Strategy of Mandibular Central Arch Reconstruction After Firearm Injury.

Gunshot wounds can cause extensive destruction of soft tissue and bone, and the maxillofacial region is often affected. The reconstructive treatment is complex due to the difficulty to reestablish the central arch mandibular contour and volume. Moreover, the goal is to avoid postoperative infections and obtain bone graft neovascularization. Therefore, this report shows a clinical case of a patient presenting mandibular deformity with a mandibular central arch discontinuity caused by a firearm injury. The strategy to the reconstructive treatment as performed with a condensed and stabilized particulate autogenous bone graft was essential and effectiveness. After 1 year, it was obtained a satisfactory result to the patient.

Traumatic dental injury in permanent teeth: knowledge and management in a group of Brazilian school teachers.

BACKGROUND/AIM: School is a place with a high frequency of dental trauma, and several studies have shown that teachers' knowledge in how to act during acute dental emergencies is lacking. Therefore, this study aimed to assess the knowledge and actions of a group of Brazilian school teachers relative to dental trauma in permanent teeth. MATERIALS AND METHODS: A cross-sectional, observational study, from 27, schools randomized by lot was performed. All 205 teachers in the 27 schools answered a structured and self-administered questionnaire. The questionnaire contained questions about the participants' education level, work experience and first-aid training, as well as knowledge about and attitudes towards dental trauma in permanent teeth as well as their experience in dental emergency situations. RESULTS: Of the 205 teachers, 91.2% reported having no knowledge about dental trauma and 16.6% of teachers had seen cases of acute dental trauma. Among the 205 teachers, 23.9% had received first-aid training and 4.1% had been educated in dental trauma. Regarding actions of acute injuries to permanent teeth, the teachers showed a significant error rate. No association was found between the level of education and first-aid training or experience with dental trauma. In relation to the experience of the teacher, association was found when managing trauma to soft tissue. CONCLUSION: The knowledge and actions of Brazilian schoolteachers in relation to care of acute injuries in permanent teeth were inconsistent and based on unfounded concepts, beliefs and intuition, and lack of training. Continuing education of teachers in oral care due to a dental trauma should be a good plan of action.

Five-year follow-up of modified implant-supported overdenture in an iliac crest autograft failure: clinical report.

The treatment of extensive pathologic lesions in the jaw, most of the time, can generate rehabilitation problems to the patient. The solid ameloblastoma is a locally invasive odontogenic tumor with a high recurrence rate. Its treatment is aggressive and accomplished through resection with safety margin. The criterion standard for reconstruction is autogenous bone, but it can provide a high degree of resorption, causing inconvenience to the patient because of lack of rehabilitative option. This study aimed to describe a patient with ameloblastoma treated through resection and reconstruction with autogenous bone graft, in which, after an extensive resorption of the graft was made, a modified bar was applied to support a prosthetic implant overdenture.

The Role of Bone Grafts in Preventing Medication-Related Osteonecrosis of the Jaw: Histomorphometric, Immunohistochemical, and Clinical Evaluation in Animal Model.

Objective: To evaluate the effects of inorganic bovine bone graft (Lumina Bone, Criteria, Brazil) and beta-tricalcium phosphate (ß-TCP) graft (ChronOS, Synthes, Brazil) in rats with the risk of developing post-extraction medication-related osteonecrosis of the jaw (MRONJ). Methods: Eighteen male Wistar rats weighing 350 to 450 g were induced to develop MRONJ using zoledronic acid for 5 weeks. In the sixth week, the right maxillary first molar was extracted. The animals in Group I (G1) did not receive bone grafts after tooth extraction, while Group II (G2) animals received inorganic bovine bone grafts, and Group III (G3) animals received beta-tricalcium phosphate (ß-TCP) grafts. Clinical evaluation and histomorphometric and immunohistochemical analyses were performed. ANOVA and Tukey's statistical tests were used and a level of significance was considered to be 5%. Results: In the clinical evaluation, animals from G2 and G3 did not present clinical manifestations of osteonecrosis, unlike the control group (G1) animals, which presented necrotic bone tissue exposure in all samples. In the histomorphometric evaluation, animals in G3 showed greater formation of bone tissue (66%) and less formation of bone lacuna (18%) than animals in G1 (58%/32%) and in G2 (59%/27%) (P < 0.05). Moderate (++) immunostaining was observed in G2 and G3 for RANKL, TRAP, and OC, while G1 showed moderate (++) labeling for OC and mild (+) immunostaining for TRAP and RANKL. Conclusions: Greater formation of bone tissue and fewer bone lacunae were found in animals treated with ß-TCP. In clinical evaluation, bone graft groups presented with the clinical manifestation of MRONJ and showed higher intensity of immunostaining for TRAP and RANKL. Despite the limitations of experimental animal studies, the results of this work may assist in the development of future clinical research for the prevention of MRONJ.

Epidemiologic evaluation of mandibular fractures in the Rio de Janeiro high-complexity hospital.

The aim of this study was to gather data on trauma etiology and mandibular fracture localization in patients who presented at the General Hospital of Nova Iguaçu, Rio de Janeiro, Brazil. From March 2007 to December 2008, 95 patients with mandibular fracture were registered in a medical form, at the Bucomaxillofacial Surgery Department of the General Hospital of Nova Iguaçu, Rio de Janeiro, Brazil. Concerning mandibular fracture etiology, 21.05% were caused by motorcycle accidents, followed by interpersonal violence without use of weapons (punches, kicks, bumps with the head, blows with the elbow, etc) (16.84%) and interpersonal violence with firearm (14.73%). It was found that 52.63% of the patients had a single fracture line. The most affected fracture area was the parasymphysis (26.02%), followed by the condyle (22.60%) and mandibular angle (18.49%). Concerning the injury area, 24.21% were directed to the mandibular symphysis, 22.17% of the patients did not remember the injury area, and 18.94% had multiple injuries. When the injury was directed to the symphysis, the result was more condyle fractures (11.64%), and injuries at the mandibular angle resulted in fractures at the angle itself (8.90%). The most common fracture cause was traffic accidents, mainly motorcycle accidents, and the most affected areas were the parasymphysis and the condyle. The mandible isolated fractures occurred in half of the cases. Motorcycle accidents resulted in more fractures in the parasymphysis area, and when the symphysis area is affected by injuries, the result is a higher percentage in condyle fractures.

Utilization of surgical trepan for the obtainment of calvarial autogenous bone graft in maxillary reconstructions.

Maxillomandibular reconstructions are traditionally performed by means of autogenous bone grafts collected from intraoral donor areas and extraoral donor areas such as clavicle, iliac bone, rib, and tibia. The calvarial bone has been studied as an alternative donor area, with a low incidence of complications and minimal postoperative morbidity. Complications such as dural lacerations associated with cerebrospinal fluid leakage and extradural and subdural bleeding were minimized due to the use of surgical trepan, allowing the diploic layer delimitation before the osteotomy, preserving the internal calvarial cortical. The purpose of this article is to suggest a new technique for the obtainment of calvarial bone grafts with surgical trepan.

Tomographic Evaluation of Mandibular Thickness on Premolar and Molar Regions Related to Monocortical Screws.

The aim of this study was to measure the thickness of the mandible from the external cortical plate to the teeth roots on premolar and molar regions using CT scan to determine the safety margin for the application of monocortical screws for internal rigid fixation. Thirty-one patients underwent CT-scan imaging for surgical planning. The images were used to measure bilaterally the distance from the external cortex of the mandible to the roots of teeth on premolar and molar region by means of Dental Slice software (Bioparts Prototipagem Biomedica, Brasília, DF, Brazil). Mean, median, standard deviation, one-way ANOVA and post hoc Tukey's test were used for statistical analysis. No statistical differences for thickness were found between right and left side (p = 0.1652). The mean thickness for the left side was 4.17 ± 1.68 mm and for right side 3.93 ± 1.49 mm. Increase in mandibular thickness from anterior to posterior regions in both sides was observed and statistical difference was found among the different groups according to the measured region (p < 0.05). The present results can predict the safety zone for the use of monocortical screws in the mandible, but the use of CT scan is imperative and individual analysis is desired owing to anatomical variations. Further studies with larger samples are necessary to confirm these data and should include other anatomic structures, different regions of mandible/maxilla, as well as other ethnic groups.

A relação entre infecção bacteriana por Pseudomonas aeruginosa e a colocação de piercing em região de cartilagem superior da orelha: relato de caso clínico / The relationship between bacterial infection by Pseudomonas aeruginosa withpiercing?s placement in the region of the upper cartilage of the ear: case report

A prática da colocação de piercings é comum entre jovens. Os motivos que levam à escolha dessa prática são os mais diversos, dentre os quais estão: expressão de identidade, estética, inclusão em grupos sociais, moda e manifestação de rebeldia. A colocação do piercing é feita mediante uma perfuração dos tecidos no local desejado, o que, em alguns casos, pode resultar em complicações pela penetração de micro-organismos nos tecidos ou em infecções mais graves. O presente trabalho tem como objetivo realizar uma revisão em relação às complicações decorrentes da utilização de piercing, bem como apresentar um relato clínico de infecção por pseudômonas após a colocação de piercing em região de cartilagem em orelha direita.

The practice of body piercing is common among young people. The reasons why the choice of this practice are several, among them are: an expression of identity, aesthetics, participation in social groups, fashion and expression of rebellion. The placement of the piercing is done through a perforation of the tissues at the desired location, which in some cases can result in complications due to the penetration of micro-organisms in tissue or in more serious infections. This paper aims to conduct a review with respect to complications related to the use of piercing, as well as present a clinical report of pseudomonas infection after placement of a region of cartilage piercing in right ear.

Otite Média e Anquilose na Região Temporomandibular Causada por Fratura de Arma de Fogo. Relato de Caso / Otitis Media and Ankylosis in Temporomandibular Region Caused by Gunshot Fracture. Case Report

As fraturas mandibulares ocupam o segundo lugar dentre todas as fraturas do esqueleto facial. Atualmente, com o aumento da violência nos grandes centros urbanos, houve, também, um aumento de fraturas decorrentes de armas de fogo em civis, tornando-se necessário o seu estudo para elaboração de protocolos de diagnóstico e tratamento desses pacientes. O presente trabalho visa apresentar um caso clínico de fratura condilar por arma de fogo, sendo esse trauma também responsável por anquilose na região da articulação temporomandibular do mesmo lado, bem como otite média.

Mandibular fractures represent the most common facial fractures. Now, with the upsurge of violence in big citys, there was also an increase of fractures caused by gunshots on civilians, and its study for drawing up protocols of diagnosis and treatment of these patients. This work aims to present a clinical case of condilar fracture by gunshot, being this trauma also responsible for an ankylosis in the region of the temporomadibular joint, as well as an otitis.

Reparo ósseo em defeito peri-implantar com e sem associação de enxerto ósseo autógeno obtido por piezocirurgia: estudo experimental em coelhos / Peri-implantar bone defect repair with and without association of autogenous bone graft obtained by piezosurgery: experimental study in rabbits

Proposição: A proposta deste estudo foi avaliar por análise histométrica a resposta tecidual óssea de enxerto autógeno coletado por piezocirurgia para o preenchimento de defeitos nas porções cervicais de implantes instalados em tíbias de coelhos. Métodos: Foram instalados 26 implantes em 13 tíbias de coelho, após a estabilidade inicial foram realizados defeitos cervicais por trefinagem, em um grupo foi mantido apenas o coágulo como preenchimento e em outro grupo o defeito foi preenchido por osso autógeno coletado por equipamento piezoelétrico, os animais foram sacrificados após 15 e 30 dias, a análise histométrica das interfaces implante-osso foram realizadas pelo software Image Lab. Resultados: Foi analisado o percentual de extensão linear de contato entre tecido ósseo e implante, a média percentual obtida de contato entre tecido ósseo neoformado e implante foram estabelecidas como médias da área de osso neoformado entre as espiras e contato osso-implante (BIC). Os resultados obtidos foram: no controle de 15 dias, o percentual entre as espiras foi de 65,2% e entre as espiras e contato osso-implante (BIC) de 88,7%. No controle de 30 dias o contato entre as espiras foi na ordem de 65,2% e entre as espiras e contato osso-implante (BIC) de 73,2%. No grupo de enxerto de 15 dias, o osso formado entre as espiras foi de 69,3% e entre as espiras e contato osso-implante (BIC) em 81%, no grupo enxerto 30 dias o osso formado entre as espiras foi de 91,47% e entre as espiras e contato ossoimplante (BIC) 91,56%. Conclusão: o enxerto ósseo autógeno particulado obtido por piezocirurgia apresenta melhor resultado que o coágulo sanguíneo no osso neoformado entre as espiras e no contato osso-implante

Purpose: The purpose of this study was to evaluate by histometric analysis the outcome of autogenous bone collected through piezo surgery equipment in filling cervical portion defects around implants placed in rabbits tibias. Materials and Methods: Twenty-six implants were installed in 13 rabbits tibias, after initial primary stability, cervical defects were carried out by the use of a trephina, in one group the cloth was maintained as the defect filling and in another group the defect was filled by autogenous bone collected through piezo surgery equipment, the animals were sacrificed after 15 and 30 days, the histometric analysis of the implant-bone interfaces were carried out by the use of Image Lab software. Results: The lineal stretch percentage of contact between bone and implant was analyzed, the average percentage obtained in the contact between the newly formed bone and the implant was established as the average area of the newly formed bone in the space between the spires and the bone-implant contact (BIC). The results obtained were: in the 15-days control group, the percentage of bone formation between the spires was of 65.2% and between the spires and boneimplant contact (BIC) was of 88.7%. In the 30-days control group the contact between the spires was of 65.2% and between the spires and bone-implant contact (BIC) of 73.2%. In the 15-days control grafted group, the formed bone between the spires was of 69.3% and between the spires and bone-implant contact (BIC) of 81%, in the 30-days control grafted group, the formed bone between the spires was of 91.47% and between the spires and bone-implant contact (BIC) of 91.56%. Conclusions: the autogenous bone collected through piezo surgery equipment showed better results than the blood clot regarding the newly formed bone between the spires and bone-implant contact (BIC)

Reparo ósseo em defeito peri-implantar com e sem associação de enxerto ósseo autógeno obtido por piezocirurgia: estudo experimental em coelhos / Peri-implantar bone defect repair with and without association of autogenous bone graft obtained by piezosurgery: experimental study in rabbits

Proposição: A proposta deste estudo foi avaliar por análise histométrica a resposta tecidual óssea de enxerto autógeno coletado por piezocirurgia para o preenchimento de defeitos nas porções cervicais de implantes instalados em tíbias de coelhos. Métodos: Foram instalados 26 implantes em 13 tíbias de coelho, após a estabilidade inicial foram realizados defeitos cervicais por trefinagem, em um grupo foi mantido apenas o coágulo como preenchimento e em outro grupo o defeito foi preenchido por osso autógeno coletado por equipamento piezoelétrico, os animais foram sacrificados após 15 e 30 dias, a análise histométrica das interfaces implante-osso foram realizadas pelo software Image Lab. Resultados: Foi analisado o percentual de extensão linear de contato entre tecido ósseo e implante, a média percentual obtida de contato entre tecido ósseo neoformado e implante foram estabelecidas como médias da área de osso neoformado entre as espiras e contato osso-implante (BIC). Os resultados obtidos foram: no controle de 15 dias, o percentual entre as espiras foi de 65,2% e entre as espiras e contato osso-implante (BIC) de 88,7%. No controle de 30 dias o contato entre as espiras foi na ordem de 65,2% e entre as espiras e contato osso-implante (BIC) de 73,2%. No grupo de enxerto de 15 dias, o osso formado entre as espiras foi de 69,3% e entre as espiras e contato osso-implante (BIC) em 81%, no grupo enxerto 30 dias o osso formado entre as espiras foi de 91,47% e entre as espiras e contato ossoimplante (BIC) 91,56%. Conclusão: o enxerto ósseo autógeno particulado obtido por piezocirurgia apresenta melhor resultado que o coágulo sanguíneo no osso neoformado entre as espiras e no contato osso-implante

Purpose: The purpose of this study was to evaluate by histometric analysis the outcome of autogenous bone collected through piezo surgery equipment in filling cervical portion defects around implants placed in rabbits tibias. Materials and Methods: Twenty-six implants were installed in 13 rabbits tibias, after initial primary stability, cervical defects were carried out by the use of a trephina, in one group the cloth was maintained as the defect filling and in another group the defect was filled by autogenous bone collected through piezo surgery equipment, the animals were sacrificed after 15 and 30 days, the histometric analysis of the implant-bone interfaces were carried out by the use of Image Lab software. Results: The lineal stretch percentage of contact between bone and implant was analyzed, the average percentage obtained in the contact between the newly formed bone and the implant was established as the average area of the newly formed bone in the space between the spires and the bone-implant contact (BIC). The results obtained were: in the 15-days control group, the percentage of bone formation between the spires was of 65.2% and between the spires and boneimplant contact (BIC) was of 88.7%. In the 30-days control group the contact between the spires was of 65.2% and between the spires and bone-implant contact (BIC) of 73.2%. In the 15-days control grafted group, the formed bone between the spires was of 69.3% and between the spires and bone-implant contact (BIC) of 81%, in the 30-days control grafted group, the formed bone between the spires was of 91.47% and between the spires and bone-implant contact (BIC) of 91.56%. Conclusions: the autogenous bone collected through piezo surgery equipment showed better results than the blood clot regarding the newly formed bone between the spires and bone-implant contact (BIC)

Reabilitação de paciente vítima de projétil de arma de fogo com dois implantes zigomáticos / Rehabilitation of a patient victim of gunshot wound through the use of two zygomatic fixtures

Os implantes zigomáticos (IZs) têm sido utilizados desde os anos de 1990 para reabilitação de maxilas severamente atróficas. Neste artigo pretendemos relatar um caso de reabilitação de maxila com perda óssea provocada por projétil de arma de fogo (PAF) através destes implantes.