Versatility and Importance of Bichat's Fat Pad in Dentistry: Case Reports of Its Use in Occlusal Trauma.

INTRODUCTION: The knowledge of the anatomy surrounding Bichat's fat pad, as well as its clinical applications, is essential to indicate and to safely perform its removal. This surgery is indicated not only for esthetic purposes, but also for functional reasons. When used properly, Bichat's fat pad is composed of stem cells that have a similar phenotype to adipose stem cells, useful in the treatment of pathologies and/or complications, such as maxillary sinus membrane perforation, oroantral/oronasal communications, peri-implantitis, ulcers, fibrosis of the oral mucosa, soft tissue reconstruction, among others. Due to its location, it is prone to suffer clinically significant pathologies, as well as constant trauma. AIM: The aim of this study is to report two clinical cases and subsequent follow-ups, where bichectomy was performed to avoid dental trauma to mucosal tissues during the masticatory function. Also, literature review on the application of Bichat's fat pad in dentistry is provided. CASE REPORT: Two female patients (20 and 24 years) reported discomfort and constant pain in the oral mucosa caused by dental trauma. At the clinical examination, patient presented augmented and injured mucosa. The surgical sequence of Bichat's fat pad removal, as well as the extra-/intraoral photographic follow-up (8, 15, 30, and 180 days) of the patients is described. CONCLUSION: In order to indicate and/or accomplish surgical procedures involving Bichat's fat pad, it is fundamental to know its anatomy and possible applications, not only for esthetic purposes, but also for functional purposes. The patients showed evident improvements following the removal of Bichat's fat pad. CLINICAL SIGNIFICANCE: Application of Bichat's fat and its removal should be evaluated, being an alternative in patients who constantly undergo mucosal injury during masticatory function.

Posterior maxillary segmental osteotomy concomitant with sinus lift using a piezoelectric device.

Tooth loss evokes functional and esthetic problems, and adjacent teeth can move if they are not corrected in a timely manner, rendering the problems of restoring the dentition more complex. If the opposing tooth is consequently extruded, several treatment modalities may be adopted, such as occlusal adjustment, crown prosthesis, orthodontic treatment, and segmental osteotomy. Segmental osteotomy is the most aggressive and invasive treatment for restoring a problematic occlusal plane due to the complications, such as hemorrhage, loss of tooth vitality, or necrosis of the segment. Piezoelectric devices have recently been used in oral surgery and implant dentistry because they preserve the soft tissue. In this report, we describe a bilateral posterior segmental osteotomy procedure to correct a collapsed occlusal plane with sinus mucosa elevation, using piezoelectric devices to preserve the integrity of the sinus membrane and the posterior superior alveolar artery.

Current Management of Subcondylar Fractures of the Mandible, Including Endoscopic Repair.

Treatment of subcondylar fractures has been the subject of debate for many years. Options for treatment include physical therapy, elastic maxillomandibular fixation, and open repair. Proper imaging and clinical evaluation are imperative when deciding on the best management option. In the past, most subcondylar fractures were treated with a closed approach. Recent data support open repair, when feasible. Studies show increased interincisal opening, lateral excursion, and protrusion with less mandibular shortening, jaw deviation, and pain. There are serious side effects that may be associated with open repair. The surgical technique for endoscopic repair is outlined in detail.

Orthognathic surgery for occlusal reconstruction of old malunited jaw fracture.

Old malunited jaw fractures of nine patients who underwent orthognathic surgery for occlusal reconstruction were clinically evaluated. Early surgery on fractures of the jaw is the optimal treatment when due attention must be paid to occlusion. Since occlusal revision surgery subsequent to inaccurate diagnosis and inappropriate surgery is certainly very difficult and often unsuccessful, surgeons need to pay special attention to this situation.

The segmental osteotomy in the management of malposed implants: a case report and literature review.

BACKGROUND: The segmental osteotomy provides an important treatment approach for the correction of skeletal-dental malocclusions that would otherwise be unmanageable with conventional orthodontic care. The combined use of orthodontics and orthognathic surgery also has been adapted for use in the correction of developmental and traumatic deformities. Severely malpositioned implant fixtures may not permit restorative correction even with custom prosthetic appliances. As an alternative to implant removal, which can be associated with significant alveolar destruction, orthognathic surgery may offer a treatment modality to improve fixture alignment, thereby enabling a more favorable esthetic and functional prosthesis. This paper presents a case report and review of the segmental osteotomy procedure. METHODS: A 32-year-old female with congenitally missing maxillary lateral incisors underwent implant surgery for prosthetic replacement of these teeth. Due to severe labial positioning of the implant fixtures, acceptable prosthetic treatment was not possible. A segmental osteotomy procedure was used to reposition the implants. The implants were splinted using a ridged interim suprastructure during the 4-month healing period. An occlusal appliance also was worn during the initial 8 weeks of this healing period. RESULTS: The surgical procedure permitted intrusion and palatal repositioning of the implants. Healing proceeded with no untoward effects. Clinical findings at second-stage surgery were consistent with complete osseous repair and integration of the fixtures. Successful prosthetic treatment was subsequently completed for the patient. CONCLUSION: The segmental osteotomy may provide an alternative treatment to the removal of severely malposed implants or their compromised prosthetic restoration.

Correction of implant malalignment by segmental osteotomy: a case report.

This case report demonstrates that the position of malaligned osseointegrated implants can be corrected by a segmental osteotomy procedure with no loss of implants or bone support. The patient was a healthy teenage girl who sustained facial trauma with loss of teeth and alveolar bone. The defect was initially bone grafted. Brånemark implants were simultaneously placed in the graft. Their initial unfavorable positions and inclinations were later corrected by a segmental osteotomy.

The combined orthodontic and surgical treatment of traumatic Class II division 2 in the adult.

A mild Class II division 2 incisal relationship is often associated with a pleasing facial profile and aesthetically acceptable arrangement of the teeth. Severe cases, however, have the potential to cause trauma and a number of older patients present with extensive soft and hard tissue damage. Management options may range from simple preventive advice to complicated surgical orthodontics. Detailed assessment of the case is paramount in developing an appropriate treatment plan.

Angle Class I malocclusion treated with lower incisor extraction.

In planning orthodontic cases that include extractions as an alternative to solve the problem of negative space discrepancy, the critical decision is to determine which teeth will be extracted. Several aspects must be considered, such as periodontal health, orthodontic mechanics, functional and esthetic alterations, and treatment stability. Despite controversies, extraction of teeth to solve dental crowding is a therapy that has been used for decades. Premolar extractions are the most common, but there are situations in which atypical extractions facilitate mechanics, preserve periodontal health and favor maintenance of the facial profile, which tends to unfavorably change due to facial changes with age. The extraction of a lower incisor, in selected cases, is an effective approach, and literature describes greater post-treatment stability when compared with premolar extractions. This article reports the clinical case of a patient with Angle Class I malocclusion and upper and lower anterior crowding, a balanced face and harmonious facial profile. The presence of gingival and bone recession limited large orthodontic movements. The molars and premolars were well occluded, and the discrepancy was mainly concentrated in the anterior region of the lower dental arch. The extraction of a lower incisor in the most ectopic position and with compromised periodontium, associated with interproximal stripping in the upper and lower arches, was the alternative of choice for this treatment, which restored function, providing improved periodontal health, maintained facial esthetics and allowed finishing with a stable and balanced occlusion. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), as part of the requirements for obtaining the BBO Diplomate title.

Ankylosis of permanent first molars: genetics or environment? A case report of a discordant twin pair.

The rare condition of secondary retention has been reported in the literature as being of genetic origin, with some authors suggesting an autosomal dominant pattern. We report the unusual case of two monozygotic biamniotic, bichorionic male twins, who were discordant for permanent first molar secondary retention, involving ankylosis. Twin A showed normal occlusion and eruption patterns, whereas Twin B displayed a left open bite, in relation with a totally submerged primary second molar leading to retention of the underlying premolar (35), and severe infraocclusion of the adjacent permanent molar (36). After orthodontic failure to close the open bite, ankylosis of 36 was confirmed, whereas 26 became severely infraoccluded.The mother had a history of bilateral molar ankylosis and presented reduced posterior alveolar height. Discordance in this twin pair demonstrates that environmental influences, in addition to epigenetic and local factors, may play a role in secondary retention, which is difficult to diagnose and challenging to treat.

Angle Class I malocclusion treated with lower incisor extraction

In planning orthodontic cases that include extractions as an alternative to solve the problem of negative space discrepancy, the critical decision is to determine which teeth will be extracted. Several aspects must be considered, such as periodontal health, orthodontic mechanics, functional and esthetic alterations, and treatment stability. Despite controversies, extraction of teeth to solve dental crowding is a therapy that has been used for decades. Premolar extractions are the most common, but there are situations in which atypical extractions facilitate mechanics, preserve periodontal health and favor maintenance of the facial profile, which tends to unfavorably change due to facial changes with age. The extraction of a lower incisor, in selected cases, is an effective approach, and literature describes greater post-treatment stability when compared with premolar extractions. This article reports the clinical case of a patient with Angle Class I malocclusion and upper and lower anterior crowding, a balanced face and harmonious facial profile. The presence of gingival and bone recession limited large orthodontic movements. The molars and premolars were well occluded, and the discrepancy was mainly concentrated in the anterior region of the lower dental arch. The extraction of a lower incisor in the most ectopic position and with compromised periodontium, associated with interproximal stripping in the upper and lower arches, was the alternative of choice for this treatment, which restored function, providing improved periodontal health, maintained facial esthetics and allowed finishing with a stable and balanced occlusion. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), as part of the requirements for obtaining the BBO Diplomate title.

No planejamento ortodôntico de casos que incluem extrações como alternativa para solucionar o problema de discrepância de espaço negativa, a decisão crítica é determinar quais dentes serão extraídos. Devemos considerar vários aspectos, como a saúde periodontal, mecânica ortodôntica, alterações funcionais e estéticas, e estabilidade do tratamento. Apesar das controvérsias, a extração de dentes para solucionar apinhamentos dentários é uma terapêutica que tem sido utilizada há décadas. As extrações de pré-molares são as mais comuns, mas há ocasiões em que extrações atípicas facilitam a mecânica, preservam a saúde periodontal e favorecem a manutenção do perfil, que tende a se alterar desfavoravelmente devido às modificações faciais decorrentes da idade. A extração de um incisivo inferior, em casos bem selecionados, é uma abordagem eficiente; e a literatura descreve maior estabilidade pós-tratamento, quando comparada com a opção de extração de pré-molares. O presente artigo relata um caso clínico de uma paciente com má oclusão de Classe I de Angle e apinhamento anterior superior e inferior, face equilibrada e perfil harmonioso. A presença de recessões gengivais e ósseas limitava grandes movimentações ortodônticas. Os molares e pré-molares estavam bem relacionados, e a discrepância concentrava-se principalmente na região anterior da arcada dentária inferior. A extração de um incisivo inferior em posição mais ectópica e com periodonto comprometido, associada a desgastes interproximais nas arcadas superior e inferior, foi a alternativa de escolha para o tratamento, que restabeleceu a função, proporcionando melhoria da saúde periodontal, manteve a estética facial, e permitiu a finalização com uma oclusão estável e equilibrada. Esse caso foi apresentado à diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO), como parte dos requisitos para obtenção do título de Diplomado pelo BBO.

Treatment of mandibular fractures in children.

Thirty-seven mandibular fractures were treated in 25 patients between January 1984 and January 1988. The patients' ages ranged from 4 months to 16 years (6.9 +/- 4.6 years [mean +/- standard deviation]). Nineteen of the patients were male and 6 were female, indicating a significant gender predilection (p less than 0.05). A treatment approach based on the patients' dental maturity and fracture location has evolved that stresses rapid restoration of osseous continuity and preoperative occlusion while striving to minimize risk to unerupted dentition.

Intrusion of overerupted molars by corticotomy and magnets.

Although posterior tooth intrusion in an adult patient is a difficult procedure, it can be achieved without extruding the adjacent teeth by performing a corticotomy and using magnets. In carrying out this procedure on 2 adult patients whose molars had overerupted due to the early loss of antagonists, tooth movement was rapidly achieved without discomfort or side effects.

[Autotransplantation of tooth germs]. / Autotraplanti di germi dentali.

During the routine orthodontic examination of a 8-year-4-month old female, it was found that the upper right canine and premolars were missing. The anamnesis revealed that their buds had been surgically removed after a trauma when she was 6 years old. The lower incisors were slightly crowded. Since the age of the patient would not permit a fixed prosthetic restoration in the next few years, it was decided to attempt an autogeneic transplant of the lower first premolars to replace the upper right canine and premolars too.

Combination syndrome: treatment with dental implants.

Occlusal plane problems are often not evaluated adequately. They can be left untreated or improperly treated. This article reviews one such problem known as Combination Syndrome. The treatment method described involves using a fixed mandibular prosthesis over implants that have been placed immediately after dental extractions.

Posterior maxillary ostectomy for mandibular implant insertion.

Posterior maxillary ostectomy was performed for a patient who had extruded left maxillary molars into the edentulous mandibular region. With this procedure, enough interarch space was obtained, and one screw implant was simultaneously inserted in the edentulous mandibular posterior ridge.

Inadequate implant angulation resulting from oroantral fistula: case report.

Successful implant surgery is largely dependent on good treatment planning and careful surgery. A complete treatment plan must encompass both surgical and prosthetic considerations for the implant restoration. Some compromised implants are restorable, and the result can be acceptable if they can be adjusted into a more ideal position. The goals of the segmental osteotomy are the preservation of a healthy dental unit, the creation of a more ideal environment for dental restoration and occlusal reconstruction, the optimization of cost effectiveness, and the minimization of edentulous space. The purpose of this study is to present the segmental maxillary osteotomy to reposition the alveolar segment with its implant that was in a highly compromised situation.