60 nmol/g wet tissue) of young rats by injecting subcutaneously homocysteine (0.3-0.6 micromol/g of body weight) twice a day at 8 h intervals from the 6th to the 28th postpartum day. Controls received saline in the same volumes. Rats were killed 12 h after the last injection. Chronic administration of homocysteine significantly decreased (50%) Na+,K+-ATPase activity in parietal, increased (36%) in prefrontal and did not alter in cingulate cortex of young rats. In vitro homocysteine decreased Na+,K+-ATPase activity and TRAP and increased TBA-RS in all cerebral structures studied. It is proposed that the alteration of Na+,K+-ATPase and induction of oxidative stress by homocysteine in cerebral cortex may be one of the mechanisms related to the neuronal dysfunction observed in human homocystinuria.

Training in inhibitory avoidance causes a reduction of Na+,K+-ATPase activity in rat hippocampus

Compelling evidence has indicated the involvement of Na(+),K(+)-ATPase in the mechanisms of synaptic plasticity. In the present study, we investigated the effect of inhibitory avoidance training on Na(+),K(+)-ATPase activity, at different times after training, in the rat hippocampus. Male adult Wistar rats were trained in a step-down inhibitory avoidance task and compared to those submitted to isolated footshock (0.4 mA) or placed directly onto the platform. Na(+),K(+)-ATPase activity decreased, by 60%, in hippocampus of rats sacrificed immediately after the isolated footshock, as well as immediately (0 min) and 6 h after training; this effect was not present 24 h after training. We also verified that enzyme activity was not altered in rats killed after just being on the platform. These findings suggest that Na(+),K(+)-ATPase activity may be involved in the memory consolidation of step-down inhibitory avoidance in the hippocampus.

Brain Na+,K(+)-ATPase inhibition induced by arginine administration is prevented by vitamins E and C

Hyperargininemia is a metabolic disorder caused by deficiency of arginase activity resulting in tissue accumulation of arginine and neurological dysfunction. We have previously demonstrated that arginine induces oxidative stress and decreases Na+,K(+)-ATPase in rat midbrain. In the present study we investigated the action of vitamins E and C on the inhibition of Na+,K(+)-ATPase provoked by arginine in the midbrain of 60-day-old rats. Animals were pretreated for 1 week with daily IP administration of saline (control) or vitamins E (40 mg/kg) and C (100 mg/kg). Twelve h after the last injection, animals received one injection of arginine (0.8 micromol/g of body weight) or saline. Chemiluminescence was significantly increased, whereas total antioxidant capacity and Na+,K(+)-ATPase activity were significantly decreased. Furthermore, treatment with vitamins E and C prevented these effects. If these effects also occur in the human condition, it is possible that antioxidant administration might slow the progression of neurodegeneration in this disorder.

Inhibition of Na+, K+-ATPase activity in rat striatum by guanidinoacetate

The aim of this work was to investigate the effect of guanidinoacetate (GAA), the principal metabolite accumulating in guanidinoacetate methyltransferase (GAMT)-deficiency, on Na(+), K(+)-ATPase, Mg(2+)-ATPase and acetylcholinesterase (AChE) activities in striatum of young rats. We also studied the kinetics of the inhibition of Na(+), K(+)-ATPase activity caused by guanidinoacetate. Guanidinoacetate did not alter acetylcholinesterase and Mg(2+)-ATPase activities, but significantly inhibited Na(+), K(+)-ATPase activity. The apparent K(m) and V(max) of Na(+), K(+)-ATPase for ATP as substrate were 0.20mM and 0.82nmol inorganic phosphate (Pi) released per min per mg of protein, respectively. K(i) value was 7.18mM, and the inhibition was of the uncompetitive type. The results also showed a competition between guanidinoacetate and argininic acid (AA), suggesting a common binding site for the guanidino compounds (GC) on the enzyme. It is proposed that Na(+), K(+)-ATPase inhibition by guanidinoacetate may be one of the mechanisms involved in the neuronal dysfunction observed in GAMT-deficiency and in other diseases which accumulate guanidinoacetate.

Impairment of energy metabolism in hippocampus of rats subjected to chemically-induced hyperhomocysteinemia

Homocystinuria is an inherited metabolic disease biochemically characterized by tissue accumulation of homocysteine (Hcy). Mental retardation, ischemia and other neurological features, whose mechanisms are still obscure are common symptoms in homocystinuric patients. In this work, we investigated the effect of Hcy administration in Wistar rats on some parameters of energy metabolism in the hippocampus, a cerebral structure directly involved with cognition. The parameters utilized were 14CO2 production, glucose uptake, lactate release and the activities of succinate dehydrogenase and cytochrome c oxidase (COX). Chronic hyperhomocysteinemia was induced by subcutaneous administration of Hcy twice a day from the 6th to the 28th day of life in doses previously determined in our laboratory. Control rats received saline in the same volumes. Rats were killed 12 h after the last injection. Results showed that Hcy administration significantly diminished 14CO2 production and glucose uptake, as well as succinate dehydrogenase and COX activities. It is suggested that impairment of brain energy metabolism may be related to the neurological symptoms present in homocystinuric patients.

Inhibition of Na(+),K(+)-ATPase activity in hippocampus of rats subjected to acute administration of homocysteine is prevented by vitamins E and C treatment

In the present study we evaluated the effect of acute homocysteine (Hcy) administration on Na(+),K(+)-ATPase activity, as well as on some parameters of oxidative stress such as total radical-trapping antioxidant potential (TRAP) and on activities of antioxidant enzymes catalase (CAT), superoxide dismutase and glutathione peroxidase in rat hippocampus. Results showed that Hcy significantly decreased TRAP, Na(+),K(+)-ATPase and CAT activities, without affecting the activities of superoxide dismutase and glutathione peroxidase. We also verified the effect of chronic pretreatment with vitamins E and C on the reduction of TRAP, Na(+),K(+)-ATPase and CAT activities caused by Hcy. Vitamins E and C per se did not alter these parameters, but prevented the reduction of TRAP, Na(+),K(+)-ATPase and CAT activities caused by Hcy. Our results indicate that oxidative stress is probably involved in the pathogenesis of homocystinuria and that reduction of Na(+),K(+)-ATPase activity may be related to the neuronal dysfunction found in homocystinuric patients.