Effect of simvastatin topical use on alveolar bone after tooth extraction: a scoping review.

OBJECTIVES: Conducting a scoping review (SR) to assess scientific evidence for topical simvastatin's impact on alveolar bone regeneration and determine its level of support for clinical applications. MATERIALS AND METHODS: This SR followed the PRISMA-ScR and OSF registries protocol; systematic searching was conducted on MEDLINE/PubMed, Cochrane, Embase, Scopus, Web of Science, and LILACS, to identify relevant articles until June 2023. Inclusion criteria covered clinical trials, case series, prospective and retrospective studies, along with in vivo investigations, involving participants of any sex and age. RESULTS: Out of 1312 identified studies, 20 (9 in vivo, 11 RCTs) met inclusion criteria. RCTs focused on third molar extraction, in vivo on mandibular incisor surgery. The majority of RCTs employed a collagen sponge and a simvastatin concentration of 10mg; conversely, most in vivo studies favored polylactide-co-glycolide and a 2 mg simvastatin concentration. RCTs had 3-month follow-ups; in vivo, studies extended to 8 weeks. Seven RCTs assessed pain outcomes, simvastatin did not significantly affect pain in six studies. Among four RCTs on postoperative swelling, only two observed a significant increase in the simvastatin group. In general, positive bone formation and the absence of adverse effects directly linked to topical simvastatin were observed across the study models. CONCLUSIONS: Intra-alveolar simvastatin post-tooth extraction has been to be shown to be effective and safe for preserving alveolar bone, with varied concentrations and carriers, with no significant adverse effects. CLINICAL RELEVANCE: This review provides critical insights into the effects of simvastatin on alveolar bone regeneration, informing potential benefits and possible challenges associated with its post-extraction application. OSF REGISTRY PROTOCOL: osf.io/q3bnf.

Do Computerized Delivery Systems Promote Less Pain and Anxiety Compared to Traditional Local Anesthesia in Dental Procedures? A Systematic Review of the Literature.

PURPOSE: The aim of this study is to assess whether the use of computerized devices to deliver local anesthesia results in less pain and anxiety compared to traditional anesthesia in adult dental procedures. METHODS: This review was registered at PROSPERO (CRD 42021265046), based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was structured according to the PICO strategy. The studies were selected based on eligibility criteria, and data were collected by 1 author and reviewed by another. RESULTS: Nine of the 10 studies included were randomized controlled trials. Differences related to pain and anxiety were observed, which favored computerized techniques; however, caution should be exercised when interpreting these results due to differences in assessment methods. The studies used different local anesthetics, including 2% lidocaine, 4% articaine, or 3% mepivacaine with epinephrine diluted 1:80,000 to 1:200,000. A total of 560 patients were evaluated. CONCLUSIONS: Computerized anesthesia devices yielded better results than conventionally delivered anesthesia after qualitative evaluation. Nevertheless, conventional anesthesia is widely used, safe, and effective. Due to the heterogeneity among the included studies, it is strongly recommended that new randomized clinical trials using well-defined methodologies be performed to improve the quality of evidence regarding this topic.

Comparative Analysis Between Computed and Conventional Inferior Alveolar Nerve Block Techniques.

OBJECTIVE: The aim of this randomized, double-blind, controlled trial was to compare the computed and conventional inferior alveolar nerve block techniques in symmetrically positioned inferior third molars. PATIENTS AND METHODS: Both computed and conventional anesthetic techniques were performed in 29 healthy patients (58 surgeries) aged between 18 and 40 years. The anesthetic of choice was 2% lidocaine with 1: 200,000 epinephrine. The Visual Analogue Scale assessed the pain variable after anesthetic infiltration. Patient satisfaction was evaluated using the Likert Scale. Heart and respiratory rates, mean time to perform technique, and the need for additional anesthesia were also evaluated. RESULTS: Pain variable means were higher for the conventional technique as compared with computed, 3.45 ±â€Š2.73 and 2.86 ±â€Š1.96, respectively, but no statistically significant differences were found (P > 0.05). Patient satisfaction showed no statistically significant differences. The average computed technique runtime and the conventional were 3.85 and 1.61 minutes, respectively, showing statistically significant differences (P <0.001). CONCLUSIONS: The computed anesthetic technique showed lower mean pain perception, but did not show statistically significant differences when contrasted to the conventional technique.

Comparative finite element analysis of the biomechanical stability of 2.0 fixation plates in atrophic mandibular fractures.

PURPOSE: The objective of the present study was to conduct a computational, laboratory-based comparison of the biomechanical stability of 2.0 fixation locking plates with different profiles in Class III atrophic mandibular fractures using 3-dimensional finite element analysis. MATERIALS AND METHODS: Three-dimensional finite element models simulating Class III atrophic mandibular fractures were constructed. The models were divided into 4 groups according to plate thickness (1.0, 1.5, 2.0, and 2.5 mm). Fractures were simulated in left mandibular bodies, and 3 locking screws were used on each side of each fracture for fixation. Bite forces of approximately 63 N were simulated in the incisor and molar regions of the mandibles in finite element models. RESULTS: The level of compressive strain on the bone around the screw was within the physiological limit. No significant difference was observed in the displacement of bone segments in the fracture region. Von Mises stress was higher during simulated bites in the molar region for plates with thicknesses of 1.0 mm. Plate tension values were below the level required for permanent deformation or fracture in all models. The 2.5-mm-thick plate presented better biomechanical performance than all other plates. The 2.0-mm-thick plate also showed satisfactory results and adequate safety limits. CONCLUSION: Large-profile (2.0-mm-thick) locking plates showed better biomechanical performance than did 1.0- and 1.5-mm-thick plates and can be considered an alternative reconstruction plate for the treatment of Class III atrophic mandibular fractures.

Why choose articaine over lidocaine for the removal of third molars? Systematic review and meta-analysis.

Background: The aim of the present study was to seek scientific evidence through a systematic review and meta-analysis for the choice of articaine over lidocaine in the removal of third molars. Material and Methods: Searches were performed of the MEDLINE/PubMed, EMBASE, Cochrane Library (CENTRAL), Web of Science, and SCOPUS databases as well as the grey literature. Results: Four hundred three articles were found, only 14 of which met the eligibility criteria. A total of 1114 third molars were removed: 557 with articaine and 557 with lidocaine. Articaine had a higher success rate than lidocaine (RR = 1.09, 95% CI: 1.03 to 1.15; P< 0.05), shorter subjective latency time (MD = -15.10, 95% CI: -21.57 to -8.63; P< 0.05), less intraoperative pain (MD = -6; P< 0.05), longer duration (MD = 68.86; P< 0.05), and less postoperative pain (MD = -3.05; P< 0.05). Conclusions: Based on the findings, articaine is superior to lidocaine for use in lower third molar surgeries due to the higher success rate, shorter time until the onset of action, greater control of intraoperative and postoperative pain, and longer duration of the anesthetic effect. Key words:Articaine, lidocaine, third molar, impacted teeth.

Malignant hyperthermia in maxillofacial surgery: Literature review supported by case presentation.

OBJECTIVE: Malignant hyperthermia (MH) is characterized by a state of hypermetabolism after exposure to halogenated inhalational anesthetics or succinylcholine. The aims of this study were to carry out an updated review on the subject and report an illustrative case of MH in urgent maxillofacial surgery. MATERIAL AND METHODS: A search of the PubMed/MEDLINE database using the keyword "malignant hyperthermia" was performed including articles published over the last 11 years in English, Spanish or Portuguese. Exclusion criteria were similar presentations but not associated with MH and cases not related to the use of anesthetic drugs as a trigger of the condition. CASE REPORT: A 45-year-old man (75 kg, ASA status IE) with a negative family history for neuromuscular diseases, victim of a car accident with a facial fracture, underwent surgery under balanced general anesthesia and developed signs of MH 4 h after anesthesia induction. In our patient, the causative agent was sevoflurane and the diagnosis of MH was confirmed, subsequently, by muscle biopsy. RESULTS/DISCUSSION: Overall, 44 cases of MH were found. According to the recent literature, MH shows a male predilection (3:1) and the mean age of patients is 32.2 ± 22.2 years. The most frequently cited causative agents were sevoflurane (30.5%), isoflurane (22.2%), and sevoflurane + succinylcholine (13.8%). The most common clinical indicators included hypercarbia (88.8%), hyperthermia (86.1%), and tachycardia (63.8%). Dantrolene was administered in 24 cases. The outcome was favorable in 31 cases (86.1%). The in vitro muscle contracture test (IVCT) was performed in only 15 patients and all of them tested positive. In our patient, the causative agent was sevoflurane and the diagnosis of MH was confirmed by muscle biopsy. CONCLUSION: The mortality from MH is still high and an early clinical diagnosis and specific treatment with dantrolene are necessary for a favorable outcome. A complete understanding will allow better management of patients with MH. At present, the best management is to identify susceptible patients and to avoid triggering agents, combined with vigilant monitoring.

Comparison of two alar cinch base suture in orthognathic surgery: a randomized clinical trial.

Le Fort I osteotomy is widely used in orthognathic surgery to correct maxillary deformities. However, this osteotomy may be related with the increase of alar base width. The aims of the present study were to compare two alar cinch suture after Le Fort I osteotomy and observe which type presents a better result in controlling the enlargement of the alar base after maxillary repositioning in orthognathic surgery. A randomized clinical trial was carried out with 40 patients randomly assigned in two intervention groups: group 1 - patients submitted to internal suture and group 2 - patients submitted to external suture. Of the 40 patients, 65% were female and 35% were male. The mean age of the patients was 30,25 in group I and 28,6 in group II. There was an increase in the alar base width in both groups, with significant difference between the means (P < 0,001). It was possible to compare the evolution of the means of the alar base width between group I and group II. Thus, it was observed that the external technique (group II) better controlled alar base width after Le Fort I osteotomy. It was not possible to relate the enlargement of the alar cinch with maxillary movement performed (P > 0,05). Overall, alar base cinch suture is an essential component of Le Fort osteotomies to control the alar base width. In this study, the external technique was more effective when compared to the internal technique in controlling the enlargement of the alar base width.

A new approach for reconstruction of a severely atrophic mandible.

PURPOSE: The purpose of this study is to report a case of a patient with a severely atrophic mandible (less than 5 mm) who was treated without bone graft using short implants and internal rigid fixation. PATIENT AND METHODS: A 61-year-old woman was referred to a private clinic in the city of Recife (Brazil) with a severely resorbed mandible (less than 5 mm). The patient reported a history of nearly 15 years of complete edentulism and consecutive treatment failures. Cone beam tomography was performed and severe atrophy was confirmed, revealing total bilateral exposed inferior alveolar nerves. There was a high risk of pathologic mandible fracture, since bone density in critical areas was very low. Treatment of choice was the placement of 4 Shorty (3.75 x 5.5 mm) implants (Nobel Biocare, Göteborg, Sweden) at the symphysis for immediate functional reasons and a 2.0-mm large profile Unilock bone plate (Synthes Maxillofacial, Paoli, PA) to reinforce the mandible. A rapid prototype model was made to help precontour the plate, enabling the insertion of the plate through the transoral approach. RESULTS: A week after surgery, a Brånemark prosthesis protocol was performed and the patient was satisfied with the result. At 29 months after surgery, the patient was still satisfied and had excellent function without complications. CONCLUSIONS: Because of the reported advances in implantology and internal rigid fixation, more patients would be able to improve their severe dental condition without the use of more invasive techniques.

Influence of local anesthethics with adrenalina 1:100.000 in basic vital constants during third molar surgery.

OBJECTIVE: The present study consists of a double-blind randomized clinical trial of paired samples. The purpose of the present study was thus to examine the effect of four different local anesthetics of the amida group (2% lidocaine with 1:100.000 adrenaline; 3% prilocaine with 0.30 IU felipressine; 2% mepivacaine with 1:100.000 adrenaline; and 4% articaine with 1:100.100 adrenaline) in patients undergoing extraction of lower third molars and verify the changes in systolic, diastolic and mean blood pressures, heart rate (HR) and oxygen saturation (SpO2). STUDY DESIGN: The sample comprised 168 extractions of lower third molars performed on 84 patients, divided into three groups, in whom lidocaine was the control anesthetic. The anesthetic solution applied differed from one side of the mouth to the other (control and experimental) in the same patient at different time periods. RESULTS: The following significant variations were observed: increase in systolic blood pressure with mepivacaine and articaine; decrease in diastolic blood pressure with lidocaine; increase in heart rate with all the anesthetics, but with no statistical significance in the case of prilocaine. The variations in mean blood pressure and oxygen saturation were not statistically significant. All the hemodynamic changes returned to normal with no need for any further treatment. No complications were observed in any of the 168 procedures performed. CONCLUSION: All the anesthetics studied behaved, in relation to lidocaine, within the parameters of hemodynamic safety, although the best performance was that of prilocaine, followed by lidocaine. The measurement of systolic blood pressure, diastolic blood pressure and heart rate are appropriate monitoring methods for patients under the effects of local anesthetic, even healthy ones.

Submental intubation in oral maxillofacial surgery: review of the literature and analysis of 13 cases.

OBJECTIVES: Various different methods of intubation are suitable for facial trauma cases. A choice often has to be made between orotracheal and nasotracheal when surgical access to the nasal or oral cavity is necessary. This work presents our current experience using submental intubation in the airway management of facial trauma patients. STUDY DESIGN: From July 2003 to February 2005, 13 sufferers from facial trauma benefited from submental intubation. All the patients were males and the ages ranged from 19 to 35 years (mean, 27 years). RESULTS: In all the patients, the submental intubation permitted simultaneous reduction and fixation of all fractures and intraoperative control of the dental occlusion without interference from the tube during the operation. There was only one intra-operative complication, when the tracheal pressure increased as a result of deviation and compression of the tube. No post-operative complications were reported. CONCLUSION: Submental intubation is a simple, secure and effective procedure for operative airway control in major maxillofacial traumas.

Comparison of two alar cinch base suture in orthognathic surgery: a randomized clinical trial

Abstract Le Fort I osteotomy is widely used in orthognathic surgery to correct maxillary deformities. However, this osteotomy may be related with the increase of alar base width. The aims of the present study were to compare two alar cinch suture after Le Fort I osteotomy and observe which type presents a better result in controlling the enlargement of the alar base after maxillary repositioning in orthognathic surgery. A randomized clinical trial was carried out with 40 patients randomly assigned in two intervention groups: group 1 - patients submitted to internal suture and group 2 - patients submitted to external suture. Of the 40 patients, 65% were female and 35% were male. The mean age of the patients was 30,25 in group I and 28,6 in group II. There was an increase in the alar base width in both groups, with significant difference between the means (P < 0,001). It was possible to compare the evolution of the means of the alar base width between group I and group II. Thus, it was observed that the external technique (group II) better controlled alar base width after Le Fort I osteotomy. It was not possible to relate the enlargement of the alar cinch with maxillary movement performed (P > 0,05). Overall, alar base cinch suture is an essential component of Le Fort osteotomies to control the alar base width. In this study, the external technique was more effective when compared to the internal technique in controlling the enlargement of the alar base width.

Resumo A osteotomia Le Fort I é amplamente utilizada em cirurgia ortognática para corrigir as deformidades maxilares. No entanto, esse tipo de osteotomia pode estar relacionado ao aumento da largura da base alar. Os objetivos do presente estudo foram comparar duas técnicas de sutura da base alar após a realização da osteotomia Le Fort I, bem como observar qual tipo apresenta melhor resultado no controle do alargamento da base alar após o reposicionamento maxilar em cirurgia ortognática. Foi realizado um ensaio clínico randomizado com 40 pacientes alocados aleatoriamente em dois grupos de intervenção: grupo 1 - pacientes submetidos à técnica de sutura interna e grupo 2 - pacientes submetidos à técnica de externa. Dos 40 pacientes, 65% eram do sexo feminino e 35% do masculino. A média de idade dos pacientes foi de 30,25 no grupo I e 28,6 no grupo II. Houve aumento da largura da base alar em ambos os grupos, com diferença significativa entre as médias (P <0,001). Foi possível comparar a evolução das médias da largura da base alar entre o grupo I e o grupo II. Assim, observou-se que a técnica externa (grupo II) controlou melhor a largura da base alar após a osteotomia Le Fort I. Não foi possível relacionar o alargamento da base alar com o tipo de movimentação maxilar realizado (P> 0,05). No geral, a sutura da base alar é um componente essencial das osteotomias Le Fort para controlar o alargamento da base alar. Nesse estudo, a técnica externa foi mais eficaz quando comparada à técnica interna no controle do alargamento da largura da base alar.

Assessment of satisfaction of patients submitted to bichectomy / Avaliação da satisfação dos pacientes submetidos à bichectomia

Objective: The aim this research was assess the level of satisfaction of patients undergoing bichectomy and its repercussions. Material and Methods: A cross-sectional and qualitative study, under protocol number 20707519.5.0000.5207, was carried out by applying a questionnaire to patients undergoing bichectomy, which made it possible to assess complaints, degree of postoperative satisfaction, satisfaction of family members, time required to perceive results, complications and adverse effects, intensity of postoperative pain, and possibility of being submitted to a new intervention. Results: The sample consisted of 30 patients, among them, 82% sought surgery for aesthetic reasons. Regarding the degree of satisfaction, the majority (70%) were very satisfied, followed by 13.3% who were satisfied, 10% considered normal, 3.3% were dissatisfied and 3.3% very dissatisfied. Regarding the opinion of friends and family, the majority were very satisfied with the result. The adverse effects found were mild, no permanent injury happened, and the pain was mild in the most majority of the sample. Conclusion: Thus, the most majority of patients were satisfied with the results, as well as their family and friends. The results were more evident between the second and third months. No major or permanent damage was observed, suggesting that it is a safe technique when performed well.(AU)

Objetivo: Avaliar o nível de satisfação dos pacientes submetidos à bichectomia, bem como correlacionar os resultados com algumas características clínicas. Material e Métodos: Foi realizado um estudo transversal e qualitativo, sob protocolo número 20707519.5.0000.5207, através da aplicação de um questionário a pacientes submetidos à bichectomia, o qual foi possível avaliar as queixas, o grau de satisfação pós-operatório, a satisfação dos familiares, o tempo para percepção dos resultados, as complicações e efeitos adversos, intensidade da dor pós operatória, e a possibilidade de ser submetido a nova intervenção. Além disso, as características demográficas da amostra (como sexo e idade) também foi registrada na ficha de avaliação. Resultados: A amostra foi composta por 30 pacientes, e desses, 82% buscaram a cirurgia por motivos estéticos. Sobre o grau de satisfação, a maioria (70%) ficou muito satisfeitos, seguidos por 13,3% que ficaram satisfeitos, 10% consideraram normal, 3,3% insatisfeitos e 3,3% muito insatisfeitos. Sobre a opinião dos amigos e familiares, a maioria ficou muito satisfeitos com o resultado. Os efeitos adversos encontrados foram leves, nenhuma lesão permanente foi encontrada, e a dor foi discreta na grande maioria da amostra. Com base na possibilidade de submeter-se a uma nova cirurgia, 70% ficaram satisfeitos e não fariam novamente. Conclusão: A grande maioria dos pacientes demonstrou-se satisfeitos com os resultados, bem como seus familiares e amigos. Os resultados foram mais evidentes entre o segundo e terceiro mês. Não foi observado qualquer dano importante ou permanente, sugerindo ser uma técnica segura quando bem executada. (AU)

Reconstruction of extensive sequel of frontal fracture: optimizing results / Reconstrução de extensa sequela de fratura frontal: otimizando resultados

Introduction: Fractures of the frontal bone correspond to 5 to 15% of all facial fractures. This type of fracture can lead to difficulties in restoring bone congruence and to postoperative secondary aesthetic problems. Objective: This paper aims to present a clinical case report of frontal bone fracture where a late reconstruction was performed using a titanium mesh with the aid of stereolithographic model prototyping. Case report: Female patient, 26 years old, with aesthetic sequelae in the upper third of the face after a motorcycle accident. The imaging exams showed a comminuted frontal bone fracture, as well as upper edge and right orbit ceiling involvement. The planning consisted of reconstruction of the affected area with the use of a titanium mesh pre-shaped in a stereolithographic model. The procedure was performed under general anesthesia and coronal access. After installation of the fixation material, pericranial flap rotation and suture of the surgical wound were performed. The patient progressed well, with considerable improvement in facial aesthetics. Conclusion: This paper reports the importance of good planning in cases of frontal bone fracture sequel, in which the use of model-shaped mesh in a stereolithographic model tends to optimize surgery, bringing aesthetic and psychosocial benefits. (AU)

Introdução: As fraturas do osso frontal correspondem de 5 a 15% de todas as fraturas faciais. Esse tipo de fratura pode levar a dificuldades na restauração da congruência dos ossos e a problemas secundários estéticos pós-operatórios. Objetivo: Este trabalho objetiva apresentar um relato de caso clínico de fratura do osso frontal onde foi realizada reconstrução tardia utilizando tela de titânio com auxílio da prototipagem de modelo estereolitográfico. Relato de caso: Paciente do sexo feminino, 26 anos, apresentando sequela estética em terço superior da face após acidente motociclístico. Os exames de imagem demonstraram fratura cominutiva em osso frontal, além de envolvimento de bordo superior e teto de órbita direita. O planejamento consistiu de reconstrução da área afetada com uso de tela de titânio pré-modelada em modelo estereolitográfico. O procedimento foi realizado sob anestesia geral e acesso coronal. Após instalação do material de fixação optou-se pela rotação de retalho de pericrânio e sutura da ferida cirúrgica. A paciente evoluiu bem, com melhora considerável da estética facial. Conclusão: Este trabalho relata a importância do bom planejamento em casos de sequela de fratura do osso frontal, no qual o uso de telas modeladas em modelo estereolitográfico tendem otimizar a cirurgia, trazendo benefícios estéticos e psicossociais. (AU)

Feasibility of three-dimensional CT reconstruction in assessing mandibular fractures: a survey among oral surgeons and dental maxillofacial radiologists

Aim: Evaluation of the reliability of 3D computed tomography (3D-CT) in the diagnosis of mandibular fractures. Methods: A cross-sectional, quantitative and qualitative study was carried out, through the application of a questionnaire for 70 professionals in the area of Oral and Maxillofacial Surgery and Radiology. 3D-CT images of mandibular fractures were delivered to the interviewees along with a questionnaire. Participants answered about the number of traces, the region and the type of fracture. The correct diagnosis, that is, the expected answer, was based on the reports of a specialist in oral and maxillofacial radiology after viewing the images in the axial, sagittal and coronal sections. The resulting data from the interviewees was compared with the expected answer and then, the data was analyzed statistically. Results: In the sample 56.9% were between 22 and 30 years old, 52.8% were oral and maxillofacial surgeons (OMF), 34.7% were residents in OMF surgery and 12.5% OMF radiologists. Each professional answered 15 questions (related to five patients) and 50.8% of the total of these was answered correctly. Specialists in Oral and Maxillofacial Surgery and Traumatology correctly answered 53.9%. Interviewees with experience between 6 and 10 years correctly answered 58.2%. In identifying fracture traces, 46.1% of the questions were answered correctly. In terms of location, 5.6% of interviewees answered wrongly while 14.2% answered wrongly regarding classification. Conclusion: 3D computed tomography did not prove to be a reliable image for diagnosing mandibular fractures when used alone. This made necessary an association with axial, sagittal and coronal tomographic sections

Treatment of hyperplasia of the coronoid process of the mandible in adults: analysis of 42 literature reports and illustrative case / Tratamento da hiperplasia do processo coronoide de mandibular em adultos: análise de 42 relatos da literatura e caso ilustrativo

ABSTRACT Objective: The objective of this research was to review the literature, compare different methods of surgical treatment for coronoid hyperplasia and report a clinical case of unilateral coronoid hyperplasia treated by coronoidectomy with intraoral access. Methods: A critical review of the literature was performed by selection of papers published in the last 20 years on the treatment of coronoid in adults in the PubMed, Medline, Scielo and Lilacs databases, with the terms coronoid hyperplasia OR coronoid elongation AND treatment OR management. The data was extracted for analysis. Results: twenty-four articles were selected. It included 42 patients, among them 69% were male patients and 81% were bilaterally affected. The age group with the highest prevalence was the people in the 20's and 30's. Sixty-nine percent of the patients were treated with coronoidectomy and 26.2% with coronoidotomy. The majority (83.3%) with intraoral access. No cases had surgical complications reported, and 71.4% underwent physiotherapy after surgery. Regarding the results, 83.3% were considered satisfactory, 11.9% were unsatisfactory. Conclusion: The great majority of the cases that brought significant results in the improvement of the pre and postoperative mouth opening were treated by coronoidectomy, proving to be an efficient and safe surgical treatment for the coronoid hyperplasia.

RESUMO Objetivo: O objetivo deste estudo foi revisar a literatura e comparar diferentes métodos de tratamento cirúrgico para hiperplasia do coronoide, além de relatar um caso clínico de hiperplasia coronoide unilateral tratada por coronoidectomia pelo acesso intraoral. Métodos: A revisão eletrônica crítica da literatura foi feita selecionando artigos publicados nos últimos 20 anos sobre o tratamento da hiperplasia do coronoide em adultos nas bases de dados PubMed, Medline, Scielo e Lilacs com os termos coronoid hyperplasia OR coronoid elongation AND treatment OR management. Os dados foram extraídos para análise. Resultados: Foram selecionados 24 artigos. Incluindo um total de 42 pacientes, dentre eles 69% eram pacientes do sexo masculino e 81% foram acometidos bilateralmente. O grupo etário com a maior prevalência compreendeu de 20 a 30 anos. Sessenta e nove por cento dos pacientes foram tratados com coronoidectomia e 26,2% com coronoidotomia, a maioria (83,3%) com acesso intra-oral. Nenhum caso teve complicações cirúrgicas relatadas e 71,4% foram submetidas à fisioterapia após a cirurgia. Em relação aos resultados, 83,3% foram considerados satisfatórios, e 11,9% insatisfatórios. Conclusão: A grande maioria dos casos que trouxeram resultados significativos na melhora da abertura bucal pré e pós-operatória foram tratados pela coronoidectomia, demonstrando ser um tratamento cirúrgico eficiente e seguro para a hiperplasia do coronoide.

Apicotomia associada ao tracionamento ortocirúrgico em dente com dilaceração radicular / Apicotomy associated with orto-surgical treatment in tooth with a root dilaceration

Introdução: A apicotomia é uma técnica, que vem sendo utilizada em dentes com dilaceração radicular acentuada, com o intuito de liberar a porção do dente impactada e, dessa forma, permitir seu reposicionamento na arcada dentária. Este trabalho tem como objetivo apresentar um relato de caso clínico do manejo ortocirúrgico de tracionamento ortodôntico associado à apicotomia em dente incluso com dilaceração radicular acentuada. Relato de caso: O paciente foi encaminhado para o serviço de bucomaxilofacial para exodontia do elemento incluso após insucesso de tracionamento ortocirúrgico, em que se verificou, ao exame radiográfico periapical, dente incluso com dispositivo ortodôntico e dilaceração radicular importante. Diante disso, realizou-se, sob anestesia local, a apicotomia e instalação do dispositivo ortodôntico. O paciente evoluiu bem, e, após 8 meses, o elemento dentário encontrava-se em posição oclusal e em função mastigatória. Considerações finais: Assim, a técnica da apicotomia mostra-se eficaz como alternativa ao insucesso do tracionamento ortodôntico tradicional, sendo uma técnica mais conservadora que a exodontia, necessitando de conhecimento teórico e domínio técnico do profissional... (AU)

Introduction: Apichotomy is a technique that has been used in teeth with severe root laceration in order to release the impacted tooth portion and thus allow its repositioning of the tooth in the dental arch. The aim of this paper is to present a clinical case report of orthosurgical orthodontic traction management associated with apichotomy in an included tooth with severe root laceration. Case report: The patient was referred to the Oral and Maxillofacial Service for extraction of the included element after ortho-surgical traction failure, which was verified by periapical radiographic examination, tooth included with orthodontic device and significant root laceration. Thus, under local anesthesia, apichotomy and orthodontic device installation were performed. The patient progressed well, and after 8 months the dental element was in occlusal position and in masticatory function. Final considerations: Thus, the apichotomy technique is effective as an alternative to the failure of traditional orthodontic traction, being a more conservative technique than extraction and requiring theoretical knowledge and technical mastery of the Professional... (AU)

Treatment of condylar fractures with an intraoral approach using an angulated screwdriver: results of a multicentre study.

BACKGROUND: This multicentre study aimed to investigate long-term radiographic and functional results following the treatment of condylar fractures using an angulated screwdriver system and open rigid internal fixation with an intraoral surgical approach. METHODS: Twenty-nine patients with a total of 32 condylar fractures were evaluated. The patients were investigated prospectively based on the following variables: age, sex, aetiology, side, location and classification of the fracture, degree of displacement, associated fractures, surgical approach, oral health status, type of osteosynthesis plate, duration of surgery, mouth-opening, complications, and duration of follow-up. RESULTS: The fractures were classified as subcondylar (n = 25) or condylar neck (n = 7). Mean patient age was 36.38 ± 16.60 years. The median duration of postoperative follow-up was 24.39 ± 13.94 months. No joint noise, weakness of the facial nerve, joint pain, or muscle pain was observed. An additional retromandibular approach was necessary to enable the treatment of one subcondylar fracture with medial displacement. CONCLUSION: Subcondylar or condylar neck fractures with medial or lateral displacement can be treated using an intraoral approach with satisfactory results with the advantages of the absence of visible scarring, the avoidance of facial nerve injury, and the ability to obtain rapid access to the fracture.

Solução de Carnoy no tratamento de ceratocisto / Carnoy's solution in treatment of keratocyst

Introdução: O objetivo do trabalho é relatar um caso de ceratocisto associado à impactação dentária, o qual foi tratado com descompressão, seguido de enucleação da lesão e utilização de solução de Carnoy. Relato de caso: Paciente do sexo masculino, 14 anos, encaminhado para avaliação de lesão encontrada após exame imaginológico de rotina. O mesmo demonstrou extensa lesão radiolúcida localizada na região de ângulo e ramo da mandíbula, com presença do elemento 48 intralesional próximo a basilar. Foi realizado biópsia incisional e instalação de dispositivo de descompressão no mesmo tempo cirúrgico, o qual o resultado histopatológico foi de ceratocisto. Após 6 meses com o dispositivo, observou-se diminuição da lesão e melhora no posicionamento do dente incluso. Frente a boa resposta à descompressão, decidiu-se pela enucleação total da lesão, exodontia dos dentes 47 e 48, curetagem rigorosa e tereapia adjuvante com aplicação da solução de Carnoy. O paciente evoluiu bem, neoformação óssea na área operada e encontra-se em acompanhamento há 6 meses, sem sinais de recidiva. Considerações finais: O uso da descompressão cirúrgica em lesões císticas mandibulares minimiza os danos as estruturas circunvizinhas, riscos de fratura patológica e lesão nervosa. Em função das altas taxas de recidiva, a terapia adjuvante após a enucleção é imprescindível para essa lesão, sendo a aplicação da solução de Carnoy uma das técnicas com melhores resultados. Dessa forma, para aumentar a taxa de sucesso e minimizar as sequelas, o planejamento cirúrgico dos ceratocistos mandibulares extensos deve ser feito de forma criteriosa e cuidadosa... (AU)

Introduction: The objective of this study is to report a case of keratocyst associated with dental impaction, which was treated with decompression, followed by enucleation lesion and Carnoy solution. Case report: Male patient, 14 years old, referred for evaluation of lesion found after routine imaging. He showed extensive radiolucent lesion located in the region of the angle and branch of the mandible, with the presence of the intralesional element 48 near the basilar. An incisional biopsy was performed and a decompression device was installed during surgical time and the histopathological result was keratocyst. After 6 months of observation a reduction of the lesion and improvement in the positioning of the tooth even were noticed. Given the good response to decompression, it was decided to complete the enucleation of the lesion, extraction of teeth 47 and 48, rigorous curettage and adjuvant therapy with Carnoy's solution. Followed up for 6 months, patient evolved well creating a new bone formation in the operated area with no signs of relapse. Final considerations: The use of surgical decompression in cystic mandibular lesions minimizes damage to surrounding structures, pathological fracture risks, and nerve damage. Because of the high rates of recurrence, keratocysts require adjuvant therapy after enucleation and Carnoy's solution is one of the best performing techniques. Thus, to increase success rate and minimize sequelae, the surgical planning of extensive mandibular keratocysts should be done carefully and judiciously... (AU)

Remoção de dente deslocado para espaço submandibular: relato de caso / Removal of displaced tooth into submandibular space: a case report

Introdução: A exodontia é um dos procedimentos mais realizados nos consultórios odontológicos, e as complicações podem surgir, principalmente, quando não existem exames de imagem no pré-operatório ou quando se usa força inadequada durante o procedimento. Dentes molares inferiores podem se deslocar para o espaço submandibular durante as exodontias, e , apesar de ser considerada uma complicação rara, o paciente pode evoluir com dor, trismo e, em casos mais graves, para infecção com envolvimento cervical. Relato de caso: O presente artigo tem como objetivo relatar o caso de um paciente com infecção crônica em região cervical após tentativa, sem sucesso, de remoção de um molar inferior cujo fragmento dentário havia sido deslocado para o espaço submandibular durante o procedimento cirúrgico. O tratamento de escolha foi a fistulectomia e a remoção cirúrgica do dente sob anestesia geral pelo acesso extraoral submandibular de Risdon, seguido de divulsionamento delicado até localização e remoção do corpo estranho deslocado. O paciente foi acompanhado clinicamente, por 3 meses, evoluindo bem, sem queixas e sem observação de recidiva do processo infeccioso. Considerações Finais: Deslocamento dentário para o espaço submandibular é um acidente, que pode ocorrer com qualquer profissional, razão por que é de extrema importância o conhecimento da prevenção e do tratamento dessa complicação... (AU)

Introduction: Exodontia is one of the most commonly performed procedures in dentistry, and complications can arise, especially when there is no preoperative imaging exams or when inadequate force is used during the procedure. Lower molar teeth may move into the submandibular space during the exodontia, and although it is considered a rare complication, the pacient may feel pain, trismus, and in more severe cases may evolve to infection with cervical involvement. Case report: This present article aims to report a case of a patient with chronic infection in the cervical region after an unsuccessful attempt of removing a lower molar, in which the dental fragment was moved to the submandibular space during the surgical procedure. The treatment of choice was a fistulectomy and the surgical removal of the tooth under general anesthesia by Risdon submandibular extraoral approuch, followed by delicate divulsion to the location and removal of the foreign body displaced. The case was followed clinically for 3 months, evolving well, without complaints and recurrence of the infectious process. Final considerations: Dental displacement to the submandibular space is an accident that can occur under any professional care, so it is extremely important to know the prevention and treatment of this complication... (AU)