Belmiro Cavalcanti Do Egito Vasconcelos

Purpose: To compare the effects of leukocyte- and platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) on bone healing and postoperative outcomes following impacted third molar extraction (ITME). Methods: A randomized, double-blind, split-mouth clinical trial was conducted in patients undergoing bilateral ITME. One extraction socket received L-PRF and the contralateral socket received A-PRF. The primary outcome was bone volume at the extraction socket, assessed by cone-beam computed tomography (CBCT), as a measure of bone healing. Secondary outcomes included trabecular thickness, trabecular spacing, soft tissue healing assessed using the modified Landry healing index, postoperative pain assessed using a visual analog scale (VAS), and facial swelling. Statistical significance was set at p < 0.05. Results: Thirty-five patients were included in the final analysis. No significant differences were observed in bone volume between the L-PRF (21.04 ± 7.46) and A-PRF (21.43 ± 7.65) groups ( p = 0.802). Trabecular thickness was significantly greater in the A-PRF group ( p = 0.012), whereas trabecular spacing did not differ between groups. An exploratory time-specific comparison showed lower pain scores in the L-PRF group at 8 h postoperatively ( p = 0.046), although no significant overall treatment effect was observed for postoperative pain. No significant differences were identified regarding facial swelling or soft tissue healing. Conclusion: Within the limitations of this randomized clinical trial, L-PRF and A-PRF demonstrated comparable effects on bone healing and postoperative clinical outcomes following impacted third molar extraction. Trial registration Brazilian registry of clinical trials [ReBEC] number: RBR-10vc6r63.

Purpose: This overview of systematic reviews aimed to compare continuous positive airway pressure and mandibular advancement devices for the treatment of obstructive sleep apnea by distinguishing objective physiological outcomes from patient-centered outcomes and critically appraising the methodological quality of the available evidence. Methods: Following PRISMA guidelines and PROSPERO registration (CRD42021268587), we systematically searched five databases to identify systematic reviews comparing continuous positive airway pressure and mandibular advancement devices in obstructive sleep apnea based on a PICO framework. The outcomes of interest included the Apnea–Hypopnea Index, oxygen desaturation index, treatment adherence, and quality of life. Methodological quality was assessed using AMSTAR-2, and overlap among reviews was evaluated using a citation matrix and the corrected covered area. Results: Fourteen systematic reviews were included. CPAP demonstrated greater efficacy than mandibular advancement devices in improving objective physiological outcomes, particularly the apnea–hypopnea index and oxygen desaturation indices. Both therapies showed comparable effects on daytime sleepiness, while some reviews reported better treatment adherence and more favorable patient-centered outcomes with MADs. Methodological quality was limited: no review was classified as high quality, and most were assessed as low or critically low quality. Analysis of the corrected coverage area indicated a high overlap between the primary studies included in the different reviews. Conclusion: Continuous positive airway pressure is more effective than mandibular advancement devices in improving the apnea–hypopnea index and oxygen desaturation index. However, mandibular advancement devices were associated with positive effects on quality of life and sleep, though certainty regarding the sustainability of these outcomes and their long-term efficacy remains limited in the current literature. Treatment choice should be individualized, and evidence should be interpreted with caution due to methodological limitations and the high overlap between the included systematic reviews. PROSPERO registration number: CRD2021268587.

Objetivo: Relatar o planejamento e a resolução de um caso clínico de deformidade padrão Classe III, discutindo os principais métodos para determinação do posicionamento sagital da maxila no planejamento da cirurgia ortognática. Relato de caso: Paciente masculino, 21 anos, apresentou queixa de “queixo grande”, com diagnóstico de deformidade dentofacial Classe III associada à deficiência maxilar e prognatismo mandibular. O planejamento foi realizado por meio de software virtual, utilizando a linha vertical verdadeira associada à análise dos tecidos moles para definição do posicionamento ântero-posterior da maxila. O tratamento incluiu preparo ortodôntico pré-operatório e cirurgia ortognática bimaxilar (osteotomia Le Fort I e osteotomia sagital do ramo mandibular), associada à mentoplastia. O planejamento considerou parâmetros estéticos faciais e a relação dos incisivos com referências de tecidos moles. Conclusão: O uso isolado de referências cefalométricas ósseas apresenta limitações. A associação com parâmetros de tecidos moles contribui para maior previsibilidade estética, especialmente em casos de deficiência maxilar, sendo essencial a individualização do planejamento cirúrgico.

Objectives: To map and characterize the therapeutic strategies described in the literature for the management of microstomia in patients with systemic sclerosis. Methods: This scoping review was conducted in accordance with the PRISMA‐ScR guidelines. Searches were performed in Medline/PubMed, Embase, Scopus, Web of Science, Cochrane Library, and gray literature searches. Studies involving adults with systemic sclerosis of any subtype who received local or systemic interventions aimed at improving microstomia and reported at least one mouth opening–related outcome were eligible. Results: Forty‐five studies were included. Non‐surgical interventions predominated, including physiotherapy, injectables, and oral medications, whereas surgical treatments were less frequently reported and mainly involved autologous fat grafting. Randomized controlled trials primarily evaluated conservative interventions, while surgical approaches were mostly investigated in quasi‐experimental studies. Heterogeneity was observed across study designs, outcome measures, follow‐up durations, and assessment instruments. Objective measures of mouth opening, especially interincisal distance, were the most reported outcomes. Conclusions: The available evidence on microstomia management in systemic sclerosis is predominantly based on non‐surgical interventions and is marked by substantial methodological heterogeneity. Future research should prioritize standardized outcome measures, longer follow‐up periods, and well‐designed multicenter studies to better define the role of conservative and surgical treatments in this clinical setting.

A prática contemporânea da Odontologia e da Cirurgia e Traumatologia Bucomaxilofacial exige a integração entre evidência científica, segurança do paciente e individualização do cuidado. Nesta edição, destacamos a importância do conhecimento epidemiológico, anatômico e clínico como base para diagnósticos mais precisos e tratamentos previsíveis. Ao mesmo tempo, discutimos os desafios da tomada de decisão em cenários complexos, nos quais características individuais, faixa etária e condições sistêmicas demandam abordagens personalizadas. Técnicas consagradas e inovações tecnológicas devem caminhar lado a lado com a segurança biológica e o manejo adequado dos riscos. Mais do que oferecer respostas definitivas, este volume busca estimular a reflexão crítica e o desenvolvimento de uma prática clínica cada vez mais fundamentada, segura e centrada no paciente.

Objective: To synthesize barriers associated with delays in the diagnosis and initiation of treatment of oral cancer across high‐income countries (HICs) and low‐ and middle‐income countries (LMICs) contexts, aligned with the Aarhus diagnostic–therapeutic intervals. Methods: A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase, and ProQuest. Observational, qualitative, and mixed‐methods studies reporting patient‐reported perceptions or system‐level barriers affecting the diagnostic‐therapeutic pathway and associated with diagnostic or treatment delays in adult oral cancer were included. Data were narratively synthesized, and identified barriers were semantically standardized and mapped to the Aarhus intervals. Results: Sixteen studies were included. Barriers were categorized into psychosocial, symptom appraisal, health literacy, structural, professional‐related, and organizational domains. Studies focusing on the patient interval most frequently reported psychosocial and appraisal‐related barriers. Studies examining diagnostic, composite, or total intervals more commonly identified professional‐related and organizational barriers. Studies from LMICs more frequently addressed extended segments of the care pathway and reported nonbiomedical management strategies, health literacy–related barriers, and professional or structural barriers beyond the patient interval. Conclusion: Delays in oral cancer care reflect an interconnected, trajectory‐based process shaped by interacting individual, professional, and system‐level factors, supporting the need for integrated interventions across the care continuum.

Purpose: The purpose of this systematic review was to compare the clinical outcomes and patient‐reported outcome measures (PROMs) of digitally and conventionally fabricated removable partial denture (RPD) frameworks. Methods: This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta‐Analyses. An electronic search was performed in PubMed/MEDLINE, Scopus, Embase, and Web of Science. Clinical studies comparing clinical outcomes and/or PROMs of digitally and conventionally fabricated RPD frameworks, with no restrictions on publication year or language, were included. Studies involving other types of oral rehabilitation or those without full‐text availability were excluded. Results: From 863 studies identified, 14 were included in this review. Clinical outcomes assessed included adaptation, periodontal health, masticatory efficiency, denture stomatitis, weight, success, and placement rates, adjustment time, stability, number of framework remakes, and components requiring adjustment. PROMs included patient satisfaction, oral health‐related quality of life (OHRQoL), and patient preference. No significant difference in rest adaptation was observed between conventional and digital workflows ( p  = 0.070). Some studies suggested that digitally fabricated RPD frameworks may be associated with reduced bone loss, improved masticatory efficiency, and fewer incidences of denture stomatitis. Regarding PROMs, the digital workflow resulted in higher patient satisfaction, whereas OHRQoL and patient preference were similar between techniques. Conclusions: Digitally fabricated RPD frameworks showed satisfactory clinical outcomes and PROMs and may represent a viable alternative to conventional methods.

A face humana é central para a identidade, a comunicação e a interação social, de modo que alterações causadas por traumas, doenças ou deformidades comprometem não apenas a anatomia, mas também a dignidade e a inserção social do indivíduo. Nesse contexto, a Cirurgia e Traumatologia Bucomaxilofacial (CTBMF) desempenha papel essencial ao atuar na reconstrução de estruturas faciais, restaurando funções vitais como mastigação e respiração e evitando incapacidades permanentes. Além das situações de urgência, a especialidade também contribui para a inclusão social por meio de procedimentos como a cirurgia ortognática e as reconstruções faciais, frequentemente equivocadamente classificadas como estéticas, mas fundamentais para corrigir distúrbios que geram estigma e limitações sociais. Diante disso, torna-se fundamental que gestores e políticas públicas reconheçam a CTBMF como investimento em saúde funcional e produtividade social, garantindo acesso adequado e estrutura hospitalar compatível com os avanços tecnológicos da especialidade.