Tomographic Pharyngeal Dimensions in Individuals With Unilateral Cleft Lip/Palate and Class III Malocclusion Are Reduced When Compared With Controls.

OBJECTIVE: The objective of this study was to three-dimensionally evaluate the pharyngeal dimensions of individuals with complete nonsyndromic unilateral cleft lip and palate (UCLP) using cone beam computed tomography. DESIGN: This was a cross-sectional prospective study. SETTING: The study took place at the Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil. PATIENTS AND PARTICIPANTS: The control group (CON) consisted of 23 noncleft adults with class III malocclusion, and the cleft group (UCLP) consisted of 22 individuals with UCLP and class III malocclusion. Two subgroups of individuals with class III malocclusion as a result of maxillary retrusion with (UCLP'; n = 19) and without (CON'; n = 8) clefts were also assessed. INTERVENTIONS: Pharyngeal volume, pharyngeal minimal cross-sectional area (CSA), location of CSA, pharyngeal length, sella-nasion-A point angle (SNA), sella-nasion-B point angle (SNB), and A point-nasion-B point angle (ANB), and body mass index were assessed using Dolphin software. MAIN OUTCOME MEASURE: The pharyngeal dimensions of UCLP individuals are smaller when compared with controls. RESULTS: Mean pharyngeal volume (standard deviation) for the UCLP patients (20.8 [3.9] cm3) and the UCLP' patients (20.3 [3.9] cm3) were significantly decreased when compared with the CON (28.2 [10.0] cm3) and CON' patients (29.1 [10.2] cm3), respectively. No differences were found in the pharyngeal minimal CSA, ANB, or pharyngeal length values between groups (CON versus UCLP and CON' versus UCLP'). CSAs were located mostly at the oropharynx, except in the UCLP' patients, which were mainly at the hypopharynx. Mean SNA in the UCLP (76.4° [4.6°]) and UCLP' groups (75.1° [3.1°]) were significantly smaller than those in the CON (82.8° [4.1°]) and CON' groups (78.6° [1.2°]). SNB values were statistically smaller only for the comparison of CON versus UCLP patients. CONCLUSION: The pharynx of individuals with UCLP and class III malocclusion is volumetrically smaller than that of individuals with class III malocclusion and no clefts.

Assessment of treatment outcomes for facial prostheses in patients with craniofacial defects: A pilot retrospective study.

STATEMENT OF PROBLEM: The longevity of silicone facial prostheses is short, and published data concerning this type of rehabilitation are limited. PURPOSE: The purpose of this retrospective study was to identify predictive variables for prosthetic failure and to highlight the results that can be expected after treatment with silicone facial prostheses. MATERIAL AND METHODS: After institutional approval, patient records from a single Brazilian institution for the time period 2004 to 2015 were assessed. A standardized form was used to collect patient data. Frailty survival modeling (simple random effects survival model) was used to test whether age, sex, type of prosthesis, source of defect, number of implants, and type of retention have a direct impact on the prosthetic failure rate (α=.05). RESULTS: Auricular prostheses were the most frequently fabricated prostheses. Eighty-four prostheses were fabricated during the follow-up period. The overall survival rate for facial prostheses was 34.5%. Color alteration was the most common reason for new prostheses (27.38%). The implant success rate was 98.18%. The number of implants approached statistical significance (P=.06) with a reduced risk of failure when the patient had 2 implants compared with patients with zero implants and patients with more than 2 implants. CONCLUSIONS: Patients should be recalled frequently so that retouches can be performed, avoiding the repeated fabrication of new prostheses. Well-designed studies are necessary to identify more relevant complications and factors that lead to prosthetic failure.

Speech Articulatory Characteristics of Individuals With Dentofacial Deformity.

PURPOSE: To analyze the speech articulatory characteristics of individuals with dentofacial deformities (DFD) and assess differences compared to individuals with dentofacial balance. METHODS: Sixty individuals participated, being 30 presenting DFD (19 with class III and 11 class II skeletal malocclusion, 18 women and 12 men, age group 18-40 years) and 30 individuals from a control group matched for gender and age. The assessment of the diadochokinesis (DDK) was evaluated using the emissions /pa/, /ta/, /ka/, /pataka/, and /i/. RESULTS: The individuals with DFD produced fewer emissions per second: at syllable "ka" and sequence "pataka" for the total of individuals; syllable "pa" and sequence "pataka" for women, individuals with class II and class III malocclusion. The parameters related to the irregularity of the cycles were higher for the group with DFD than for the control, as well as emission of the syllable "pa" for the total of individuals, group of class III malocclusion and women, during production of the syllables "ta" and "ka" for all individuals and group of class III and during emission of the vowel "ï" for women. CONCLUSIONS: Differences regarding speed and stability of oral and laryngeal DDK were found among individuals with DFD compared with the control group.

Genotoxicity of endosseous implants using two cellular lineages in vitro.

The genotoxic potential of corrosion eluates obtained from a single dental implant using murine fibroblasts or osteoblasts cells in vitro by the single-cell gel (comet) assay was examined. A single commercially available dental implant (Biotechnology) was eluted in a solution consisting of equal amounts of acetic acid and sodium chloride (0.1 M) for 1, 3, 7, 14, and 21 days. Murine fibroblast or osteoblast cultures were then exposed to all corrosion eluates obtained from endosseous dental implants for 30 minutes at 37°C. The results suggest that none of the eluates produced genotoxic changes in murine fibroblasts regardless of the length of exposure to the eluate. Similarly, no genotoxicity was found in osteoblasts. The results suggest that the dental implant eluates tested in this study did not induce genetic damage as depicted by the single-cell gel (comet) assay. Because DNA damage is an important event during oncogenesis, this study represents a relevant contribution to estimate the real risks to the cellular system induced by the corrosion products of a dental implant.

Influence of orthognathic surgery on voice fundamental frequency.

Considering that orthognathic surgery promotes changes in orofacial structures constituting the resonating system, functional changes secondary to surgery are expected to affect speech, leading to the need for further speech and voice adjustments. Thus, understanding the possible relationships of these structures with voice production is important. Therefore, this study aimed to describe the changes in voice fundamental frequency of a patient submitted to orthognathic surgery and observe if there is a relationship with hyoid bone positioning at the different treatment periods. The results revealed that voice fundamental frequency increased after surgery, returning to values close to the preoperative condition, which corresponded to vertical movement of the hyoid bone.

Fibrovascularization and osteogenesis in high-density porous polyethylene implants.

High-density porous polyethylene (HDPP) has been extensively used in craniofacial reconstructions with high-level success and minimal complications. It is known for its biocompatibility and satisfactory stability in the receptor bone area, presenting only a few reports of mobility and infection. In the current study, attention was given to the interface area between HDPP and bone surface to analyze fibrous and bone tissue formation and ingrowth into the pores of the material placed in the mandible of rabbits. Twelve male New Zealand rabbits underwent surgical procedure to receive bilateral HDPP implants in buccal face of dentate mandibular alveolar process, fixed with titanium screws. After 7, 14, 45, and 90 days, the animals were killed, and the specimens were retrieved for histologic and immunohistochemical analyses. No implant loss or infection was detected at the retrieval of the specimens. The microscopic analysis presented satisfactory integration of the material to the bone surface, with new bone formation from the receptor bed and inside the pores of the material, observed from the 15th day. After 90 days, remodeling bone and fibrous tissue was seen in the interface region. Among some of the pores, mature lamellar bone was present. Immunohistochemistry pointed out a moderate expression either to Core binding factor protein 1/RUNX2 or to vascular endothelial growth factor for early periods evaluated, that is, 7 and 15 days after surgery. These results confirm the osteoconductive behavior and high biocompatibility of the material, associated to its adequate immobilization, leading to its lifelong presence in human biologic system.

Analysis of vertical marginal discrepancy in feldspathic porcelain crowns manufactured with different CAD/CAM systems: Closed and open.

OBJECTIVE: The objective of this study is to compare the marginal adaptation of feldspathic porcelain crowns using two computer-aided design/computer-aided manufacturing systems, one of them is open and the other is closed. MATERIALS AND METHODS: Twenty identical titanium abutments were divided into two groups: open system (OS), where ceramic crowns were created using varied equipment and software, and closed system (CS), where ceramic crowns were created using the CEREC system. Through optical microscopy analysis, we assess the marginal adaptation of the prosthetic interfaces. The data were subjected to the distribution of normality and variance. The t-test was used for the analysis of the comparison factor between the groups, and the one-way ANOVA was used to compare the variance of crown analysis regions within the group. A significance level of 5% was considered for the analyses. RESULTS: There was a significant difference between the systems (P = 0.007), with the CS group having the higher mean (23.75 µm ± 3.05) of marginal discrepancy when compared to the open group (17.94 µm ± 4.77). Furthermore, there were no differences in marginal discrepancy between the different points between the groups (P ≥ 0.05). CONCLUSIONS: The studied groups presented results within the requirements set out in the literature. However, the OS used presented better results in marginal adaptation.

The establishment of a protocol for the total rehabilitation of atrophic maxillae employing four zygomatic fixtures in an immediate loading system--a 30-month clinical and radiographic follow-up.

BACKGROUND: The existing approaches to the treatment of the atrophic maxilla are difficult and involve an element of risk. PURPOSE: The aim of the present study was to establish a new surgical/prosthetic protocol for the treatment of extremely atrophic maxillae using four zygomatic implants (ZIs) in an immediate loading system. MATERIALS AND METHODS: Twelve patients were treated with the surgical placement of 48 ZIs, and the totally edentulous maxillae were rehabilitated with protocol-type maxillary prostheses rigidly fixed to the ZIs in an immediate loading system. Follow-up was conducted at 6 months and again at 30 months. RESULTS: Of the 48 ZIs inserted, one implant failed to achieve osseointegration. The prosthetic components fitted well and no sinus pathology was detected in any of the patients. CONCLUSION: The surgical/prosthetic protocol showed that it was possible to insert four ZIs in an immediate loading system and achieve stability for up to 30 months.

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

PURPOSE: This study aimed to quantify, using cone-beam computed tomography (CBCT) in patients who underwent a mandibular advancement surgery associated with genioplasty, three-dimensional changes in airway space and to evaluate whether these changes differ between men and women. MATERIALS AND METHODS: Preoperative and 8-month postoperative CBCT scans of 38 patients aged 18-45 years of either sex and any ethnicity who underwent mandibular advancement surgery associated with genioplasty were analyzed using the Xoran software (Xoran Technologies, Ann Arbor, MI, USA). The linear distances gonion-gnathion (Go-Gn) and condylion-menton (Co-Me) were obtained. Airway volume was measured using the Dolphin Imaging software, version 11.0. Then, data were tabulated and analyzed using Student's t-test. RESULTS: Mean patient age was 30.3 years; 39.47% were men and 60.63% were women. The mean Go-Gn distance was 72.05 mm before surgery and 78.56 mm after surgery, with a mean gain of 6.51 mm. The mean Co-Me distance was 113.47 mm before surgery and 119.89 mm after surgery, with a mean increase of 6.42 mm. Both differences were statistically significant. The mean volume of airway space was 17,272.92 mm3 before surgery and 24,173.74 mm3 after surgery, with a statistically significant mean increase of 6900.82 mm3. There was no statistically significant difference in mean volumetric gain between men (7566.69 mm3) and women (7456.69 mm3). CONCLUSION: Mandibular advancement surgery results in significant increase of airway space, and there is no difference in airway volume between men and women.

Expression of cell cycle regulatory proteins in epithelial components of dental follicles.

Dental follicle is a component of tooth germs, which remain adjacent to the crown of unerupted or impacted teeth. Under the influence of pathologic changes, however, dental follicles that possess reduced epithelium can proliferate into stratified squamous epithelium as far as originate dental cysts. In order to clarify the role of apoptosis and cellular proliferation herein, expression of p53 and PCNA was examined in epithelial components of dental follicles associated with impacted third molars by means of immunohistochemistry. A total of 40 cases was included in this study being 22 cases with reduced epithelium and 18 cases with stratified epithelium. Expression of p53 expression was weak or not detected in dental follicles with reduced and stratified squamous epithelium. By contrast, PCNA positive cells were evidenced in basal and supra basal layers of the stratified squamous epithelium and in reduced epithelium of dental follicles, but without any significant statistically differences between them (P > 0.05). In conclusion, these data suggest that dental follicles possess proliferative activity as depicted by PCNA-positive nuclei in some epithelial cells. However, the biological behavior of dental follicles during the late stage of dental eruptive process may not be associated with deregulation of death and/or cell proliferation.

Bone Volume Changes After Sinus Floor Augmentation with Heterogenous Graft.

PURPOSE: The aim of this study was to evaluate the volumetric stability of deproteinized bovine bone after sinus augmentation, using cone beam computed tomography (CBCT) and three-dimensional (3D) analysis. MATERIALS AND METHODS: Using a specific selection tool and 3D reconstruction from InVesalius 3.0, volumetric analysis of CBCT scans was performed in patients undergoing a sinus elevation technique in critical defects, using deproteinized bovine bone. The first scan was performed immediately after graft surgery (T1), and the second was performed 8 months after graft surgery (T2). RESULTS: A total of 13 patients met the inclusion criteria of this retrospective study; 26 postoperative CBCT scans were analyzed for these patients. All patients exhibited an increase in bone volume (9.10%). The mean bone volume increase from T1 to T2 was 0.137 cm(3) (SD: ± 0.104 cm(3)). There was a statistically significant correlation between bone volume and time (P < .0001). The mean bone volume was 1.506 cm(3) (SD: ± 0.473 cm(3)) for T1 and 1.644 cm(3) (SD: ± 0.506 cm(3)) for T2. CONCLUSION: Within the limited sample, the study demonstrated an increase in graft volume after sinus elevation with deproteinized bovine bone in critical defects.

Microscopic analysis of reconstructed maxillary alveolar ridges using autogenous bone grafts from the chin and iliac crest.

PURPOSE: The aim of this study was to histologically analyze the bone repair of maxillary areas reconstructed with autogenous bone grafts using 2 different donor sites, the ilium and the chin. MATERIALS AND METHODS: Specimens were retrieved with trephine burs positioned transversely in augmented ridges 4 months after placement of the grafts. To analyze bone conditions, a histomorphometric study of ground sections was performed using a special template to identify 3 specific regions of the specimens: cortical bone, cancellous bone, and the region of transition between the alveolar ridge and the graft. Ten patients, 5 men and 5 women, with a mean age of 47 years (range 28 to 67) were evaluated. RESULTS: Results indicated good incorporation of the grafts in this period, demonstrated by intense osteogenesis indicating an active remodeling process. DISCUSSION: In both groups, the improvement in bone quality of the receptor site was evident, independent of the size of the reconstruction, although chin grafts presented better bone quality. CONCLUSIONS: From this study it was possible to conclude that a period of 4 months is sufficient for the placement of osseointegrated implants in reconstructed areas, where chin or iliac autogenous grafts have been used.

A comparison between cutting torque and resonance frequency in the assessment of primary stability and final torque capacity of standard and TiUnite single-tooth implants under immediate loading.

PURPOSE: In this study, standard Brånemark System implants and Brånemark TiUnite implants were evaluated regarding primary stability and placement torque. The correlation between placement torque and primary stability as well as the influence of implant design on placement torque and primary stability were examined. MATERIALS AND METHODS: Twelve patients who presented bilateral loss of either maxillary lateral incisors or premolars were treated with 24 immediately loaded dental implants. Each patient received 1 standard 3.75 x 13-mm Brånemark System implant and one 3.75 x 13-mm TiUnite Mk III implant. One at a time, each implant was connected by a transducer to an Osstell machine that automatically translated a resonance frequency value for the implant into an implant stability quotient value. Osseocare equipment was used to measure the placement torque for both types of implants. RESULTS: Statistical analysis showed higher mean values for standard implants in relation to placement torque and resonance frequency values. DISCUSSION: There was no overall correlation between placement torque and resonance frequency values; this finding supported previous studies. CONCLUSION: Stability was shown to be higher for the standard implants. Mean values of torque resistance were higher for the standard implants than for the TiUnite implants. Implant design appeared to influence primary stability and placement torque.

Bovine hydroxyapatite (Bio-Oss(®)) induces osteocalcin, RANK-L and osteoprotegerin expression in sinus lift of rabbits.

PURPOSE: The aim of this study was to analyze and compare the expression of osteocalcin, RANK-L, osteoprotegerin, in sinus lift procedures using bovine hydroxyapatite (HA). MATERIAL AND METHODS: Twenty four male rabbits underwent bilateral sinus lift procedures were distributed into two groups, according to the sinus filling material: Group 1) autogenous bone graft; and Group 2) bovine HA. All groups were sacrificed after 14 and 30 days, for microscopic and immunohistochemistry analysis. RESULTS: At 14 days after surgery, discrete osteogenesis was observed in the highly vascularized granulation tissue surrounding HA particles, as well as woven bone deposition on the biomaterial surface. Following 30 days, well organized bone trabeculas were seen surrounding the HA granules presenting areas of osteogenic activity. Morphometric findings did not show remarkable differences between groups. Bovine HA induced similar osteocalcin, RANK-L, osteoprotegerin immunoexpressivity when compared to autogenous bone graft group for both periods evaluated in this setting. CONCLUSION: Taken together, these data are consistent with the notion that HA has a similar biological behavior to autogenous bone graft in sinus lift of rabbits.

Segmental osteotomy for the correction of a malpositioned single implant: an 8-year follow-up.

This case report is an 8-year follow-up of a malpositioned single implant, which was treated with segmental osteotomy, to confirm the treatment's characteristics, indications, and advantages. Deep buccal positioning of an endosseous implant placed in the maxillary left central incisor area did not permit acceptable prosthetic rehabilitation, despite its favorable bone insertion with no significant marginal bone loss. The surgical procedure included osteotomy and block movement performed toward the lingual and cervical position, fixed with a provisional prosthesis and miniplates and mini-implants. A connective tissue graft was necessary for esthetics optimization and was performed in a second stage. Advantages including the prevention of alveolar ridge damage, the improvement of gingival contour, and the use of an already integrated implant are presented. Clinically satisfactory hard and soft tissue stability permitted us to consider segmental surgery as a reliable alternative for malpositioned osseointegrated implants.

Two prosthetic crowns supported by a single implant: an esthetic alternative for restoring the anterior maxilla.

Esthetic complications due to nonharmonious peri-implant soft tissue profiles are common in the anterior maxilla, especially when 2 adjacent implants are found. This article suggests the use of a single implant to replace 2 lost adjacent teeth in this region and demonstrates the treatment with 2 clinical cases. The main advantage is preservation of the interdental papilla and gingival contours, compensating for the alveolar bone crest resorption at the platform of a second implant.

Oral myofunctional and vocal characteristics in subjects subjected to oral rehabilitation with osseointegrated implants.

PURPOSE: The aim of this study was to evaluate the effect of oral rehabilitation using immediately loaded fixed implant-supported mandibular prostheses, considering chewing, swallowing, speech and voice aspects. MATERIAL AND METHODS: Fourteen patients subjected to this treatment were evaluated by a clinical examination of the stomatognathic system and perceptual evaluation of voice quality before oral rehabilitation, as well as after 1 and 4 months. RESULTS: After oral rehabilitation, the results showed that there were no significant modifications in the aspects investigated. CONCLUSION: Thus, implant-supported prosthetic rehabilitation, despite providing a more satisfactory occlusal standard, did not yield changes in the functional patterns of individuals in this study.

Short- and long-term effect of surgically assisted maxillary expansion on nasal airway size.

Transverse maxillary deficiency (TMD) may reduce nasal dimensions and lead to oral breathing. The objective of the present study was to investigate the short- and long-term effects of surgically assisted maxillary expansion on nasal airway size of patients with TMD. Eleven subjects with TMD and skeletal maturity were submitted to posterior rhinomanometry to determine the minimum nasal cross-sectional area (CSA) before and 3, 6, and 12 months after surgery. Subjects were also investigated concerning their habitual diurnal and nocturnal breathing mode (oral, nasal, and oronasal). A statistically significant increase in mean CSA was observed in the early postoperative period (3 months), followed by a decrease to the preoperative levels in the subsequent periods (6 and 12 months). No variations were observed in the breathing mode for 63.6% of the subjects. The results showed that, in the short-term, maxillary expansion most frequently produced an increase in nasal patency. However, it was observed that the effect did not persist over time in most subjects.

Tissue response to poly-L-lactide acid-polyglycolic acid absorbable screws in autogenous bone grafts: a histologic morphological analysis.

OBJECTIVES: To evaluate the local bone condition of autogenous chin grafts in contact with resorbable polymers fixation devices. MATERIAL AND METHODS: Seven patients presenting severe maxillary and mandibular atrophy underwent alveolar ridge reconstruction with autogenous chin grafts fixed with conventional metallic screws, who received poly L-lactide acid-polyglycolic acid and titanium test screws for histological evaluation after 4 months of implantation. RESULTS: Viable bone tissue could be seen in the specimens related to titanium test screws, with no signs of bone resorption or inflammation. A thick layer of fibrous connective tissue was observed between the resorbable test screws and bone tissue, which presented a few areas of resorption. CONCLUSION: There are no contraindications of both materials for use as fixation devices in autogenous bone grafts. However, care must be taken when using absorbable screws in a period of 4 months, which can interfere with the sequence of the treatment with endosseous dental implants.

Evaluation of the facial soft tissues following surgically assisted maxillary expansion associated with the simple V-Y suture.

Bone movement in orthognathic surgery gives rise to changes in the positions of the adjacent soft tissues, with such change varying according to the location, direction, and degree of movement. The behavior of the soft tissues, especially the labial tissues, can be influenced by the type of suture employed. This study sought to characterize alterations induced into the soft tissue, by the effect of different suturing techniques, on the upper lip in patients undergoing surgically assisted maxillary expansion. Twenty-three patients were divided into 2 groups and analyzed, with group 1 receiving conventional suturing and group 2 receiving the simple V-Y suture. The results were determined through cephalometric tracings conducted immediately preoperative and a minimum of 6 months postoperative. From these results, it was possible to detect a tendency toward more posterior positioning of the upper lip with this procedure, which can be compensated by the V-Y suture. Alterations in the vertical position of the soft tissues were not significant.