Avaliação da ozonioterapia no tratamento da osteonecrose induzida por zoledronato em ratas senis / Evaluation of ozone therapy in the treatment of zoledronate-induced osteonecrosis in senile rats

A ozonioterapia vem se demonstrando uma ferramenta promissora na prevenção de infecções e no auxílio da reparação tecidual, conciliando com os desafios no tratamento da osteonecrose dos maxilares induzida por medicamentos (ONM-M), este projeto objetiva analisar os efeitos da ozonioterapia, em 55 ratas senis (18 meses), entre 300-350g, induzidas a osteonecrose via medicamentosa (Zoledronato 100µg/kg), após exodontia do primeiro molar inferior. Os animais foram divididos em 4 grupos equitativos (10 ratas por grupo), o primeiro grupo SAL, recebeu aplicações de soro fisiológico por 7 semanas, grupo SAL + OZ recebeu aplicações de soro fisiológico por 7 semanas e o tratamento com a ozonioterapia (0,7mg/kg) a cada 2 dias por 28 dias, o grupo ZOL recebeu aplicações de zoledronato (100µg/kg) por 7 semanas e por último o grupo ZOL + OZ recebeu também aplicações de zoledronato no mesmo protocolo e foi tratado com a ozonioterapia (0,7mg/kg) a cada 2 dias por 28 dias. Todos as ratas receberam a antibioticoterapia (Cristacilina® 0,1ml/kg por dia) iniciando 3 dias antes do procedimento de extração, se estendendo até 4 dias de pós-operatório, passaram pela extração do molar na terceira semana de experimento e foram submetidas a eutanásia na sétima semana de experimento. Após a eutanásia as mandíbulas foram ressecadas, reduzidas e preparadas para as análises microtomográficas (caracterização óssea do osso senil (MCT0) e após terapia com zoledronato (MCT1ZOL) contra seu par controle (MCT1SAL), parâmetros volumétricos (Bv,Bv.Tv,Tb.Th,Tb.N,Tb.Sp,Po.Tot) dos grupos experimentais), histométricas (porcentagem de osso neoformado e porcentagem de osso não vital) e imunoistoquímicas (expressão de TNFa, IL-1b, VEGF, OCN e TRAP). Os resultados da caracterização óssea não apresentaram diferença quando comparado os grupos experimentais (p> 0,05), possivelmente devido ao pouco tempo decorrido na terapia com zoledronato. Os demais resultados comparando os grupos experimentais mostrou com diferenças estatisticamente significativas (p< 0,05) uma característica de osso vítreo, denso, sem vitalidade, pobre em vascularização, com elevados valores para marcadores de inflamação, traduzindo isso em osteonecrose dos maxilares relacionada com a medicação, destoando principalmente do grupo controle SAL, que apresentou melhora na reparação alveolar e características de osso vital e vascularizado. A ozonioterapia (ZOL+OZ, SAL+OZ) apresentou valores significantes estatisticamente quando comparado ao grupo sem tratamento, traduzindo em melhora na vascularização do tecido ósseo, em melhora reparacional do alvéolo, modulação da inflamação local e o aparecimento/manutenção de células osteoblásticas ativas (p< 0,05). Mostrando-se uma terapia viável no controle/tratamento da osteonecrose dos maxilares relacionado com medicamentos(AU)

Ozone therapy has been shown to be a promising tool in the prevention of infections and in the aid of tissue repair, reconciling with the challenges in the treatment of medication-induced jaw osteonecrosis (ONM-M), this project aims to analyze the effects of ozone therapy in 55 rats senile (18 months), between 300-350g, induced to osteonecrosis via medication (Zoledronate 100µg / kg), after extraction of the lower first molar. The animals were divided into 4 equitable groups (ten rats per group), the first SAL group, received saline applications for 7 weeks, SAL + OZ group received saline applications for 7 weeks and ozone therapy (0, 7mg / kg) every 2 days for 28 days, the ZOL group received applications of zoledronate (100µg / kg) for 7 weeks and lastly the ZOL + OZ group also received applications of zoledronate in the same protocol and was treated with ozone therapy (0.7mg / kg) every 2 days for 28 days. All rats received antibiotic therapy (Cristacilina® 0.1ml / kg per day) starting 3 days before the extraction procedure, extending up to 4 days after the operation, underwent molar extraction in the third week of the experiment and were submitted to euthanasia in the seventh week of experiment. After euthanasia, the mandibles were resected, reduced and prepared for microtomographic analysis (bone characterization of senile bone (MCT0) and after therapy with zoledronate (MCT1ZOL) against its control pair (MCT1SAL), volumetric parameters (Bv, Bv.Tv, Tb .Th, Tb.N, Tb.Sp, Po.Tot) of the experimental groups), histometric (percentage of newly formed bone and percentage of non-vital bone) and immunohistochemistry (expression of TNFa, IL-1b, VEGF, OCN and TRAP) . The results of bone characterization did not show any difference when comparing the experimental groups (P> 0.05), possibly due to the short time elapsed in zoledronate therapy. The other results comparing the experimental groups showed with statistically significant differences (P < 0.05) a characteristic of vitreous bone, dense, without vitality, poor in vascularization, with high values for inflammation markers, translating this into a related jaw osteonecrosis with medication, disagreeing mainly with the SAL control group, which showed improvement in alveolar repair and characteristics of a vital and vascularized bone. Ozone therapy (ZOL + OZ, SAL + OZ) showed statistically significant values when compared to the untreated group, translating into an improvement in bone tissue vascularization, a reparational improvement of the alveolus, modulation of local inflammation and the appearance/maintenance of cells active osteoblasts (P < 0.05). Showing to be a viable therapy in the control/treatment of osteonecrosis of the jaws related to drugs(AU)

Características clínicas y radiológicas en individuos con Síndrome Treacher Collins: reporte de casos / Radiologic and clinic characteristics in individuals with Treacher Collins Syndrome: case report

El Síndrome de Treacher Collins es una malformación craneofacial autosómica dominante (STC) que se presenta cuando el gen TCOF1 (5q32-q33.1) sufre una mutación. Su incidencia se estima en 1/50,000 nacidos y presenta manifestaciones en tejidos blandos y duros. Métodos: Seis individuos diagnosticados con STC, remitidos de la Asociación Treacher Collins México AC, para la realización de estudios imagenológicos prequirúrgicos. Objetivo: Describir las características clínicas, radiográficas y morfométricas de individuos con esta condición. Resultados: No existen suficientes estudios en los cuales se determinen patrones específicos en un mismo individuo, e incluso cuando se comparan entre sí, por lo que es necesario establecer protocolos para su manejo. Conclusiones: Las características clínicas del individuo con STC varían de acuerdo con la severidad de expresión genética, las cuales se pueden corroborar con fotografías, imágenes radiográficas y medidas morfométricas que nos orientaran en el manejo y planeación del tratamiento. (AU)

Treacher Collins Syndrome is a craniofacial, autosomal dominant, severe and complex malformation that occurs when the TCOF1 (5q32-q33.1) gene suffers a mutation. Its incidence is estimated at 1/50,000 births and shows manifestations in soft and hard tissues. Methods: Six individuals whit TCS diagnosis refer from Asociacion Treacher Collins México AC to do a pre-surgical imaging studies. Objective: Describe the clinical, radiographic and morphometric characteristics of individuals with this condition. Results: There are not enough studies that may establish specific patterns in the same individual and even when compared to each other, so it is necessary to establish protocols for their management. Conclusions: The clinical characteristics of the individual with TCS vary according to the severity of genetic expression, which can be corroborated with photographs, radiographic images and morphometric measurements that will guide us is the management and planning of treatment. (AU)

Describing the mandible in patients with craniofacial microsomia based on principal component analysis and thin plate spline video analysis.

Craniofacial microsomia (CFM) is most often described as a unilateral malformation of derivatives of the first and second branchial arches. The mandible has been classified using several classification systems. However, all are based on two-dimensional imaging. The aim of this study was to mathematically describe the deformed mandible based on principal component analysis (PCA) in a three-dimensional way. This may aid in defining the flaws in existing surgical corrections of the mandible through the identification of the differences in shape compared with a normal mandible in a holistic view with the help of videos. Forty-three homologous landmarks were defined to describe a mandible with CFM. Computed tomography scans of 22 patients and 30 controls were marked manually. The changes in shape between the mandibles were visualized using videos. A lateral rotation with increase in posterior rotation of the condyle due to shortening of the condyle-gonial height and a longitudinal rotation with outward bending of the mandibular angle were noted on the affected side, as well as an inward bending of the angle on the unaffected side. Due to the compensatory remodelling of the mandible on the unaffected side, one could suggest that CFM is never truly unilateral.

Bifid mandibular canal ­an anesthetic challenge for maxillofacial surgeons­ case report

Bifid mandibular canal is a variation of the normal anatomy. such anomalies can result in difficult anesthesia while performing surgeries of the posterior mandible under local anesthesia. moreover there is a high chance of damaging the neurovascular bundle leading to complications. here we present a case of a bifid mandibular canal which posed difficulty in achieving appropriate anesthesia. the inferior alveolar nerve is of special interest for maxillofacial and oral surgeons. its relation with mandibular third molar plays an important role while performing disimpaction surgery, in cases of bilateral sagittal split osteotomy, prosthesis placement in resorbed ridges, mandibular trauma procedures, and may be traumatized by penetration of the implant drill.

Morphological study and mineral analysis of the lower mandible of adult Atlantic salmon (Salmo salar) from Scotland with mandibular deformation / Estudio morfológico y análisis de minerales de la mandíbula inferior de salmones del Atlántico (Salmo salar) adultos con deformación mandibular, provenientes de Escocia

Mandibular deformity is a condition that affects the jaw bone of adult salmon and has been observed in Norway and Chile, causing weight loss, poor quality of farmed fish and increased mortality. The causes range from high temperatures of the state of eggs, to poor nutrition phosphorus or vitamin C. This work aims to analyze this deformity by histochemical and mineral analysis technique during an episode presented in centers of the Scotia Sea. Jaw and spinal segments of 21 Atlantic salmon in Scotland were used. These samples were classified into three groups: Group 1: Severely deformed. Group 2: Mildly affected. Group 3: Normal controls. Four jaws per group were fixed in 10 % formalin and embedded in Paraplast, sections of 5 microns were performed using a Microm® microtome histochemical technique Von Kossa was used for the detection of calcium deposits, which highlights the calcium osteoid black and red color. For proximate analysis, and in order to obtain and compare levels of calcium, phosphorus, zinc and magnesium in total 9 bone jaws (6 affected with DM and 3 controls) and 9 body sections the Mann-Whitney test was used to compare these values between misshapen salmon and controls. To correlate values, jaw and body segment a Spearman corrrelation was applied. Fish group 1 presented a ventral deviation of the alveolar bone body. In fish group 2 prominence of the visible joint on both sides or unilaterally was observed. Comparing the values of % Ca, % P, % Mg and Zn jaws with DM and healthy ones with Mann Witney method it was found that the values of these minerals vary between salmon and controls affected. There was a significant difference in the percentage of P, which indicates that there is less P in affected fish vertebrae. Spearman correlation noted that the percentages of the minerals studied in dental bone and vertebral segments are uncorrelated. Rather, Von Kossa distribution indicates that Ca/P is not homogeneous in the dental bone, as a result of mineral resorption from the skeleton including the operculum, articular bone and dental towards kype. This paper states that Von Kossa histochemical technique showed significant differences between deformed fish and controls and also showed differences between the various segments of the dental bone. The alveolar bone is a dynamic structure adapted to continuous histological changes may be involved in MD, phosphorus deficient diets, coupled with the initial formation of Kippe.

La deformación mandibular es una patología que afecta al hueso dentario de salmones adultos, se observó en Noruega y en Chile, ocasionando disminución de peso, baja calidad de peces cultivados y aumento de la mortalidad. Las causas varían desde temperaturas elevadas al estado de ovas, hasta alimentación deficitaria en fósforo o vitamina C. Este trabajo tiene como propósito analizar esta deformación mediante una técnica histoquímica y de análisis de minerales durante un episodio presentado en centros de mar de Escocia. Se utilizó la mandíbula y segmento vertebral de 21 salmones del Atlántico de Escocia. Estas muestras se clasificaron en tres grupos Grupo 1: Severamente deformes. Grupo 2: Levemente afectados. Grupo 3: Controles normales. Cuatro mandíbulas por grupo fueron fijadas en formalina al 10 % y se incluyeron en paraplast, se realizaron cortes de 5 µm utilizando un micrótomo Microm®. Se utilizó la técnica histoquímica de Von Kossa para la detección de depósitos de calcio la cual destaca al calcio de color negro y el osteoide de color rojo. Para el análisis químico proximal, y con el propósito de obtener y comparar niveles de calcio, fósforo, zinc y magnesio en los huesos se utilizó un total de 9 mandíbulas (6 afectadas con DM y 3 controles) y sus 9 secciones corporales. Para comparar estos valores entre salmones deformes y controles se utilizó la prueba de Mann-Whitney. Para correlacionar los valores de mandíbula y segmento corporal se hizo una correlación por jerarquías de Spearman. Los peces del grupo 1, presentaron una desviación ventral del cuerpo del hueso dentario. En los peces del grupo 2 se observó la prominencia de la articulación visible en ambos lados o unilateralmente. Al comparar los valores de % Ca, % P, % Mg y Zn de las mandíbulas con DM y sanas con el método de Mann Witney se encontró que los valores de estos minerales no varían entre salmones afectados y controles. Hubo una diferencia significativa en el porcentaje de P, lo cual indica que existe menos P en vértebras de peces afectados. La correlación de Spearman señaló que los porcentajes de los minerales estudiados en huesos dentarios y segmentos vertebrales no están correlacionados. Por el contrario, la técnica Von Kossa mostró que la distribución de Ca/ P no es homogénea en el hueso dental producto de la reabsorción mineral desde el esqueleto incluyendo el opérculo, hueso articular y dental hacia la kype. El presente trabajo establece que la técnica histoquímica de Von Kossa fue la que permitió observar diferencias importantes entre peces deformados y controles, además mostró diferencias entre los distintos segmentos del hueso dentario. El hueso dentario es una estructura dinámica adaptada a continuos cambios histológicos pudiendo estar involucrados en la DM, dietas deficientes de fósforo, sumado a la formación inicial del Kippe.

Concurrence of Torus Palatinus, Torus Mandibularis and Buccal Exostosis.

Torus palatinus (TP), torus mandibularis (TM), and buccal exostosis are localised, benign, osseous projections, occurring in maxilla and mandible. Etiology is multifactorial and not well established. Tori and exostoses have been associated with parafunctional occlusal habits, temporomandibular joint (TMJ) disorders, migraine and consumption of fish. Concurrence of TP, TM, and exostosis in the same individual is very rare. Concurrence of TPand TM has not been reported from Pakistan. We report a case of a 22-year female patient manifesting concurrence of TP, bilateral TM, and maxillary buccal exostoses; with possible association of abnormal occlusal stresses and use of calcium and vitamin D supplements.

Skeletal Class III and anterior open bite treatment with different retention protocols: a report of three cases.

The treatment of skeletal class III and anterior open bite can be unstable and orthodontists frequently observe relapse. Here, we report on the management of three patients with skeletal class III profiles and open bites treated by orthodontic camouflage. Each received a retention protocol involving the use of two separate appliances during the night and day accompanied by myofunctional therapy. Long-term follow-up revealed a stable outcome.

Non surgical treatment of a Class II malocclusion with skeletal hyperdivergency and anterior open bite.

The malocclusions with hyperdivergent vertical growth patterns are more difficult to treat without a combined approach, including orthodontics and orthodontic surgery. The goal of this article is to describe a nonsurgical approach of a Class II malocclusion on an adult patient presenting a skeletal hyperdivergency. Fundamental criteria must be respected including proper diagnosis, proper treatment timing to maximize growth potential, patient cooperation, etc. These factors are critical in the favorable treatment outcome of any jaw discrepancy.

Nonextraction and nonsurgical treatment of an adult with skeletal Class II open bite with severe retrognathic mandible and temporomandibular disorders.

AIM: The treatment of an adult patient with a skeletal Class II Division 1 malocclusion, retrognathic mandible with downward and backward rotation, anterior open bite, and temporomandibular disorders is presented. Treatment objectives included establishing a stable occlusion with normal respiration, eliminating temporomandibular disorder symptoms, and improving facial esthetics through nonextraction and nonsurgical treatment. SUBJECT AND METHODS: The patient was a Japanese adult female, who had previously been advised to have orthognathic surgery. An expansion plate was used to reshape the maxillary dentoalveolar arch. Distalization of the maxillary arch and forward movement of the mandible were achieved by reduced excessive posterior occlusal vertical dimension, through uprighting and intruding the mandibular posterior teeth, and rotating the mandible slightly upward and forward. The functional occlusal plane was reconstructed by uprighting and intruding the mandibular posterior teeth with a full-bracket appliance, combined with a maxillary expansion plate and short Class II elastics. Myofunctional therapy and masticatory and cervical muscle training involved chewing gum exercises and neck-muscle massage. RESULTS: The excessive posterior vertical occlusal dimension was significantly reduced, creating a small clearance between the posterior maxilla and mandible. The occlusal interferences in the posterior area were eliminated by the expansion of the maxillary dentoalveolar arch. As a result, the mandible moved forward, creating a more favorable jaw relationship. Distal movement of the maxillary arch was also achieved. The functional occlusal plane was reconstructed and a normal overjet and overbite were created. Adequate tongue space for normal respiration was established during the early stage of treatment. A stable occlusion with adequate posterior support and anterior guidance was established in a treatment time of 25 months, without orthognathic surgery, extraction, or headgear; this result was maintained at more than 1 year 8 months posttreatment.

Sex-related differences in procarbazine-induced cleft palate and microgenia and the anti-teratogenic effect of prenatal folic acid supplementation in rats.

Sex-related differences in the frequency of cleft palates and microgenia in rat fetuses prenatally treated with procarbazine (200 mg/kg on day 14 of gestation (GD14), group 1), and the anti-teratogenic effect of prenatal folic acid supplementation (4 mg/kg on GD14 through GD17, group 2) were studied in LEW.1A rats. In group 1, complete clefts were observed in 69% of the male and in 36% of the female fetuses while incomplete clefts (present only in the hard palate) were exhibited by 31% of the males and 43% of the females. Microgenia occurred in all males but only in 64% of the female fetuses. In group 2, the prenatal folic acid supplementation significantly reduced the occurrence frequency of complete clefts to 9% in males and to 0% in females. In contrast, incomplete clefts increased to 82% in males and 91% in females. Microgenias were reduced to 73% and 57% in male and female fetuses, respectively. Since incomplete clefts present in the hard palate are assumed to be residues of spontaneous intra-uterine repair processes of exogenously induced complete palatal clefts, we conclude that prenatal supplementation with folic acid at a dose of 4 mg/kg promotes the intra-uterine repair of cleft palates and offers a partial protection against procarbazine teratogenicity. Furthermore, it is deduced that gender-specific differences exist in the susceptibility to procarbazine and in the anti-teratogenic effect of folic acid on procarbazine-induced microgenia.

Malformations in offspring of diabetic rats: morphometric analysis of neural crest-derived organs and effects of maternal vitamin E treatment.

BACKGROUND: We have previously reported on a malformation-prone Sprague-Dawley rat substrain (U), which presents a high frequency of micrognathia in the offspring of diabetic mothers. This malformation is related to impaired development of the cranial neural crest cells (NCC); the defect may be prevented by antioxidative treatment of the mother. METHODS: We have therefore investigated whether fetuses of diabetic rats display other malformations associated with altered cranial NCC development and whether maternal vitamin E supplementation may affect such malformations. RESULTS: Fetuses of diabetic rats showed low-set external ears, severely malformed Meckel's cartilage, small thyroid and thymus, and absence of parathyroid glands. Cardiac anomalies were frequently observed, including rightward displacement of the aorta, double outlet right ventricle (DORV), persistent truncus arteriosus (PTA) combined with ventricular septal defects due to a malaligned outlet septum. The malformations in the outflow tract included abnormalities of the great arteries; right-sided aortic arch/descending aorta, and double aortic arches. These defects tended to occur together within individual fetuses. Maternal dietary treatment with 2% vitamin E markedly reduced the severity of the malformations. CONCLUSIONS: The phenotypic appearance of these defects is strikingly similar to the DiGeorge anomaly in humans, which has been found in children of diabetic mothers together with an overrepresentation of PTA and DORV. The malformations associated with defective NCC development in the offspring of diabetic U rats show several morphological similarities to those in humans; hence the teratogenic mechanisms may be similar and accessible for study.

[Standardized ultrasound follow-up of callus distraction of the mandible]. / Standardisierte sonographische Verlaufskontrolle bei der Kallusdistraktion am Unterkiefer.

Up to now the clinical follow-up in mandibular callus distraction was supported by radiologic methods, although low-mineralized structures are only insufficiently described by X-rays. Mandibular callus distraction was performed on 14 patients suffering from uni- or bilateral mandibular hypoplasia, using either intra- or extraoral devices. The clinical follow-up was supplemented by standardized sonographic investigations. With the exception of postoperative pin placement control, which was done by using X-rays, all interesting items of treatment could be visualized by sonography. We found a reliable correlation between sonographically measured distances and distances measured on the device. Due to early detection of complications, a premature ossification was detected in one case and an infection was diagnosed in another, using ultrasound. Sonography proved to enhance the possibilities of monitoring in mandibular callus distraction treatment and can be recommended in clinical routine.

Clinical application of bone biology to mandibular and maxillary reconstruction.

Bony reconstruction of the mandible and maxilla is accomplished through the application of three general approaches: cancellous marrow grafts, cranial bone grafts, and microvascular transfers. This article discusses each of these techniques in detail.

Síndrome de Waardenburg tipo II: a propósito de dos casos clínicos / Waardenburg's syndrome type II: a propose of 2 clinical cases

El Síndrome de Waardenburg representa la forma más común de sordera congénita; es una condición pleitrópica, autosómica dominante, con penetrancia y expresividad variable. Se describen dos casos clínicos de Síndrome de Waardenburg tipo II. Las principales manifestaciones son la sordera sensorioneural congénita, alteraciones de la pigmentación pilosa y cutánea, puente nasal ancho, hipertricosis de las cejas, mandíbula cuadrada, encanecimiento prematuro y alteraciones neurológicas. Se revisan los criterios de diagnóstico de la enfermedad y los hallazgos asociados descritos de la literatura

Augmentation genioplasty: when bone is not enough.

PURPOSE: Augmentation genioplasty is indicated to correct microgenia. When a large defect must be corrected, the additional use of a soft alloplastic implant may be indicated. METHODS: A 22-year-old patient is presented who required correction of microgenia. A 15-mm advancement of the chin was required to obtain an acceptable cosmetic result. RESULTS: An augmentation genioplasty achieved an 8-mm correction. This was supplemented by a silicone gel-filled implant inserted subperiosteally. This resulted in an outstanding cosmetic result. CONCLUSIONS: Chin contour is an important aspect of facial aesthetics. The sliding genioplasty is ideally suited for correcting most chin deformities; however, the insertion of an alloplast may augment patients with severe microgenia. Avoidance of the donor-site morbidity associated with the use of autogenous bone is a major benefit of this procedure.

Temporal crest canal: case report and statistics on a rare mandibular variant.

A child's mandible retrieved from a North American archaeological site had an anomalous canal 2 mm in diameter and 10 mm long, opening posteriorly behind the temporal crest and anteriorly in the retromolar fossa. Radiographic analysis revealed a second canal passing down from the temporal crest canal (TCC) toward the molar roots. A survey of retromolar variants in a large skeletal series (N2391) revealed TCC present in 1.7% of all persons on average, ranging up to 23% in certain population samples. It appeared to be more common in males than in females and in native Americans than in other racial groups. From its location and orientation, TCC was inferred to have conveyed all or part of the buccal nerve. The clinical significance of this variant is that pain fibers from the molar roots joining the nerve as it runs in this canal would exit the bone behind the temporal crest, thus escaping anesthetization in routine injections for inferior alveolar and buccal nerve block.

Similarity of effects--experimental hyperthermia as a teratogen and maternal febrile illness associated with oromandibular and limb defects.

Experimental hyperthermia in pregnancy causes oromandibular and limb anomalies. In humans, hyperthermia has been suspected of being teratogenic. Two patients were investigated; both had limb defects and one had oromandibular anomalies. Their mothers had a febrile illness at about the 10th wk of gestation. The similarity of defects produced by experimental hyperthermia and those reported here is striking.