Ozone therapy effect in medication-related osteonecrosis of the jaw as prevention or treatment: microtomographic, confocal laser microscopy and histomorphometric analysis.

OBJECTIVE: This study aimed to evaluate the efficacy of ozone therapy in the preoperative (prevention) and/or postoperative (treatment) of MRONJ. MATERIAL AND METHODS: Forty male Wistar rats were caudally treated with zoledronic acid (ZOL) and to ozone therapy before extraction (prevention, POG), after extraction (treatment, TOG), or both (prevention and treatment, TPOG), and treated with saline (SAL). The animals received intramuscular fluorochrome (calcein and alizarin), and 28 days postoperatively, they were euthanized, and the tissues were subjected to microtomographic computed tomography (microCT), LASER confocal, and histomorphometric analyses. RESULTS: Micro-CT showed a higher bone volume fraction average in all groups than that in the ZOL group (P < 0.001), the ZOL group showed high porosity (P = 0.03), and trabecular separation was greater in the TOG group than in the POG group (P < 0.05). The mineral apposition rate of the POG group was high (20.46 ± 6.31) (P < 0.001), followed by the TOG group (20.32 ± 7.4). The TOG group presented the highest mean newly formed bone area (68.322 ± 25.296) compared with the ZOL group (P < 0.05), followed by the SAL group (66.039 ± 28.379) and ZOL groups (60.856 ± 28.425). CONCLUSIONS: Ozone therapy modulated alveolar bone repair in animals treated with ZOL, mainly after surgery trauma, leading to bone formation as healing tissue. CLINICAL RELEVANCE: Osteonecrosis has been a challenge in dentistry, and owing to the lack of a consensus regarding therapy, studies presenting new therapies are important, and ozone has been one of the therapies explored empirically.

Photobiomodulation Therapy Improves Postoperative Pain and Edema in Third Molar Surgeries: A Randomized, Comparative, Double-Blind, and Prospective Clinical Trial.

PURPOSE: Laser light has biological effects that can modulate inflammatory processes. Thus, this study aimed to evaluate the effects of photobiomodulation (PBM) therapy on pain, edema, and trismus after the extraction of retained third molars. METHODS: A split-mouth, double-blind, randomized clinical trial (RCT) was conducted in 13 patients with similar bilateral third molars who received intraoral application PBM therapy at 4 points with a diode laser at 810 nm wavelength, 6 J (100 mW, 60 seconds/point) on 1 side (the PBM side); and laser irradiation simulation on the other side (SHAM side). The pain was assessed through visual analog scale (VAS) at 0, 12, 24, 48, and 72 hours, number of analgesic-relief (NAR), and mean time of first analgesic use; edema, through VAS, and linear facial measurements at 0, 24, 48, and 72 hours; and trismus, through the mouth opening measurements at 0, 24, 48, and 72 hours. The repeated-measures analysis was applied to assess the effect of the treatment, followed by Tukey's post hoc test for multiple comparisons (P < .05). RESULTS: Thirteen patients (61.77% male and 38.63% female) with age of 24.16 ± 2.06 participated in this research. VAS showed that PBM controlled pain better (7.56 ± 6.25) than SHAM (32.25 ± 22.78) at 24 hours (P < .001) and 48 hours (19.47 ± 9.27 and 39.87 ± 4.21, respectively) (P = .011). VAS also showed that PBM controlled edema better (19.7 ± 13.27) than SHAM (32.38 ± 15.28) at 24 hours (P = .037) and 48 hours (19.47 ± 13.11 and 39.87 ± 22.77, respectively) (P = .002). CONCLUSION: The PBM therapy in this study resulted in pain and edema reduction after third molar surgery and may be considered as adjuvant therapy after the surgical procedure.

Proof-of-Principle Study Suggesting Potential Anti-Inflammatory Activity of Butyrate and Propionate in Periodontal Cells.

Short-chain fatty acids (SCFAs) are potent immune modulators present in the gingival crevicular fluid. It is therefore likely that SCFAs exert a role in periodontal health and disease. To better understand how SCFAs can module inflammation, we screened acetic acid, propionic acid, and butyric acid for their potential ability to lower the inflammatory response of macrophages, gingival fibroblasts, and oral epithelial cells in vitro. To this end, RAW 264.7 and primary macrophages were exposed to LPSs from Porphyromonas gingivalis (P. gingivalis) with and without the SCFAs. Moreover, gingival fibroblasts and HSC2 oral epithelial cells were exposed to IL1ß and TNFα with and without the SCFAs. We report here that butyrate was effective in reducing the lipopolysaccharide (LPS)-induced expression of IL6 and chemokine (C-X-C motif) ligand 2 (CXCL2) in the RAW 264.7 and primary macrophages. Butyrate also reduced the IL1ß and TNFα-induced expression of IL8, chemokine (C-X-C motif) ligand 1 (CXCL1), and CXCL2 in gingival fibroblasts. Likewise, butyrate lowered the induced expression of CXCL1 and CXCL2, but not IL8, in HSC2 cells. Butyrate further caused a reduction of p65 nuclear translocation in RAW 264.7 macrophages, gingival fibroblasts, and HSC2 cells. Propionate and acetate partially lowered the inflammatory response in vitro but did not reach the level of significance. These findings suggest that not only macrophages, but also gingival fibroblasts and oral epithelial cells are susceptive to the anti-inflammatory activity of butyrate.

Management of Complications Related to Removal of the Buccal Fat Pad.

ABSTRACT: Removal of the buccal fat pad (BFP) is an important topic of discussion in the literature. Several studies have reported improvements in facial esthetics as a result of this technique. The BFP is close to vital structures, such as the facial nerve, parotid duct, and vessels. Injuries related to these structures may occur during the surgical procedure. This manuscript aimed to report and discuss 2 clinical cases of the complications after removal of the BFP. Besides the case presentation, a comprehensive review of the literature was also provided. The reported cases were 2 patients aged 31 and 38 years who were attended by the oral and maxillofacial surgery teams after a complication in the BFP surgery. The first case involved swelling due to Stensen's duct injury, and the second involved uncontrolled bleeding from the internal maxillary artery. Removal of the BFP must have precise indications. Complications may occur during or after surgery; hence, anatomical knowledge is fundamental to appropriate patient management.

Accuracy evaluation of computer-guided implant surgery associated with prototyped surgical guides.

STATEMENT OF PROBLEM: Correct implant placement by means of a pretreatment planning software program is still subject to deviations between the planned and achieved implant positions. Inaccuracy at this level may have drastic consequences, including neurovascular trauma. Further data are therefore needed to evaluate the accuracy of such computer-guided implant planning software programs. PURPOSE: The purpose of this clinical study was to evaluate the accuracy of computer-guided implant surgery associated with prototyped surgical guides. MATERIAL AND METHODS: Cone beam computed tomography (CBCT) scans were made of the participants with a tomographic guide to merge anatomic and prosthetic data. This allowed virtual planning with a prosthetically guided approach respecting the anatomy of the participant. A prototyped surgical guide was then fabricated from the virtual plan, determining the intrasurgical position of the implants. Flapless guided implant surgery was carried out according to the manufacturer's instructions. A second CBCT was made 30 days after the surgery, to enable overlapping of the data from before and after the implant placement. The angular, coronal, central, and apical deviations of the placed implants were measured and compared with those virtually planned. The data were submitted to descriptive statistic and intraclass correlation coefficient (ICC), analysis of variance, and the Student t test (α=.05). RESULTS: A total of 61 implants were analyzed. The mean angular deviation was 2.04 degrees. The mean coronal, central, and apical linear deviations were 0.68 mm, 0.72 mm, and 0.82 mm, respectively. No statistically significant difference was found between the virtual and the real position of the implants inserted. A tendency toward a greater absolute error was observed in the mandible than in the maxilla in terms of angular (P=.047), central (P=.043), and coronal error (P=.031). CONCLUSIONS: Flapless computer-guided implant surgery with virtual planning had some angular and linear deviations; nevertheless, this technique should be acceptably safe and accurate.

Strategy for Optimizing Airway Volume With Genioglossal Advancement Using Cutting Guide in the Treatment of Obstructive Sleep Apnea.

The genioglossus advancement muscle is a technique used to treat obstructive sleep apnea and depends on the precise location of the muscle insertion into the geniotubercle. The aim of this article was to present a case report about a 38-year-old male patient with obstructive sleep apnea even after undergoing uvulopalatopharyngoplasty and mentoplasty. A maxillo-mandibular advancement and genioglossus was proposed, for this a virtual planning of the surgical guide was done using a specialized software. The great advantage is to reduce the osteotomy by focusing precisely on the insertion of the muscle. The cutting guide facilitated the surgical procedure in all aspects and brought safety.

Comparative in vivo study of alloy titanium implants with two different surfaces: biomechanical and SEM analysis.

OBJECTIVES: The purpose of this study was to evaluate the biomechanical behavior of the interface formed between bone and implants with machined surfaces (MS) and those modified by Al2O3 sandblasting and acid etching (SBAS). MATERIALS AND METHODS: Before surgery, topographic characterization was performed by SEM-EDX and by mean roughness measurements. Ten Albinus rabbits received randomly 20 Ti-6Al-4V implants on its right and left tibiae, with one implant placed in each tibia. After implant insertion, the implant stability quotient (ISQ) was measured by means of resonance frequency analysis (RFA). After 3 and 6 weeks, the ISQ was again measured, followed by torque removal measurements. Analysis of variance and Tukey tests were used to analyze the data. The surface of the implants removed was evaluated by SEM-EDX. Immunohistochemical analysis of osteopontin (OPN) and osteocalcin (OC) protein was performed in bone tissue. RESULTS: The topographic characterization showed differences between the analyzed surfaces, and the mean roughness values of SBAS group were statistically higher than MS. Overall, higher statistically significant ISQ values were observed in the SBAS group compared to the MS group (p = 0.012). The intra-group comparison of ISQ values in the SBAS group showed statistically significant differences between 0 and 3 weeks (p = 0.032) and 0 and 6 weeks (p = 0.003). The torque removal measurements of group SBAS were statistically higher when compared with the torque removal measurements of group MS in the time intervals of 3 weeks (p = 0.002) and 6 weeks (p < 0.001). SEM-EDX of the implant surfaces removed in SBAS group showed greater bone tissue covering and mean values atomic in percentage of Ca, P, and O statistically superior (p < 0.05) than MS group. Immunohistochemical reactions showed intense OC immunolabeling at 6 weeks postoperative for SBAS group. CONCLUSIONS: The topographical modifications made in group SBAS allowed a better mechanical interlocking between the implant and bone tissue.

Upper Airway Obstruction in a Panfacial Fracture.

Panfacial fractures are considered the most aggressive and complex facial fracture, and most of them are the results of a high energy trauma. Therefore, a clinical report of a male patient with a panfacial fracture and Richards type 3 fracture resulting in an airway obstruction is presented. This type of fracture can promote an upper airway obstruction, which needs a correct and fast diagnosis to the life support of the patient.

Maxillary Alveolar Ridge Atrophy Reconstructed With Autogenous Bone Graft Harvested From the Proximal Ulna.

Atrophy of the alveolar ridge requires bone grafting at the implant site for rehabilitation of the masticatory function with dental implants. Despite the advances in the development of bone substitutes, autogenous bone graft remains the "criterion standard" because of its osteogenic, osteoinductive, osteoconductive potential, and non-immunogenic properties. However, harvesting of autogenous bone is not exempt from donor site morbidity. In this context, the use of autogenous bone derived from the proximal ulna might be a viable resource to obtain corticocancellous bone graft, as the harvesting from this donor site is associated with low morbidity. Thus, this article aimed to describe a case in which a maxillary sinus floor augmentation was performed by means of autogenous bone graft harvested from the proximal ulna, as the donor site. An appositional bone block graft harvested from the same region was used to augment the residual alveolar ridge. Clinically, healing proceeded uneventfully with no major complications. After 8 months, a proper amount of bone was found at the implant site, allowing a prosthetically driven implant insertion and subsequent implant-supported rehabilitation. Results were clinically and radiographically stable after a 3-year follow-up. The present case report suggested that proximal ulna as a donor site should be considered as a safe and reliable alternative for alveolar ridge augmentation. Besides the case presentation, a comprehensive review of the literature was also provided.

Immediate Treatment of Complex Mandible Fracture in a Pediatric Patient.

The facial fractures in pediatric patients are rare, and they can need an immediate treatment to recover the function and aesthetic to the young patients. However, the open reduction internal fixation is controversial in pediatrics; it can be effectiveness to treat complex mandible fractures. Therefore, we present a case of a pediatric patient with a complex mandible fracture caused by an auto accident. The immediate treatment was successful with the use of open reduction internal fixation.

Simplified Access for Reduction and Fixation of a Frontal Bone Fracture.

The frontal bone fractures occur very often in service units in oral and maxillofacial surgery. Bicoronal access is the most common for the surgical treatment of frontal bone fractures. However, patients are surprised when they receive notice that such invasive access will be made. This approach allows adequate visualization of the fracture site, but may be associated with complications, which can be avoided by the use of less invasive techniques. We describe an alternative approach that aims to minimize the complications of a coronal incision.

Respiratory Obstruction Due to Richards Type 4 Fracture.

Facial fractures can be potentially fatal in polytraumatized patients due to retropositioning tissues to upper airway obstruction. In the first aids, this situation can be reversed using a tracheostomy procedure to break out the airways. However, fractures leading to airway obstruction are rare and according to Richards Classification can be classified into 5 types. The purpose of this article is to report a clinical patient with a bilateral condylar and mandibular symphysis fractures that resulted in airway obstruction and severe mandibular rear projection.

Oral Myiasis in a Patient With HIV Manifestations and Neurologic Toxoplasmosis Treated by Ivermectin.

Myiasis has been defined as a pathologic condition where dipterous larvae are lodged in mammalian hosts causing an infestation, which feeds on living or dead tissue for at least a certain period inside the host and develops itself as parasites. In humans, the most commonly affected sites are the nose, eyes, skin wounds, sinuses, lungs, ears, gut, gall bladder, vagina, nasal cavities, and rarely the mouth because the oral tissues are rarely exposed to the external environment. The etiology of oral myiasis is usually related to local factors such as poor oral hygiene, periodontal disease and labial incompetence, and systemic factors such as neurologic deficits.

Strain Gauge Evaluation of Transfer Impression Techniques of Multiple Implant-Supported Prosthesis.

PURPOSE: This in vitro study assessed the accuracy of multiple implant-level impression techniques (open tray and closed tray) for the fabrication of 3-unit implant prostheses with strain gauge (SG) analysis. MATERIALS AND METHODS: A polyurethane master model was designed to simulate a clinical situation. Two rigid custom trays were fabricated for the model. The impression material used was polysulfide. Transfer implant impressions were made using 2 techniques; ten tapered copings not splinted (custom closed tray) and ten square copings splinted with acrylic-resin (custom open tray). The improved stone models were allowed to set for 1 hour before being separated from the impression. The superstructures were sprued, invested, and cast with a cobalt-chromium alloy. Four SGs were bonded on the surface of each polyurethane block. RESULTS: A statistically significant difference was found between the 2 impression techniques tested (P = 0.000). This study found a significant average difference of 144.68 ± 5.53 µÎµ for open custom tray and 253.3 ± 16.7 µÎµ for closed custom tray. CONCLUSION: The custom open tray technique was the most accurate impression for multiple implants compared with closed custom tray.

In vivo evaluation of cp Ti implants with modified surfaces by laser beam with and without hydroxyapatite chemical deposition and without and with thermal treatment: topographic characterization and histomorphometric analysis in rabbits.

OBJECTIVE: We aimed to assess the surfaces of commercially pure titanium implants (cp Ti) with modified surfaces by laser beam (LS) with and without hydroxyapatite (HA) deposition, without (HAB) and with (HABT) thermal treatment. Furthermore, we have compared them with implants with surfaces modified by acid treatment (AS) and with machined surfaces (MS) utilizing histomorphometric and descriptive histologic analyses. MATERIAL AND METHODS: Surface topography characterization was analyzed by scanning electron microscopy (SEM), X-ray energy-dispersive spectroscopy (EDX), and surface roughness (Ra) before implant installation. Forty-five rabbits received seventy-five implants in their left and right tibias and were randomly divided into five groups (n = 5 implants per group): (1) cp Ti implant modified by LS, (2) cp Ti implant modified by laser beam associated with HA deposition without heat treatment (HAB), (3) cp Ti implant modified by laser beam associated with HA deposition with heat treatment (HABT), (4) cp Ti implant with modified surface by means of acid treatment (Master Porous) commercially available (AS), and (5) cp Ti implant with MS commercially available. After 30, 60, and 90 days, the animals were euthanized and the implants and surrounding bone were removed and prepared by a non-decalcified histological process. The percentage of bone-to-implant contact (BIC) and the bone area fraction occupancy (BAFO) between the first three threads was evaluated to the higher cortical region. RESULTS: BIC (%) was statistically superior (p < 0.001) on the LS (69.36 ± 7.91, 71.67 ± 8.79, and 79.69 ± 3.3), HAB (73.22 ± 3.75, 69.48 ± 1.89, and 75.7 ± 4.62), and HABT (65.41 ± 5.51, 71.3 ± 2.5, and 79.68 ± 5.01) compared with AS (49.15 ± 5.76, 41.94 ± 2.85, and 57.18 ± 7.81) and MS (36.69 ± 7.24, 52.52 ± 2.75, and 51.31 ± 6.96) in the 30, 60, and 90-day periods, respectively. BAFO (%) of HAB at 30 days (90.17 ± 6.24) was statistically superior (p < 0.01) to all the other groups. At 60 and 90 days, BAFO of LS (87.17 ± 5.9 and 87.99 ± 2.52), HAB (85.95 ± 3.93 and 82.17 ± 3.65), and HABT (83.27 ± 1.44 and 88.67 ± 2.67) was higher than the AS (77.49 ± 5.83 and 76.42 ± 5.98) and MS (74.01 ± 4.68 and 73.81 ± 4.91). CONCLUSIONS: Collectively, our data indicate that the modified surfaces LS, HAB, and HABT favored the interaction between bone and implant and increased bone formation. In addition, HAB showed higher biological behavior favoring the osseointegration. CLINICAL RELEVANCE: Our study provides evidence that LS, HAB, and HABT-modified surfaces improved bone-to-implant contact and increased bone formation around osseointegrated implants compared to conventional machined implants favoring the osseointegration process.

Diagnosis and Management of Cerebrospinal Fluid Leak in a Panfacial Fracture.

Cerebrospinal fluid fistula caused by head trauma is a potentially dangerous problem and precise localization and radical treatment are necessary. We present a case of a patient with Panfacial fracture caused by a motorcycle accident, resulting in a cerebrospinal fluid leakage. The correct diagnosis was realized by computed tomography and auxiliary tests. The successful treatment can be confirmed with the support of radionuclide cisternography examination.

Large Dentigerous Cyst Associated to Maxillary Canine.

Dentigerous cysts are defined as a cyst originated by separation of the follicle of dental crown of a tooth unerupted. Although most dentigerous cysts are considered developmental cysts, some cases seem to have an inflammatory origin. The aim of this study was to show a case of an 8-year-old patient, male, presenting a lesion in maxilla with large proportions. Computed tomography scans showed a hypodense image, well-defined, associated to unerupted teeth. The case was treated by enucleation of the lesion under local anesthesia. Histopathological examination confirmed the diagnostic suspicious of dentigerous cyst. Currently, 3-year follow-up period showed no signs of recurrence, and it was observed eruption of the teeth associated to the lesion. This case highlights the importance of the association between clinical and radiographic analysis together to the surgical findings, aiming the best treatment for the patient.

Andy Gump Fracture of the Mandible in a Pediatric Patient.

The mandibular fractures in pediatric patients are rare, and they can need a fast and safe treatment. We present a case of a pediatric patient with "Andy Gump" fracture, resulting in a retrognathic mandible, distress to breathe, and functional discomfort to the patient caused by a cycling accident. The treatment was successful with the fast release of airway path and use of titanium plates to fix the fracture.

Comparative Microstrain Study of Internal Hexagon and Plateau Design of Short Implants Under Vertical Loading.

PURPOSE: To quantify microstrain development during axial loading using strain gauge analysis for short implants, varying the type of fixture-abutment joint and thread design. MATERIALS AND METHODS: An internal hexagon implant (4 × 8 mm) and a plateau design implant (4 × 8 mm) were embedded on the center of 10 polyurethane blocks with dimensions of 190 × 30 × 12 mm. The respective abutments were screwed onto the implants. Four strain gauges (SGs) were bonded onto the surface of each block, and 4 vertical SGs were bonded onto the side of each block. Axial load of 30 kgf was applied for 10 seconds in the center of each implant. RESULTS: The data were analyzed statistically by analysis of variance for repeated measures and Tukey test (P < 0.05). The interaction between implant and region factors have been statistically significant (P = 0.0259). Tukey test revealed a difference on plateau's horizontal region. The cervical region presented higher microstrain values, when compared with the medium and apical regions of the implants. CONCLUSION: Within the purpose of the study, the type of fixture-abutment joint is a relevant factor to affect the amount of stress/strain in bone simulation. The microstrain development was concentrated on the cervical region of the implant.

Surgical treatment of severe frontal bone fracture.

Craniofacial trauma can lead to several complications. The combined fractures of anterior and posterior walls of the frontal bone are almost always followed by lesions in nasofrontal orifices and disruption of nasofrontal ostia or ducts, a significant factor for the development of early and late complications after sinus fractures. This article reports a case of trauma patient, who underwent neurological evaluation and at first showed good general condition. Computed tomography noted fracture of the anterior and posterior walls of the frontal sinus and small foci of pneumocephalus in the cerebral cortex. The patient was monitored periodically and 9 days after trauma showed increased areas of pneumocephalus in prefrontal cortex, cerebrospinal fluid draining, and large dura mater lesion, with signs of necrosis and inflammation (meningitis). The necrotic tissues were removed, and dura mater was repaired through the approximation with resorbable wire polyglactin 910 5-0, oxidized cellulose application, and bonding with human fibrin sealant (fibrinogen, thrombin, and calcium chloride). Sinusectomy, frontal sinus, and nasofrontal duct obliteration with pedicled pericranium flap were performed. Tomographically, a reanatomization was noted in frontal region, and a 12-month follow-up showed no complication. The use of fibrin glue to repair dura mater lacerations, as well as the pedicle pericranium flap for frontal sinus and nasofrontal duct obliteration, is an efficient method for treating fractures of the frontal bone.