Condiciones de aplicación del injerto ilíaco óseo en la sustitución de defectos mandibulares: un estudio retrospectivo de 11 años de experiencia / Conditions of iliac bone grafts application in mandibular defects replacement: a retrospective study of 11-years’ experience

Antecedentes: Este estudio tenía como objetivo aclarar la aparición y las causas de complicaciones postoperatorias en pacientes con defectos mandibulares continuos, reconstruidos con injertos óseos ilíacos libres. Pacientes y métodos: Los pacientes con defecto de continuidad mandibular con pérdida de tejido óseo, que dio lugar a una brecha de 2 cm o más, se sometieron a reconstrucción con injerto óseo de cresta ilíaca no vascularizado. La variable de resultado fue el fracaso del injerto, que se definió como su pérdida por infección postoperatoria, exposición del injerto, reabsorción completa o no unión del injerto. Los factores predictivos fueron el momento de la reconstrucción, la longitud del defecto óseo, la presencia preoperatoria de defecto mucoso y/o dehiscencia y el método de fijación. Todas las variables explicativas y predictoras se analizaron mediante regresión logística binomial univariante.Resultados: El estudio incluyó los resultados de 50 reconstrucciones mandibulares con injerto óseo de cresta ilíaca no vascularizado que se observaron retrospectivamente. El seguimiento de los pacientes incluidos osciló entre 6 meses y 11 años. 34 pacientes (68 %) tuvieron resultados quirúrgicos satisfactorios. En 16 pacientes (32 %) se perdieron los injertos óseos. Todos ellos debido al desarrollo de infección, supuración y/o exposición del injerto durante los primeros 6 meses del periodo de observación. En el análisis univariante, las principales variables predictoras de fracaso fueron el tabaquismo (OR 5,8; IC: 1,48-22,7; p = 0,002), el momento de la reconstrucción (OR 7,94; IC: 1,88-33,5; p = 0,004) y el defecto o dehiscencia de la mucosa (OR 8,49; IC: 2,21-32,6; p = 0,002). El análisis multivariante también reveló la afectación sinfisaria del defecto (OR 5,63; IC: 1,14-27,8; p = 0,034) como factor predictivo significativo de fracaso en un caso de reconstrucción inmediata. ... (AU)

Background: This study aimed to clarify the occurrence and causes of postoperative complications in patients with continuous mandibular defects, reconstructed with free iliac bone grafts.Patients and methods: Patients with mandibular continuity defect with bone tissue loss, resulting in a 2 cm gap or more underwent reconstruction with non-vascularized iliac crest bone graft. The outcome variable was graft failure which was defined as its loss due to the postoperative infection, graft exposure, full resorption or non-unition of the graft. The predictors were timing of reconstruction, length of the bone defect, preoperative presence of mucosa defect and/or dehiscence and fixation method. All explanatory and predictor variables were analyzed with univariate binomial logistic regression.Results: The study included the results of 50 mandibular reconstructions with non-vascularized iliac crest bone graft which were observed retrospectively. The follow-up of included patients ranged from 6 months to 11 years. 34 patients (68 %) had successful surgery results. In 16 patients (32 %) the bone grafts were lost. All of them due to the infection development, suppuration and/or graft exposure during the first 6-months of the observation period. In univariate analysis, the main failure predictor variables were smoking (OR 5.8, CI 1.48-22.7, p = 0.002), timing of reconstruction (OR 7.94, CI 1.88-33.5, p = 0.004) and mucosa defect or dehiscence (OR 8.49, CI 2.21-32.6, p = 0.002). The multivariate analysis also revealed symphyseal involvement of defect (OR 5.63, CI 1.14-27.8, p = 0.034) as the significant failure predictor in a case of immediate reconstruction. The length of defect and fixators type remained statistically non-significant for mandibular reconstruction with NVICG (p < 0.05).Conclusion: ... (AU)

Atrofia combinada maxilo-mandibular. Uso de implantes cortos y estrechos (BTI(R) CORE y BTI(R) 3.0) / Combined maxillo-mandibular atrophy. Use of short and narrow implants (BTI(R) CORE AND BTI(R) 3.0)

Cada día con más frecuencia en las clínicas odontológicas nos enfrentamos a atrofias maxilares y mandibulares más extremas y en muchos casos con el retratamiento de implantes fracasados biológica y/o mecánicamente. En el presente caso clínico mostramos una paciente con una atrofia combinada (horizontal y verticalmente) además de un tratamiento con implantes dentales fracasado

More and more frequently in dental clinics we are confronted with more extreme maxillary and mandibular atrophy and in many cases with the retreatment of biologically and/or mechanically failed implants. In the present clinical case we show a patient with a combined atrophy (horizontally and vertically) in addition to a failed dental implant treatment

Planificación, resultados y anatomía de la vía aérea superior en síndrome de apnea/hipopnea obstructiva del sueño tras avance bimaxilar: 20 casos / Planning, results and anatomy of the upper airway in obstructive sleep apnea/hypopnea syndrome after bimaxillary advancement: 20 cases

OBJETIVOS: El objetivo es presentar el protocolo de trabajo, resultados clínicos y cambios en la vía aérea superior de una cohorte de 20 pacientes con síndrome de apnea/hipopnea obstructiva del sueño, intervenidos de avance maxilomandibular con rotación antihoraria. MATERIAL Y MÉTODOS: Un comité multidisciplinar determina la indicación quirúrgica, que los pacientes consienten. Se llevan a cabo tomografías computarizadas y polisomnografías antes y después de la cirugía, como protocolo habitual de trabajo. El comité ético de investigación clínica regional aprobó el estudio. Longitudes, volúmenes, área mínima, dimensión anteroposterior, dimensión transversal y otras medidas son determinadas en la vía aérea. El análisis estadístico es descriptivo y comparativo por pares con p < 0,05. RESULTADOS: Los movimientos planificados son 10,40 mm de avance y 2,11 mm de impactación anterior. El índice de apnea/hipopnea se reduce 30,50 puntos y la saturación de oxígeno capilar periférica mínima aumenta 5,00 puntos. Los resultados clínica y estadísticamente significativos son: 10,98 mm de acortamiento y 6,26 mm3 de incremento de volumen, especialmente en el compartimento retro-palatal; 91,45 mm2, 3,68 mm y 8,00 mm de aumento de área, dimensión antero-posterior y dimensión transversal respectivamente; el hioides avanza 1,92 mm. CONCLUSIONES: El avance maxilomandibular con rotación antihoraria en síndrome de apnea/hipopnea del sueño moderado-severo logra a corto plazo índice de apnea/hipopnea < 15 en el 80 % y saturación de oxígeno periférica capilar > 85 en el 75 % de nuestra serie. Los principales cambios en vía aérea son: acortamiento, incremento de volumen y áreas, forma elíptica y posicionamiento antero-superior del hioides

OBJECTIVES: To present the working protocol, clinical outcomes and upper airway changes of a 20-patient cohort with moderate-severe obstructive sleep apnea/hypopnea syndrome undergoing maxillo-mandibular advancement with counterclockwise rotation. MATERIAL AND METHODS: A multidisciplinary committee determines the surgical indication, which patients consent. Computed tomographies and polysomnographies are performed before and after surgery, as the usual clinical practice protocol. The clinical investigation ethics institutional review board approved the study. Lengths, volumes, minimum area, antero-posterior dimension, transverse dimension and other measurements are determined in the upper airway. Statistical analysis is descriptive and comparative by pairs with p < 0.05. RESULTS: Planned movements are 10.40 mm of advance and 2.11 mm of anterior impaction. Apnea/hypopnea index reduces by 30.50 points and minimum peripheral capillary oxygen saturation increases by 5.00 points. Clinically and statistical significant findings are: 10.98 mm of shortening and 6.26 mm3 of volume enlargement, especially in the retro-palatal compartment; 91.45 mm2, 3.68 mm and 8.00 mm of area, antero-posterior dimension and transverse dimension widening respectively; hyoid bone advances 1.92 mm. CONCLUSIONS: Maxillo-mandibular advancement with counterclockwise rotation in moderatesevere obstructive sleep apnea/hypopnea syndrome achieves in short-term follow-up apnea/hypopnea index < 15 in 80 % and minimum peripheral capillary oxygen saturation > 85 in 75 % of our series. Main upper airway changes are: shortening, volume and area increase, elliptical shape, and antero-superior hyoid bone movement

Riesgos asociados al uso de Expansión Rápida del Maxilar / Risks associated with the use of Maxillary Rapid Expansion

INTRODUCCIÓN: Las anomalías dentomaxilares corresponden a un grupo de alteraciones que dificultan el desarrollo armónico de los maxilares, donde encontramos las anomalías transversales. La expansión rápida del maxilar (ERM) se utiliza como tratamiento de anomalías transversales, su objetivo es aumentar la distancia transversal por la separación de ambas hemiarcadas a nivel de la sutura palatina, utilizando un aparato expansor fijo y rígido. Los disyuntores más utilizados son los expansores Hass, Hyrax y de McNamara. OBJETIVO: El objetivo de la presente revisión es identificar los riesgos de la RME reportados en la literatura relacionados con disyuntores Hass, Hyrax y Mc Namara. METODOLOGÍA: Se realizó una búsqueda en PubMed, Scielo, Science Direct, Trip Database y Google Acadèmico utilizando los tèrminos: "Rapid Maxillary Expansion", "Risks", "Child", "Maxillary Expansion", "RME", "Palatal Expansion", "Hyrax", "Hass". Se incluyeron estudios en inglès y español, sin límites en el año de publicación o tipo de estudio. Como criterios de exclusión consideramos la expansión quirúrgica, expansión lenta u otro tratamiento simultáneo durante la fase de expansión activa. RESULTADOS: De los artículos encontrados, veinte cumplieron los criterios de inclusión. Dentro de los riesgos se encuentran: deglución accidental del dispositivo de activación del expansor, bacteremia transitoria, desviación del septum nasal, reabsorción radicular, compromiso periodontal, cambio posicional de los cóndilos, cambios faciales de tejido blando y cambios esqueletales. CONCLUSIÓN: La ERM es un procedimiento ortopèdico eficaz, sus indicaciones en el tratamiento precoz han aumentado debido a resultados positivos. De acuerdo con la bibliografía encontrada los beneficios superan considerablemente a los efectos negativos

INTRODUCTION: The dentomaxillary anomalies correspond to a group of alterations that hinder the harmonic development of the jaws, where we find the transversal anomalies. Rapid Maxillary Expansion (RME) is used as a treatment for transverse anomalies, its objective is to increase the transversal distance by separating both hemiarchies at the level of the palatal suture, using a fixed and rigid expander. The most used are the Hass, Hyrax and McNamara expanders. OBJECTIVE: The objective of this review is to identify the EMR risks reported in the literature related to Hass, Hyrax and Mc Namara expander. METHODOLOGY: A search was made in PubMed, Scielo, Science Direct, Trip Database and Google Scholar using the terms: "Rapid Maxillary Expansion", "Risks", "Child", "Maxillary Expansion", "RME", "Palatal Expansion", "Hyrax", "Hass". Studies in English and Spanish were included, without limits in the year of publication or type of study. As exclusion criteria, we consider surgical expansion, slow expansion or other simultaneous treatment during the active expansion phase. RESULTS: Of the articles found, twenty met the inclusion criteria. Among the risks are: accidental swallowing of the expander activation device, transient bacteremia, deviation of the nasal septum, root resorption, periodontal involvement, positional change of the condyles, soft tissue facial changes and skeletal changes. CONCLUSION: RME is an effective orthopedic procedure, its indications in early treatment have increased due to positive results. According to the bibliography found, the benefits considerably outweigh the negative effects

Fusión congénita de la mandíbula con el maxilar y complejo cigomático, revisión de la literatura. Reporte de un caso / Congenital fusion of the mandible with the maxilar and the zygomatic complex, literatura review. A case report

La signatia es una rara malformación congénita en la que se encuentra una fusión ósea del maxilar con la mandíbula. Puede ser unilateral o completa y se caracteriza por la incapacidad de abrir la boca del recién nacido. Esta puede clasificarse de acuerdo con su presentación clínica. Las complicaciones de esta anomalía pueden ser muy graves: incompatibilidad con la vida, incapacidad de proteger la vía aérea, dificultades para la alimentación, así como alteraciones en el crecimiento. Se han referido casos con distintos abordajes, por lo que el protocolo terapéutico-quirúrgico estará dado según las particularidades de cada individuo. En el presente caso se hace referencia de un lactante femenino que se presentó con fusión del complejo cigomático-maxilar con la mandíbula unilateral, el abordaje y seguimiento

Syngnathia is a rare congenital malformation in which a fusion of the mandible with the maxilla is found, it can be unilateral or complete and is characterized by the inability to open the mouth of the newborn, this can be classified according to its clinical presentation. The complications of this anomaly can be inability to protect the airway, difficulties for feeding, as well as alterations in growth. There have referred cases with different approaches, thus the therapeutic-surgical protocol will be given according to the particularities of each individual. In the present case reference is made of female infant with unilateral maxillo-mandibular-zygomatic fusion, diagnosis and follow-up

Técnicas de reposición del nervio alveolar inferior: transposición y lateralización / Techniques for the reposition of the inferior alveolar nerve: transposition and lateralization

La rehabilitación de los sectores mandibulares con atrofias óseas severas utilizando implantes es objeto de desafío para cualquier profesional debido a las dificultades que presentan. Existen dos técnicas quirúrgicas para llevar a cabo la reposición del nervio dentario que son relativamente seguras y ofrecen una alta tasa de supervivencia de los implantes: la transposición y la lateralización. El objetivo de este trabajo es llevar a cabo una actualización sobre las técnicas de reposición del nervio alveolar inferior, y para ello se ha efectuado una búsqueda de estudios sobre humanos empleando las bases de datos PubMed y Scopus, utilizando como palabras clave: "transposition", "alveolar nerve", "atrophic mandibles" y "nerve complications". Se revisan para ello un total de 22 artículos de casos clínicos y estudios in vitro; 9 de ellos sobre lateralización, 8 sobre transposición y 5 sobre ambas técnicas. Tanto la lateralización como la transposición del nervio dentario presentan riesgos relacionados con complicaciones neurosensoriales y fractura mandibular. Se observa una alta tasa de éxito en la supervivencia de los implantes sin discriminación significativa de la técnica. Las técnicas de reposición del nervio dentario no están exentas de complicaciones. La inserción de los implantes combinados con la técnica de transposición presenta un comportamiento similar a cualquiera de las otras técnicas empleadas en el campo de la implantología, siendo su pérdida ósea marginal similar a la de otras superficies implantarias

The use of dental implants for the rehabilitation of the atrofic posterior mandible has been a challenge due to the complications they may carry. There are two surgical techniques for the reposition of the inferior alveolar nerve which are relatively sure and offer a high survival rate of the implants: transposition and lateralization. A research of studies about human beings is carried out, using PubMed and Scopus data bases. The key words were: "transposition", "alveolar nerve", "atrophic mandibles" and "nerve complications". It is performed a total review of 22 articles of clinical cases and in vitro studies; 9 about lateralization, 8 about transposition and 5 about both techniques. Both lateralization and transposition of the inferior alveolar nerve present risks related with neurosensorial complications and mandibular fracture. A high survival rate of the implants without discrimination of the technique is observed. Complications may appear when reposition technique of the inferior alveolar nerve is performed. It is observed a similar behavior between the use of dental implants with a reposition technique and any other, especially in terms of marginal bone loss

Estabilidad esquelética postoperatoria en la cirugía ortognática bimaxilar convencional vs. rotación del complejo maxilomandibular / Postoperative skeletal stability in conventional bimaxillary orthognathic surgery vs rotation of the maxillomandibular complex

Introducción: La estabilidad esquelética postoperatoria en cirugía ortognática ha sido objeto de evaluación durante el paso del tiempo. Diversos autores han reportado que se produce una disminución de la misma en diversos movimientos de los maxilares en ocasiones utilizados en casos de rotación del complejo maxilomandibular. El objetivo del presente trabajo fue comparar la estabilidad esquelética postoperatoria de la cirugía ortognática bimaxilar convencional vs. cirugía ortognática bimaxilar con rotación del complejo maxilomandibular en pacientes sometidos a cirugía ortognática en el Servicio de Cirugía Oral y Maxilofacial del Hospital Militar Central de Bogotá, entre enero de 2012 hasta julio de 2016. Materiales y métodos: Se trata de un estudio retrospectivo. Se llevó a cabo análisis cefalométrico para comparar la estabilidad esquelética entre los pacientes de cirugía ortognática bimaxilar convencional vs. los pacientes de cirugía ortognática bimaxilar con rotación del complejo maxilomandibular durante tres momentos: preoperatorio (T1), postoperatorio inmediato (T2), postoperatorio al menos de seis meses (T3). Resultados: Se obtuvo una cohorte de 45 pacientes sometidos a cirugía ortognática bimaxilar convencional o cirugía ortognática bimaxilar con rotación del complejo maxilomandibular. La mayoría de las medidas realizadas mostraron que no existe diferencia significativa de estabilidad a largo plazo en ambos grupos. Conclusiones: La cirugía ortognática con rotación del complejo maxilomandibular, tanto en sentido horario como antihorario, es un procedimiento estable cuando se utiliza fijación interna rígida, cuando se está en presencia de articulacion temporomandibular (ATM) sanas y cuando la rotación se lleva a cabo en un punto a través del cóndilo mandibular

Introduction: Postoperative skeletal stability in orthognathic surgery has been evaluated over time, several authors have reported a decrease of it in movements of the jaws occasionally used in cases of alteration of the maxillo-mandibular complex. The aim of the present study was to compare the postoperative skeletal stability of conventional bimaxillary orthognathic surgery versus bimaxillary orthognathic surgery with rotation of the maxillo-mandibular complex in patients undergoing orthognathic surgery at the Oral and Maxillofacial Surgery Service of the Central Military Hospital of Bogotá between January 2012 until July 2016. Materials and methods: A retrospective study was conducted. We performed a cephalometric analysis to compare the skeletal stability between patients with conventional bimaxillary orthognathic surgery versus bimaxillary orthognathic surgery patients with maxillo-mandibular alteration during 3 moments: before surgery (T1), right after the surgery (T2), at least 6 months after surgery (T3). Results: A cohort of 45 patients undergoing conventional bimaxillary orthognathic surgery or bimaxilar orthognathic surgery with rotation of the maxillo-mandibular complex was obtained. Most of the measurements showed that there is no significant difference in long-term stability in both groups. Conclusions: Orthognathic surgery with rotation of the maxillo-mandibular complex both clockwise and counter-clockwise is a stable procedure when rigid internal fixation is used, when the temporomandibular joints (TMJs) are healthy and stable and when rotation is performed at a point through the mandibular condyle

Stafne bone defects radiographic features in panoramic radiographs: Assessment of 91 cases

Background: To evaluate 91 cases of Stafne bone defect (SBD) in panoramic radiographs (PR) to determine the prevalence of different SBD variants, considering age, gender, and side. Additionally, to assess the most frequent imaging features of SBD. Material and Methods: Participant data were collected from 91 SBD cases with PR imaging. First, SBDs were classified according to their location, as anterior, posterior, or ramus variant. SBD imaging features were classified according to radiographic imaging findings, assessing margins, degree of internal radiolucency, shape, topographic relationship between the defect and mandibular border, location of the defect according to mandibular teeth, and locularity. The topographic relationship between the SBD and the mandibular canal was described for the inferior variant only. Mean sizes were also described. Results: A total of 92 SBD cases were evaluated from 91 radiographs. One case presented multiple defects. Mean patient age was 60.80 years. Men were more affected than women. The most frequent SBD variant was the posterior variant, and the least frequent was the ramus variant. The most observed radiographic features were thick sclerotic bone margin in the entire contour of the defect, partially radiolucent internal content, oval shape, continuity with mandible base without discontinuity of mandible border, third molar region location, and unilocular shape. With the posterior variant only, the most common topographic relationship between the defect and the upper wall of the mandibular canal was the defect located below the upper wall and continuous with the inferior wall of the mandibular canal. Conclusions: The knowledge of common SBD radiographic imaging features in PR can help dental practitioners with the differential diagnosis of SBD

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Doble colgajo libre para reconstrucción mandibular compleja: osteocutáneo de peroné y antebraquial radial. Caso clinic / Double free flap for complex mandibular reconstruction: osteocutaneous fibula flap and radial forearm flap. Case report

La reconstrucción mandibular con doble colgajo libre vascularizado es inusual en la reconstrucción de cabeza y cuello. El presente artículo describe el caso de una paciente de 24 años de edad con osteosarcoma condroblástico de alto grado de piso de boca y hemimandíbula izquierda. Se realizó hemimandibulectomía amplia con resección de piel submandibular, procedimiento que dejó un defecto complejo que incluía hueso, mucosa y piel. La resección tumoral y la reconstrucción del defecto fue llevada a cabo en un solo procedimiento quirúrgico a través de 2 colgajos libres: uno osteocutáneo de peroné y otro antebraquial radial. Esta reconstrucción permitió alcanzar una función masticatoria adecuada, un contorno mandibular estético y una fonación normal

Mandibular reconstruction with double vascularized free flap in the reconstruction of head and neck is unusual. This article describes the case of a female patient 24 years old with a high-grade chondroblastic osteosarcoma of the floor of the mouth and of the left hemimandible. Hemimandibulectomy was performed with a wide resection of submandibular skin, leaving a complex defect which included bone, mucosa and skin. Tumor resection and reconstruction of the defect was performed in a single surgical procedure through 2 free flaps: a free osteocutaneous fibula flap and radial forearm flap. The reconstruction allowed to achieve an adequate chewing function, aesthetic mandibular contour and normal phonation

Distracción mandibular ósea: resultados del postoperatorio inmediato / Mandibular distraction osteogenesis: immediate postoperative outcome

Introducción. La distracción osteogénica mandibular es una relativamente nueva técnica quirúrgica de alargamiento mandibular para aliviar la obstrucción de la vía aérea en pacientes con hipoplasia mandibular. Ha revolucionado el manejo de defectos en el campo de la cirugía craneofacial, y el procedimiento se ha convertido en ampliamente aceptado en hospitales de todo el mundo. Objetivos. Describir la evolución y la tasa de complicaciones en el postoperatorio inmediato de la distracción osteogénica mandibular en el Hospital Materno-Infantil de Granada, hospital de referencia andaluz de dicha técnica. Material y métodos. Estudio observacional descriptivo de los niños en los que se ha realizado una distracción mandibular en el período comprendido entre los años 2006 y 2016. Se incluyen un total de 20 pacientes. Los datos han sido analizados con el paquete estadístico IBM SPSS Statistics 20. Resultados. Precisaron ingreso en la UCIP durante 5,5 días de mediana (2-9), los días totales de ingreso hospitalario fueron de 8 días de mediana (4,25-14). Un total de 10 enfermos (50%) presentaron fiebre. Se consiguió instaurar la nutrición enteral, de media, a los 2 días de la intervención. Conclusiones. Los pacientes con secuencia Pierre Robin pueden presentar retro/micrognatia grave que les produzca desde dificultad a la entrada de aire hasta apnea obstructiva, en cuyo caso la distracción mandibular es el tratamiento de elección. El postoperatorio de dicha intervención requiere estancia en UCIP para el manejo de la vía aérea, entre otros. Según los datos que presentamos, concluimos que el postoperatorio es corto y con una baja tasa de complicaciones (AU)

Introduction. Mandibular distraction osteogenesis is a relatively new surgical technique to relieve mandibular lengthening airway obstruction in patients with mandibular hypoplasia. It has revolutionised the management of defects in the field of craniofacial surgery, and the procedure has become widely accepted in hospitals worldwide. Goals. To describe the evolution and rate of complications in the immediate postoperative period following mandibular distraction osteogenesis in the Mother and Child Hospital of Granada, Andalusia's referral hospital for this technique. Material and methods. Descriptive observational study of children who underwent mandibular distraction in the period between 2006 and 2016. A total of 20 patients were included. The data were analysed with the statistical package SPSS Statistics 20. Results. The children required admission to ICU for a median of 5.5 days (2-9), the total days of hospital stay were a median of 8 (4.25 to 14). A total of 10 patients (50%) developed a fever. Enteral nutrition was established, on average, at 2 days after surgery. Conclusions. Patients with Pierre Robin sequence may have severe retro/micrognathia causing them symptoms including from difficulty in air entry to obstructive apnoea, in which case mandibular distraction is the treatment of choice. After this intervention the postoperative period should be in ICU for airway management and other care. According to the data presented, we conclude that the postoperative period is short and with a low rate of complications (AU)

CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus: Importance to sagittal split osteotomy

Background: Mandibular Sagittal Split Osteotomy (MSSO) is a popular technique in orthognathic surgery used both to advance and to retreat the mandible. However, MSSO may incur in important complications, such as bad splits and sensorineural injuries. Knowing the location of the fusion between the buccal and lingual cortical (FBLC) in the mandibular ramus and the bone thickness in the region where osteotomies will be performed is determinant in MSSO planning to avoid complications. The aim of this study was to document and evaluate possible differences between sexes regarding the location of the FBLC in relation to the superior cortical of mandibular foramen (MF) and bone thickness in the region of interest for MSSO in a Brazilian population. Material and Methods: Eighty five cone-beam Computed Tomography (CBCT) scans were used to perform linear measurements to determine the location of the FBLC. Bone thickness from the mandibular canal (MC) to the cortical external surfaces and the diameter of the MC were measured at three different points: mandibular ramus (A), mandibular angle (B) and mesial of the second molar (C). Results: The FBLC was located at a mean distance of 8.3 mm from the superior cortical of the MF in males and 8.1 mm in females. There was no difference between males and females regarding the mean bone thickness from the MC to the buccal external surface at all the points investigated (p>0.05). Bone thickness from the lingual external surface to the MC was bigger among females than males in regions B and C (p < 0.05). The diameter of the MC was bigger among males in regions B and C. Conclusions: Sexual dimorphism regarding mandibular bone thickness but not regarding the location of FBLC was present. This fundamental knowledge may assist to the panning of MSSO (AU)

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Distracción maxilar con dispositivos internos en pacientes fisurados: Planificación virtual y transferencia de datos al campo quirúrgico / Maxillary distraction with internal devices in cleft patients: virtual planing and transference of dates to surgical field

Objetivo. Los dispositivos internos de distracción maxilar han sido poco utilizados debido a la dificultad que supone su colocación precisa. Esto se debe a que pequeñas imprecisiones en su orientación dan lugar a grandes imprecisiones en la posición final del hueso distraído. En este sentido, la cirugía asistida por ordenador es una herramienta de gran ayuda para alcanzar la máxima precisión. El objetivo de este trabajo es presentar nuestro protocolo de planificación de la posición de distractores internos, así como un nuevo objeto CAD/CAM para transferir los datos al campo quirúrgico. Material y método. Se planifica de forma virtual el avance maxilar de 2 pacientes fisurados y los vectores de movimiento virtual. Para la transferencia de datos al campo quirúrgico se utiliza una férula especial con acoples laterales que orientan el vector de distracción. Resultados. Dos pacientes fueron intervenidos con resultados satisfactorios. Conclusión. Tanto el protocolo de planificación virtual del vector de distracción como el objeto CAD/CAM para transferencia de datos al campo quirúrgico presentado son útiles para aumentar la precisión en la posición final del maxilar. De esta forma el uso de distractores internos para avances menores de 12 mm resulta una técnica predecible (AU)

Objetive. Maxillary internal distractors have not been widely used since the accurate positioning is challenging. This is because a small deviation in the positioning results in a great deviation in the final position of the distracted maxilla. Computer assisted surgery is a powerful tool to reach accurate results. The authors report a protocol for internal distractor positioning as well as a new object for transferring dates from virtual planning to surgical field. Material and method. Virtual planning was performed to plan the maxillary advance in 2 cleft patients. A wafer with 2 lateral attachments was used to transfer the vector of distraction from virtual planning to surgical field. Results. Satisfactory result was achieved in both patients. Conclusion. This virtual planning protocol as well as the CAD/CAM objet to transfer dates from computer to surgical field are useful in order to achieve a suitable final position of the maxilla. These tools facilitate the positioning of internal distractors, leaving the use of external distractors for advancement greater than 12 mm (AU)

Sarpe. Técnica de anclaje óseo. Revisión de la literatura a propósito de un caso clínico / Sarpe. Bone anchoring technique. Case report and review

Objetivo: Conocer las principales ventajas, inconvenientes y nuevas alternativas del tratamiento de expansión rápida palatina quirúrgicamente asistida o ‘SARPE’ (Surgically Assisted Rapid Palatal Expansion), realizando para ello una revisión de la literatura científica a propósito de un caso clínico de una compresión transversal del maxilar en un paciente adulto. Caso clínico: Paciente mujer de 19 años con mordida cruzada posterior bilateral asociada a hipoplasia del maxilar a la que se decide realizar un tratamiento de expansión rápida quirúrgicamente asistida. La peculiaridad de este caso se encuentra en que antes de la cirugía se colocó un disyuntor hecho a medida anclado directamente al hueso palatino. Se realizó la cirugía, la expansión y el posterior tratamiento de ortodoncia y, tras un período de seguimiento, se pudo observar una significativa expansión maxilar, evitando los inconvenientes dentales y periodontales de la técnica tradicional. Conclusiones: Los nuevos procedimientos tienden a realizar un anclaje del disyuntor al hueso palatino mediante microtornillos, consiguiendo una expansión palatina satisfactoria, pero evitando los inconvenientes que provoca utilizar un disyuntor dentoanclado (AU)

Objective: To know the main advantages, disadvantages and new alternatives of the treatment of Surgically Assisted Rapid Palatal Expansion (SARPE), making for it a review of the scientific literature on purpose of a clinical case. Clinical case: A 19-year-old female patient with bilateral posterior crossbite associated with maxillary hypoplasia who was decided to perform a surgically assisted rapid expansion treatment. The peculiarity of this case is that before the surgery was placed a custom-made distractor anchored directly to the palatal bone. Surgery, expansion and subsequent orthodontic treatment were performed and, after a follow-up period, a significant maxillary expansion was observed, avoiding the dental and periodontal drawbacks of the traditional technique. Conclusions: New procedures tend to make a direct bone placement of the distractor by means of microimplants, achieving satisfactory palatal expansion but avoiding the inconveniences of using a dental anchorage disjunctor (AU)

Implantes dentales cortos en la rehabilitación de los maxilares atróficos. Puesta al día / Short dental implants in atrophic jaws rehabilitation. Update

Los implantes dentales cortos, aunque históricamente se han asociado a un mal pronóstico en las rehabilitaciones orales implantosoportadas, con el paso de los años y los avances en implantología, se han convertido en un tratamiento habitual en la práctica diaria de muchos clínicos, obteniendo tasas de éxito que se han incrementado recientemente hasta prácticamente igualarse a los implantes convencionales para muchos autores. La necesidad de reducir tiempos de trabajo, costes económicos y morbilidad intraoperatoria unida a la creciente demanda derehabilitaciones implanto soportadas en pacientes de un rango de edad cada vez mayor hace necesario añadirlos entre nuestras opciones rehabilitadoras implantológicas. Para ello es necesario conocer sus pros y contras y establecer unos protocolos quirúrgicos y de selección del paciente receptor (AU)

Short dental implants, with the passage of time and advances in implantology, have become astandard treatment in clinical practice. The need to reduce intraoperative time, morbidity and economic costs, linked to the increasing demand for implant rehabilitation in patients with a range of growing old (elder patients) makes it necessary to add the min our rehabilitative implantology options. For this reason, it is important to know its advantages and disadvantages, to set up thesurgical protocols and to select the patients correctly (AU)

Estrategia quirúrgica reconstructiva en un caso de duplication palatina compleja / Surgical reconstructive approach in a case of complex palatine duplication

La duplicación palatina es una malformación congénita rara de las estructuras craneofaciales. En la mayoría de casos se asocia a otras malformaciones faciales de diferente grado de severidad. Presentamos el caso de un paciente con duplicación de paladar y fisuras faciales raras, con el planteamiento y la estrategia quirúrgica para su reconstrucción. Con el apoyo de las imágenes escenográficas con reconstrucción tridimensional se realizó el planeamiento quirúrgico. Programamos resección en cuna de los segmentos mediales de cada paladar, a cada lado de la fisura facial, y transferencia medial en bloque del maxilar comprometido. La gran variación anatómica encontrada durante el procedimiento, 2 orificios infraorbitarios divididos por la fisura facial, y la alteración del seno maxilar del lado comprometido, nos impusieron un reto quirúrgico para la reconstrucción. Logramos la resección en bloque planeada recreando un único paladar. La evolución postoperatoria fue favorable, no se presentaron complicaciones y la oclusión funcional resultante fue la esperada (AU)

The palatine duplication is an uncommon congenital malformation of the craniofacial skeleton that is frequently associated to craniofacial malformations of different grades of severity. A case of palatine duplication associated to a rare craniofacial cleft, the planning and the surgical approach is presented. 3D reconstruction tomography images were used to guide the surgical planning. A wedge resection of both medial palatal arches with medial displacement were done. The highly disrupted maxillary anatomy made the reconstruction planning a surgical challenge. The wedge resection successfully achieves a single and anatomical palate. The postoperative follow shown no complications and the desired occlusion was obtained (AU)

Retrospective study of the bone morphology in the posterior mandibular region. Evaluation of the prevalence and the degree of lingual concavity and their possible complications

BACKGROUND: In order to choose the appropriate implant size and to prevent complications, an oral surgeon must know the size and shape of the mandible. In the posterior mandibular region, a lingual undercut is often found and could represent a difficulty hard to manage if a lingual or buccal perforation occur. A large series of computed tomography (CT) images of the mandibular first molar was evaluated and the bone morphology, the prevalence and the degree of the lingual concavity in the first molar region were studied. MATERIAL AND METHODS: One hundred and fifty-one computed tomography (CT) examinations of patients were retrospectively evaluated to determine anatomical variations in bone morphology in the submandibular fossa region. RESULTS: A total of 151 subjects were included, consisting of 64 males (M) (42.4%) and 87 females (F) (57.6%). The under-cut type ridge was present in 64.2% of the cases. The concavity angle was 66.6 ± 8.9° (M) and 71.6 ± 8.4° (F) and the linear concavity depth 4.5 ± 2.3 mm (M) and 3.1 ± 1.7 mm (F) (p > 0.05). CONCLUSIONS: Mandibles with any lingual concavity present a potential increased risk of lingual cortical perforation during implant placement surgery. CT imaging allows characterizing the anatomy of the submandibular fossa and provides other important information for the preoperative assessment of the posterior mandible for dental implants placement

Rehabilitation of the severely atrophied dentoalveolar ridge in the aesthetic region with corticocancellous grafts from the iliac crest and dental implants

BACKGROUND: the aim of this study was to assess changes in bone volume after block bone augmentation and placement of dental implants and further evaluate the aesthetic outcome of the treatment. MATERIAL AND METHODS: 9 patients with atrophied anterior maxilla were included in this study. They received total of 21 implants. Dimensions of the alveolar ridge were measured from cone-beam computed tomography x-rays. The bone level at the implant sites was analysed from intraoral x-rays and the aesthetic outcome was assessed from clinical photographs using a pink aesthetic score (pes) scaling. RESULTS: The mean gained horizontal bone width at the marginal crest and 5 mm apically was accordingly 2.7mm and 5.0 mm. The mean pes rating was 9.8/14. The survival rate of. CONCLUSIONS: Reconstruction of the atrophied anterior maxilla with bone blocks and dental implants is a safe procedure with high survival rate and acceptable aesthetic outcome

Randomized controlled study of a mandibular advancement appliance for the treatment of obstructive sleep apnea in children: A pilot study

BACKGROUND: The current limited evidence may be suggestive that mandibular advancement appliance (MAAs) result in improvements in AHI scores, but it is not possible to conclude that MAAs are effective to treat paediatric OSA. There are significant weaknesses in the existing evidence due primarily to absence of control groups, small sample sizes, lack of randomization and short-term results. AIM: the objective of the present study was to evaluate MAAs in children with OSA. MATERIAL AND METHODS: Children presenting an apnea-hypopnea index (AHI) greater than or equal to one event per hour were considered to be apneic. This group of children with AHI greater than or equal to one was randomly divided through a draw into two subgroups: half of them in an experimental subgroup and half of them in a control subgroup. In the experimental subgroup, molds of each of these children's maxillary and mandibular arches were taken using standard molds and molding material. The control group did not use any intraoral device and did not undergo any type of treatment for OSAS. The MAAs used in this study had the aim of achieving mandibular advancement, thereby correcting the mandibular position and dental occlusion, and perhaps increasing the airway and treating OSAS. After 12 consecutive months of use of the mandibular advancement devices, polysomnography examinations using the same parameters as in the initial examinations were requested for both the experimental and the control subgroup. RESULTS: There was a decrease in AHI in the experimental group and an increase in the control group, with statistical significance. These data were used to calculate the sample size, which was 28 children in total in the groups. CONCLUSIONS: There was a decrease in AHI one year after implementing use of mandibular advancement devices, in comparison with the group that did not use these devices

Rapid maxillary expansion and obstructive sleep apnea: A review and meta-analysis

BACKGROUND: OSAS during childhood leads to significant physical and neuropsychomotor impairment. Thus, it needs to be recognized and treated early in order to avoid or attenuate the chronic problems associated with OSAS, which are deleterious to a child's development. Adenotonsillectomy and, in select cases, continuous positive airway pressure (CPAP) have been the preferred treatments for OSAS in children, and yet they are ineffective at fully ameliorating the disease. Minimally invasive treatments have recently been proposed, comprising intra-oral and extra-oral devices as well as speech therapy. OBJECTIVE: to conduct a meta-analysis on studies from around the world that used rapid maxillary expansion (RME) to treat OSAS in children. MATERIAL AND METHODS: We performed a meta-analysis of studies using RME for OSA treatment in children. A literature survey was conducted using PubMed and Medline for English articles published up to December 2014 with the following descriptors: Sleep Apnea, Obstructive, Children, Treatment, Orthodontic, Othopaedic, Maxillary expansion. Studies were included in the meta-analysis if they were case-controlled studies, randomized, and involved non-syndromic children aged 0 to 12years old diagnosed with OSA by the polysomnography apnea hypopnea index (AHI) before and after the intervention, submitted RME only. RESULTS: In all, 10 articles conformed to the inclusion criteria and were included in this meta-analysis. The total sample size across all these articles was 215 children, having a mean age of 6.7 years, of whom58.6%were male. The mean AHI during the follow-up was -6.86 (p< 0.0001). CONCLUSIONS: We concluded that rapid maxillary expansion (RME) in children with OSAS appears to be an effective treatment for this syndrome. Further randomized clinical studies are needed to determine the effectiveness of RME in adults

Predictability of short implants (< 10 mm) as a treatment option for the rehabilitation of atrophic maxillae. A systematic review

BACKGROUND: Short implants (< 10 mm) are one of the treatment options available in cases of limited vertical bone. Although such implants are now widely used, there is controversy regarding their clinical reliability. The purpose of this paper is to evaluate the predictability of short implants as an alternative to technically more complex treatments in patients with atrophic maxillae, based on a systematic review of the literature and the analysis of the implant survival rates, changes in periimplant bone level, and associated complications. It is postulated that short implants offer clinical results similar to those of longer implants. MATERIAL AND METHODS: A Medline-PubMed search was made covering the period between January 2004 and December 2014 (both included). Studies in English published in indexed journals, involving at least 20 implants and with a follow-up period of at least 12 months were considered. A manual search in four high impact journals was also conducted. RESULTS: A total of 37 studies meeting the inclusion criteria were included in this review. 9792 implants placed in over 5000 patients were analyzed. CONCLUSIONS: Based on the results of this review, short implants are seen to offer clinical results in terms of survival, bone loss and complications similar to those of longer implants