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Introdução:Disfunções temporomandibularessão um termo coletivopara uma série de sinais e sintomas clínicos que envolvem os músculos mastigatórios, a articulação temporomandibular e estruturas associadas. O tratamento de pacientes deverá envolver uma equipe multidisciplinareparaquehajauma intervenção eficaz notratamento da disfunção é necessário que os profissionais envolvidos atuem emconjuntoetenhamplenoconhecimento das funções estomatognáticas.Objetivo:revisar aliteratura sobreas formas terapêuticas das disfunções temporomandibulares e sua eficácia.Metodologia:Trata-se de um estudosobre o panorama atual das terapêuticas utilizadas para o tratamento de disfunções temporomandibulares.Para compor o presente trabalho foi consultado o banco de dados da PubMed utilizando as palavras-chave "temporomandibular disorder" e "therapy" associados ao operador booleano AND. Os critérios de inclusão foram os artigos publicados, limitando-se ao período de 2020 a 2024 no idioma inglês. A busca computou um total de 545 artigos, dos quais foram excluídos os artigos que desviavam do tema proposto, artigos que abordavam técnicas com pouco embasamento científico e os artigos que não estavam disponíveis por completo.Resultados:os achados na literatura corroboram com a escolhaem primeiro plano de um tratamentoconservador, reversível e não invasivo. Dentre as opções destacam-se orientações de autocuidado, confecção de placa oclusal, terapias manuais, exercícios musculares, biofeedback e manejo farmacológico em casos de sintomas somáticos. A toxina botulínica tem sido sugerida para tratamento em casos de disfunções temporomandibularesmusculares, no entanto, com baixa evidência científicaquanto aos efeitos adversos. Técnicas cirúrgicas são indicadas em casos de não resolução com terapias conservadoras.Conclusões:Apesar dagrande diversidade nos protocolos,o tratamento conservador demonstra resolução do problema na maioria dos casos de disfunções temporomandibularese aquelestratamentos que combinam várias técnicasevidenciam melhores resultados do que tratamentos isolados (AU).

Introduction: Temporomandibular disorders are a collectiveterm for a range of clinical signs and symptoms involving the masticatory muscles, the temporomandibular joint, and associated structures. Treating patients with disorder temporomandibularshould involve a multidisciplinary team, and for effective intervention in dysfunction treatment, it is necessary for the involved professionals to work together and have a comprehensive understanding of stomatognathic functions. Objective: review the literature on therapeutic modalities for temporomandibular disorders and their effectiveness. Methodology:This is a study on the current landscape of therapies used for the treatment of temporomandibular disorders. To compose this work, the PubMed database was consulted using the keywords "temporomandibular disorder" and "therapy" associated with the boolean operator AND. Inclusion criteria were articles published in English from 2020 to 2024. The search yielded a total of 545 articles, from which articles deviating from the proposed theme, articles discussing techniques with little scientific basis, and articles not fully available were excluded. Results:Literature findings support the prioritization of conservative, reversible, and non-invasive treatment. Among the options, self-care guidance, occlusal splint fabrication, manual therapies, muscle exercises, biofeedback, and pharmacological management for somatic symptoms stand out. Botulinum toxin has been suggested for treatment in cases of muscular disordertemporomandibular, however, with low scientific evidence regarding adverse effects. Surgical techniques are indicated in cases where conservative therapies fail to resolve the issue. Conclusions:Despite the diversity in protocols, conservative treatment demonstrates resolution of the problem in most cases of disorder temporomandibular,and treatments combining multiple techniques show better results than isolated treatments (AU).

Introducción:Las disfunciones temporomandibulares son un término colectivopara una serie de signos y síntomas clínicos que afectan a los músculos masticatorios, la articulación temporomandibular y estructuras asociadas. El tratamiento de pacientes con disfunciones temporomandibularesdebe involucrar a un equipo multidisciplinario para una intervención efectiva, requiriendo que los profesionales actúen conjuntamente y conozcan bien las funciones estomatognáticas. Objetivo:revisar la literatura sobre las terapias paradisfunciones temporomandibularesy su eficacia. Metodología:Estudio comparativo de las terapias actuales para disfunciones temporomandibulares, utilizando la base de datos PubMed con las palabrasclaves "temporomandibular disorder" y "therapy" y el operador booleano AND, limitado a 2020-2024 en inglés. La búsqueda obtuvo un total de 545 artículos de los cuales fueron excluidos los que no abordaban el tema propuesto. Resultados:Los hallazgos respaldan un tratamiento conservador, reversible y no invasivo, destacando el autocuidado, placas oclusales, terapias manuales, ejercicios, biofeedback y manejo farmacológico. La toxina botulínica se sugiere para disfunciones temporomandibulares musculares, pero con poca evidencia científica de sus efectos adversos. Las técnicas quirúrgicas se reservan para casos sin resolución.Conclusiones: A pesar de la diversidad de protocolos, el tratamiento conservador resolveula mayoría de los casos de disfunciones temporomandibulares, y los tratamientos combinados muestran mejores resultados que los aislados (AU).

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BACKGROUND: Bladder training (BT), the maintenance of a scheduled voiding regime at gradually adjusted intervals, is a common treatment for overactive bladder (OAB). OBJECTIVES: To assess the effects of isolated BT and/or in combination with other therapies on OAB symptoms. METHODS: A systematic review of eight databases was conducted. After screening titles and abstracts, full texts were retrieved. Cochrane RoB 2 and the GRADE approach were used. RESULTS: Fourteen RCTs were included: they studied isolated BT (n = 11), BT plus drug treatment (DT; n = 5), BT plus intravaginal electrical stimulation (IVES; n = 2), BT plus biofeedback and IVES (n = 1), BT plus pelvic floor muscle training and behavioral therapy (n = 2), BT plus percutaneous tibial nerve stimulation, and BT plus transcutaneous tibial nerve stimulation (n = 1). In a meta-analysis of short-term follow-up data, BT plus IVES resulted in greater improvement in nocturia (mean difference [MD]: 0.89, 95% CI: 0.5, 1.20), urinary incontinence (UI; MD: 1.93, 95% CI: 1.32, 2.55), and quality of life (QoL; MD: 4.87, 95% CI: 2.24, 7.50) than isolated BT, while DT and BT improved UI (MD: 0.58, 95% CI: 0.23, 0.92) more than isolated BT. CONCLUSION: In the short term, BT plus IVES improves the OAB symptoms of nocturia and UI while improving QoL. The limited number of RCTs and heterogeneity among them provide a low level of evidence, making the effect of BT on OAB inconclusive, which suggests that new RCTs should be performed.

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Osteoporotic vertebral fractures frequently result in pain and decreased quality of life (QoL). The management of these fractures remains a topic of debate. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we analyzed randomized controlled trials comparing percutaneous vertebroplasty (PV) with non-operative treatment (non-OT). The outcomes of interest included pain, QoL, cement leakage, and new osteoporotic vertebral fractures after 1 year. Compared to non-OT regarding pain relief, PV yielded significant improvement at 1-2 weeks, 1 month, 6 months (standard mean difference [SMD] = -0.67 (6/14; 95% confidence interval [CI]: -1.29 to -0.06; I2 = 92%, random effects) and 1 year (mean difference = -1.07 (4/14; 95% CI: -1.97 to -0.18; I2 = 97%, random effects). For QoL, notable improvements were observed at 1 week (standard mean difference = -2.10 (5/14; 95% CI: -3.77 to -0.42; I2 = 98%, random effects) and 3 months (mean difference = -1.58 (4/14; 95% CI: -3.07 to -0.09; I2 = 96%, random effects), with 1 month, 6 months and 1 year being inconclusive. A cement leakage rate of 42% (10/14; 95% CI: 25% to 59%; I2 = 99%, random effects) was found. Further, PV did not significantly heighten the risk of new fractures within a year (odds ratio = 1.26 (6/14; 95% CI: 0.63 to 2.53; I2 = 74%, random effects). PV emerges as a promising intervention for specific time intervals regarding pain relief, especially in the extended-term analysis, and QoL, especially in the short-term analysis, compared to non-OT. However, clinicians must consider cement leakage risks. Heterogeneity among studies underscores careful patient selection.

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Objective: To investigate whether a combined hip and knee muscle strengthening program is superior to a knee strengthening program for people after lateral patellar dislocation (LPD). Design: Single-blind, superiority, randomized controlled trial with 48 weeks follow-up. Setting: Physiotherapy out-patient clinic. Participants: Forty individuals aged 16 or older, with a history of non-traumatic LPD were randomized to a knee-based strengthening (KBSG) or quadriceps and hip strengthening exercise (HQSG) program (N=40). Inclusion criteria included a positive apprehension sign, pain on palpation along the medial retinaculum, and J sign. Exclusion criteria included restricted range of motion (<90° knee flexion), and traumatic or postsurgical LPD. Interventions: Concealed randomization was performed using random permuted blocks of size 4. Individuals received their corresponding exercise program according to randomization and group allocation: knee-based strengthening (n=20) or combined hip and quadriceps strengthening (n=20) twice weekly for 8 weeks over 16 appointments. Main Outcome Measures: Primary outcome was the Lysholm Knee Score. Secondary outcomes included Numerical Pain Ratings Scale (NPRS) at rest and during effort, Norwich Patellar Instability Score (NPIS), Kujala Anterior Knee Pain Scale (AKPS), Lower Extremity Functional Scale (LEFS), 4 domains of the WHOQOL-Bref, and recurrence rate. Patient-reported outcome measures were assessed from the baseline to 48 weeks. Assessments were performed by a physiotherapist who was blinded to the group allocation. Data were analyzed by using a repeated-measures ANOVA model with Tukey's post hoc test after an intention-to-treat principle. Results: At the primary time-point of 8 weeks, there were no substantial between-group differences in the Lysholm Knee Score: mean difference=-6.8 (95% CI -14.3 to 3.7); NPIS: mean difference=23.5 (95% CI 5.6 to 41.3); AKPS: mean difference=-1.54 (95% CI -8.6 to 5.6), NPRS at rest and during effort (mean difference=0.32 (95% CI -0.37 to 1); and mean difference=0.68 (95% CI -0.9 to 1.86); LEFS mean difference=-1.08 (95% CI -5.9 to 2.4), WHOQOL-Bref domains (physical health: mean difference=-0.12, (95% CI -1.26 to 1.02); psychological: mean difference=-0.32 (95% CI -2.04 to 1.4); social relations: mean difference=-0.7 (95% CI -2.2 to 0.82); environment: mean difference=0.44 (95% CI -1 to 1.9), and recurrence rate (P=.69). Conclusion: This study indicates that combined hip and knee muscle strengthening is not superior to knee-based strengthening for LPD treatment. The limitations stemming from the underpowered nature of the trial must be acknowledged, concerning the potential oversight of moderate intervention effects.

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Odontogenic Keratocyst (OKC) is an aggressive cystic lesion of the jaws and one of the most common odontogenic cysts, usually affecting the posterior region of the mandible. Recurrences are frequently recorded and may be directly related to the treatment modality adopted. Two patients presenting OKC were treated by combining decompression and intralesional irrigation with the drug Elixir Sanativo® for 8 months before enucleation surgery. In both patients, the association between decompression and irrigation with Elixir Sanativo® represented a safe and effective method to reduce the preoperative lesion dimensions.

El queratoquiste odontogénico (QO) es una lesión quística agresiva de la mandíbula y es uno de los quistes odontogénicos más frecuentes, que suele afectar a la región posterior de la mandíbula. Las recidivas se registran con frecuencia y pueden estar directamente relacionadas con la modalidad de tratamiento adoptada. Presentación del caso: Dos pacientes que presentaban OKC fueron tratados combinando descompresión e irrigación intralesional con el fármaco Elixir Sanativo® durante 8 meses antes de la cirugía de enucleación. En ambos pacientes, la asociación entre descompresión e irrigación con Elixir Sanativo® representó un método seguro y eficaz para reducir las dimensiones de la lesión preoperatoria.

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Objective: This article aims to evaluate the evolution of radio-graphic parameters (radial tilt, volar tilt, and radial height) of distal radius fractures in patients indicated for conservative treatment at three different times: date of diagnosis, first outpatient visit within 2 weeks after closed reduction, and last outpatient visit. Methods: We included 84 patients seen at the emergency department of Hospital Municipal Odilon Behrens, with a diagnosis of distal radius fracture and an indication for conservative treatment. We considered only those patients who had serial radiographs taken at least three different times (n=69) in this analysis. Results: There was an improvement in radiographic parameters of volar tilt after closed reduction and immobilization, which was maintained until the last outpatient visit. Radial inclination and radial height showed increased values from the first to the second radiographic evaluation and both values had regression when comparing the second to the third (last) evaluation. Conclusion: Universal classification stable fractures tend to evolve well with conservative therapy. Level of Evidence II; Development of Diagnostic Criteria in Consecutive Patients (with Gold Standard of Reference Applied).

Objetivo: O objetivo deste artigo foi avaliar a evolução dos parâmetros radiográficos (inclinação radial, inclinação volar e altura radial) das fraturas da extremidade distal do rádio em pacientes com indicação de tratamento conservador em três momentos diferentes: data do diagnóstico, primeira consulta ambulatorial dentro de. semanas após a redução fechada e última consulta ambulatorial. Métodos: Incluímos 84 pacientes atendidos no departamento de emergência do Hospital Municipal Odilon Behrens, com diagnóstico de fratura distal do rádio e indicação de. conservador. Consideramos nesta análise apenas os pacientes que tiveram radiografias seriadas realizadas pelo menos três vezes diferentes (n=69). Resultados: Houve uma melhora nos parâmetros radiográficos da inclinação volar após a redução fechada e a imobilização, que foi mantida até a última consulta ambulatorial. A inclinação radial e a altura radial apresentaram valores aumentados da primeira para a segunda avaliação radiográfica e ambos os valores tiveram regressão quando comparados da segunda para a terceira (última) avaliação. Conclusão: As fraturas estáveis de classificação universal tendem a evoluir bem com a terapia conservadora. Nível de Evidência II; Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com aplicação de referência padrão ouro).

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INTRODUCTION: One of the changes caused by pelvic cancers is the decrease in patients' sexual function, which influences their quality of life (QoL) during and after treatment. Sexual dysfunction (SD) is associated with severe ejaculatory dysfunction, sexual dissatisfaction, reduced libido and sexual desire, decreased intensity of orgasm, difficulty in erection, and lower sexual frequency. OBJECTIVES: This systematic review investigated the effectiveness of conservative treatments (nonsurgical and nonpharmacologic) for SD in males with pelvic cancer. METHODS: Systematic searches were performed in the Cochrane Library, PubMed, CINAHL, PEDro, Embase, and VHL databases in September 2023 by using MeSH terms related to population, study design, intervention, and outcome. RESULTS: Only prostate cancer studies were included due to a lack of studies in other treatments. Studies used pelvic floor muscle training (8 studies); biofeedback (1 study); a penile vibrator (1 study); electrostimulation (2 studies); shock wave therapy (2 studies); aerobic, resistance, and flexibility exercises (2 studies); and a vacuum erection device (1 study). All articles assessed sexual function and reported improvements in the intervention group, including 5 with no differences between the groups. Articles involving shock wave therapy described improvements in SD but were not clinically relevant. Studies evaluating QoL reported benefits in the experimental groups. Adverse effects of a vacuum erection device and penile vibrator were reported. CONCLUSION: Conservative treatments are more effective than others in treating SD in men with prostate cancer. Further studies are needed to assess the unwanted effects of these treatments. In this study, we found evidence that this type of therapy improves sexual function and QoL in this population.

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BACKGROUND: The registry of cerebral aneurysms <5 mm, known for their low risk of rupture, is significant, given their high incidence globally. Our study aimed to identify, in small aneurysms (<5 mm), the potential morphological characteristics, risk factors that can predict the risk of rupture, and the risk or benefit of treating them with endovascular or conservative treatment in ruptured and unruptured intracranial aneurysms. METHODS: The medical records of patients with cerebral aneurysms <5 mm were retrospectively reviewed between January 2014 and December 2022 at two neurovascular centers in Colombia. We evaluated clinical and angiographic outcomes using statistical tests. RESULTS: Two hundred fifty-six patients (425 intracranial aneurysms) were registered in the database. Two hundred and seventy-five IA were treated with endovascular treatment: 70 ruptured aneurysms and 205 unruptured aneurysms. One hundred fifty intracranial aneurysms underwent conservative treatment (follow-up). Women accounted for 82.1% of cases. Most cases were incidentally diagnosed (83.5%). After a year of follow-up, 87.3% of unruptured and 67.1% of ruptured intracranial aneurysms had an mRS 0-2. In the Raymond-Roy occlusion classification, among 101 unruptured intracranial aneurysms embolized were 53 cases class I, and among 66 ruptured intracranial aneurysms embolized, 67.1% were class I. CONCLUSION: Endovascular therapy for aneurysms <5 mm appears to be a technically feasible treatment, with satisfactory occlusion rates and few re-treatments at the 12-month follow-up. The complication rates were similar to those reported in studies on small aneurysms.

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OBJECTIVES: The aim of the study was to investigate the clinical effect of stainless-steel wire fixation on the early mouth-opening movement of an intracapsular fracture involving the condylar process. MATERIALS AND METHODS: In this study, patients who underwent mandibular condylar intracapsular fracture surgery in our hospital from 2012 to 2020 were selected as research subjects. A total of 44 patients received steel wire internal fixation treatment, 32 patients received titanium plate-and-nail rigid internal fixation, and 28 patients underwent conservative non-surgical treatment. RESULTS: For the patients in the stainless-steel wire group, the degree of mouth opening reached normal levels of 3.7 cm approximately 10 days after surgery. The recovery time for the patients in the titanium plate-and-nail rigid internal-fixation group was 21 days, while the patients in the conservative treatment group needed 60 days to recover. CONCLUSION: The treatment of fixation with a stainless-steel wire for intracapsular condylar fracture reduced the time taken to perform mouth-opening exercises and improved the recovery rate of patients.

OBJETIVO: Explorar el efecto clínico de la fijación de alambre de acero inoxidable en el movimiento temprano de apertura de la boca en la fractura interna del cóndilo. MÉTODO: Este estudio seleccionó a pacientes que se sometieron a cirugía de fractura intracapsular de cóndilo en nuestro hospital de 2012 a 2020 como sujetos de investigación. Un total de 44 pacientes recibieron tratamiento de fijación interna de alambre de acero, 32 recibieron placa de titanio y fijación interna con clavos, y 28 recibieron tratamiento conservador no quirúrgico. RESULTADOS: En los pacientes del grupo de alambre de acero inoxidable, alrededor de 10 días después de la cirugía el grado de apertura de la boca alcanzó un valor normal de 3.7 cm. El tiempo de recuperación de los pacientes en el grupo de fijación interna con clavos y placa de titanio fue de 21 días, mientras que los pacientes en el grupo de tratamiento conservador tardaron 60 días en recuperarse. CONCLUSIONES: La fijación con alambre de acero inoxidable para el tratamiento de la fractura intracapsular del cóndilo acorta el tiempo hasta la apertura de la boca y mejora la tasa de recuperación de los pacientes.

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Introdução: O processo de desmineralização proveniente da cárie leva à formação de manchas brancas que são a primeira manifestação visível da doença. Os infiltrantes resinosos surgem como uma alternativa para o tratamento dessas lesões não cavitadas, pois sãoresinas de baixa viscosidade e faz parte dos procedimentos que visam uma odontologia menos invasiva. Objetivo: Este estudo objetiva relatar a experiência clínica no uso de infiltrante resinoso, Icon, em lesões de mancha branca de etiologias cariosa e não cariosa em dois pacientes distintos, insatisfeitos com a estética do seu sorriso. Descrição do caso: Ao exame clínico foi observado nos pacientes com lesões brancas. No primeiro paciente, de 14 anos, verificou-se a presença da atividade de cárie e micro cavitações. Dessa forma, o plano de tratamento perpassou orientação de higiene oral supervisionada, aplicação de verniz fluoretado, Enamelast, semanal, adequação do meio com restaurações em resina, e só então o uso do infiltrante. A segunda paciente, de 11 anos, já possuía saúde bucal adequada e tinha queixa estética devido à lesão branca não cariosa, hipoplasia, cujo plano de tratamento foi à utilização do Icon apenas. Conclusões: Nos dois casos obteve-se melhoria estética considerável com este procedimento microinvasivo. Melhoria na saúde bucal, aliado à devolução da estética, pode ser observada com o uso de infiltrantes resinosos (AU).

Introduction: The process of demineralization resulting from caries leads to the formation of white spots that are the first visible manifestation of the disease. Resin infiltrants appear as an alternative for the treatment of these non-cavitated lesions, since they are low viscosity resins and are part of the procedures that aim at a less invasive dentistry.Objective:This study aims to report the clinical experience in the use of a resin infiltrant, Icon,in white spot lesions of carious and non-carious etiologies in two different patients who were dissatisfied with the esthetics of their smiles.Methodology: On clinical examination, white lesions were observed in both patients. In the first patient,14 years old,the presence of caries activity and micro cavitations was verified. Thus, the treatment plan included supervised oral hygiene guidance, weekly application of fluoride varnish,Enamelast, adaptation of the environment with resin restorations, and, onlythen, the use of the infiltrant, Icon. The second patient, 11 years old,already had adequate oral health and had an esthetic complaint due to a non-carious white lesion, hypoplasia, whose treatment plan consisted of the use of Icon only.Conclusions:In both cases considerable esthetic improvement was obtained with this microinvasive procedure. Improvement in oral health, combined with the return of esthetics, can be observed with the use of resin infiltrants (AU).

Introducción: El proceso de desmineralización resultante de la caries conduce a la formación de manchas blancas, que son la primera manifestación visible de la enfermedad. Losinfiltrantes de resina aparecen como una alternativa para el tratamiento de estas lesiones no cavitadas, pues se tratan de resinas de baja viscosidad y forman parte de los procedimientos que buscan una odontología menos invasiva. Objetivo:Este estudio tiene como objetivo relatar la experiencia clínica en el uso del infiltrante de resina,Iconen lesiones de mancha blanca de etiologías cariosas y no cariosas en dos pacientes diferentes, insatisfechos con la estética de sus sonrisas.Metodología: En el examen clínico se observaron lesiones blancas en ambos pacientes. En el primer paciente, 14 añosse verificó la presencia de actividad de caries y micro cavitaciones. De ese modo, el plan de tratamiento incluyó la orientación supervisada de la higiene bucal,la aplicación semanal de barniz de flúor (Enamelast), la adaptación del entorno con restauraciones de resina y, sólo después, el uso del infiltrante,Icon. La segunda paciente, 11 años,ya tenía una salud bucal adecuada y presentaba una queja estética debido a una lesión blanca no cariosa, hipoplasia, cuyo plan de tratamiento fue el uso exclusivo de Icon. Conclusiones: En ambos casos, se consiguió una mejora estética considerable con este procedimiento microinvasivo. La mejora de la salud bucal, unida a la recuperación de la estética, puede observarse con el uso de infiltrantes de resina (AU).

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