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.

A Simple Method to Retract the Descending Palatine Neurovascular Bundle During Osseous Removal of Posterior Interferences in Le Fort I Osteotomy.

ABSTRACT: For accurate repositioning of the maxilla in Le Fort I osteotomy, bone removal around the descending palatine neurovascular bundle and maxillary tuberosity is frequently required. Such task can be challenging due to the high vascularity of the region, which is the most common site of hemorrhage during removal of bony interferences. Although a rare occurrence, ligation of the descending palatine artery in cases of intraoperative vascular damage can be related to the development of aseptic necrosis. This article reports a simple technique for retraction and protection of the descending palatine neurovascular bundle during bony removal related to a posterior maxillary impaction, which can be easily reproduced in orthognathic selected cases.

A Simple Method of Transoperative Maxillomandibular Fixation in Pediatric Facial Fractures.

ABSTRACT: Maxillomandibular fixation in pediatric facial fractures is quite challenging to be achieved, especially in mid-mixed dentition. Traditional well established intermaxillary devices have a lot of limitations in these patients. This article presents a case of a 9-year-old female patient with a displaced mandibular fracture in which orthodontic buttons were used for transoperative maxillomandibular fixation followed by internal fixation after adequate occlusion reestablishment and fracture reduction. The method showed high efficacy and celerity, allowing the success of treatment, with satisfactory evolution of the patient.

Analysis of the Survival of Dental Implants Installed in Reconstructed Maxilla With Autogenous Iliac Crest Graft: 7- to 9-Year Follow-Up.

The aim of this study was to analyze the survival of dental implants installed in maxillae reconstructed with autogenous iliac crest grafts and to assess patient satisfaction with the treatment by means of a questionnaire. The study conducted medical record reviews and clinical/radiographic assessments of 10 patients with severe maxillary atrophy who had undergone reconstruction with autogenous iliac crest grafts and rehabilitation with dental implants between 2008 and 2011. Patients were assessed for the survival of the implants, considering implant diameter and length, smoking status, diagnosis of diabetes, type of loss, and region of implant loss. In addition, a questionnaire with specific questions on the patients' satisfaction with the treatment was administered. Seventy-six implants were installed in the sampled patients, and only 1 loss was observed (late loss in the anterior maxilla region) after an average follow-up of 7.9 years, which corresponds to a 98.60% survival rate. The installed implants were of the most frequently used dimension (3.75 × 10 mm). One sampled patient was diabetic, and a second patient was both diabetic and a smoker. No loss of implants was observed in these 2 patients. All patients reported being completely satisfied with the treatment and would undergo the procedure again or refer it to a friend/relative. Six patients reported regular maintenance of the prosthesis, and only 3 had changed the prosthesis prior to the time of questionnaire administration. The results of this limited study with a restricted sample population suggest that the reconstruction of the maxilla with an autogenous iliac crest graft provides both adequate implant survival and patient satisfaction.

Sandwich Osteotomies to Treat Vertical Defects of the Alveolar Ridge.

PURPOSE: To evaluate the vertical bone gain after osteotomy sandwich. MATERIALS AND METHODS: Fourteen patients (mean age, 41 years) underwent 17 procedures of osteotomy sandwich. Of these 17 procedures, 15 involved reconstructive surgery and 2 involved the repositioning of implants. The patients were submitted to computed tomography before the surgical procedure and 4 months after the completion of the graft, with measurements taken to assess the vertical gain that had been achieved. RESULTS: The results confirmed a satisfactory vertical gain in all cases (mean, 5.12 mm). The use of autogenous graft or biomaterial particles (in isolation) between the osteotomized segments proved to be viable. Three patients reported postoperative paresthesia, which healed spontaneously after 3 months. One patient exhibited dehiscence due to not following the postoperative recommendations. Forty implants were installed in the grafted regions, and 2 implants were repositioned. CONCLUSION: The technique of sandwich osteotomy was found to be effective for height gain, and different materials can be used between the osteotomized segments.

Evaluation of patients' perceptions of alterations after chin bone graft harvesting.

OBJECTIVE: To evaluate patients' perceptions of alterations occurring after chin bone harvesting. MATERIALS AND METHODS: Thirty patients were evaluated subjectively by visual analog scale-related sensitivity, facial aesthetics, eating, speaking, and lower lip movement, during 12 months. Objective analysis used the static light touch neurosensorial test. The statistical analysis was executed with Friedman test with P < 0.05 for both samples. RESULTS: Subjective analysis revealed no alterations (1) to facial aesthetics, eating, speaking or lower lip movement but sensitivity of the mental region went from a lot of alteration initially (5) to little at the end of the study (3). Objective analysis results showed normal sensitivity (1) in the region after 12 months. CONCLUSION: The discrepancy between subjective and objective analyses may be indicative of the limited precision of clinical testing for subjective impressions assessment.

Prospective clinical assessment of morbidity after chin bone harvest.

The aim of this prospective research was to assess soft tissue morbidity in the symphyseal region after bone graft harvesting. Thirty patients, with average age 45 years, underwent symphyseal bone graft harvesting followed up for a period of 12 months. Follow-up involved neurosensory testing of 2-point discrimination, static light touch, brush directional stroke, pinprick, and thermal discrimination to cold and hot; the statistical analysis was performed using McNemar test and Friedman test with P < 0.05. The results showed that 50% of patients had postoperative morbidity in the first month after surgery showing statistical positive relation with surgery (P < 0.05); at 6 months, this situation diminished to 23%, and at the end of the monitoring period (1 year); the neurosensory tests revealed no persistent morbidity. In conclusion, all neurosensory tests revealed high morbidity in the first month with total resolutions at 1-year follow-up; however, this complication associated to surgery is indispensable to discharge the patient properly.

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.

Planejamento virtual em cirurgia ortognática: relato de caso / Virtual planning for orthognathic surgery: case report / Planificación virtual en cirugía ortognática: reporte de caso

Introdução: A correção das deformidades dentofaciais depende do bom diagnóstico, da precisão do planejamento e da correta execução da técnica cirúrgica. Buscando maior precisão, o planejamento virtual para cirurgia ortognática tem sido uma ferramenta amplamente aplicada pela cirurgia bucomaxilofacial. Este trabalho demonstra, por meio de caso clínico, os benefícios adquiridos pelo planejamento virtual, no que diz respeito a quantificação do movimento, avaliação da predição dos tecidos moles e osteotomias, assim como discorre sobre os cuidados e passos necessários para um correto planejamento. Relato do caso: Paciente de perfil classe II, submetida ao protocolo de planejamento virtual com aquisição de imagens tomográficas, escaneamento intraoral e utilização de software digital para avaliação diagnóstica, planejamento e impressão dos guias cirúrgicos. A mesma foi acompanhada durante 3 meses de pós operatório, apresentando boa precisão e previsibilidade nos movimentos cirúrgicos realizados. Discussão: Ao se realizar uma avaliação clínica acurada, somada a aquisição de imagens tridimensionais, a partir das tomografias de face, escaneamentos intraorais e o manejo da tecnologia CAD/CAM, é possível se alcançar maior precisão no planejamento e predictibilidade cirúrgica, bem como realizar um melhor diagnóstico das deformidades transversas. Contudo, deve-se levar em consideração a necessidade de conhecimento teórico-prático para a correta execução dos passos para o planejamento virtual. Considerações finais: Dado o exposto, foi possível observar precisão no resultado obtido e compatibilidade entre os movimentos planejados e executados. Assim como, demonstrou se aspectos relativos a cada um dos passos para o protocolo virtual, expondo-se suas particularidades e diferenças em relação ao planejamento convencional... (AU)

Introducción: La corrección de las deformidades dentofaciales depende de un buen diagnóstico, de la precisión de la planificación y la correcta ejecución de la técnica quirúrgica . Buscando mayor precisión, la planificación virtual para cirugía ortognática ha sido una herramienta aplicada ampliamente por la cirugia bucomaxilofacial. Este trabajo demuestra, por medio de un caso clínico, los beneficios obtenidos por la planificación virtual, en lo que respecta a la cuantificación del movimiento, evaluación de la predicción de los tejidos blandos y de las osteotomia, así enfatizando los cuidados y pasos necesarios para una correcta planificación. Relato de caso: Paciente con perfil clase II, utilizando protocolo de planificación virtual con adquisición de imágenes tomográficas, escaneamento intra-oral y uso de software digital para evaluación diagnóstica, planificación e impresión 3D de los guías quirúrgicos. La paciente tuvo seguimiento pos operatorio por tres meses, corroborando la precisión y previsibilidad de los movimientos quirúrgicos planificados y ejecutados. Discusión: Al realizarse una evaluación clínica acurada, sumando una adquisición de imágenes tridimensionales, a partir de la tomografía facial, escaneamento intra-oral y el manejo de tecnologia CAD/CAM, es posible alcanzar mayor precisión en la planificación y previsibilidad quirúrgica, así como un diagnóstico más acurado de las alteraciones transversas. Con todo, se debe considerar la necesidad de conocimiento teórico práctico para la correcta elaboración de un proyecto de planificación quirúrgica virtual. Consideraciones finales: Por lo expuesto, se observó precisión en el resultado obtenido considerando los movimientos planificados y ejecutados. Así como se describió aspectos relativos a cada uno de los pasos del protocolo virtual utilizado, exponiendo sus particularidades y diferencias en relación a la planificación quirúrgica convencional... (AU)

Introduction: The correction of dentofacial deformities depends directly on a good diagnosis, the precision of the surgical planning and the correct execution of the technique. Seeking greater precision, virtual planning for orthognathic surgery has been a tool widely applied in oral and maxillofacial surgery. This work demonstrates, through a case report, the benefits acquired by virtual planning, regarding the quantification of movement, evaluation of the prediction of soft tissues and osteotomies, as well as discusses the accuracy and steps necessary for a correct planning. Case report: Class II facial profile patient, submitted to the virtual planning protocol with acquisition of tomographic images, intraoral scanning and use of digital software for diagnostic evaluation, planning and printing of surgical guides. She was followed up for 3 months after the operation, showing good precision and predictability in the surgical movements performed. Discussion: When performing an accurate clinical evaluation, added up to the acquisition of three-dimensional images, from face tomography, intra-oral scans and the management of CAD/CAM technology, it is possible to achieve greater precision in surgical planning and predictability, as well as accomplish a better diagnosis of transverse deformities. However, one must take into account the need for theoretical practical knowledge for the correct execution of the steps for virtual planning. Final considerations: Given the above, it was possible to observe precision in the result obtained and compatibility between the planned and executed movements. As well, aspects related to each of the steps for the virtual protocol were demonstrated, exposing their particularities and differences in relation to conventional planning... (AU)

Paracoccidioidomicose afetando a mucosa bucal: relato de caso / Paracoccidioidomycosis affecting the buccal mucosa: case report / Paracoccidioidomicosis con afectación de la mucosa oral: relato de caso

Introdução: A paracoccidioidomicose é uma infecção micótica sistêmica com manifestações pulmonares primária que podem apresentar lesões cutâneas e orais. É mais comum no Brasil e em alguns outros países da América Latina, representando um importante problema de saúde pública devido às suas características potencialmente fatais. Relato de caso: Trabalhador rural de 53 anos, fumante e etilista, apresentando lesão ulcerada de aspecto moriforme em mucosa bucal direita. Realizou-se biópsia incisional cujo laudo histopatológico foi de paracoccidioidomicose. O paciente foi encaminhado ao médico infectologista para tratamento por meio de itraconazol (200mg por dia) por 18 meses. Após 03 meses de tratamento já apresentava regressão da lesão. Considerações Finais: Portanto, o objetivo deste trabalho é enfatizar a importância do cirurgião-dentista no reconhecimento das lesões oral e realização da biópsia para o correto diagnóstico e manejo desta doença por meio de um relato de caso clínico... (AU)

Paracoccidioidomycosis is a systemic mycotic infection with primary pulmonary manifestations that can present cutaneous and oral lesions. It is more common in Brazil and some other Latin American countries, representing an important public health problem due to its potentially fatal characteristics. Case report: 53-year-old rural worker, smoker and drinker, presenting an ulcerated lesion with a moriform aspect in the right oral mucosa. An incisional biopsy was performed, and the histopathological report was of paracoccidioidomycosis. The patient was referred to the infectious disease physician for treatment with itraconazole (200mg per day) for 18 months. After 03 months of treatment, he already had regression of the lesion. Final Considerations: Therefore, the objective of this paper is to emphasize the importance of the dentist in recognizing oral lesions and performing a biopsy for the correct diag... (AU)

La paracoccidioidomicosis es una infección micótica sistémica con manifestaciones pulmonares primarias que pueden presentar lesiones cutáneas y bucales. Es más común en Brasil y algunos otros países de América Latina, lo que representa un importante problema de salud pública debido a sus características potencialmente fatales. Caso clínico: trabajador rural de 53 años, fumador y bebedor, con lesión ulcerada de aspecto moriforme en mucosa oral derecha. Se realizó biopsia incisional y el informe histopatológico fue de paracoccidioidomicosis. El paciente fue remitido al médico de enfermedades infecciosas para tratamiento con itraconazol (200 mg al día) durante 18 meses. Después de 03 meses de tratamiento, ya tenía regresión de la lesión. Consideraciones finales: Por lo tanto, el objetivo de este trabajo es enfatizar la importancia del odontólogo en el reconocimiento de las lesiones bucales y la realización de una biopsia para el correcto diagnóstico y manejo de esta enfermedad a través de la presentación de un caso clínico... (AU)

Influência da cirurgia ortognática na harmonia facial: série de casos / Influence of orthognathic surgery on facial harmony: case series

A cirurgia ortognática é uma opção terapêutica viável no tratamento daqueles pacientes que apresentam deformidades dento-esqueléticas. De acordo com a literatura, esse procedimento cirúrgico possibilita aos pacientes resultados funcionais e estéticos, proporcionando mudanças significativas na vida destes. Sendo assim, este trabalho teve por objetivo relatar uma série de casos de pacientes submetidos à cirurgia ortognática, cujos resultados pós-operatórios demonstram uma importante melhora na harmonia facial destes, o que vem a confirmar que esse procedimento é um importante instrumento de mudança na vida dos pacientes, possibilitando uma convivência normal destes em sociedade... (AU)

The orthognathic surgery is a viable therapeutic option in the treatment of those patients who have dental-skeletal deformities. According to the literature, this surgical procedure allows the functional and aesthetic results patients, providing significant changes in their lives. Thus, this study aimed to report a case series of patients undergoing orthognathic surgery whose postoperative results show a significant improvement in facial harmony of the same, which confirms that this procedure is an important tool change in the lives of patients, allowing a normal coexistence of these patients in society... (AU)

Considerações atuais sobre a remoção de enxerto do mento / Current considerations on the chin bone harvesting

A utilização de enxerto ósseo do mento com o objetivo de readequar regiões alveolares atróficas é reportada na literatura como um procedimento viável e previsível, com elevados índices de sucesso. No entanto, trabalhos relacionados a essa modalidade de enxerto, abordando os cuidados necessários e principalmente as alterações que essa remoção causa na região doadora, são escassos. O objetivo deste trabalho foi relatar um caso clínico, procurando abordar e discutir as alterações que a remoção de enxerto do mento pode causar no contorno do tecido mole da região, na sensibilidade do tecido mole e pulpar, além de abordar o potencial de neoformação óssea e a percepção dos pacientes frente a essas alterações... (AU)

The use of the chin bone graft in order to readjust atrophic alveolar regions is reported in the literature as a viable and predictable procedure with high success rates. However, works related to this type of graft covering the necessary care and especially the changes that the removal because the donor region are scarce. Therefore, the objective was case report seeking to address and discuss the changes that the removal of the graft in treatment can cause soft tissue contour of the region, the sensitivity of the soft tissue and pulp, and to discuss the potential for new bone formation and perception of patients treated with these changes... (AU)

Descompressão cirúrgica no tratamento de lesões císticas da cavidade oral / Surgical decompression in the treatment of cystic lesions of the oral cavity

Os cistos são lesões formadas por uma cavidade revestida de tecido epitelial, as quais contêm, em seu interior, material líquido ou semisólido, podendo ser classificados em cistos odontogênicos e não odontogênicos. Apesar de existirem diversas modalidades de tratamentos descritas na literatura para tratamentos dos cistos da cavidade oral, até o presente momento, não se observa um consenso em relação à qual técnica que oferece os melhores resultados. Sendo assim, procurou-se relatar um caso clínico com a utilização da técnica de descompressão, procurando evidenciar suas indicações, vantagens, desvantagens e demais peculiaridades... (AU)

Cysts are lesions formed by a cavity lined with epithelial tissue, which contains in its interior material liquid or semisolid, and may be classified into odontogenic cysts and non-odontogenic. Although there are several treatment modalities described in the literature for treatment of cysts of the oral cavity, to date not seen a consensus as to which technique offers the best results. Therefore, we sought to a case report using the technique of decompression, seeking to highlight their indications, advantages, disadvantages and other peculiarities... (AU)

Estudio radiográfico prospectivo de la reparación ósea en sínfisis mandibular posterior a la remoción ósea de mentón / Radiographic prospective study of osseous repair in mandibular symphysis after chin bone remove

El retiro de hueso de sínfisis mandibular ha sido utilizado ampliamente para diferentes procedimientos reconstructivos maxilofaciales. El objetivo de esta investigación fue establecer la existencia de la reparación ósea en el defecto creado en sínfisis debido al retiro de hueso. Treinta pacientes (22 mujeres, 8 hombres) de entre 21 y 65 años fueron operados para retirar hueso de mentón que fue posteriormente aplicado en reconstrucción ósea alveolar; las cirugías fueron realizadas por dos cirujanos maxilofaciales y los pacientes fueron evaluados con telerradiografías en la etapa preoperatoria, postoperatoria inmediata (PIn) y postoperatoria tardía (PTar), donde se realizaron medidas horizontales y verticales del defecto óseo; los valores fueron estudiados con la prueba t de Student con valor de p<0,05. Luego del retiro óseo se observó un defecto vertical promedio de 12,80+/-1,99 y horizontal de 8,33+/-1,77; luego de un año, se obtuvo una disminución de 32,8 por ciento en el sentido vertical y 50,3 por ciento horizontal, presentando significancia estadística en relación al PIn. Se concluye que existe reparación ósea del defecto originado en sínfisis siendo próximo al 30 por ciento-50 por ciento en la evaluación de un año posterior a la cirugía.

Bone harvest of mandibular symphysis has been used in maxillofacial reconstruction procedures. The aim of this research was to establish the presence of bone repair into osseous defect caused by removal of bone. Thirty patient s, 2 female and 8 male, ranging between 21 and 65 years of age underwent surgery for chin bone harvest and alveolar reconstruction. The surgery was performed by two maxillofacial surgeons and the patients were evaluated with lateral radiography in the pre-operatory stage, in early post-operatory and in late post-operatory stages. Horizontal and vertical measures of bone defect were realized; the dates were analyzed by Student t test with a value of p<0.05. After bone harvest, a vertical defect of 12.80 +/-1.99 was observed and a horizontal defect of 8.33 +/- 1.77 was observed. After one year the defect decreased to 32.8 percent in vertical evaluation, and 50.3 percent in the horizontal evaluation with a statistical significance (p<0.05) in relation to the early post-operatory stage. Therefore, we conclude that in bone repair of mandibular symphysis defect is close to 30 ­ 50 percent in a one-year follow-up.

Retrospective four year analysis in 199 bone grafts of the alveolar ridge / Análise retrospectiva de quatro anos em 199 enxertos autógenos do rebordo alveolar

Objective: To evaluate the factors that lead to complications in autogenous bone grafting. Methods: Review of clinical records of the patients that were candidates for rehabilitation, between May 2004 and December 2008. With regard to the donor area, of the 199 reconstructions, 175 were autogenous bone graft procedures and 210 donor areas were acted upon.Results: A total of 48 procedures (24.12%) were grafts using particulate bone while sinus lift grafts were performed on 28 patients (14.07%).Osteogenesis distraction and inferior alveolar nerve lateralization were performed in five (2.51%) and three (1.51%) procedures respectively.Eleven autogenous bone grafts were lost, of which 90.9% were onlay block. Conclusion: The use of autogenous bone grafting in atrophic alveolar ridge reconstruction is a highly successful treatment, and the sinus lift procedure is the most predictable form of treatment.

Objetivo: Avaliar os fatores que levam às complicações em enxertia óssea autógena. Métodos: A amostra foi composta pela revisão de prontuários clínicos de pacientes candidatos à reabilitação no período entre maio de 2004 e dezembro de 2008. Em relação à área doadora, das 199 reconstruções, 175 foram procedimentos de enxerto de osso autógeno, sendo abordadas 210 áreas doadoras. Resultados: Os enxertos com osso particulado totalizaram 48 procedimentos (24,12%). O levantamento de seio maxilar foi realizado em 28 pacientes (14,07%). Já a distração osteogênica e lateralização do nervo alveolar inferior foi realizada em cinco (2,51%) e três (1,51%) procedimentos respectivamente. Foi registrada a falha de 11 enxertos com osso autógeno. Dos enxertos perdidos, 90,9% deles foram os de bloco tipo onlay. Conclusão: A utilização de enxertos ósseos autógenos nas reconstruções de rebordos alveolares que apresentam atrofia é um tratamento com alto índice de sucesso, destacando-se a cirurgia de levantamento de soalho de seio maxilar como a modalidade mais previsível de reconstrução óssea.

Acidentes durante a realização da osteotomia sagital do ramo mandibular: relato de caso / Accidents during the course of the sagittal split osteotomy of the mandibular ramus: Literature review and case report

A osteotomia sagital do ramo mandibular é um procedimento amplamente utilizado para a correção de deformidades dentofaciais, tanto para aquelas que necessitam de avanços ou recuos mandibulares. Diversos autores realizaram estudos e sugeriram modificações procurando aperfeiçoar esta técnica, sendo que na atualidade este pode ser considerado um procedimento corriqueiro, versátil e previsível. Mas, como toda técnica cirúrgica, ela não esta livre da ocorrência de acidentes e complicações. Sendo assim, o objetivo do presente trabalho é relatar o caso clínico de uma paciente submetida à realização de OSRM para tratamento de retrognatismo mandibular, onde durante o procedimento cirúrgico houve uma fratura indesejada no segmento proximal, bem como a descrever forma de tratamento realizada.

The sagittal split osteotomy of the mandibular ramus is a widely used procedure for the correction of dentofacial deformities, both for those who require mandibular advances or retreats. Several authors have conducted studies and suggested changes trying to perfect this technique, and at present this procedure can be considered predictable and versatile. But, like any surgical technique, it is not free of accidents and complications. Therefore, the objective of this study is to report the case of a patient submitted to a sagittal split osteotomy of the mandibular ramus for treatment of mandibular retrognathia, where during the surgical procedure was an unwanted fracture in the proximal segment, as well as to describe a form of treatment performed.

Otimização de resultados através da colocação do Implante Dentário e associação de osso liofilizado e membrana reabsorvível û relato de caso / Optimizing results through dental implant installation associated with lyophilized bone and resorbable membrane û case report

A realização de enxertia óssea convencional visando corrigir defeitos ósseos, para posterior colocação de implantes dentários é uma opção viável e previsível, mas que aumenta o tempo e a morbidade dos tratamentos implantodônticos. Sendo assim, a realização da implantação mesmo em áreas com deficiente volume ósseo, associada à colocação de biomateriais e membranas reabsovíveis é uma opção para reduzir a duração e a morbidade do tratamento. De acordo com a literatura, esse método quando bem indicado e executado, proporciona resultados semelhantes à enxertia convencional. Diante do exposto, o objetivo do presente trabalho foi relatar e discutir o caso clínico de um paciente que apresentava perda óssea em região anterior de mandíbula e que foi tratado através de implantação, colocação de biomaterial e membrana reabsorvível sobre a superfície exposta do implante, no mesmo momento cirúrgico. Os resultados pós-operatórios demonstram estabilidade, tecidos moles mantidos em posição e volume gengival adequado, o que vem a evidenciar o sucesso do plano de tratamento executado.

The performance of conventional bone grafting aiming to correct bone defects, for later placement of dental implants is a viable and predictable option, but it increases implantodontic treatments time and morbidity. Thus, performing the implantation even in areas with poor bone volume associated with the placement of biomaterials and resorbable membranes is an option for reducing treatment duration and morbidity. According to the literature this method when well indicated and performed provides similar results to conventional grafting. Considering all this, the objective of this study was to report and discuss the case of a patient with bone loss in the anterior jaw, who was treated through implantation, placement of biomaterial and resorbable membrane on the exposed surface of the implant at the same surgical time. The postoperative results have demonstrated stability, soft tissue held in place and adequate gingival volume, which shows the success of the treatment plan implemented.

Utilização de exostose óssea associada com biomaterial em cirurgia de levantamento do soalho do seio maxilar / Use of bone exostosis associated with biomaterial in maxillary sinus floor elevation

Exostoses ósseas são crescimentos ósseos benignos do esqueleto craniofacial, que ocorrem ao longo da região vestibular, lingual (tórus mandibular) ou palatina (tórus palatino) dos maxilares. A presença dessas estruturas pode interferir na fonação, mastigação e adaptação de próteses parciais removíveis ou totais, devendo sua remoção ser sempre considerada. Além disso, a remoção e aproveitamento de tais estruturas deve ser considerada, também, nos casos de atrofia do rebordo alveolar, quando o objetivo é a reabilitação por meio de implantes dentários. Sendo assim, o objetivo do presente trabalho é relatar o caso clínico de uma paciente que apresentava um tórus palatino e necessitava de cirurgia para levantamento do soalho do seio maxilar, para posterior colocação de implante; o tórus foi removido e aproveitado em associação com biomaterial heterógeno...

Bone exostosis refers to benign bone growth in the craniofacial skeleton. They occur along the labial, lingual (mandibular torus) or palatal (palatal torus) regions of the jaws. The presence of these structures can affect phonation, chewing and adaptation to partial or completely removable dental prostheses. The removal of these structures should always be considered. In addition, the removal and use of these structures should also be considered in cases of atrophy of the alveolar ridge, when seeking to promote rehabilitation through the use of dental implants. Therefore, the aim of the present study was to report a clinical case in which a patient exhibited a palatal torus and required surgery for maxillary sinus floor lifting and subsequent implant placement. The palatal torus was removed and used in association with heterogeneous biomaterial...

Considerações sobre a utilização dos implantes imediatos carregados em região estética û relato de caso / Considerations on the use of immediate loaded implants in aesthetic region û case report

A remoção de um elemento dentário resulta constantemente em defeitos ósseos que dificultam a instalação de um implante dentário, sendo que na grande maioria dos casos é necessária a realização de um enxerto ósseo. Atualmente, os implantes imediatos representam uma opção viável e previsível para repor um elemento dentário que esteja condenado, possibilitando, na grande maioria dos casos, até mesmo o carregamento imediato do implante. No entanto, para se obter bons resultados com as implantações imediatas é necessário especial cuidado relacionado com o carregamento imediato do implante e também na preservação da tábua óssea vestibular remanescente. Sendo assim, no presente trabalho procurou-se relatar um caso clínico de implantação imediata, bem como discutir esses cuidados especiais que precisam ser tomados durante o ato operatório, para possibilitar a estabilidade dos resultados a longo prazo.

The extraction of a tooth results in bone defects which hinder the installation of a dental implant, and requiring bone graft for most of the cases. Currently, immediate implants represent viable option to replace an impaired tooth and in most cases enable even the immediate loading of the implant. However, in order to be succsesful the immediate loading of implants must be carefully executed and preserve the remaining buccal bone plate. Thus, the present study sought to report a case of immediate implementation and to discuss these special cares that must be taken during surgery to enable stability of long-term results.

Considerações clínicas para otimização dos resultados em enxertia óssea: parte II / Clinical considerations for optimizing results in bone grafting: part II

Na Implantodontia, a otimização dos resultados é uma preocupação constante dos profissionais que a exercem. Para isso, é necessário abordar, de forma adequada, fatores que podem influenciar diretamente os resultados desses tipos de reabilitações. Nesse sentido, abordamos e discutimos, neste trabalho, a importância de alguns aspectos que influenciam diretamente os enxertos de tecido ósseo, como sua adaptação e fixação ao leito receptor, bem como o preenchimento de interfaces e a cobertura dos enxertos com biomateriais, aliados ao uso de membranas reabsorvíveis. Além disso, abordamos e discutimos, também, sobre a crescente utilização de biomateriais no preenchimento do espaço vestibular nos casos de implantes imediatos, o que veio a dar segurança nesse tipo de implantação, estabilizando os tecidos envolvidos. Desse modo, atualmente, é possível afirmar que os bons resultados obtidos com as implantações imediatas possibilitam uma diminuição no número de grandes reconstruções...

Optimization of results is an ongoing concern shared by professionals in the field of Implantology. In order to achieve the best results possible, it is necessary to adequately address factors that can directly affect them. Thus, the aim of the present study was to assess and discuss the importance of some aspects that have a direct effect on bone tissue grafting, such as adaptation and fixation to the receptor site, the use of biomaterial to fill interfaces and cover grafts, together with the use of resorbable membranes. In addition, we address and discuss the increasing use of biomaterial to fill the buccal gap in cases of immediate implants, which renders immediate implant placement safer by stabilizing all tissues involved. Thus, it is possible to state that results obtained with immediate implants aresatisfactory and can reduce the number of large-scale reconstructions...