Clinical Assessment of Biphasic Calcium Phosphate in Granules and Paste Forms in Human Maxillary Sinus Bone Augmentation: A Randomized, Split-Mouth Clinical Trial.

The aim of the present study is to compare the biphasic calcium phosphate (BCP) using two different forms-(1) granules and (2) paste-in human maxillary sinus bone reconstruction as a split-mouth study using histomorphometric and immunolabeling for osteocalcin. Ten patients with bilateral maxillary posterior partial edentulism were selected in order to reconstruct bone height. They were divided into two groups: BCPG and BCP-P. After six months of bone healing, biopsies were harvested to assess the new bone formation and immunostaining for osteocalcin. The BCP g group had the following results: mean of bone formation in pristine bone 49.4 ± 21.6%, intermediate 49.4 ± 16.2%, and apical 55.3 ± 21.4%. The group BCP-P had a mean of 41.9 ± 17.3% in the pristine bone region, 37.5 ± 7.8% for intermediate, and 39.0 ± 13.5% for apical. The osteocalcin immunolabeling was high for both groups, demonstrating bone calcification. Thus, the two biomaterials present suitable results for the placement of dental implants.

Which Histometric Analysis Approach Is More Reliable for Assessing Histological Bone Tissue Samples?

This study aims to evaluate the grid of Merz and ImageJ methods for histometric quantification, verifying which is more reliable and defining which is most suitable based on the time required to perform. Thirty histological samples of maxillary sinuses grafted with xenografts were evaluated using an optical light microscope attached to an image capture camera and connected to a microcomputer. The images were digitalized and recorded as a TIFF image, and the new bone formation was evaluated using the grid of Merz and ImageJ. The Bland-Altman analysis was used to identify the agreement between the methods and determine suitable future research options. The timing of the quantification was also performed to identify a possible advantage. The mean value for the quantification analysis timing for the grid of Merz was 194.9 ± 72.0 s and for ImageJ was 871.7 ± 264.4, with statistical significance between the groups (p = 0.0001). The Bland-Altman analysis demonstrated a concordance between the methods, due to the bias being next to the maximum concordance (-1.25) in addition to the graphic showing the scattering points next to the mean of differences and inside of limits of agreement. Thus, it was demonstrated that the grid of Merz presents reliable outcomes and advantages over the ImageJ methodology regarding the time spent to contour the areas of interest.

The new bone formation in human maxillary sinuses using two bone substitutes with different resorption types associated or not with autogenous bone graft: a comparative histomorphometric, immunohistochemical and randomized clinical study

Abstract Objective The aim of this study is to evaluate the new bone and connective tissue formation and the biomaterial remaining after maxillary sinus bone augmentation using 5 different bone substitutes. The osteocalcin immunolabeling was performed to demonstrate their calcification and the possibility of receiving dental implants. Methodology 40 patients underwent maxillary sinus bone augmentation and were divided in 5 groups: Group 1 with 8 maxillary sinuses were grafted with autogenous bone graft (AB); Group 2 with 8 maxillary sinuses grafted with bioactive glass (BG); Group 3 with 8 maxillary sinuses grafted with bioactive glass added to autogenous bone graft (BG + AB) 1:1; Group 4 with 8 maxillary sinuses grafted with Bio-Oss (BO) and Group 5 with 8 maxillary sinuses grafted with Bio-Oss added to autogenous bone graft (BO + AB) 1:1. Results In group AB, 37.8% of bone was formed in the pristine bone region, 38.1% in the intermediate and 44.5% in the apical region. In group BG, 43.6% was formed in the pristine bone, 37% in the intermediate and 49.3% in the apical region. In group BG + AB 1:1, 39.0% was formed in the pristine bone region, 34.8% in the intermediate and 36.8% in apical region. In group BO, 33.4% was formed in the pristine bone, 32.5% in the intermediate and 34.3% in the apical region. In group BO + AB 1:1, 32.8% was formed in the pristine bone, 36.1% in intermediate and 27.8% in the apical regions. The immunolabeling for osteocalcin showed an intensive staining for all groups, which could demonstrate the calcification of the bone formed. Conclusion This study showed that the groups evaluated formed a suitable lamellar bone in the maxillary sinus reconstruction after six months of bone healing, thus being indicated to receive dental implants.

The new bone formation in human maxillary sinuses using two bone substitutes with different resorption types associated or not with autogenous bone graft: a comparative histomorphometric, immunohistochemical and randomized clinical study.

OBJECTIVE: The aim of this study is to evaluate the new bone and connective tissue formation and the biomaterial remaining after maxillary sinus bone augmentation using 5 different bone substitutes. The osteocalcin immunolabeling was performed to demonstrate their calcification and the possibility of receiving dental implants. METHODOLOGY: 40 patients underwent maxillary sinus bone augmentation and were divided in 5 groups: Group 1 with 8 maxillary sinuses were grafted with autogenous bone graft (AB); Group 2 with 8 maxillary sinuses grafted with bioactive glass (BG); Group 3 with 8 maxillary sinuses grafted with bioactive glass added to autogenous bone graft (BG + AB) 1:1; Group 4 with 8 maxillary sinuses grafted with Bio-Oss (BO) and Group 5 with 8 maxillary sinuses grafted with Bio-Oss added to autogenous bone graft (BO + AB) 1:1. RESULTS: In group AB, 37.8% of bone was formed in the pristine bone region, 38.1% in the intermediate and 44.5% in the apical region. In group BG, 43.6% was formed in the pristine bone, 37% in the intermediate and 49.3% in the apical region. In group BG + AB 1:1, 39.0% was formed in the pristine bone region, 34.8% in the intermediate and 36.8% in apical region. In group BO, 33.4% was formed in the pristine bone, 32.5% in the intermediate and 34.3% in the apical region. In group BO + AB 1:1, 32.8% was formed in the pristine bone, 36.1% in intermediate and 27.8% in the apical regions. The immunolabeling for osteocalcin showed an intensive staining for all groups, which could demonstrate the calcification of the bone formed. CONCLUSION: This study showed that the groups evaluated formed a suitable lamellar bone in the maxillary sinus reconstruction after six months of bone healing, thus being indicated to receive dental implants.

Lip Synechia Resulting From Toxic Epidermal Necrolysis: A Rare Condition.

Toxic epidermal necrolyses represent a severe epidermolytic reaction characterized by cutaneous erythema and target lesions affecting >30% of the body surface, skin, and mucous membranes. Ulcerative lesions on the labial mucosa may evolve during healing, resulting in rare complications, such as lip adhesions. This report shows the successful treatment of a lip synechia resulting from the healing of mucosal lesions in a patient with toxic epidermal necrolysis caused by the use of Lamotrigine and Ibuprofen. Although the treatment of the presented lip synechia was simple, this sequela can be avoided by measures such as hydration, hygiene and lip lubrication.

Influence of surgical ultrasound used in the detachment of flaps, osteotomy and odontosection in lower third molar surgeries. A prospective, randomized, and "split-mouth" clinical study

BACKGROUND: As third molar surgery is the most commonly procedure performed in Dentistry and has been accompanied by serious postoperative disorders such as pain, edema and trismus, the study aimed to evaluate if ultrasound device would be able to reduce such postoperative features. The aim of this study was to assess the effects of soft tissue flap elevation, osteotomy and odontosection using piezosurgery versus conventional technique in mandibular third molar extractions. MATERIAL AND METHODS: Twenty patients with impacted mandibular third molars underwent tooth extractions using two different methods. Ten patients were included in the Piezo Flap Group (PFG - the flap was elevated using piezosurgery) and ten patients were part of the Piezo Ostectomy Group (POG - osteotomy and odontosection were carried out with ultrasound tips). The contralateral tooth was included in the Control Group (CG - conventional technique). The patients were evaluated at postoperative periods of 1, 3, 7 and 14-days. The measured parameters were duration of surgery, pain, trismus and swelling. RESULTS: The mean duration of surgery for the PFG was 17.21 minutes (CG 10.07 minutes) and POG was 40.09 minutes (CG 15.97 minutes). There was no statistically significant difference in pain and trismus for any of the postoperative periods evaluated in PFG and POG (p > 0.05). There was a statistically significant difference in swelling between the PFG and POG, presenting less swelling at the 3-day postoperative period (p = 0.038; p < 0,05). However, for the remaining analyzed periods there was no difference (p > 0.05). CONCLUSIONS: Piezosurgery for tissue elevation of the surgical flap, osteotomy and dental sectioning in mandibular third molar extraction surgery promoted less edema in the early postoperative stages in mandibular third molar extractions despite the longer surgical duration

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Estudo clínico prospectivo, randomizado do tipo "Split mouth" do aumento ósseo em enxertos sinusais realizados com o fosfato de cálcio bifásicozado do tipo "Split mouth" do aumento ósseo em enxertos sinusais realizados com o fosfato de cálcio bifásico / Prospective, randomized "split mouth" clinical study of bone augmentation in sinus grafts performed with biphasic calcium phosphate

Objetivos: Avaliar e comparar o comportamento do Fosfato de Cálcio Bifásico (FCB) na forma granulada e em pasta enxertados em seios maxilares de humanos, através da análise histomorfometrica e imunoistoquímica. Metodologia: Este estudo é do tipo Split mouth com radomização controlada, em que 10 pacientes participaram do estudo, 10 seios maxilares foram enxertados com FCB na forma de pasta e 10 com FCB na forma de grânulos. Aos 6 meses após a enxertia, foi colhida a biópsia para as análises histomorfometrica e imunoistoquímica. O teste de normalidade mostrou resultados paramétricos para todas as análises, portanto foi aplicado o teste t. Resultados: A média de quantidade de tecido ósseo foi de 1923705,9 ± 364393 µm2 para o grupo Grânulos e 1532468,7 ± 334892 µm2 para o grupo Pasta (p=0,0223), a média da quantidade de biomaterial foi de 1468571 ± 230879 µm2 para o grupo Grânulos e 1658428 ± 122324 µm2 (38,60%) para o grupo Pasta (p=0,0338) e a média da quantidade de tecido mole foi de 897786 ± 270137,9 µm2 para o grupo Grânulos e 1099166,5 ± 221947,3 µm2 para o grupo Pasta (p=0,0852), as marcações para a osteocalcina foi intenso para ambos os grupos. Conclusão: O FCB em forma de pasta, assim como o FCB em grânulos, pode ser utilizado adequadamente como substituto ósseo para enxerto em seio maxilar de humanos(AU)

Objectives: To evaluate and compare the behavior of Biphasic Calcium Phosphate (BCP) in granulated and paste form grafted on maxillary sinuses of humans, through histometric and immunohistochemical analysis. Metodology: This study is of the Split mouth type with controlled radomization, in which 10 patients participated in the study, 10 maxillary sinuses were grafted with BCP in the form of paste and 10 with BCP in the form of granules. At 6 months after grafting, a biopsy was taken for histometric and immunohistochemical analysis. The normality test showed parametric results for all analyzes, so the t test was applied. Results: The mean amount of bone tissue was 1923705.9 ± 364393 µm2 for the Granules group and 1532468.7 ± 334892 µm2 for the Pasta group (P = 0.0223), the average biomaterial amount was 1468571 ± 230879 µm2 for the Granules group and 1658428 ± 122324 µm2 (38.60%) for the Pasta group (P = 0.0338) and the average amount of soft tissue was 897786 ± 270137.9 µm2 for the Granules group and 1099166.5 ± 221947.3 µm2 for the Pasta group (P = 0.0852), the markings for osteocalcin were intense for both groups. Conclusion: BCP in paste form, like BCP in granules, can be used properly as a bone substitute for grafting in the maxillary sinus of humans(AU)

Failure rate of pterygomandibular block in lower third molar extraction procedures / Taxa de falha do bloqueio pterigomandibular nos procedimentos de extração do terceiro molar inferior / Tasa de falla del bloqueo pterigomandibular en los procedimientos de extracción del tercer molar inferior

The aim of this study was to evaluate the anaesthetic failure rate of the pterygomandibular technique with an inferior alveolar nerve block in lower third molar extraction procedures. Materials and Methods: A total of 67 healthy patients (men and women, aged between 18­35 years) requiring third molar extractions were selected from the Discipline of Surgery, of the Araçatuba Dental School. The anaesthetic technique utilised was a pterygomandibular block using 2% mepivacaine hydrochloride with epinephrine 1:100,000 (Mepivalem®) in a maximum standardised amount of three tubes (5.4 ml) per procedure (performed by the same operator). Surgical procedures were initiated after confirming the sensation of anaesthesia in the area anesthetised at the inferior alveolar nerve. Painful symptoms were recorded during surgery. Results: In total, 117 surgical procedures, i.e., 114 exodontias and three coronectomies, were performed. During surgical procedures, four patients reported pain during manoeuvres of odontosection, representing an anaesthetic failure rate of 3.41%. Alternative techniques utilised in these four patients involved milohioideo nerve, intraligamentaria, and intrapulpal anaesthesia. Conclusion: The success of inferior alveolar nerve block anaesthesia is difficult to predict due to large anatomical variations, and it is difficult to observe via diagnostic means. The relatively low percentage of anaesthetic failure reported in this study may be related to the number of procedures performed(AU)

O objetivo deste estudo foi avaliar a taxa de falha anestésica da técnica pterigomandibular com bloqueio do nervo alveolar inferior em procedimentos de extração do terceiro molar inferior. Material e Método: um total de 67 pacientes saudáveis (homens e mulheres, com idade entre 18-35 anos) que requeriam extrações do terceiro molar foram selecionados da Disciplina de Cirutgia da Faculdade de Odontologia de Araçatuba. A técnica anestésica utilizada foi um bloqueio pterigomandibular usando cloridrato de mepivacaína a 2% com epinefrina 1: 100,000 (Mepivalem®) em uma quantidade máxima padronizada de três tubos (5,4 ml) por procedimento (realizado pelo mesmo operador). Os procedimentos cirúrgicos foram iniciados após confirmação da sensação de anestesia na área anestesiada no nervo alveolar inferior. Sintomas dolorosos foram registrados durante a cirurgia. Resultados: No total, foram realizados 117 procedimentos cirúrgicos, isto é, 114 exodontias e três coronectomias. Durante os procedimentos cirúrgicos, quatro pacientes relataram dor durante as manobras de odontossecção, representando uma taxa de falha anestésica de 3,41%. As técnicas alternativas utilizadas nesses quatro pacientes envolveram nervo milohioideo, intraligamentar e anestesia intrapulpar. Conclusão: o sucesso da anestesia com bloqueio do nervo alveolar inferior é difícil de prever devido a grandes variações anatômicas e é difícil de observar por meio de meios diagnósticos. A porcentagem relativamente baixa de falha anestésica relatada neste estudo pode estar relacionada ao número de procedimentos realizados(AU)

El objetivo de este estudio fue evaluar la tasa de falla anestésica de la técnica pterigomandibular con bloqueo del nervio alveolar inferior en procedimientos de extracción del tercer molar inferior. Material y método: un total de 67 pacientes sanos (hombres y mujeres, con edad entre 18-35 años) que requerían extracciones del tercer molar fueron seleccionados de la Disciplina de Cirutía de la Facultad de Odontología de Araçatuba. La técnica anestésica utilizada fue un bloqueo pterigomandibular usando clorhidrato de mepivacaína al 2% con epinefrina 1: 100,000 (Mepivalem®) en una cantidad máxima estandarizada de tres tubos (5,4 ml) por procedimiento (realizado por el mismo operador). Los procedimientos quirúrgicos se iniciaron después de confirmar la sensación de anestesia en el área anestesiada en el nervio alveolar inferior. Los síntomas dolorosos se registraron durante la cirugía. Resultados: En total, se realizaron 117 procedimientos quirúrgicos, es decir, 114 exodontias y tres coronectomías. Durante los procedimientos quirúrgicos, cuatro pacientes relataron dolor durante las maniobras de odontosección, representando una tasa de falla anestésica del 3,41%. Las técnicas alternativas utilizadas en estos cuatro pacientes involucraron nervio milohioideo, intraligamentar y anestesia intrapulpar. Conclusión: el éxito de la anestesia con bloqueo del nervio alveolar inferior es difícil de predecir debido a grandes variaciones anatómicas y es difícil de observar por medio de medios diagnósticos. El porcentaje relativamente bajo de falla anestésica reportada en este estudio puede estar relacionado al número de procedimientos realizados(AU)

Cervicofacial Necrotizing Fasciitis and Drugs.

Necrotizing fasciitis (NF) is a devastating disease that typically affects immunocompromised patients, chronically debilitated patients or drug users, but can also affect healthy patients. Necrotizing fasciitis can rapidly produce septic shock and requires immediate surgical management of the necrotic tissue. It is a bacterial infection that progresses rapidly and has a high mortality generally caused by aerobic and anaerobic bacteria. The patient was immunocompromised and drug user. During treatment, a combination of broad-spectrum antibiotic therapy with Ciprofloxacin and Metronidazole, besides the use of activated charcoal dressing composed of carbonized fabric and impregnated with 0.15% silver nitrate enveloped by layer of fabric without activated carbon, chemical-mechanical debridement with hydrogen peroxide, 0.9% saline, and povidone iodine. According to the patient presented, for the treatment of NF there is a need for broad-spectrum antibiotic therapy associated with surgical debridement, use of activated charcoal for antiseptic compression and general intensive care.

Bioactive glass added to autogenous bone graft in maxillary sinus augmentation: a prospective histomorphometric, immunohistochemical, and bone graft resorption assessment.

OBJECTIVE: The aim of this study was to compare the bone resorption rate, histomorphometry and immunohistochemical findings of bioactive glass (Biogran; Biomet, Warsaw, IN, USA) mixed with autogenous bone grafts (1:1) and autogenous bone graft isolate in maxillary sinus elevation surgery. MATERIAL AND METHODS: A total of 9 maxillary sinuses were grafted with Biogran with autogenous bone graft (group 1) and 12 were mixed with autogenous bone graft (group 2). Postoperative cone beam computed tomography (CBCT) was used to measure the initial graft volume after 15 days (T1), and 6 months later, another CBCT scan was performed to evaluate the final graft volume (T2) and determine the graft resorption rate. The resorption outcomes were 37.9%±18.9% in group 1 and 45.7%±18.5% in group 2 (P=0.82). After 6 months, biopsies were obtained concurrent with the placement of dental implants; these implants were subjected to histomorphometric analysis and immunohistochemical analysis for tartrate-resistant acid phosphatase (TRAP). RESULTS: The average bone formation in group 1 was 36.6%±12.9 in the pristine bone region, 33.2%±13.3 in the intermediate region, and 45.8%±13.8 in the apical region; in group 2, the values were 34.4%±14.4, 35.0%±13.9, and 42.0%±16.6 of new bone formation in the pristine bone, intermediate, and apical regions, respectively. Immunostaining for TRAP showed poor clastic activity in both groups, which can indicate that those were in the remodeling phase. CONCLUSIONS: The similarity between the groups in the formation and maintenance of the graft volume after 6 months suggests that the bioactive glass mixed with autogenous bone (1:1) can be used safely as a bone substitute for the maxillary sinus lift.

Lower third molar displaced to lateral pharyngeal space after mandibular angle fracture: a case report.

The removal of displaced dental elements from deep anatomical spaces is a condition that requires the knowledge of the region and skills to perform the procedure. The lateral pharyngeal space contains important structures such as the internal carotid artery and close proximity with the cranium basis. The aim of this paper is to report a clinical case of a lower third molar displaced to the lateral pharyngeal space after a mandibular angle fracture and its treatment by surgical intervention. The tooth was removed under general anesthesia by direct approach and the fracture was reduced and fixed with a plate and screws. This case report illustrates the importance of an immediate procedure to avoiding severe complications and further damage to important anatomical structures.

Bone regeneration with recombinant human bone morphogenetic protein 2: a systematic review.

AIM: The aim of this work was to perform a systematic literature review on the clinical application of rhBMP-2 in bone reconstruction prior to placing implants. MATERIALS AND METHODS: A PUBMED search was made about the subject and nine clinical trials were selected according to strict inclusion criteria. RESULTS: Overall success rates of bone regeneration with rhBMP-2 was 81.4% and success of implants placed was 87.4%. Most frequent adverse events were pain, edema and erythema. CONCLUSION: It was concluded that the treatment with rhBMP-2 foi satisfactory in most cases and the placement of dental implants in the bone regenerated with rhBMP-2 is feasible.

Prospective and Randomized Evaluation of ChronOS and Bio-Oss in Human Maxillary Sinuses: Histomorphometric and Immunohistochemical Assignment for Runx 2, Vascular Endothelial Growth Factor, and Osteocalcin.

PURPOSE: The aim of this study was to compare ChronOS (ß-tricalcium phosphate), Bio-Oss, and their addition to an autogenous bone graft in a 1:1 ratio in human maxillary sinus bone augmentation. MATERIALS AND METHODS: Thirty maxillary sinuses were divided in 5 groups: group 1 included 6 maxillary sinuses grafted with autogenous bone graft alone; group 2 included 6 maxillary sinuses grafted with ChronOS; group 3 included 6 maxillary sinuses grafted with ChronOS and autogenous bone graft in a 1:1 ratio; group 4 included 6 maxillary sinuses grafted with Bio-Oss; and group 5 included 6 maxillary sinuses grafted with Bio-Oss and autogenous bone graft in a 1:1 ratio. The number of samples for each group was determined by the statistical power test. RESULTS: The median areas of new bone formation in groups 1, 2, 3, 4, and 5 were 121,917.0, 83,787.0, 99,295.0, 65,717.0, and 56,230.0 µm2, respectively. Statistically significant differences were found between groups 3 and 5, groups 1 and 4, and groups 1 and 5 (P < .05). The median areas of remaining biomaterial were 2,900.5, 5,291.0, 2,662.0, 56,258.5, and 64,753.5 µm2 in groups 1, 2, 3, 4 and 5, respectively. Statistically significant differences occurred between groups 1 and 5, groups 3 and 5, and groups 2 and 5 (P < .05). Areas of connective tissue were 67,829.0 ± 22,984.6 µm2 in group 1, 97,445.9 ± 18,983.3 µm2 in group 2, 88,256.0 ± 21,820.5 µm2 in group 3, 65,501.8 ± 6,297.6 in group 4, and 70,203.2 ± 13,421.3 µm2 in group 5. CONCLUSIONS: ChronOS combined with autogenous bone graft presented a behavior similar to that of autogenous bone graft alone. However, the groups treated with Bio-Oss showed immuno-labeling results indicating maturation of grafted bone.

Bioactive glass added to autogenous bone graft in maxillary sinus augmentation: a prospective histomorphometric, immunohistochemical, and bone graft resorption assessment

Abstract Objective The aim of this study was to compare the bone resorption rate, histomorphometry and immunohistochemical findings of bioactive glass (Biogran; Biomet, Warsaw, IN, USA) mixed with autogenous bone grafts (1:1) and autogenous bone graft isolate in maxillary sinus elevation surgery. Material and Methods A total of 9 maxillary sinuses were grafted with Biogran with autogenous bone graft (group 1) and 12 were mixed with autogenous bone graft (group 2). Postoperative cone beam computed tomography (CBCT) was used to measure the initial graft volume after 15 days (T1), and 6 months later, another CBCT scan was performed to evaluate the final graft volume (T2) and determine the graft resorption rate. The resorption outcomes were 37.9%±18.9% in group 1 and 45.7%±18.5% in group 2 (P=0.82). After 6 months, biopsies were obtained concurrent with the placement of dental implants; these implants were subjected to histomorphometric analysis and immunohistochemical analysis for tartrate-resistant acid phosphatase (TRAP). Results The average bone formation in group 1 was 36.6%±12.9 in the pristine bone region, 33.2%±13.3 in the intermediate region, and 45.8%±13.8 in the apical region; in group 2, the values were 34.4%±14.4, 35.0%±13.9, and 42.0%±16.6 of new bone formation in the pristine bone, intermediate, and apical regions, respectively. Immunostaining for TRAP showed poor clastic activity in both groups, which can indicate that those were in the remodeling phase. Conclusions The similarity between the groups in the formation and maintenance of the graft volume after 6 months suggests that the bioactive glass mixed with autogenous bone (1:1) can be used safely as a bone substitute for the maxillary sinus lift.

Diagnosis and Management of Cerebrospinal Fluid Leak in a Panfacial Fracture.

Cerebrospinal fluid fistula caused by head trauma is a potentially dangerous problem and precise localization and radical treatment are necessary. We present a case of a patient with Panfacial fracture caused by a motorcycle accident, resulting in a cerebrospinal fluid leakage. The correct diagnosis was realized by computed tomography and auxiliary tests. The successful treatment can be confirmed with the support of radionuclide cisternography examination.

Dental Infection and Pregnancy: the Lack of Treatment by the Dental Professional Evolving to a Complex Maxillofacial Infection.

Infections of the maxillofacial complex caused by caries disease are common in dental practice. The professionals have to have technical knowledge to treat it at the onset of the condition and avoid the spread to deep anatomical spaces of face and neck, which can implicate in a risk of patients' life.In Brazil, current dental professionals usually denied oral surgical treatments in patients with some clinical conditions, not because of fear to resolve it but for lack of knowledge to treat it. An example of these conditionals is pregnancy. It is well known that during the pregnancy period, the patient can be treated in the correct period of gestation. Early diagnosis is crucial for effective therapy in serious infections. The treatment has to be crucial during pregnancy because of the potentially fatal situation that the disease can create to the pregnant woman and the fetus.The aim of this article is to demonstrate a case of dental caries in a pregnant patient, which was evaluated by other professionals and had the treatment denied, evolving to a serious maxillofacial infection.

Lipoma on the Lower Lip.

Lipoma is a benign tumor of fat tissue, found frequently in subcutaneous tissues. However, oral manifestations are relatively rare. The present patient illustrates the successful treatment of a lipoma treated by complete excision of the lesion. A female patient, 75 years old, presenting lesion in the right oral vestibule where excisional biopsy was performed. The professional must diagnose this type of injury as soon as possible and treat it so that it does not take large proportions, which can result in esthetic and functional sequelae to the patient.

Assessment of bone repair in critical-size defect in the calvarium of rats after the implantation of tricalcium phosphate beta (ß-TCP).

OBJECTIVES: Evaluating the osteoconductive property of tricalcium phosphate beta (ß-TCP) in comparison to that of inorganic bovine bone for repair in a critical-size defect in the rat calvarium. MATERIALS AND METHODS: Critical-size defects of 7mm were made with a trephine in the calvaria of 48 Wistar rats. The animals were divided into four groups, and the defects in each group were filled with tricalcium phosphate beta (ß-TCP), inorganic bovine bone (Bio-Oss), autogenous bone, or left empty. The animals were euthanized at two different time points (30 and 60days post-operation). All defects were recovered with a absorbable membrane of bovine cortical bone. Histological, histometric, and immunohistochemical (osteocalcin) assessments were carried out at 30 and 60days post-operation. RESULTS: At 30days post-operation, all groups showed areas of bone formation, predominantly when autogenous grafts were used. However, there were no statistically significant differences between the treatment groups (p>0.05). After 60days, there were similarities in the bone formation patterns between the ß-TCP (26.32±) and Bio-Oss (17.35±) groups (p=0.549). In terms of the immunohistochemical assessment of osteocalcin, the clot group showed light to moderate staining at 30 and 60days. The autogenous group showed moderate staining at 30days and moderate to intense staining after 60days. The Bio-Oss group showed light to moderate staining after 30days and intense staining at 60days. The ß-TCP group showed moderate staining at 30 and 60days post-operation. CONCLUSION: ß-TCP is a good osteoconductive material with similar effects to those of inorganic bovine bone graft and is suitable for utilization in the repair of bone defects.