Laddec® versus Bio-Oss®: The effect on the healing of critical-sized defect - Calvaria rabbit model.

The aim of this study was to evaluate the in vivo performance of two different deproteinized bovine bone (DBB) grafting materials: DBBB (Bio-Oss®) and DBBL (Laddec®), for the regeneration of critically sized (8 mm) defects in rabbit's calvaria. Three round-shaped defects were surgically created in the calvaria of 13 New Zealand White rabbits proximal to the coronal suture in the parietal bone. Two of the defects were filled with one of the grafting materials while a third was left empty to serve as a negative control. Bone regeneration properties were evaluated at 4- and 8-weeks after implantation by means of histological and histomorphometrical analyses. Statistical analyses were performed through a mixed model analysis with fixed factors of time and material. Histological evaluation of the control group evidenced a lack of bridging bone formation across the defect sites at both evaluation time points. For the experimental groups, new bone formation was observed around the defect periphery and to progress radially inwards to the center of the defect site, regardless of the grafting material. Histomorphometric analyses at 4 weeks demonstrated higher amount of bone formation through the defect for DBBB group. However, at 8 weeks, DBBL and DBBB demonstrated osteoconductivity and low resorption rates with evidence of statistically similar bone regeneration through the complete boney defect. Finally, DBBB presented lower soft tissue migration within the defect when compared to DBBL at both evaluation time points. DBBB and DBBL presented similar bone regeneration performance and slow resorption rates. Although both materials promoted bone regeneration through the complete defect, DBBB presented lower soft tissue migration within the defects at 4- and 8-weeks.

Análise das vias aéreas superiores pós cirurgia ortognática bimaxilar: estudo retrospectivo / Upper airway analysis after bimaxillary orthognathic surgery: retrospective study / Análisis de la vía aérea superior después de la cirugía ortognática bimaxilar: estudio retrospectivo

Objetivo: O objetivo do presente estudo foi avaliar retrospectivamente as mudanças ocorridas nas vias aéreas superiores (VAS) pós cirurgia ortognática bimaxilar. Metodologia: A amostra compreendeu 14 pacientes, que foram divididos em dois grupos, conforme o tipo de movimentação realizada na cirurgia: grupo 1 (n = 6), avanço bimaxilar; grupo 2 (n = 8) cirurgia de avanço de maxila e recuo de mandíbula. Foram realizadas tomografias computadorizadas no pré-operatório (T0) e pós-operatório de 1 ano (T1). Através do software Dolphin Imaging procedeu-se a análise das VAS em três parâmetros: área total (AT), volume total (VT) e área axial mínima (AAM), que foram comparadas entre T0 e T1 em um mesmo grupos pelo Teste de Wilcoxon e entre grupos pelos Teste de Mann-Whitney (p < 0.05). Resultados: Ambos os grupos apresentaram aumento significativo de AT, VT e AAM entre T0 e T1. Contudo, essas variações foram estatisticamente maiores no grupo 1 quando comparadas ao grupo 2. Conclusão: As cirurgias bimaxilares promoveram o aumento da AT, VT e AAM das VAS e essas mudanças foram significativamente superiores nos pacientes submetidos ao avanço bimaxilar... (AU)

Objective: The objective of the present study was to retrospectively evaluate the changes that occurred in the upper airways (UAS) after bimaxillary orthognathic surgery. Methodology: The sample comprised 14 patients, who were divided into two groups, according to the type of movement performed in the surgery: group 1 (n = 6), bimaxillary advancement; group 2 (n = 8) maxillary advancement and mandibular setback surgery. Computed tomography scans were performed preoperatively (T0) and 1 year postoperatively (T1). Through the Dolphin Imaging software, the analysis of the UAS was carried out in three parameters: total area (TA), total volume (TV) and minimum axial area (MAA), which were compared between T0 and T1 in the same groups by the Wilcoxon Test and between groups by the Mann-Whitney test (p < 0.05). Results: Both groups showed a significant increase in TA, TV and MAA between T0 and T1. However, these variations were statistically higher in group 1 when compared to group 2. Conclusion: Bimaxillary surgeries promoted an increase in the TA, TV and MAA of the UAS and these changes were significantly higher in patients undergoing bimaxillary advancement... (AU)

Objetivo: El objetivo del presente estudio fue evaluar retrospectivamente los cambios ocurridos en las vías aéreas superiores (VAS) después de la cirugía ortognática bimaxilar. Metodología: La muestra estuvo compuesta por 14 pacientes, quienes fueron divididos en dos grupos, según el tipo de movimiento realizado en la cirugía: grupo 1 (n = 6), avance bimaxilar; grupo 2 (n = 8) cirugía de avance maxilar y retroceso mandibular. Las tomografías computarizadas se realizaron antes de la operación (T0) y 1 año después de la operación (T1). A través del software Dolphin Imaging se realizó el análisis de la VAS en tres parámetros: área total (AT), volumen total (VT) y área axial mínima (AAM), los cuales fueron comparados entre T0 y T1 en los mismos grupos por el Prueba de Wilcoxon y entre grupos por la prueba de Mann Whitney (p < 0,05). Resultados: Ambos grupos mostraron un aumento significativo de AT, VT y AAM entre T0 y T1. Sin embargo, estas variaciones fueron estadísticamente mayores en el grupo 1 en comparación con el grupo 2. Conclusión: Las cirugías bimaxilares promovieron un aumento de la AT, VT y AAM de las VAS y estos cambios fueron significativamente mayores en los pacientes sometidos a avance bimaxilar... (AU)

Granulomatose de Wegener: reabilitação oral com prótese bucomaxilofacial / Wegener's granulomatosis: oral rehabilitation with maxillofacial prosthesis / Granulomatosis de Wegener: rehabilitación oral con prótesis bucomaxilofacial

Introdução: A granulomatose de Wegener é uma doença autoimune rara que ocorre através de mediadores imunológicos. Sua etiologia permanece desconhecida. No entanto, sabe-se que é caracterizada principalmente pela inflamação dos vasos sanguíneos que acometem preferencialmente as vias aéreas superiores, inferiores e os rins. A doença apresenta altas taxas de morbidade e mortalidade quando não tratada, seu principal tratamento é através do uso de corticoides e imunossupressores. Objetivo: realizar um relato de caso de Granulomatose de Wegener tratando a comunicação orosinusal através de prótese bucomaxilofacial e uma discussão baseada na literatura recente. Relato de caso: paciente do gênero masculino, 40 anos de idade, leucoderma, encaminhado ao serviço de Bucomaxilofacial do Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC) queixando-se de comunicação oronasal em região de palato. Foi tratado com prótese BMF obturadora, o que devolveu ao paciente a capacidade de fonação, deglutição e convívio social. Conclusão: o tratamento com a prótese BMF reestabelece o velamento velofaríngeo, corrige hipernasalidade, melhora a deglutição e dá conforto psicológico ao paciente com estabilidade protética funcional... (AU)

Introduction: Wegeners' Granulomatulosis is a rare autoimmune disease that acts through immunologic mediators. It's etymology remains unknown. However, it is known that it's mainly characterized by the inflammation of blood vessels that affect, by preference, upper and lower airways, as well as kidneys. The disease presents high rates of morbidity and mortality when not treated, and it's main treatments are corticoids and immunosuppressants. Objective: Perform a Wegener's Granulomatulosis case report treating orosinusal communication through the use of a bucomaxilofacial prosthesis and a discussion based on current literature. Case report: Male patient, 40 years of age, leucoderma, brought to the Bucomaxilofacial department of Federal University of Santa Catarina (HU UFSC) with complaints regarding oronasal communication in the palate region. The patient was treated with a BMF prosthetics, which has allowed the patient to resume normal social activities, as well as returning phonation and deglutition. Conclusion: Treatment with a BMF prosthetics reestablishes velopharyngeal veiling, assists in the correction of nasal voice, improves deglutition and offers the patient psychological comfort with functional prosthetic stability... (AU)

Introducción: la granulomatosis de Wegener es una enfermedad autoinmune rara que se presenta a través de mediadores inmunológicos. Su etiologia permanece desconocida. Sin embargo, se sabe que se caracteriza principalmente por la inflamación de los vasos sanguíneos que afectan preferentemente las vías respiratorias superiores e inferiores y los riñones. La enfermedad tiene altas tasas de morbilidad y mortalidad cuando no se trata, su principal tratamiento es mediante el uso de corticosteroides e inmunosupresores. Objetivo: realizar un reporte de caso de Granulomatosis de Wegener en el tratamiento de la comunicación orosinusal mediante prótesis maxilofacial y una discusión basada en la literatura reciente. Caso clínico: paciente de sexo masculino, 40 años, leucoderma, remitido al Servicio Maxilofacial del Hospital Universitario de la Universidad Federal de Santa Catarina (HU-UFSC) por comunicación oronasal en región paladar. Fue tratado con una prótesis obturatriz de BMF, que le devolvió al paciente la capacidad de hablar, tragar y socializar. Conclusión: el tratamiento con la prótesis BMF restablece el velo velofaríngeo, corrige la hipernasalidad, mejora la deglución y proporciona confort psicológico al paciente con estabilidad protésica funcional... (AU)

Ridge Architecture Preservation Following Minimally Traumatic Exodontia Techniques and Guided Tissue Regeneration.

OBJECTIVE: To compare hard-tissue healing after 3 exodontia approaches. MATERIALS AND METHODS: Premolars of dogs were extracted: (1) flapless, (2) flap, and (3) flap + socket coverage with polytetrafluoroethylene (dPTFE) nonresorbable membrane (flap + dPTFE). Animals were euthanized at 1 and 4 weeks. Amount of bone formation within socket and socket total area were measured. RESULTS: Amount of bone formation revealed significant difference between 1 and 4 weeks; however, there was no differences among groups. Socket total area decreased after 4 weeks, and the flap + dPTFE group showed significantly higher socket total area. As a function of time and group, flap + dPTFE 4 weeks presented similar socket total area values relative to flap + dPTFE at 1 week, and significantly higher socket total area than flapless and flap. The histological sections revealed almost no bone formation within socket after 1 week, which increased for all groups at 4 weeks. CONCLUSION: Socket coverage with polytetrafluoroethylene (dPTFE) membrane showed to effectively preserve bone architecture. Bone formation within sockets was not influenced by tooth extraction technique.

Bone Healing Around Dental Implants: Simplified vs Conventional Drilling Protocols at Speed of 400 rpm.

PURPOSE: This study evaluated whether simplified drilling protocols would provide comparable histologic and histomorphometric results to conventional drilling protocols at a low rotational speed. MATERIALS AND METHODS: A total of 48 alumina-blasted and acid-etched Ti-6Al-4V implants with two diameters (3.75 and 4.2 mm, n = 24 per group) were bilaterally placed in the tibiae of 12 dogs, under a low-speed protocol (400 rpm). Within the same diameter group, half of the implants were inserted after a simplified drilling procedure (pilot drill + final diameter drill), and the other half were placed using the conventional drilling procedure. After 3 and 5 weeks, the animals were euthanized, and the retrieved bone-implant samples were subjected to nondecalcified histologic sectioning. Histomorphology, bone-to-implant contact (BIC), and bone area fraction occupancy (BAFO) analysis were performed. RESULTS: Histology showed that new bone was formed around implants, and inflammation or bone resorption was not evident for both groups. Histomorphometrically, when all independent variables were collapsed over drilling technique, no differences were detected for BIC and BAFO; when drilling technique was analyzed as a function of time, the conventional groups reached statistically higher BIC and BAFO at 3 weeks, but comparable values between techniques were observed at 5 weeks; 4.2-mm implants obtained statistically higher BAFO relative to 3.75-mm implants. CONCLUSION: Based on the present methodology, the conventional technique improved bone formation at 3 weeks, and narrower implants were associated with less bone formation.

Cortical and Trabecular Bone Healing Patterns and Quantification for Three Different Dental Implant Systems.

PURPOSE: The present study hypothesized that different bone healing patterns through initial stages of osseointegration would be observed when three distinct commercially available implant systems (Nobel Groovy, Implacil, and Zimmer TSV) were used, leading to significant variations in histometric levels of total bone and new bone formation during the osseointegration process. MATERIALS AND METHODS: A total of 48 implants were placed bilaterally on the tibias of eight beagle dogs and allowed to heal for 2 and 6 weeks. Following euthanasia, nondecalcified specimens were processed for morphologic and histometric evaluation. Bone-to-implant contact (BIC) and new bone area fraction occupancy (BAFO) analyses for native and new bone were performed along the whole perimeter of each implant and separately for the cortical and trabecular bone regions. RESULTS: Morphologic evaluation of cortical bone presented different healing patterns and osseointegration levels for different implant systems as time elapsed in vivo. Interfacial remodeling was the chief healing pattern in Zimmer implants, while a combination of interfacial remodeling and healing chambers was observed in Nobel and Implacil implants. When trabecular bone was evaluated, similar bone healing patterns were observed between systems despite different levels of osseointegration observed as a function of implantation time, implant system, and native and/or new bone BIC and BAFO. CONCLUSION: Different implant systems led to different healing patterns during early stages of osseointegration. Such variation in pattern was more noticeable in the cortical regions compared to the trabecular regions. The variation in bone healing pattern did significantly influence overall indicators of native and new BIC and BAFO during the osseointegration process. The postulated hypothesis was accepted.

The Effect of Osteotomy Dimension on Implant Insertion Torque, Healing Mode, and Osseointegration Indicators: A Study in Dogs.

PURPOSE: This study investigated the effect of the osteotomy diameter for implant placement torque and its effect on the osseointegration. MATERIALS AND METHODS: Eight male beagle dogs received 48 implants (3.75 mm × 10 mm) in their right and left radius, 3 implants per side and allowed to heal for 3 weeks. Three experimental groups were evaluated. Group 1: implant with an undersized osteotomy of 3.0 mm; group 2: osteotomy of 3.25 mm, and group 3: osteotomy of 3.5 mm. The insertion torque was recorded for all implants. Histological sectioning and histometric analysis were performed evaluating bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). RESULTS: Implants of group 1 presented statistically higher insertion torque than those of groups 2 and 3 (P < 0.01). No differences in BIC or BAFO were observed between the groups. From a morphologic standpoint, substantial deviations in healing mode were observed between groups. CONCLUSION: Based on the present methodology, the experimental alterations of surgical technic can be clinically used with no detrimental effect over the osseointegration process.

The Synergistic Effect of Leukocyte Platelet-Rich Fibrin and Micrometer/Nanometer Surface Texturing on Bone Healing around Immediately Placed Implants: An Experimental Study in Dogs.

Aims. This study evaluated the effects of L-PRF presence and implant surface texture on bone healing around immediately placed implants. Methods. The first mandibular molars of 8 beagle dogs were bilaterally extracted, and implants (Blossom™, Intra-Lock International, Boca Raton, FL) were placed in the mesial or distal extraction sockets in an interpolated fashion per animal. Two implant surfaces were distributed per sockets: (1) dual acid-etched (DAE, micrometer scale textured) and (2) micrometer/nanometer scale textured (Ossean™ surface). L-PRF (Intraspin system, Intra-Lock International) was placed in a split-mouth design to fill the macrogap between implant and socket walls on one side of the mandible. The contralateral side received implants without L-PRF. A mixed-model ANOVA (at α = 0.05) evaluated the effect of implant surface, presence of L-PRF, and socket position (mesial or distal), individually or in combination on bone area fraction occupancy (BAFO). Results. BAFO values were significantly higher for the Ossean relative to the DAE surface on the larger mesial socket. The presence of L-PRF resulted in higher BAFO. The Ossean surface and L-PRF presence resulted in significantly higher BAFO. Conclusion. L-PRF and the micro-/nanometer scale textured surface resulted in increased bone formation around immediately placed implants.

Relação entre extensão do cantilever e complicações biológicas em implantes distais de próteses totais fixas / Relation between cantilever extension and biological complication of distal implants in full fixed prostheses

Este estudo tem como objetivo avaliar a relação entre a extensão do cantilever em próteses totais fixas e a presença de peri-implantite e perda óssea peri-implantar em implantes distais. A amostra consistiu em 32 pacientes portadores de prótese total fixa implantossuportada instalada há, pelo menos, 1 ano. Os implantes foram divididos em dois grupos conforme a extensão do cantilever: G1) ≤10 mm (43 implantes) e G2) ≤10 mm (21 implantes). Os dados coletados inclu¡ram parâmetros clínicos, tais como profundidade de sondagem (PS), sangramento … sondagem (SS) e perda óssea (PO). Esses dados foram agrupados para cada implante a fim de conduzir o diagnóstico de peri-implantite e perda óssea. Não houve diferença estatística (p<0,05) para os parâmetros clínicos avaliados ou para a presença da doença entre G1 – 8 (18,60%) com peri-implantite e 32 (74,42%) implantes com perda óssea e G2 – 3 (14,29%) implantes com peri-implantite e 19 (90,48%) implantes com perda óssea. Conclui-se que a extensão do cantilever não foi relacionada com peri-implantite e perda óssea nos implantes distais

This study aimed to evaluate the relationship between cantilever extension and the prevalence of peri-implantitis and peri-implant bone loss around the distal implants of full fixed prostheses. The sample consisted of 32 patients using full fixed prostheses for at least 1 year. Implants were divided into two groups regarding cantilever extension: G1 ≤ 10 mm (43 implants) and G2 >10 mm (21 implants). Data collection included clinical parameters, like probing depth (PD), bleeding on probing (BOP), and bone loss (BL). All the data were pooled for each group in order to conduct to diagnosis of peri-implantitis and bone loss. As a result, there was no statistical relevance (p<0.05) for the clinical parameters previously evaluated nor for the presence of the disease between G1 – 8 subjects (18.60%) with peri-implantitis and 32 implants (74.42%) with bone loss, and G2 – 3 subjects (14.29%) with peri-implantitis and 19 implants (90.48%) with bone loss. It was concluded that the cantilever extension in full fixed prostheses was not related with peri-implantitis nor with bone loss in the distal implants

Treatment of odontogenic myxoma: a multidisciplinary approach-6-year follow-up case.

The most aggressive diseases that affect the oral environment are considered tumors of the jaw. The surgical treatment is preferably done by surgical resection of the lesion, resulting in a great loss of tissue and esthetics. Multidisciplinary planning is required for the rehabilitation of these cases. Autogenous grafting techniques or vascularized flaps allow ridge reconstruction for implant placement, restoring function, and esthetics. This paper reports a 6-year follow-up case of an odontogenic myxoma treated with wide resection and mandibular bone reconstruction for posterior rehabilitation with dental implants.

Osteonecrose maxilo-mandibular induzida por bisfosfonato: revisão bibliográfica / Maxillomandibular osteonecrosis induced by bisphosphonate: a literature review

Diante da necessidade de novas tecnologias farmacêuticas para o tratamento de diversos tipos de lesões malignas, surgiram os bisfosfonatos, medicamentos amplamente administrados a pacientes portadores de câncer de mama e próstata com metástases ósseas, mieloma múltiplo, osteoporose, doença de Paget, hipercalcemia maligna e outras lesões ósseas metastáticas. Várias reações adversas oriundas do uso desse medicamento têm surgido, destacando-se a osteonecrose dos maxilares (ONM). Mediante de uma revisão bibliográfica, o objetivo deste trabalho é o de realizar uma abordagem objetiva acerca das principais características desse fármaco, suas complicações, prevenção e terapêutica da ONM. Diante da ausência de um protocolo de tratamento efetivo para a ONM, a prevenção apresenta-se como melhor opção. Faz-se pertinente frisar que os pacientes submetidos à quimioterapia com os bisfosfonatos devem ser encaminhados ao serviço odontológico para criteriosa avaliação de possíveis fatores predisponentes ao aparecimento da ONM. O tratamento de pacientes com osteonecrose maxilo-mandibular bisfosfonatoassociado, além da natural dificuldade, apresenta resultados imprevisíveis.

The need for new pharmaceutical technologies in the treatment of several types of malignant lesions led to the emergence of the bisphosphonates, a drug widely administered to patients with breast and prostate cancer with bone metastases, multiple myeloma, osteoporosis, Paget's disease, hypercalcemia and other malignant metastatic bone lesions. Several adverse reactions have emerged, in particular osteonecrosis of the jaw (ONJ). This paper sets out to objectively address some of the main characteristics of this drug, its complications and role in the prevention and treatment of ONJ. Given the absence of a protocol for the effective treatment of ONJ, prevention is seen to be the best option. It is important to note that patients undergoing chemotherapy with bisphosphonates should be referred to a dental unit for careful evaluation of possible predisposing factors. Apart from the inherent difficulty of the treatment of patients with biphosphonate-associated maxillomandibular osteonecrosis, its results are unpredictable.

Medial canthal region as an external reference point in orthognathic surgery.

PURPOSE: The aim of this investigation was to evaluate the effectiveness of using the medial canthal region (MCR) as an external reference point to determine the vertical dimension during maxillary repositioning as planned in model surgery and predictive tracing. MATERIALS AND METHODS: The analyzed group consisted of 43 consecutive patients who underwent maxillary or bimaxillary orthognathic surgery. Before downfracture, the vertical height was established from the distance of the MCR to the incisal edge of the right upper central incisor (UCI). The vertical dimension was obtained with frequent measurements by use of calipers as desired during cephalometric tracing and model surgery. After rigid fixation, the vertical height was verified again. The UCI was traced from the postoperative cephalogram and predictive tracing onto a preoperative tracing. Repositioning of the maxilla and postsurgical movements of the UCI were registered at the horizontal and vertical planes. Comparison was made between the predicted maxillary position on the cephalometric tracing and the actual position, as well as between the planned maxillary position in model surgery and the actual position. RESULTS: The mean difference between the planned UCI position on predictive tracing and postsurgical position was 0.30 mm (SD, 0.21 mm; P > .05) in the vertical plane. The variation between the planned maxillary position in model surgery and the actual position was 0.37 mm (SD, 0.31 mm; P > .05) in the vertical plane. CONCLUSIONS: Good surgical accuracy in positioning the mobilized maxilla can be achieved by use of the MCR as an external reference point.

Avaliação da técnica de utilização da matriz/cunha na microinfiltração de restaurações de resina composta em dentes posteriores / Evaluation of the technique of matrix/wedge use on the microleakage of composite resin restorations in posterior teeth

O objetivo deste estudo foi avaliar a técnica de utilização da matriz/cunha na microinfiltração de restaurações de resina composta em dentes posteriores, utilizando dois sistemas adesivos. Foram realizados 40 preparos, Classe II, em 20 molares hígidos, sendo que em cada dente foram realizadas duas cavidades, uma na face distal e outra na face mesial. No Grupo I, foi utilizado Single Bond/Filtek Supreme (3M Dental Products, St Paul, MN, USA) e a colocação da matriz/cunha foi antes do procedimento adesivo. No grupo II, os procedimentos foram semelhantes ao grupo I, exceto a colocação da matriz/cunhaque foi depois do procedimento adesivo. No grupo III, foi utilizado Scotchbond Multi-Uso/P 60 (3M Dental Products, St Paul, MN, USA) e a colocação da matriz/cunha foi antes do procedimento adesivo. No grupo IV, os procedimentos foram semelhantes ao grupo III, exceto a colocação da matriz/cunha que foi depois do procedimento adesivo. Os dentes foram submetidos à ciclagem térmica (500 ciclos, entre 5°C e 55°C), impermeabilizados com esmalte de unha e seccionados no sentido mesio-distal. As secções foram avaliadas pelo grau de infiltração do corante (fucsina básica 0.5%). Após a realização do teste de Kruskal-Wallis, observou-se que não houve diferença entre os grupos (p=0,33). A seguir, compararam-se os dados por sistema de união utilizado, unindo os grupos I e II (SB) e III e IV (SBMP), pelo teste U de Mann-Whitneye, também, não apresentou diferença significativa (p=0,071). Conclui-se que o momento da inserção da matriz/cunha não interferiu no grau de microinfiltração das restaurações de resina composta em dentes posteriores.