Effect of low-level laser therapy on incorporation of block allografts.

OBJECTIVE: To assess the effect of low-level laser therapy (LLLT) on the incorporation of deep-frozen block allografts in a rabbit model. BACKGROUND DATA: Studies have shown that LLLT has beneficial effects on tissue repair and new bone formation. METHODS: Bone tissue was harvested from two rabbits, processed by deep-freezing and grafted into the calvaria of 12 animals, which were then randomly allocated into two groups: experimental (L) and control (C). Rabbits in group L were irradiated with an aluminum gallium arsenide diode laser (AlGaAs; wavelength 830 nm, 4 J/cm(2)), applied to four sites on the calvaria, for a total dose of 16 J/cm(2) per session. The total treatment dose after eight sessions was 128 J/cm(2). Animals were euthanized at 35 (n = 6) or 70 days (n = 6) postoperatively. RESULTS: Deep-freeze-processed block allografts followed by LLLT showed incorporation at the graft-host interface, moderate bone remodeling, partial filling of osteocyte lacunae, less inflammatory infiltrate in the early postoperative period, and higher collagen deposition than the control group. CONCLUSION: Optical microscopy and scanning electron microscopy showed that allograft bone processed by deep-freezing plus LLLT is suitable as an alternative for the treatment of bone defects. Use of the deep-freezing method for processing of bone grafts preserves the structural and osteoconductive characteristics of bone tissue.

Central odontogenic fibroma: an international multicentric study of 62 cases.

OBJECTIVE: The aim of this study was to report the clinicopathologic features of 62 cases of central odontogenic fibroma (COdF). STUDY DESIGN: Clinical and radiographic data were collected from the records of 13 oral pathology laboratories. All cases were microscopically reviewed, considering the current World Health Organization classification of tumors and were classified according to histopathologic features. RESULTS: There were 43 females and 19 males (average age 33.9 years; range 8-63 years). Clinically, COdF lesions appeared as asymptomatic swellings, occurring similarly in the maxilla (n = 33) and the mandible (n = 29); 9 cases exhibited palatal depression. Imaging revealed well-defined, interradicular unilocular (n = 27), and multilocular (n = 12) radiolucencies, with displacement of contiguous teeth (55%) and root resorption (46.4%). Microscopically, classic features of epithelial-rich (n = 33), amyloid (n = 10), associated giant cell lesion (n = 7), ossifying (n = 6), epithelial-poor (n = 3), and granular cell (n = 3) variants were seen. Langerhans cells were highlighted by CD1a staining in 17 cases. Most patients underwent conservative surgical treatments, with 1 patient experiencing recurrence. CONCLUSIONS: To the best of our knowledge, this study represents the largest clinicopathologic study of COdF. Most cases appeared as locally aggressive lesions located in tooth-bearing areas in middle-aged women. Inactive-appearing odontogenic epithelium is usually observed within a fibrous/fibromyxoid stroma, occasionally exhibiting amyloid deposits, multinucleated giant cells, or granular cells.

Treatment of comminuted mandibular fractures: a critical review.

The treatment of comminuted fractures of the mandible is challenging due both to the severity of the injuries generally associated with this type of fracture, and the lack of consensus as to the most appropriate treatment method.There are two distinct approaches for treating comminuted fractures of the mandible: closed reduction with maxillomandibular fixation (MMF) - the oldest and classical treatment - and open operation and internal fixation. The morbidity rate of closed reduction is lower but, with the advent of modern anaesthesia and antibiotics, open surgery has become more frequent. Stable internal fixation (SIF) is acheived using plates, miniplates and/or screws. The advantage of this approach is that there is a more precise reduction of the fragments, with the possibility of early function by eliminating or reducing the time of MMF. This paper reviews the main advantages, disadvantages and differences between the two techniques.

The treatment of condylar fractures: to open or not to open? A critical review of this controversy.

The treatment of condylar process fractures has generated a great deal of discussion and controversy in oral and maxillofacial trauma and there are many different methods to treat this injury. For each type of condylar fracture, the techniques must be chosen taking into consideration the presence of teeth, fracture height, patient's adaptation, patient's masticatory system, disturbance of occlusal function, deviation of the mandible, internal derangements of the temporomandibular Joint (TMJ) and ankylosis of the joint with resultant inability to move the jaw, all of which are sequelae of this injury. Many surgeons seem to favor closed treatment with maxillomandibular fixation (MMF), but in recent years, open treatment of condylar fractures with rigid internal fixation (RIF) has become more common. The objective of this review was to evaluate the main variables that determine the choice of method for treatment of condylar fractures: open or closed, pointing out their indications, contra-indications, advantages and disadvantages.

Myxoid calcified hamartoma and natal teeth: a case report.

We report the case of a 4-month-old Caucasian male baby who presented an uncommon mass in the anterior mandibular ridge. The patient was born with two natal mandibular incisors, which exfoliated some weeks after birth, followed by a growth of nodular lesion in the same region. Based on the clinical and histopathological features, the diagnosis was of myxoid calcified hamartoma. Immunohistochemical and scanning electron microscopic analysis of the lesion were performed. Hamartomas in the mandibular ridges associated with natal teeth are rare, but they must be considered in the differential diagnosis of common lesions, such as congenital granular cell epulis.

Malignant peripheral nerve sheath tumor of the lower labial mucosa: case report and literature review.

Malignant peripheral nerve sheath tumor (MPNST) is an uncommon soft tissue sarcoma with a predilection for the extremities and trunk of adults, rarely occurring in the oral cavity. To date, 10 cases of MPNSTs affecting the lower labial mucosa have been reported in the English language literature. We describe an additional case of MPNST in the lower labial mucosa of a 67-year-old male patient, who exhibited a painful swelling with a history of 4 months of evolution. Microscopic examination showed dense plexiform fascicles of spindle cells with wavy atypical nuclei. Mitotic figures and nuclear pleomorphism were evident. Immunohistochemical analysis of tumor cells revealed positivity for S-100 protein, CD56, CD34, and neuron-specific enolase but was negative for neurofilament protein, glut-1, claudin-1, desmin, and smooth muscle actin. Ki-67 labeling was 20%. The final diagnosis was MPNST. The lesion was surgically removed with wide margins, with no signs of recurrence after 4 years of follow-up.

Effect of Recombinant Human Growth Hormone on Osseointegration of Titanium Implants: A Histologic and Biomechanical Study in Rabbits.

To evaluate the action of recombinant human growth hormone (rhGH) on osseointegration of titanium implants in rabbits. Fourteen adult New Zealand rabbits, aged 30 weeks, were used in the study, and randomly divided into 2 groups. In each animal, 2 (2.2 mm × 6 mm) pure titanium implants were placed in the left tibia. In one group (test group), 1 IU (0.3 mg) of rhGH as a lyophilized powder was applied to each osteotomy site prior to implant placement. Only titanium implants were placed in osteotomy sites of the other group (control). Animals were humanely killed at 14 and 42 days after surgery, and samples were then prepared for histologic analysis and biomechanical test. The biomechanical test showed tensile pull-out stress values of 33.88 N/cm(2) for controls and 59.26 N/cm(2) for the rhGH group at 14 days and 25.99 N/cm(2) and 29.69 N/cm(2) for the control and the test group, respectively, at 42 days. Scanning electron microscope analysis showed more uniform and abundant bone tissue in contact with the implants for the test group at 14 days, and no differences between groups at 42 days. Furthermore, histologic analysis also showed accelerated bone repair in 14 days and a more advanced stage of bone remodeling for the rhGH-treated group when compared to controls after 42 days of repair. Such results show that the topical use of rhGH induces new bone formation in the early stages of bone repair and hence accelerates osseointegration of titanium dental implants.

Retrospective study of prevalence of face fractures in southern Brazil.

CONTEXT: Trauma has been an important public health problem worldwide. Facial injuries are among the most common types of trauma treated at emergency departments, associated or not with injuries in other anatomic sites. The patterns of facial fractures are usually affected by geography and socioeconomic conditions. AIM: To investigate the prevalence of facial fractures in Lages, state of Santa Catarina, southern Brazil, from September 2003 to August 2008. SETTINGS AND DESIGN: Cross-sectional, retrospective, epidemiological study. MATERIALS AND METHODS: Data on patients' gender, age, etiological agent, and facial region affected by fracture were collected from the charts of patients treated with facial fractures. STATISTICAL ANALYSIS USED: Qualitative variables were expressed as absolute and relative frequencies, and quantitative variables as means and standard deviation. The Chi-square test was used to evaluate the association between gender, traffic accidents and facial region affected. The association between etiological agents and facial region affected was assessed using the chi-square test and the adjusted residuals analysis. RESULTS: 492 patients presented with oral and maxillofacial trauma, with 988 facial fractures; 80.9% of the patients were men, and the most frequent age group was 21-30 years (29.5%). The most frequent causes of fractures were: Traffic accidents in 27.9%, physical assault in 14.9%, and bicycle falls in 10.5%; several other causes scored below 10%. CONCLUSION: Regular publication of epidemiological data is extremely important for the implementation of prevention campaigns and for an increased awareness of the etiology of fractures affecting the face and other anatomic sites.

Mucocutaneous dyskeratosis with periodontal destruction and premature tooth loss.

We report the case of a 16-month-old boy who presented an exuberant erythematous gingival swelling and severe tooth mobility. Radiographic examination confirmed alveolar bone loss, and gingival biopsy showed epithelium containing numerous dyskeratotic cells. Because of feeding difficulties, the enlarged gingival tissue and involved teeth were removed. One year later, similar problems were encountered during the eruption of the deciduous second molars. The patient also exhibited papular skin lesions. Histopathologic features on biopsies of the skin and oral lesions were similar. The oral and cutaneous lesions presented by this patient were similar to those described by From et al. in 1978 in a father and son, reported as dyskeratosis benigna intraepithelialis mucosae et cutis hereditaria--the sole report in the English language. To avoid confusion with hereditary benign intraepithelial dyskeratosis (Witkop-von Sallmann syndrome) we have renamed the condition as mucocutaneous dyskeratosis with periodontal destruction and tooth loss.

Low-level laser therapy for implants without initial stability.

OBJECTIVE: This study evaluated the effect of low-level infrared laser on removal torque values of implants with poor initial stability inserted in rabbit tibias. BACKGROUND DATA: It is important to analyze the effects of laser radiation on bone repair when low-quality bone and implants with poor initial stability are used. MATERIALS AND METHODS: Thirty male white New Zealand rabbits (Oryctolagus Cuniculus) about 2 mo old and weighing 1.5-2.0 kg were used. Machined implants with poor initial stability were inserted in the tibia of each animal. Animals were randomly divided into two groups: laser irradiated and laser nonirradiated. Each group was further divided into three subgroups, according to the day the animals were killed: 15, 30, or 45 d. Torque values were measured with an axial digital torquemeter that applied counter-torque. The Student's t-test was used to calculate means and standard deviations for the comparisons between laser and control groups. RESULTS: A significant increase (p = 0.050) in removal torque values was found in the group of laser-irradiated implants at 15 and 30 d when compared with the control groups. At 45 d, no significant differences were found. CONCLUSION: In this study, low-level laser therapy promoted the osseointegration of implants with poor initial stability, particularly in the initial stages of bone healing.

Implante dentário unitário imediato / Immediate unitary dental implant

O presente estudo trata-se de uma revisão de literatura a respeito de Implante Dentário Unitário Imediato e também uma revisão atualizada com critérios de inclusão pré-estabelecidos relatando taxas de longevidade do ano de 1999 a 2009, bem como procedimentos clínicos associados a sua instalação. Foi realizada uma revisão de literatura com busca de artigos científicos na base de dados MEDLINE e os critérios de inclusão dos mesmos foram: artigos publicados de 1999 a 2009; ensaios clínicos randomizados e não-randomizados; estudos de coorte; estudos de caso-controle; relatos de casos clínicos com um número mínimo de 10 casos; taxas de sucesso e de longevidade devem ter um período de proservação de pelo menos 6 meses; relatos de casos clínicos somente com instalação de implantes imediatos. Foram identificados um total de dez estudos que preenchiam os critérios de seleção desta revisão. Eles relatam as taxas de longevidade de implantes imediatos e alguns ainda comparam com implantes tardios. O período de observação dos mesmos foi de seis meses a seis anos. Na presente revisão, a maior parte dos estudos apresentaram taxas de longevidade de implantes imediatos acima de 90%, ou seja, similar aos implantes colocados em alvéolos cicatrizados. Os autores não encontraram diferenças estatísticas significantes nas taxas de longevidade para técnicas de colocação imediata e tardia. A taxa de longevidade de implantes imediatos foi de 100% em quatro estudos. Dois estudos apresentaram maior taxa de sucesso com colocação imediata (96,8%) quando comparada com a tardia (93,9%). As menores taxas encontradas foram a de 89,3% e 85%. Com isso, os autores concluem que a técnica de instalação de Implante Unitário Imediato é uma técnica confiável e segura apresentado taxas de sucesso semelhante a implantes tardios

The present study is about a literature review regarding it Implants Dental Unitary Implants Immediate and an updated revision with inclusion criteria prestablished showing rates of longevity of the year from 1999 to 2009 as well as associated clinical procedures at its installation. A literature review was accomplished with a research of scientific MEDLINE database and the inclusion criteria of it were: Published from 1999 to 2009 ; randomized and non-randomized clinical rehearsals; cohort studies; case-control studies; reports of clinical cases with a minimum number of 10 cases; success and longevity rates should have a post accompaniment period of at least 6 months; reports of clinical cases only with placement of immediate implants. Ten studies that fitted out the criteria of selection of this revision were identified. They report the longevity rates of immediate dental implants and some still compare to late dental implants. The observation time was from six months to six years. In the present revision, most of the studies presented longevity rates of its immediate implants above 90%, in other words, similar to the implant placed in scarred alveoli. The authors didn’t find significant statistical differences in the longevity rates for techniques of immediate and late placement. The longevity rate of its immediate implant was 100% in six studies. Two studies presented larger success rate with immediate placement (96,8%) when compared with the late (93,9%). 89,3% and 85% were the lowest rates among reported ones, were found in two studies. Thus, we can conclude that the placement technique of it Immediate Unitary Dental Implants is a reliable technique and it holds presented rates of similar success to late implants

Treatment of comminuted mandibular fractures: A critical review

The treatment of comminuted fractures of the mandible is challenging due both to the severity of the injuries generally associated with this type of fracture, and the lack of consensus as to the most appropriate treatment method.There are two distinct approaches for treating comminuted fractures of the mandible: closed reduction with maxillomandibular fixation (MMF) - the oldest and classical treatment - and open operation and internal fixation. The morbidity rate of closed reduction is lower but, with the advent of modern anaesthesia and antibiotics, open surgery has become more frequent. Stable internal fixation (SIF) is acheived using plates, miniplates and/or screws. The advantage of this approach is that there is a more precise reduction of the fragments, with the possibility of early function by eliminating or reducing the time of MMF. This paper reviews the main advantages, disadvantages and differences between the two techniques (AU)

Implicações da perda óssea peri-implantar em área estética / Clinical implications of the peri-implantar bone loss in the esthetic zone

O sucesso dos implantes osseointegrados está relacionado diretamente com a integração entre o implante e os tecidos que o envolvem. Qualquer alteração nos tecidos pode promover mudanças estéticas e até mesmo comprometer a longevidade dos implantes. O objetivo desse trabalho é revisar a literatura no que diz respeito às causas das perdas ósseas peri-implantares e a sua relação com o desenho dos implantes e a manutenção da papila gengival. Atualmente existem diferentes hipóteses para a causa da perda óssea precoce da crista, não havendo consenso entre os autores, porém dentre estas se destacam seis fatores: trauma cirúrgico, sobrecarga oclusal, peri-implantite, microgap entre a peça protética e o implante, recuperação do espaço biológico e módulo da crista do implante. Sua influência é percebida nos espaços proximais com alterações na papila gengival e na face vestibular com recessões que influenciam diretamente a estética do tratamento. Na tentativa de solucionar esse problema, alterações nos desenhos das conexões, como o uso de plataforma protética em diâmetro menor que a do implante (plataforma switching) e conexão tipo cone morse têm sido desenvolvidas mostrando resultados interessantes e que merecem mais estudos longitudinais para comprovarem a real eficácia destas.

The success of osseointegrated implants is directly related to the integration between the implant and the marginal tissues. Any tissue modification can promote aesthetic changes and even compromise the implant longevity. The aim of the present study is to review the literature concerning peri-implant bone loss and its relation to implant design and gingival papilla maintenance. Nowadays, there are different hypothesis for the precocious bone crest loss and there is no consensus among authors, but six factors are underlined: surgical trauma, occlusal overload, peri-implantitis, microgap between the abutment and the implant, re-establishment of biological width and implant crest module. Its influence is noticed in the approximal spaces with changes in the gingival papilla and in the buccal surface with recessions which directly influence the treatment aesthetic result. Connection design modifications are being developed in the attempt of solving this problem, such as the usage of prosthetic platform with a smaller diameter than the implant diameter (platform switching) and morse cone connection, showing interesting results which deserve more longitudinal studies to prove their real effectiveness.

Utilização do osso alógeno em bloco para aumento de rebordo alveolar: revisão da literatura / The use of allogeneic bone block for alveolar ridge augmentation: a literature review

Apesar da segurança proporcionada pelo osso autógeno para a correção de defeitos alveolares é constante a busca de alternativas que eliminem ou diminuam a morbidade de uma segunda região operada. Com o advento das técnicas de regeneração óssea guiada é também crescente o interesse pelo uso do osso alógeno. Este trabalho tem por objetivo fazer uma revisão da literatura sobre o uso do osso alógeno em bloco para a reconstrução de rebordos alveolares deficientes, associado ao tratamento com implantes dentários.

Transplante autógeno de germe dentário de terceiro molar inferior para o alvéolo do segundo molar inferior: relato de caso / Uatogenous transplantation of lower third molar to lower second molar alveolus: case report

O transplante dentário autógeno tem se tornado um procedimento alternativo em cirurgias bucais. Embora os implantes dentais e as próteses tenham sua indicação precisa na odontologia moderna como forma de restituir aos paicentes elementos dentários perdidos, os custos desses procedimentos podem ser uma das causas que os inviabilizam. Assim, há situações em que os transplantes autógenos servirão como mais uma opção para a reabilitação bucal do paciente. Os autores apresentaram um caso clínico de um transplante autógeno de terceiro molar inferior para o alvéolo do segundo molar inferior

Carcinoma epidermóide metástico em glândula submandibular: relato de caso / Metastatic squamous cell carcinoma in submandibular gland: of caso report

Relataremos um caso de carcinoma epidermóide metastático em glândula submandibular. Paciente, leucoderna, aposentado, 72 anos, apresentava aumento de volume, em regiäo submandibular. A história médica do paciente constava de uma cirurgia de biópsia de lábio inferior, lado esquerdo. Buscamos o resultado histopatológico (de 4 anos atrás) desta lesäo e constatamos o diagnóstico de carcinoma epidermóide, moderadamente diferenciado para um fragmento e bem diferenciado para o outro. Solicitamos tomografia computadorizada da regiäo submandibular e foi constatado grande aumento de volume da glândular submandibular esquerda (em torno de 6 cm de diâmetro), sem comprometimento de linfonodos. Após a excisäo cirúrgica total da glândula e o encaminhamento para o histopatológico, o diagnóstico foi de carcinoma epidermóide metastático grau II; esta metástase proveniente da regiäo primária, o lábio inferior. A raridade deste caso, além de o carcinoma epidermóide ser incomum em glândula submandibular, deve-se ao fato de que, geralmente, o carcinoma epidermóide de lábio inferior dá metástase para os linfonodos submentonianos, submandibulares e/ou cervicais profundos e, neste caso específico, a metástase ocorreu na glândula submandibular

Avaliaçäo clínica e histológica do reparo da pele de suíno com o uso de zíper cirúrgico (Woundcloser R) / Clinical and histological evaluation of the skin repair of a pig using Wondcloser R

Este trabalho tem por objetivo realizar uma revisäo bibliográfica das técnicas e materiais de síntese utilizados pelos cirurgiöes, e uma avaliaçäo clínica e histológica do reparo da pele em suínos com o uso de um novo material de síntese, o zíper cirúrgico (Woundcloser R), comparando-o a uma técnica e um material de sutura tradicional, a técnica de pontos simples isolados com fio de nylon. Para a descriçäo dos resultados histológicos, foram considerados os tecidos epitelial e conjuntivo e o período de cicatrizaçäo destes tecidos. A análise clínica foi feita através do exame clínico e de fotografias do pós-operatório imediato e na remoçäo dos materiais de síntese, sendo avaliados: o edema, cicatrizaçäo, a deiscência das bordas da ferida e as marcas deixadas pelos materiais de síntse. Como modelo experimental foram utilizados quatro grupos de Suis scrofa domesticus, com dois suínos em cada grupo. Durante o experimento, foram feitas quatro incisöes no dorso de cada animal, regiäo na qual se fez uso dos seguintes procedimentos: duas suturas com pontos isolados simples (lado esquerdo) e duas síntese com o zíper cirúrgico Woundcloser R (lado direito). Os espécimes foram avaliados no quinto, sétimo, 14º e 21º dias de pós-operatório. A análise clínica dos resultados revelou que os melhores resultados estéticos foram obtidos pelo zíper cirúrgico Woundcloser R, tanto em relaçäo às marcas de sutura quanto ao edema resultante das incisöes e da reaçäo aos materiais. No que diz respeito à cicatrizaçäo, o alinhamento e deiscência das bordas da ferida, houve pequena vantagem para as incisöes fechadas com o fio de nylon 5-0. A análise histológica da regiäo da incisäo apontou resultados semelhantes entre os materiais em todos os grupos. Porém, a vantagem do zíper cirúrgico se deve a dois fatores: 1) a sua técnica de inserçäo na pele é traumática, contrastando com a técnicade pontos isolados com o fio de nylon 5-0; 2)a penetraçäo da agulha nos tecidos cutâneos e subcutâneos e a inserçäo de material (nylon) estranho ao organismo ocasionam uma reaçäo inflamatória maior, o que parece levar à epitelializaçäo do trajeto do fio de sutura pelos tecidos, com invaginaçäo das bordas e a persistência por vários dias da crosta sangüínea

Conduta cirúrgica em fratura bilateral de mandíbula atrófica em paciente senil edêntulo: relato de caso / Surgical conduct in bilateral fracture of atrophy mandible in senile patient: relate of case

Os autores relatam um caso de fratura de mandíbula atrófica bilateral, em paciente senil edêntulo, com envolvimento de colo de côndilo do lado esquerdo e corpo mandibular do lado direito. Há uma grande controvérsia entre os autores quanto ao melhor tratamento para estes casos, se a reduçäo fechada (incruenta) ou a reduçäo aberta (cruenta). Propomos para estes casos de fraturas bilaterais, um método de tratamento eficiente e de baixo custo, que consiste em reduçäo aberta com osteossíntese à fio de aço e cerclagem mandibular, suspensäo da prótese superior e bloqueio maxilo-mandibular, onde os resultados de uma reduçäo anatômica das fraturas, säo mais favoráveis, principalmente, do ponto de vista funcional

Expansäo rápida da maxila assistida cirurgicamente: revisäo de literatura / Rapid maxillary expansion with surgical assistence: literature review

Neste artigo, foi realizado uma revisäo da literatura sobre expansäo rápida da maxila assistida cirurgicamente na qual foram discutidos as indicaçöes, contra-indicaçöes, técnicas cirúrgicas e alteraçöes na maxila e estruturas anexas

Comparativo no tratamento de fraturas baixas de côndilo com uma ou duas osteossínteses à fio de aço / Comparative in the treatment of low fractures of condyle with one or two osteosynthesis in steel string

Os autores relatam um estudo realizado em 22 pacientes que apresentavam fraturas de côndilo, sendo que destes, 18 apresentavam fraturas unilaterais e 4 fraturas bilaterais, totalizando 26 fraturas. O tratamento cirúrgico foi realizado com fixação com fio de aço com uma osteossíntese (14 fraturas), e com duas osteossínteses (12 fraturas). Através de uma avaliação radiográfica pós-operatório destes pacientes, observou-se um melhor resultado nos casos onde foram utilizadas duas osteossínteses