Comparative Effects of Different Materials on Alveolar Preservation.

OBJECTIVE: The purpose of this study was to compare different materials' effects on alveolar ridge preservation of postextraction sockets in anterior maxilla. MATERIALS AND METHOD: In this prospective, single center, randomized, controlled clinical trial, healthy patients who needed one single anterior maxillary tooth extraction (including bicuspids) were selected. After a minimally traumatic extraction without complications, 44 patients were randomly allocated into 4 groups: 1) natural socket healing (blood clot), 2) xenograft and gingival free graft, 3) dense polytetrafluoroethylene membrane, and 4) platelet rich fibrin plugs. Alveolar ridge height and width loss were evaluated in cone beam computed tomography (CBCT) and in dental casts at 3 moments: 1) preoperative (T1), 2) 7 days postoperative (T2), and 3) 120 days postoperative (T3). Height and width alveolar ridge loss detected in CBCT and in dental casts were compared among the groups (two-way analysis of variance [ANOVA]; P < .05). RESULTS: Forty patients (24 women and 16 men) ranging from 25 to 70 years old (mean of 42 years old) participated in this study. Group 2 showed the least alveolar ridge height loss results in CBCT (9.8 ± 1.9% at T3) and dental cast analysis (1.0 ± 0.2 mm). Groups 2 (12.7 ± 4.7% at T3) and 3 (15.4 ± 2.7% at T3) showed the least alveolar ridge width loss measured in CBCT compared with groups 1 and 4, but the difference between groups 2 and 3 were not statistically significant (P = .968). Group 3 (0.9 ± 0.2 mm) and group 2 (1.0 ± 0.2 mm) showed the least width loss compared with groups 1 and 4 in dental cast analysis. Again, the difference between groups 3 and 2 was not statistically significant (P = 1.000). CONCLUSION: In postextraction sockets of the anterior maxilla and bicuspid region, group 2 (xenogenous bone graft with free gingival graft) and group 3 (dense polytetrafluoroethylene) obtained the best results in alveolar preservation, with group 2 being more indicated when the vertical alveolar ridge preservation is mandatory.

Mandibular Angle Contouring Using Porous Polyethylene Stock or PEEK-based Patient Specific Implants. A Critical Analysis.

ABSTRACT: Contour augmentation and mandibular angle modification surgery is becoming increasingly. The aim of this research is to compare technique and outcomes in augmentations done with standard implants or PEEK-based patient specific implants (PSI) in mandibular angle. Data from surgical planning, operative and post-operative of 6 months follow-up were revised for 21 patients who were submitted to facial surgery using a stock implant obtained from companies currently on the market or 3D implants created with CAD/CAM technology using PEEK 3D printing. Surgical time, intra-operative and post-operative complications were compared, analyzing the advantages and disadvantage of each technique. Statistical analyses using t-test and chi-squared were performed considering P value< 0.05 for statistical differences. Twelve patients were operated on with stock implants and nine patients with PSI. The surgical time was 15 minutes less for the 3D implant surgeries (P = 0.021) and intraoperatively only the stock implants needed modifications with wear and adaptation methods; post-operative infections were observed in both groups with no significant differences (P > 0.05). The 3D implants had greater levels of facial symmetry than the stock implants, although they did not present significant differences.Considering the limitations of this study, mandibular angle implants with a PEEK-based 3D CAD/CAM are efficient, stable and have a low complication rate; the CAD/CAM strategy is useful in facial surgery and can be integrated as a standard for surgical planning in facial makeover surgery.

Three-Dimensional Planning and Surgical Technique for Modified Le Fort I and Le Fort III Osteotomy in Non-Syndromic Patients.

Total midface deficiency, to include the orbits, nose, zygomas, and maxilla, can occur in both syndromic and non-syndromic individuals. The treatment with combination of Le Fort III and I osteotomy could be used and it is few reported in the literature. The aim of the study is to present how technology can make the procedure for the correction of hypoplasia of the middle third more predictable and safer. The 2 clinical cases were managed under submental intubation and using VSP that generated 3D printing of oclusal splints and cutting guides. Modified oblique Le Fort III osteotomy (MOLFIIIO) and Le Fort I osteotomy were used due to patients present large sagittal discrepancy between maxilla and mandible (18 and 17 mm). The patients presented good outcomes without complications. In this study, the authors demonstrate that non-syndromic patient could be managed safety with MOLFIII and Le Fort I osteotomies for the correction of midfacial deformities using virtual surgical planning (VSP) associated with 3D printing technique and piezoelectric surgery.

Is Surgical Treatment Based on a 1-Step or 2-Step Protocol Effective in Managing the Odontogenic Keratocyst?

PURPOSE: The literature does not present any consensus on a uniform treatment plan for odontogenic keratocysts (OKCs) and does not provide adequate evidence for determining which modality is most effective in lowering morbidity or preventing recurrence. The purpose of this study was to compare the effectiveness of surgical treatment based on a 1- versus 2-step protocol. MATERIALS AND METHODS: The authors designed and implemented a retrospective cohort study and enrolled a sample of patients diagnosed with OKC from 1991 through 2018. The medical records of all cases were retrieved from files of the Oral and Maxillofacial Surgery Division of the Piracicaba Dental School (Piracicaba, Brazil). The predictor variable was treatment group (1- vs 2-step protocol). Statistical analysis was performed using Kaplan-Meier analysis, Mantel-Cox log-rank test, and proportional hazard regression analysis. RESULTS: The sample was composed of 72 patients (38 male) with a mean age of 40.72 years. Thirteen patients received 1-step treatment and 59 received 2-step treatment. The complex composed of the body, angle, and mandibular ramus was the site most frequently affected. In the individual Kaplan-Meier analysis for each presented variable only involved tooth was significant (P = .0128 by log-rank test), with the risk of relapse 4.23 times higher for the involved tooth than for the non-involved tooth. CONCLUSION: The 1- and 2-step protocols for treatment of OKCs are safe and appropriate as the first treatment option, offering a conservative and effective option with low morbidity. Treatment protocols associated with systematic monitoring promote a better quality of life for patients with low potential for complications.

Condylar Hyperplasia in a Monozygotic Twin Girl: An Argument About Etiology.

The diagnosis of unilateral condylar hyperplasia (UCH) requires a combined assessment consisting of clinical, radiological, and histopathological examination. The etiology of this condition is unknown. The purpose of this study is to report a rare case of UCH in a monozygotic twin. A 15-year-old girl was referred to our department complaining of facial asymmetry and malocclusion. Computed tomography and single-photon emission computed tomography imaging reveal enlargement of the left condyle and condylar neck, and an increased uptake that was diagnosed as active UCH. During the investigation of family and co-twin facial profile, no cases of UCH were identified. From the case reported in this study, the authors raise a hypothesis that can exist some environmental factor that is related in the development of condylar hyperplasia given the occurrence of this disease in one of twins.

Evaluation of Failed Implants by Metallographic and Energy Dispersive X-ray Analysis.

OBJECTIVE: To evaluate the microscopic structure and chemical composition of titanium dental implants removed from patients with implant failure. MATERIALS AND METHODS: Thirty-eight dental implants removed from 29 patients between January 2012 and September 2014 were studied by metallographic analysis, and 7 of these implants were also studied by energy-dispersive x-ray (EDX) analysis. Medical records of these patients were examined. RESULTS: Dental implants were removed in a median of 54.6 ± 88.1 weeks after insertion. The lack of osseointegration without symptomatology or signs of infection was the main reason for implant failure (55.17%). Seventeen patients presented implant failure in the maxilla and 12 patients in the mandible. Metallographic analysis revealed that all the dental implants were manufactured from commercially pure titanium, presenting microscopic uniform appearance, with no "alpha case". The implants studied by EDX analysis presented between 99.85% and 99.87% of titanium and 0.13% and 0.15% of iron by mass. All the implants evaluated were within the ASTM specifications in both analyses. CONCLUSION: There was no relationship between dental implant failure and the microscopic structure and chemical composition of these devices.

Comparative Evaluation of Condylar Volume Between Patients With Unilateral Condylar Hyperplasia and Class III Dentofacial Deformity.

PURPOSE: To compare the condylar volume of patients with unilateral condylar hyperplasia (UCH) with that of patients with a Class III skeletal relation. MATERIALS AND METHODS: Twenty cone-beam computed tomograms of patients were analyzed. Images were divided into 2 groups: 10 from patients with transverse asymmetry of the face and 10 from patients with a Class III facial deformity. Patients' ages ranged from 15 to 30 years. Volumetric data were reconstructed using Dolphin 3D software (Dolphin Imaging & Management Solutions, Chatsworth, CA). This software measured the condylar volume above the deepest point of the sigmoid notch, the lower arch midline deviation, and the overjet. RESULTS: The condyle with hyperplasia exhibited the largest volume (1.97 ± 0.52 cm3) and a statistically significant difference compared with the contralateral condyle (χ2 = 14.30; P < .01). The Class III condyle exhibited relative symmetry of volume between the left and right sides. These condyles exhibited a larger volume compared with the non-hyperplastic condyles in the UCH group, with a statistically significant difference (χ2 = 6.22; P = .013; χ2 = 5.50; P = .019). CONCLUSIONS: Hyperplastic condyles were similar in volume to the condyles of patients with mandibular prognathism, suggesting that patients with a Class III skeletal relation could exhibit bilateral condylar hyperplasia.

A Rare Case of Malignant Fibrous Histiocytoma (Undifferentiated High-Grade Pleomorphic Sarcoma) of Malar Region.

Malignant fibrous histiocytoma is a sarcoma with rare occurrence in the oral and maxillofacial region; surgery is the most reliable treatment. Inadequate resection of the sarcoma on the oral and maxillofacial region is associated with a high incidence of local recurrence and a poor prognosis. Only few patients of malignant fibrous histiocytoma of the malar region have been previously reported in the literature. The authors report a new patient of malignant fibrous histiocytoma on the right malar region that treated a complete tumor surgical excision without lymph node dissection. Examination of the resected specimen revealed that the tumor was completely removed.

Retention and Mechanical Behavior of Attachment Systems for Implant-Retained Auricular Prostheses.

OBJECTIVE: Auricular prostheses are artificial substitutes for facial defects. The retention of these has often been a problem. This study aimed to evaluate the mechanical behavior of 3 retained auricular prosthetic connections when submitted to a mechanical cycling test. MATERIALS AND METHODS: Twelve samples with installed implants were obtained and divided into 3 groups according to their retention system with 4 samples in each group. I: bar-clip system; II: magnet system; and III: ball/o-ring system. Each of samples was submitted to the pull-out test during 3240 cycles (f = 0.5 Hz) to determine its tensile strength. The mechanical cycling test was performed using the servo-hydraulic machine MTS 810-Flex Test 40 (Eden Prairie, MN) that had a 2.5 mm shift at a 10 mm/s velocity. The retaining strength for each of the samples was obtained at 7 intervals. RESULTS: The tensile strength for the group retained by the bar-clip system (29.60 N) was higher with statistically significant difference (P < 0.05) when compared with the group retained by the ball/o-ring system (9.41 N) and magnets system (8.61 N) for all periods assessed. The ball/o-ring system showed loss of retention during the fatigue test (Kruskal-Wallis, chi-squared = 17.28; P < 0.01). CONCLUSIONS: The evaluated systems showed a tensile strength compatible with the clinical use and no fractures of the components were observed.

Removal of a Solitary Synovial Chondromatosis of the Temporomandibular Joint Using Arthroscopy.

The diagnosis of synovial chrondromatosis of temporomandibular joint (TMJ) requires a combined assessment consisting of clinical, radiologic, and histopathologic examinations. The purpose of this study is to report in 1 patient the removal of a single large cartilaginous nodule floating in the upper joint compartment using arthroscopy. A 30-year-old woman was referred to our department complaining about pain in preauricular area and restricted mouth opening. Imaging of magnetic resonance reveals anterior disc displacement and right joint effusion. Arthroscopy of TMJ was performed for diagnosis and treatment. During the arthroscopy a large loose body was identified and removed with a biopsy forceps; lavage was conducted with ringer solution. Hyaluronic acid was injected in TMJ at surgery, 1 and 3 months after surgery. Postoperative magnetic resonance imaging showed articular disc on position and no effusion. The patient was followed up of 1 year without sign and symptoms. Arthroscopic procedure of TMJ was effective in diagnosis and removal of a solitary loose body of synovial chrondromatosis. Viscosupplementation appers to offer benefits in controlling pain and functional improvements.

Characteristics of Maxillofacial Trauma Among Alcohol and Drug Users.

The aim of the current study was to identify and compare the characteristics of maxillofacial trauma in alcohol and drug users with those of nonusers. A retrospective study was conducted using the medical records of patients treated for facial trauma between April 1999 and March 2012 at the Maxillofacial Surgery Division of the Piracicaba Dental School. The data were analyzed by descriptive analysis, binary logistic regression, and correlational analysis using SPSS 18.0 software. The results were considered relevant at P < 0.05. Medical records of 3724 patients with facial trauma were analyzed, of which 173 were illicit drug users and 19.36% reported alcohol intake. The use of illicit drugs was reported by 4.64%. The prevalent etiological factor among drug and alcohol users was interpersonal violence. The mandible was the face part most affected by fractures. Male patients exhibited increased odds of experiencing fractures (OR = 1.43), as did users of illicit drugs (OR = 1.62), when compared with nonusers. When faced with maxillofacial trauma, male drug users exhibited an increased chance of experiencing fractures. This knowledge should be used as a baseline to implement more efficient prevention strategies for this population.

Comparison of two anorganic bovine bone in maxillary sinus lift: a split-mouth study with clinical, radiographical, and histomorphometrical analysis.

BACKGROUND: Anorganic bovine bone (Bio-Oss®) has been extensively used for reconstruction of posterior area of maxilla in sinus lift procedure; however, a new graft material (Lumina-Bone Porous®), that has a different manufacturing process, has not been yet compared in clinical and histological terms. The manufacturing process of bovine bone graft is related to size and porosity of the particles, and this can change osteoconductive property of the material and bone formation. The use of Lumina-Porus® could improve bone formation, reduce the remaining particles of the biomaterial using a low-cost material. The aim of this research was to compare the clinical, radiological, and histomorphometrical results from maxillary sinus lift with two different anorganic bovine bone substitutes Bio-Oss® (control) and Lumina-Bone Porous® (test). RESULTS: A split-mouth study was performed with 13 volunteers. The mean bone ridge height in the deepest portion of maxillary sinuses floor was 3.11 ± 0.83 mm in the Bio-Oss® and 2.38 ± 0.75 mm in the Lumina-Bone Porous®. After sinus lift, the Bio-Oss® group shows bone ridge height of 11.56 ± 2.03 mm and Lumina-Bone® of 10.62 ± 1.93 mm. The increase in alveolar bone height scores was significant between pre-augmentation and 6 months after SL in both groups (p < 0.001). No statistical significant difference in newly formed bone in the Bio-Oss® group (20.4 ± 5.4%), and Lumina-Bone Porous® (22.8 ± 8.5%) was histomorphological observed (p > 0.05). On the other hand, the residual graft particles showed significant difference between the Bio-Oss® group (19.9 ± 8.6%) and Lumina-Bone Porous® (14.6 ± 5.6%) (p < 0.05). The survival rate of dental implants for augmented area with Lumina Bone Porous® was 88.88%, while for Bio-Oss® group was 100%. CONCLUSION: Both materials Bio-Oss® and Lumina-Bone Porous® can be used in the maxillary sinus floor augmentation with good predictability in clinical, radiographical, and histological point of view.

Split Crest Technique with Immediate Implant to Treat Horizontal Defects of the Alveolar Ridge: Analysis of Increased Thickness and Implant Survival.

OBJECTIVE: To assess bone thickness augmentation and implant survival in ridges with horizontal atrophy managed through split crest technique with concomitant installation of dental implants. MATERIALS AND METHODS: Thirteen patients with maxillary bone atrophy underwent surgery and had their bone thickness assessed through cone beam computed tomography 6 months pre- and postoperatively. Comparative measurements of initial and final bone height and thickness were taken using Dolphin Imaging® 11.5 software. The distance between the nasal fossa floor or the maxillary sinus and the alveolar crest determined the bone height, while the measurement of bone thickness took into account the distance between the vestibular cortical bone and the palatal cortical bone at the crest level, and at 5 mm and 10 mm from it. RESULTS: The bone height loss of 0.68 mm was statistically significant (p = 0.01). The average horizontal bone gain was 3.45 mm at ridge level, 3.03 mm at 5 mm from it and 2.42 mm at 10 mm from it. The mean horizontal gain for the three regions was 2.97 mm, and the values were statistically significant for all three regions assessed (p < 0.01). No complications were associated with the surgical procedures, and 23 implants were installed following the surgical expansion. No implants were lost (100% survival). CONCLUSION: The split crest technique proved to be viable and predictable, enabling a significant increase in ridge thickness and a high percentage of implant survival.

Comparative evaluation of different fixation techniques for sagittal split ramus osteotomy in 10 mm advancements. Part two: Finite element analysis.

PURPOSE: To evaluate three rigid, stable fixation methods for sagittal split ramus osteotomy (SSRO), using finite element analysis. The hypothesis is that a customized miniplate presents better stress concentration and distribution. MATERIALS AND METHODS: A 3D model of a hemimandible was created, and a 10-mm-advancement SSRO was simulated and fixed as follows: 3-DCP group - one custom miniplate fixed by eight screws; 4-H2P group - two miniplates of four holes each, fixed by eight screws; and 6-H2P group - two miniplates of six holes each fixed by 12 screws. After a vertical loading of 100 N, the values for von Mises stress, modified von Mises stress, and maximum and minimum principal stresses were measured. RESULTS: The area of maximum principal stress was similar for the three groups - located in the upper miniplate, in the screw near the proximal segment osteotomy. The maximum von Mises stresses were 1580.4 MPa, 1005 MPa, and 977.56 MPa for the 3DCP, 4-H2P, and 6-H2P groups, respectively, showing an allowable displacement of 2.57 mm, 1.62 mm, and 1.52 mm for the 3DCP, 4-H2P, and 6-H2P groups, respectively. CONCLUSION: The customized miniplate did not present better stress distribution than two commonly used types of fixation. Fixation with two straight miniplates, either with four or six holes, offers adequate resistance for 10 mm linear advancements.

Self-medication Among Myofascial Pain Patients: A Preliminary Study.

BACKGROUND: Self-medication has been reported as an option which people choose to relieve the suffering of conditions that cause pain, however, this could delay the correct diagnosis and therapy. OBJECTIVE: The aim of the present study was to determine the prevalence of self-medication among patients with Temporomandibular Disorder (TMD), and to analyze correlations with the severity of the disease. METHODS: A prospective study was conducted with patients who had been diagnosed with TMD. The patients were submitted to anamnesis and a physical examination. This research also used the Fonseca`s Anamnestic Index (FAI) and a questionnaire that was developed specifically for this study, containing questions related to the first health professional contacted and self-medication. The data were analyzed using comparative and correlative analysis (Version 18.0 of SPSS software), with the level of significance set at p<0.05. RESULTS: Thirty-four patients were included, with a prevalence of females (91.2%) and a mean age of 39.76 years. Half of the patients claimed to have chosen their own medications at time, especially analgesics. Sodium dipyrone was used by 12 of the participants. Dentists were the most commonly contacted health professionals (55.5%). No correlation was found between self-medication and the severity of TMD according to the FAI. Furthermore, the time period between the onset of symptoms and the first consultation was not affected by self-medication. CONCLUSION: Self-medication seems to be highly prevalent among patients with TMD, although this practice does not seem to alter the severity of the disease.

Comparison of instruments used to select and classify patients with temporomandibular disorder.

The aim of the present study was to identify the relationship among instruments used to screen and diagnose temporomandibular disorders (TMD). A retrospective study was conducted using medical records of patients with temporomandibular disorder who had visited the institution for initial assessment between January and December 2015. Medical history and physical examination data were collected, particularly those focusing on the diagnosis of TMD and TMJ (temporomandibular joint) function. The following instruments were used to assess the severity of the TMD signs and symptoms: the Fonseca Anamnestic index (FAI), the Helkimo index (HI), the American Association of Orofacial Pain Questionnaire (AAOPQ) and the Jaw Symptom & Oral Habit Questionnaire (JSOHQ). Thirty-eight patient records were included, with prevalence of women (84. 6%) and mean age 37. 42 ± 14. 32 years. The patients who were classified as having severe TMD by the FAI exhibited more positive responses on the AAOPQ (6. 25 ±1. 42; one-way ANOVA F= 15. 82), with a statistically significant difference when compared to patients with mild TMD (3. 0 ±1. 22; p<0. 01). A positive correlation (r=0. 78; p<0. 01) was found between the number of positive responses on the AAOPQ and the sum of the JSOHQ scores. Patients who were classified with severe TMD on the FAI exhibited higher scores on the JSOHO (18. 58 ±4. 96/oneway ANOVA F=14. 43), with a statistically significant difference when compared to patients with moderate (12. 08 ±5. 64; p<0. 01) and mild TMD (7. 46 ±4. 89; p<0. 01). CONCLUSION: In the study sample, there was consistency among the instruments used to differentiate patients with severe and mild TMD. The selection of instruments should be rational, in order to improve the quality of the results.

O objetivo deste estudo foi identificar a relação entre os instrumentos utilizados para selecionar e diagnosticar os pacientes com disfunção temporomandibular (DTM). Foi realizado um estudo retrospectivo utilizando prontuários odontológicos de pacientes atendidos devido a dor e disfunção na articulação temporomandibular, que haviam procurado a instituição para uma avaliação inicial entre janeiro e dezembro de 2015. Foram coletados dados da história médica e do exame físico, particularmente aqueles que se concentraram no diagnóstico de DTM. Os seguintes instrumentos foram utilizados para avaliar a gravidade dos sinais e sintomas da DTM: o índice anamnésico de Fonseca (FAI); O índice Helkimo (HI); o questionàrio da Associação Americana de Dor Orofacial (AAOPQ) eo Questionàrio de Sintomas e Hábitos Orais (JSOHQ). Foram incluidos trinta e oito prontuários de pacientes, comprevalencia de mulheres (84,6%) e idade média de 37,42 ± 14,32 anos. Os pacientes que foram classificados com DTM severa pela FAI apresentaram maior número de respostas positivas no AAOPQ (6,25 ± 1,42; ANOVA F = 15,82), com diferenga estatisticamente significativa em comparação com pacientes com DTM leve (3,0 ± 1,22; p < 0,01). Foi encontrada uma correlação positiva (r = 0,78; p <0,01) entre o número de respostas positivas no AAOPQ e a soma dos escores no JSOHQ. Os pacientes que foram classificados com DTM severa na FAI exibiram pontuações mais altas no JSOHO (18,58 ± 4,96/ANOVA F = 14,43), com diferenga estatisticamente significativa quando comparados a pacientes com DTM média (12,08 ± 5,64; p <0,01) e leve (7,46 ± 4,89; p <0,01). Na amostra estudada, houve congruéncia entre os instrumentos utilizados para diferenciar os pacientes com DTM grave e leve. A seleção de instrumentos deve ser racional, a fim de melhorar a qualidade dos resultados.

Comparative evaluation of different fixation techniques of the sagittal split ramus osteotomy in 10 mm advancements: Mechanical testing and screw insertion torque.

PURPOSE: To compare the mechanical characteristics of five techniques for the functionally stable fixation of simulated sagittal split ramus osteotomy with 10 mm of advancement and to evaluate the screw insertion torque. MATERIALS AND METHODS: Fifty polyurethane hemimandibles with sagittal split ramus osteotomy and containing an advancement of 10 mm fixed and distributed as follows: Customized 3D Plate Group: 1 customized 3D miniplate; 4-Hole Plate Group: 2 miniplates with 4 holes; 6-Hole Plate Group: 2 miniplates with 6 holes; Hybrid Group: 1 flat miniplate with 4 holes and 1 bicortical screw; and Bicortical Screw Group: 3 bicortical screws. We conducted a mechanical test using vertical linear loading with a displacement velocity of 1 mm/min on a universal testing machine and assessed the screw insertion torque using a digital torque wrench. RESULTS: The means of strength for the 1-, 3- and 5-mm displacements were determined by a one-way analysis of variance (ANOVA) followed by the post hoc Tukey test. Statistically significant differences were observed only for the 5-mm displacement (F = 3.36; p = 0.01). There was a difference between the 4-H2P and HG groups (p = 0.04). CONCLUSION: The customized miniplate, the fixation methods with three bicortical screws, or with two straight miniplates with either 4 or 6 holes, all offer a similar mechanical resistance suitable for fixation.

Mechanical evaluation of the use of conventional and locking miniplate/screw systems used in sagittal split ramus osteotomy.

OBJECTIVES: The aim of this study was to compare the mechanical resistance of four different osteosyntheses modeled in two different sagittal split ramus osteotomy (SSRO) designs and to determine the linear loading in a universal testing machine. MATERIALS AND METHODS: An in vitro experiment was conducted with 40 polyurethane hemimandibles. The samples were divided into two groups based on osteotomy design; Group I, right angles between osteotomies and Group II, no right angles between osteotomies. In each group, the hemimandibles were distributed into four subgroups according to the osteosynthesis method, using one 4-hole 2.0 mm conventional or locking plate, with or without one bicortical screw with a length of 12.0 mm (hybrid technique). Each subgroup contained five samples and was subjected to a linear loading test in a universal testing machine. RESULTS: The peak load and peak displacement were compared for statistical significance using PASW Statistics 18.0 (IBM Co., USA). In general, there was no difference between the peak load and peak displacement related to osteotomy design. However, when the subgroups were compared, the osteotomy without right angles offered higher mechanical resistance when one conventional or locking 2.0 mm plate was used. One locking plate with one bicortical screw showed higher mechanical resistance (162.72±42.55 N), and these results were statistically significantly compared to one conventional plate with monocortical screws (P=0.016) and one locking plate with monocortical screws (P=0.012). The difference in peak displacement was not statistically significant based on osteotomy design or internal fixation system configuration. CONCLUSION: The placement of one bicortical screw in the distal region promoted better stabilization of SSRO. The osteotomy design did not influence the mechanical behavior of SSRO when the hybrid technique was applied.

Responsabilidade profissional por lesão do nervo lingual durante exodontia de terceiro molar inferior: análise de nove processos judiciais / Professional responsibility for lingual nerve injury during lower third molar extraction: analysis of nine court proceedings

Introdução: A remoção cirúrgica dos terceiros molares inferiores apresenta o risco potencial de lesões a estruturas nobres como o nervo lingual devido sua localização anatômica. O grau de comprometimento do nervo indicará se a lesão é transitória ou permanente. A injúria nervosa pode motivar o paciente a acionar judicialmente o cirurgião-dentista, e sendo evidenciada a culpa profissional, caberá a reparação pecuniária dos danos causados ao paciente, sejam de natureza material ou moral. Objetivo: Analisar nove decisões judiciais de 1ª e 2ª instância, disponíveis no site do Tribunal de Justiça de São Paulo (TJSP), motivadas pela lesão do nervo lingual durante a exodontia de terceiro molar inferior. Metodologia: Após a leitura e análise foram extraídas informações como: perfil das partes, tempo de duração dos processos, procedência ou não da ação, valor da indenização, responsabilidade profissional e presença de TCLE. Resultados: Na primeira instância, seis dos nove casos foram julgados improcedentes; em segunda instância, quatro destas sentenças foram reformadas para procedência. No total, após decisão de segunda instância, houve procedência da ação em sete dos nove casos. Nas ações procedentes, as indenizações para dano moral variaram de R$ 5 mil a R$ 50 mil, sendo a imperícia e negligência as modalidades de culpa mais atribuídas aos profissionais. Conclusão: Sabendo-se que a lesão do nervo lingual durante a extração de terceiro molar inferior, mesmo previsível, nem sempre é evitável, verifica-se a importância do TCLE (ou documento similar) na prática clínica como instrumento de defesa jurídica do profissional, diante da alegação de falha de informação. Este documento foi mencionado em apenas três dos nove casos processuais, sendo em que em dois destes não houve constatação de falha técnica ou de informação (ação improcedente nas duas instâncias)

Introduction: Surgical removal of lower third molars presents the potential risk of injury to noble structures such as the lingual nerve due to its anatomical location. The level of nerve involvement will indicate whether the injury is transient or permanent. Nervous injury can motivate the patient to sue the dentist, and if professional guilt is evidenced, it will be up to pecuniary compensation for the damage caused to the patient, whether of a material or moral nature. Objective: To analyze nine court decisions of 1st and 2nd instances, available on the Court of Justice of State of São Paulo (Brazil) website, motivated by lingual nerve injury during lower third molar extraction. Methodology: After reading and analysis, information was extracted such as: profile of the litigating parties, duration of the processes, judge decision for the action, indemnity value, professional responsibility and presence of TCLE. Results: In the first instance, six of the nine cases were dismissed, the sentence was reformed in four cases, confirming the merits of the action in seven of the nine cases. In the cases of valid actions, compensation for moral damages ranged from R$ 5 thousand to R$ 50 thousand, with malpractice and negligence being the types of fault most attributed to professionals. Conclusion: Knowing that lingual nerve injury during mandibular third molar extraction, even if predictable, is not always avoidable, the importance of the informed consent (or similar document) in clinical practice as an instrument for the professional's legal defense is mandatory, to avoid the allegation of miss information. This document was mentioned in only three of the nine cases, and in two of these there was no finding of technical or information failure (unfounded action in both instances)