Premaxilla: up to which age it remains separated from the maxilla by a suture, how often it occurs in children and adults, and possible clinical and therapeutic implications: Study of 1,138 human skulls

ABSTRACT Objective: To evaluate topographic and temporal aspects of premaxillary bone and premaxillary-maxillary suture, since they are fundamental anatomical elements little explored clinically. Methods: 1,138 human dry skulls were evaluated, of which 116 (10.19%) of the specimens were children, and 1,022 (89.81%) were adults. The skulls were photographed and the percentage of premaxillary-maxillary suture opening was determined. Subsequently the data were tabulated and submitted to statistical analysis, adopting a level of significance of 5%. Results: The progression of premaxillary suture closure from birth to 12 years of age was 3.72% per year. In 100% of the skulls up to 12 years, the premaxillary-maxillary suture open in the palatal region was observed, while 6.16% of adults presented different degrees of opening. Conclusions: The premaxilla exists in an independent way within the maxillary complex and the presence of the premaxilla-maxillary suture justifies the success of anteroposterior expansions to stimulate the growth of the middle third of the face, solving anatomical and functional problems.

RESUMO Objetivo: avaliar aspectos topográficos e temporais do osso pré-maxilar e da sutura pré-maxilar/maxilar, por serem elementos anatômicos fundamentais pouco explorados clinicamente. Métodos: foram avaliados 1.138 crânios secos humanos, sendo 116 (10,19%) dos espécimes crianças e 1.022 (89,81%) adultos. Os crânios foram fotografados e determinou-se a porcentagem de abertura da sutura pré-maxilar/maxilar. Posteriormente, os dados foram tabulados e submetidos a análise estatística, adotando-se nível de significância de 5%. Resultados: a progressão de fechamento da sutura pré-maxilar/maxilar do nascimento aos 12 anos de idade foi de 3,72% ao ano. Em 100% dos crânios até 12 anos, observou-se a sutura pré-maxilar/maxilar aberta na região palatina, enquanto 6,16% dos adultos apresentavam diferentes graus. Conclusões: a pré-maxila existe de forma independente dentro do complexo maxilar e a presença da sutura pré-maxilar / maxilar justifica o sucesso de expansões anteroposteriores para estimular o crescimento do terço médio da face, solucionando problemas anatômicos e funcionais.

Premaxilla: up to which age it remains separated from the maxilla by a suture, how often it occurs in children and adults, and possible clinical and therapeutic implications: Study of 1,138 human skulls.

OBJECTIVE: To evaluate topographic and temporal aspects of premaxillary bone and premaxillary-maxillary suture, since they are fundamental anatomical elements little explored clinically. METHODS: 1,138 human dry skulls were evaluated, of which 116 (10.19%) of the specimens were children, and 1,022 (89.81%) were adults. The skulls were photographed and the percentage of premaxillary-maxillary suture opening was determined. Subsequently the data were tabulated and submitted to statistical analysis, adopting a level of significance of 5%. RESULTS: The progression of premaxillary suture closure from birth to 12 years of age was 3.72% per year. In 100% of the skulls up to 12 years, the premaxillary-maxillary suture open in the palatal region was observed, while 6.16% of adults presented different degrees of opening. CONCLUSIONS: The premaxilla exists in an independent way within the maxillary complex and the presence of the premaxilla-maxillary suture justifies the success of anteroposterior expansions to stimulate the growth of the middle third of the face, solving anatomical and functional problems.

Association between Tooth Agenesis and Skeletal Malocclusions.

OBJECTIVES: The aim of this study was to evaluate the association between tooth agenesis and skeletal malocclusions in Brazilian non-syndromic orthodontic patients. MATERIAL AND METHODS: Pretreatment orthodontic records of 348 patients of both genders and with various skeletal malocclusions were examined. Tooth agenesis was evaluated in panoramic radiographs. Angular measurements were taken from lateral cephalometric radiographs to classify the patient's malocclusion as skeletal Class I, Class II and Class III. Subjects were divided into 2 groups, "with tooth agenesis" and "without tooth agenesis". Chi-square or Fisher exact test was used to compare categorical data. ANOVA with Tukey's post-test was used for means comparisons. An alpha of 5% was established. RESULTS: From 348 analysed patients, 28 presented tooth agenesis. There was no difference between genders (P = 0.27) nor mean age (P = 0.16). The most prevalent skeletal malocclusion was Class I (63.11%), followed by Class II (25.94%), and Class III (10.95%). The mean of congenitally missing teeth was 1.3 (SD 0.13). Thirteen subjects had premolar agenesis, 13 upper lateral incisor agenesis, 4 lower incisor agenesis and 2 molars agenesis. The group with tooth agenesis presented A point-nasion-B point (ANB) angle smaller (1.66 [SD 2.52]) than the group without tooth agenesis (2.86 [SD 2.49]) (P = 0.01). ANB angle had a negative correlation with the number of congenitally missing teeth (P = 0.039; r = -0.39). CONCLUSIONS: Tooth agenesis is associated with a smaller A point-nasion-B point angle and is negatively correlated with the number of congenitally missing teeth.

Cisto gengival do adulto: diagnóstico diferencial com fístulas, abscessos, mucoceles e neoplasias / Gingival cyst of the adult: differential diagnosis with fístulas, abscesses, mucoceles and neoplasias

O cisto gengival do adulto nem sempre é notado, devido ao seu crescimento limitado e ausência de sintomatologia. Em quase todos os casos, está localizado na face vestibular. O diagnóstico diferencial inclui mucocele, abscesso gengival, fístulas e algumas neoplasias benignas. Os adenomas, neuromas e neoplasias ou cistos odontogênicos periféricos podem se localizar nos tecidos gengivais e, quando ainda são pequenos e detectáveis, podem simular o cisto gengival do adulto. Esse apresenta-se como uma tumefação arredondada, em forma de domo, bem delimitada e firme à palpação, localizada nos tecidos gengivais, especialmente na gengiva aderida. Localiza- -se quase sempre na região dos pré-molares e caninos inferiores ou em suas áreas imediatamente vizinhas; em uma minoria de casos, pode ocorrer na mesma região da maxila. A maioria dos pacientes tem mais de 40 anos de idade, independentemente do sexo, mas qualquer idade pode ser afetada; eventualmente é bilateral. O cisto gengival do adulto deve ser incluído no diagnóstico diferencial de casos em que a nodulação ou tumefação localizada na gengiva aderida não se relaciona com nenhum dente com necrose pulpar, e depois que a possibilidade de abscesso gengival ou periodontal tiver sido descartada, pela presença de saúde plena dos tecidos periodontais. A conduta frente ao cisto gengival do adulto deve ser sua remoção cirúrgica completa e posterior análise microscópica. O prognóstico tende a ser muito bom e não há casos de transformação agressiva ou malignização.

Premaxilla: an independent bone that can base therapeutics for middle third growth!

Premaxilla, in its early descriptions, had the participation of Goethe. In our face, in a certain period of growth and development processes, premaxilla is an independent and, then, a semi-independent bone to finally be totally integrated to the maxilla. Formation of the premaxilla acts as a stabilization element inside the facial skeleton comparable to the cornerstone of a Roman arch and is closely related to the development of human face and its abnormal growth with characteristic malformations. Until when the premaxillary-maxillary suture remains open and offers opportunities to orthopedically influence facial growth to exert influence over facial esthetics and function? Contact with preliminary results in 1183 skulls from anatomic museums at USP, Unicamp and Unifesp led us to question therapeutic perspectives and its clinical applicability.

Cisto periodontal lateral não requer tratamento endodôntico, apenas cirúrgico! / Lateral periodontal cyst does not require endodontic treatment, only surgical!

Não existe o cisto periodontal lateral inflamatório na parte lateral das raízes, tal como se forma o cisto periodontal apical a partir de um granuloma periapical imunogênico. O cisto periodontal lateral é um cisto do desenvolvimento derivado de restos da lâmina dentária localizados no ligamento periodontal, com crescimento limitado e sem natureza inflamatória. O dente associado tem vitalidade pulpar e o tratamento da lesão não requer uma abordagem endodôntica terapêutica, apenas sua remoção cirúrgica, o que já constitui uma biopsia excisional. A análise microscópica é fundamental quando for removido o cisto periodontal lateral, pois, quando incipientes, algumas lesões como o ameloblastoma, o queratocisto odontogênico e o tumor odontogênico escamoso podem apresentar-se com a mesma imagem e aspectos clínicos. O prognóstico do cisto periodontal lateral é muito bom e geralmente não há recidiva, mas o prognóstico dessas outras lesões inclui as recidivas ao longo do tempo e uma agressividade clínica maior para o paciente.

Premaxilla: an independent bone that can base therapeutics for middle third growth!

ABSTRACT Premaxilla, in its early descriptions, had the participation of Goethe. In our face, in a certain period of growth and development processes, premaxilla is an independent and, then, a semi-independent bone to finally be totally integrated to the maxilla. Formation of the premaxilla acts as a stabilization element inside the facial skeleton comparable to the cornerstone of a Roman arch and is closely related to the development of human face and its abnormal growth with characteristic malformations. Until when the premaxillary-maxillary suture remains open and offers opportunities to orthopedically influence facial growth to exert influence over facial esthetics and function? Contact with preliminary results in 1183 skulls from anatomic museums at USP, Unicamp and Unifesp led us to question therapeutic perspectives and its clinical applicability.

RESUMO A descrição inicial da pré-maxila teve a participação de Goethe. Na face, em determinado período do crescimento e desenvolvimento, têm-se a pré-maxila como um osso independente e, depois, semi-independente para, finalmente, se integrar totalmente à maxila. A formação da pré-maxila atua como um elemento estabilizador dentro do esqueleto facial, comparável com a pedra angular de um arco romano, e está intimamente relacionada com o desenvolvimento da face humana e seu crescimento anormal, com malformações características. Até quando a sutura pré-maxilar-maxilar continua aberta e oferece oportunidades para se influenciar ortopedicamente o crescimento facial e modificar a estética e função da face? O contato com estudos preliminares em 1.183 crânios de museus anatômicos da USP, Unicamp e Unifesp nos induziu a questionar sobre as perspectivas terapêuticas e aplicabilidades clínicas.

Cimentos endodônticos podem induzir câncer? como saber? / Can root canal sealers induce cancer? how can we investigate that?

Os cimentos obturadores podem ser à base de hidróxido de cálcio, óxido de zinco e eugenol, ionômero de vidro, de natureza resinosa com metacrilato em sua composição ou, ainda, de silicone. Eles deveriam ser submetidos à investigação sobre seu possível efeito genotóxico e mutagênico antes de serem lançados no comércio especializado, com livre comercialização, pois essas propriedades fazem parte do conceito de biocompatibilidade. No presente artigo, destacam-se os tipos de testes e os conceitos de genotoxicidade, mutagenicidade e carcinogênese.

Sex Differences in Pediatric Dental Pain Perception.

PURPOSE: To evaluate sex-related differences in dental pain perception in children. METHODS: Fifty-two children who received a dental procedure with local anesthesia were selected to participate. Pain perception levels were assessed with the Wong-Baker FACES Pain Rating Scale. Twenty-four and 48 hours following the procedure, the parents were contacted by phone for a verbal survey to assess their child's postoperative pain. Age, type of dental procedure, and behavior were also evaluated as covariables. The data were analyzed using Epi Info 7.0 software and GraphPad Prism 5.0 software. Chi-square or t test were performed with a significance level of five percent. RESULTS: The mean age of the children was 6.7 (±2.4 [SD]) years. Twenty-seven (51.9 percent) were boys. None of the parents reported pain at 48 hours. None of the covariables were differentially distributed among the sexes (P>0.05). There was no statistical difference between sex and pain perception immediately after the procedure (P=0.64) and after 24 hours (P=0.41). However, when the analysis was performed according to age group, a borderline association was found. Female preschoolers reported more pain immediately after the procedure than male preschoolers (P=0.06). CONCLUSION: There was no statistical difference in pain perception between sexes.