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1.
J Craniofac Surg ; 31(2): 549-552, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31934980

RESUMO

The aim of this study was to analyze the newly formed bone volume (FV), 6 months after secondary alveoloplasty using iliac cancellous bone graft, with and without platelet-rich plasma (PRP). Forty patients with unilateral alveolar cleft were involved in this randomized, prospective, comparative study, with 20 patients each forming the control (group A) and PRP (group B) groups, respectively. The preoperative alveolar defect volume (DV) and the postoperative FV were automatically calculated by the computer-aided engineering software using the patients' pre and postsurgical computed tomography data. The volume of the actual bone graft (AV) was identical to the DV calculated before surgery. The bone formation ratio (BF%) was calculated as follows: BF% = (FV/AV) × 100%. The mean BF% was 42.54 ±â€Š9.32% in group A and 46.97 ±â€Š18.49% in group B. There was no statistically significant difference between the 2 groups for BF% (P > 0.05). The study presents a fast and accurate method for assessing the effect of PRP in alveolar grafting. However, the study found no conclusive evidence on the effect of PRP on bone growth.


Assuntos
Enxerto de Osso Alveolar , Osteogênese , Plasma Rico em Plaquetas , Adolescente , Enxerto de Osso Alveolar/métodos , Alveoloplastia/métodos , Transplante Ósseo , Criança , Fissura Palatina/cirurgia , Feminino , Humanos , Imageamento Tridimensional , Masculino , Estudos Prospectivos , Tomografia Computadorizada por Raios X
3.
Plast Reconstr Surg ; 143(5): 1385-1395, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30789479

RESUMO

BACKGROUND: Bone morphogenetic proteins (BMPs) have played a central role in the regenerative therapies for bone reconstruction, including alveolar cleft and craniofacial surgery. However, the high cost and significant adverse effect of BMPs limit their broad application. Hydroxycholesterols, naturally occurring products of cholesterol oxidation, are a promising alternative to BMPs. The authors studied the osteogenic capability of hydroxycholesterols on human mesenchymal stem cells and the impact of hydroxycholesterols on a rodent alveolar cleft model. METHODS: Human mesenchymal stem cells were treated with control medium or osteogenic medium with or without hydroxycholesterols. Evaluation of cellular osteogenic activity was performed. A critical-size alveolar cleft was created and one of the following treatment options was assigned randomly to each defect: collagen sponge incorporated with hydroxycholesterols, BMP-2, or no treatment. Bone regeneration was assessed by means of radiologic and histologic analyses and local inflammation in the cleft evaluated. Moreover, the role of the hedgehog signaling pathway in hydroxycholesterol-mediated osteogenesis was examined. RESULTS: All cellular osteogenic activities were significantly increased on human mesenchymal stem cells treated with hydroxycholesterols relative to others. The alveolar cleft treated with collagen sponge with hydroxycholesterols and BMP-2 demonstrated robust bone regeneration. The hydroxycholesterol group revealed histologically complete bridging of the alveolar defect with architecturally mature new bone. The inflammatory responses were less in the hydroxycholesterol group compared with the BMP-2 group. Induction of hydroxycholesterol-mediated in vitro osteogenesis and in vivo bone regeneration were attenuated by hedgehog signaling inhibitor, implicating involvement of the hedgehog signaling pathway. CONCLUSION: Hydroxycholesterols may represent a viable alternative to BMP-2 in bone tissue engineering for alveolar cleft.


Assuntos
Alveoloplastia/métodos , Proteína Morfogenética Óssea 2/farmacologia , Regeneração Óssea/efeitos dos fármacos , Hidroxicolesteróis/farmacologia , Osteogênese/efeitos dos fármacos , Fator de Crescimento Transformador beta/farmacologia , Processo Alveolar/efeitos dos fármacos , Processo Alveolar/fisiologia , Animais , Proteína Morfogenética Óssea 2/economia , Técnicas de Cultura de Células , Linhagem Celular , Meios de Cultura/química , Meios de Cultura/economia , Meios de Cultura/farmacologia , Humanos , Hidroxicolesteróis/economia , Masculino , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/fisiologia , Modelos Animais , Ratos , Ratos Sprague-Dawley , Proteínas Recombinantes/economia , Proteínas Recombinantes/farmacologia , Tecidos Suporte/química , Tecidos Suporte/economia , Fator de Crescimento Transformador beta/economia
4.
Cleft Palate Craniofac J ; 56(4): 548-551, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30068230

RESUMO

OBJECTIVE: Describe the surgical repositioning of the premaxilla using an innovative minimally invasive endonasal approach and secondary bone graft at the same time. We want to emphasize the importance of virtual surgical planning in this technique. MATERIAL AND METHODS: A total of 6 patients with bilateral complete cleft lip and palate underwent a surgical repositioning of the premaxilla. Virtual surgical planning was performed in all cases. The ages varied between 8 and 12 years and all were male. Five patients were in the mixed dentition phase and 1 patient was in the definitive phase. Three of the patients had been prepared with presurgical nasoalveolar molding. The other 3 were not prepared for various reasons. All patients had primary repair of cleft lip and palate. INTERVENTIONS: An innovative minimally invasive endonasal approach is presented that has allowed a safe 3-D reposition of the premaxilla in patients with bilateral cleft palate. A simultaneous secondary alveoloplasty with the use of absorbable osteosynthesis is a good choice to achieve symmetry and stability. CONCLUSIONS: Virtual surgical planning is an exceptional instrument to make an appropriate presurgical selection of the patients in which combine the 2 procedures.


Assuntos
Fenda Labial , Fissura Palatina , Alveoloplastia , Criança , Humanos , Masculino , Maxila , Nariz
5.
J Craniofac Surg ; 29(6): 1445-1451, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30067525

RESUMO

Cleft lip and palate is a congenital malformation that requires a multidisciplinary treatment that evolves pediatrician, obstetrics, fetal medicine, genetics, plastic surgery, orthodontics, speech therapist, nursery, and psychology. Actually, the authors believe that it could be possible to ad protocols to use stem cells.The intrauterine diagnosis leads to preborn parental orientation and better parental collaboration to accept a precocious multidisciplinary treatment. After birth the authors' protocol is: orthodontic devices, phonoaudiology, and surgical procedures.The authors' cleft lip and palate reconstructive surgery protocol demands several steps and begins at 4 to 6-month old with rhinocheiloplasty and soft palate closure at the same moment. The treatment sequence involves the hard palate surgery (8-18 months after the first surgical step), alveoloplasty (after 10 years old), and secondary rhinoplasty (after 14 years old).New ideas to use stem cells and blood from the umbilical cord and also blood from placenta are discussed to improve final surgical results. Maternal stem cells are easy to collect, there are no damage to the patient and mother, it is autologous and it could be very useful in the authors' protocol.Nine patients with clef lip and palate were operated and had stem cells from umbilical cord blood and placenta blood injected into the bone and soft tissue during the primary procedure (rhinocheiloplasty).The stem cells activity into soft tissue and bone were evaluated. Preliminary results have shown no adverse results and improvement at the inflammatory response. A treatment protocol with stem cells was developed. It had a long time follow-up of 10 years.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Transplante de Células-Tronco de Sangue do Cordão Umbilical/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Rinoplastia/métodos , Adolescente , Alveoloplastia/métodos , Criança , Protocolos Clínicos , Feminino , Seguimentos , Humanos , Lactente , Masculino , Avaliação de Resultados em Cuidados de Saúde , Palato Duro/cirurgia , Palato Mole/cirurgia , Tempo para o Tratamento
6.
Periodontol 2000 ; 77(1): 84-92, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29493814

RESUMO

Crown lengthening is one of the most common surgical procedures in periodontal practice. Its indications include subgingival caries, crown or root fractures, altered passive eruption, cervical root resorption and short clinical abutment, and its aim is to re-establish the biologic width in a more apical position. While the procedure in posterior areas of the dentition has been thoroughly investigated, crown lengthening performed for esthetic reasons in the anterior areas is still a matter of debate and an evidence-based technique is not available. This paper provides accurate descriptions of the surgical and restorative phases of the esthetic crown-lengthening procedure by answering the following questions: what is the ideal surgical flap design? how much supporting bone should be removed? how should the position of the flap margin relate to the alveolar bone at surgical closure? and how should the healing phase be managed in relation to the timing and the position of the provisional restoration with respect to the gingival margin?


Assuntos
Aumento da Coroa Clínica/métodos , Estética Dentária , Alveolectomia/métodos , Alveoloplastia/métodos , Restauração Dentária Temporária , Humanos , Retalhos Cirúrgicos , Cicatrização/fisiologia
7.
Spec Care Dentist ; 37(6): 304-308, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29194721

RESUMO

BACKGROUND: Primary surgical repair of the bilateral cleft lip and palate (BCLP) deformity is challenging. Infant Orthopedic (IO) procedures are often used to assist surgical reconstruction of normal anatomy. Nasoalveolar molding (NAM) is a presurgical infant orthopedic procedure that attempts to reduce the cleft nasal deformity, in addition to the lip and alveolus, leading to an esthetic primary surgical repair. OBJECTIVE: NAM provides the surgical team with a better foundation for an easier and more esthetic single stage repair at the level of nose in addition to the lip and alveolus. METHOD: Infant nasal cartilages are amenable to correction with NAM in the first few weeks of infancy when they retain their plasticity. NAM-assisted surgical repair of a complete BCLP infant is discussed. Postoperatively nasal stents were used to retain results and minimize relapse. RESULTS: NAM helped correct premaxillary deviation and protrusion, reduce alveolar cleft width and improve the nasal morphology prior to surgery in the BCLP infant. CONCLUSIONS: NAM helped reduce the severity of the cleft deformity in the BCLP infant and facilitated an easier and esthetic single stage primary surgical repair.


Assuntos
Processo Alveolar/anormalidades , Fenda Labial/terapia , Fissura Palatina/terapia , Nariz/anormalidades , Procedimentos Ortopédicos/instrumentação , Alveoloplastia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estética , Humanos , Recém-Nascido , Cuidados Pré-Operatórios , Stents
8.
Cleft Palate Craniofac J ; 54(3): 249-255, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27031266

RESUMO

OBJECTIVE: To report the surgical outcomes of secondary alveolar bone grafting with premaxillary osteotomy in a single surgeon cohort of complete bilateral cleft lip and palate patients. DESIGN: Retrospective review of 44 consecutive patients using hospital notes and radiographs. SETTING: Single specialist cleft lip and palate center, UK. PATIENTS: Consecutive patients with complete bilateral cleft lip and palate who were being treated with secondary alveolar bone grafting incorporating premaxillary osteotomy. OUTCOME MEASURES: Assessment of success of bone graft by Kindelan score; canine eruption; closure of fistulae and assessment of morbidity. RESULTS: Between January 6, 2000, and August 8, 2013, 44 patients with complete BCLP underwent secondary ABG with a premaxillary osteotomy as a one-stage procedure. The mean follow-up was 7.3 years (range 1.4 to 14.6). Eighty-five percent of ABGs were successful (a Kindelan score of 1 or 2), and canine eruption was 89%. Failure of the ABG occurred in 7%. Fistulae recurrence rate was 11%, all of which were asymptomatic. No premaxillae were devitalized. CONCLUSION: Incorporating a premaxillary osteotomy into the secondary ABG surgical protocol can be a safe technique that gives excellent surgical exposure for fistula repair.


Assuntos
Enxerto de Osso Alveolar/métodos , Alveoloplastia/métodos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Criança , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Maxila/cirurgia , Osteotomia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido
9.
Cleft Palate Craniofac J ; 54(3): 327-333, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27043653

RESUMO

OBJECTIVE: The defect volume measured on computed tomography (CT) for secondary bone graft (SBG) is well correlated to the actual amount of particulate cancellous bone and marrow (PCBM) transplanted in unilateral cleft lip and palate (UCLP) patients. However, the validity of such measurements have not been completely verified due to lack of evaluation of treatment results. The objective of this study was to propose an estimation method by CT based on the data of successfully treated patients. For this purpose, the association was initially verified between the weight of transplanted PCBM and the defect volume measured on CT using the results of successfully treated patients. METHODS: Treatment results were evaluated 1 year after SBG by intraoral radiography in 50 UCLP patients. For the patients with good results, the correlation was investigated between the defect volume on CT and the transplanted PCBM weight, and a method was proposed based on PCBM density, calculated as PCBM weight divided by defect volume on CT. RESULTS: In successfully treated patients showing level 3 or 4 alveolar resorption, a strong correlation (r = .87) was found between the volume on CT and the PCBM weight. Level 4 results were observed in 22 of 23 (95.7%) patients who had calculated PCBM densities of more than 6 g/cm3. CONCLUSIONS: Volume estimation on preoperative CT was confirmed to have sufficient validity. The weight of PCBM transplanted should be greater than the defect volume on CT multiplied by 6.


Assuntos
Alveoloplastia/métodos , Transplante Ósseo/métodos , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/transplante , Fenda Labial/diagnóstico por imagem , Fenda Labial/cirurgia , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Medula Óssea/diagnóstico por imagem , Criança , Feminino , Humanos , Masculino , Resultado do Tratamento
10.
J Plast Reconstr Aesthet Surg ; 69(11): e217-e224, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27667546

RESUMO

Few studies have examined the long-term outcomes of gingivoperiosteoplasty at the age of permanent canine eruption. The success rates of gingivoperiosteoplasty vary significantly depending on the surgeon because of the difficulty of the surgical technique. Therefore, the authors utilized a simplified gingivoperiosteoplasty technique by inserting one or two large, triangular-shaped mucoperiosteal flaps on the opposite side in a tongue-in-groove or interdigitation fashion. The purpose of this study was to evaluate the long-term outcomes of this simplified gingivoperiosteoplasty technique at the age of permanent canine eruption. Forty nonsyndromic cleft lip and palate patients who had undergone simplified gingivoperiosteoplasty were retrospectively reviewed. Canine eruption and the bone formation rate of the interalveolar septum using the Bergland method and a modified Long et al. method were evaluated. A total of 55 alveolar cleft sites were treated. Simplified gingivoperiosteoplasty was performed at a mean age of 13.4 months, and the mean age at the time of follow-up was 14.3 years. The overall success rate of simplified gingivoperiosteoplasty was 50.90%. With regard to cleft types, clefts of the primary palate and unilateral alveolar clefts showed a significantly higher success rate than clefts of the primary and secondary palates and bilateral alveolar clefts, respectively. Our gingivoperiosteoplasty technique is a simple surgical procedure and is performed at 12 months of age, at which time the cleft alveolus has grown sufficiently, to ensure the success of the delicate surgical technique. Therefore, we could obtain favorable outcomes.


Assuntos
Fissura Palatina/cirurgia , Gengivoplastia , Alveoloplastia/métodos , Fissura Palatina/diagnóstico por imagem , Feminino , Seguimentos , Gengivoplastia/métodos , Humanos , Lactente , Masculino , Periósteo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento
11.
J Plast Reconstr Aesthet Surg ; 69(11): 1544-1550, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27502020

RESUMO

BACKGROUND: Optimal timing for cleft lip rhinoplasty is controversial. Definitive rhinoplasty is deferred until facial skeletal growth is completed. Intermediate rhinoplasty is performed after stabilization of the grafted alveolar bone, because the grafted bone tends to be absorbed over several months postoperatively, distorting the nasal profile. Here, we report our experience with simultaneous rhinoplasty during alveolar bone grafting for indicated patients, describe our surgical technique that ensures long-term bone graft survival, and report graft take rates and nasal profile changes. METHODS: This retrospective chart review included a total of 54 patients; 44 underwent alveolar bone grafting only, and 10 underwent simultaneous cleft lip rhinoplasty. All surgeries were conducted with a judicious mucosal incision for tensionless wound closure. Bone graft take was evaluated with dental radiographs by the Bergland classification. Further, nasal aesthetic outcome was evaluated with medical photographs, based on nostril height and width and alar base width. RESULTS: In total, 96.3% of clefts showed graft success with Type I (66.7%) or Type II (27.8%) classifications; only 3.7% of clefts showed unfavorable results classified as Type III, and no clefts showed Type IV failure. The nasal shape was flatter with a decreased nostril height and increased nostril width after alveolar bone grafting, while nostril height was increased and nostril width was decreased in patients who underwent simultaneous rhinoplasty. CONCLUSION: With surgical techniques ensuring alveolar bone graft survival, simultaneous cleft lip rhinoplasty can result in nasal aesthetic improvement for patients with severe nasal deformities, decreasing the number of operations.


Assuntos
Enxerto de Osso Alveolar , Alveoloplastia , Fenda Labial/cirurgia , Rinoplastia , Adolescente , Alveoloplastia/métodos , Transplante Ósseo , Criança , Feminino , Humanos , Masculino , Fotogrametria , Estudos Retrospectivos , Rinoplastia/métodos , Retalhos Cirúrgicos , Fatores de Tempo , Resultado do Tratamento
13.
Ann Ital Chir ; 87: 5-12, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27026208

RESUMO

PURPOSE: Bone grafting of the alveolus has become an essential part of the contemporary surgical management of the oral cleft. The aim of this retrospective study was to evaluate the results of bone grafting in association with PRP (plateletrich plasma) to enhance osteogenesis and osteointegration. PATIENTS AND METHODS: The study included 16 patients, aged between 9 and 11, affected with unilateral residual alveolar clefts, who underwent bone grafting using secondary alveoplasty. The eight patients belonging to the control group were administered autologous bone graft alone while the study group, consisting of 8 patients, underwent autologous bone grafting in association with PRP. All patients had pre and post surgery orthodontic treatment. The statistical analyses included Student's t test, 2 test and Kaplan-Meir time to event analysis. The p-value was considered significant if p<0.05. All statistical analyses were performed using SAS Software release 9.3 (SAS Institute, Cary, Nc). RESULTS: The control group (M 50%, mean age 10.2±2.3) underwent simple autologous bone graft while the study group (M 62.5%, mean age 9.9±2.2) was treated with a combination of autologous bone and PRP. No statistically significant differences were found between the two groups as regards age, gender and labial-palatal cleft clinical characteristics. 6, 12, 24 month follow-ups were performed by means of clinical and radiographic investigations. None of the study group developed oronasal fistulas or experienced bone height, bone bridging and bone quality loss; only two patients developed mild periodontal problems. The study group was able to undergo a significantly (p<0.001) earlier and shorter orthodontic treatment. CONCLUSIONS: In our experience, the use of PRP enhances the quality of osteoplasty, accelerates "creeping substitution" and bone healing and favours earlier orthodontic treatment. KEY WORDS: Alveolar cleft, Bone grafting, Palate, Platelet-rich plasma.


Assuntos
Enxerto de Osso Alveolar/métodos , Processo Alveolar/anormalidades , Fissura Palatina/cirurgia , Processo Alveolar/cirurgia , Alveoloplastia/métodos , Criança , Terapia Combinada , Feminino , Humanos , Ílio , Masculino , Ortodontia Corretiva , Plasma Rico em Plaquetas , Estudos Retrospectivos , Fatores de Tempo , Transplante Autólogo , Resultado do Tratamento
14.
Plast Reconstr Surg ; 137(2): 365e-374e, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26818327

RESUMO

BACKGROUND: The goal of this study was to evaluate with a three-dimensional method the long-term quality of alveolar ossification in unilateral cleft lip and palate patients who underwent early secondary gingivoalveoloplasty according to the Milan surgical protocol. METHODS: The sample consisted of 63 computed tomographic scans of unilateral cleft lip and palate patients in permanent dentition. The average age at the time of assessment was 15.7 years. Alveolar thickness, nasoalveolar height, nasal floor ossification, and hard palate morphology were evaluated using dental, axial, and coronal cuts on computed tomographic scans and three-dimensional models. All measurements were normalized and ratios of the affected side versus the nonaffected side were provided. Volume measurements and ratios of each hemimaxilla were added. The presence or absence of the permanent lateral incisor on the cleft side was also recorded. RESULTS: Alveolar thickness and height were ideal or good, respectively, in 89.5 and 91.4 percent of the sample. Insufficient ossification (<25 percent) was found in three patients (5.2 percent), and only one of them (1.7 percent) presented no bone bridging. A statistically significant association was detected between the degree of alveolar ossification, the type of nasal floor ossification, and volume ratio. CONCLUSIONS: Early secondary gingivoalveoloplasty seemed to allow an adequate ossification of both the alveolar and nasal region. Three-dimensional evaluation of the alveolar cleft ossification provided further information on alveolar bridging and allowed evaluation of the bone availability for implant placement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Processo Alveolar/diagnóstico por imagem , Processo Alveolar/crescimento & desenvolvimento , Alveoloplastia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Gengivoplastia , Osteogênese , Tomografia Computadorizada por Raios X , Adolescente , Feminino , Humanos , Masculino , Fatores de Tempo
17.
J Oral Maxillofac Surg ; 74(1): 55-67, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26375368

RESUMO

Severe tridimensional alveolar ridge defects complicate the placement of dental implants, and surgical removal of some oral tumors might not leave adequate bone for dental implant placement. Regenerating an adequate amount of bone vertically and horizontally to achieve a satisfying outcome for well-osseointegrated implants and thus ensure long-term success of implant restoration is challenging. This report describes the clinical feasibility of a simple approach using a screw tent-pole combined with guided bone regeneration to augment complicated tridimensional alveolar ridge defects in a case of extensive bone loss due to maxillary tumor surgery. Titanium screws were arranged in "tented" fashion to provide stable room for bone regeneration. Regenerated bone was achieved and 2 more implants were placed in the regenerated ridge 10 months later, leading to a successful maxillary prosthesis.


Assuntos
Aumento do Rebordo Alveolar/métodos , Regeneração Óssea/fisiologia , Parafusos Ósseos , Regeneração Tecidual Guiada/instrumentação , Neoplasias Maxilares/cirurgia , Alveoloplastia/métodos , Materiais Biocompatíveis/química , Arco Dental/cirurgia , Implantes Dentários , Prótese Dentária Fixada por Implante , Prótese Parcial Fixa , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Maxila/cirurgia , Planejamento de Assistência ao Paciente , Titânio/química , Adulto Jovem
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