ABSTRACT
OBJECTIVE: The purpose of this article is to present the MISMARPE technique, a new minimally invasive surgical procedure to treat maxillary transverse atresia in adult patients under local anesthesia and on an outpatient basis. TECHNIQUE DESCRIPTION: The technique consists of miniscrew-assisted rapid palatal expansion (MARPE) associated with a minimally invasive approach using maxillary osteotomies, latency and activation periods until the desired expansion is achieved. The present MISMARPE technique was performed in 25 consecutive cases with a success rate of 96%, yielding good skeletal outcomes with minimal trauma. The expander appliances, with their anchorage types, and a description of the surgical steps of the MISMARPE technique are presented. CONCLUSION: MISMARPE is a new and effective alternative for less invasive treatment of maxillary transverse deficiency in adults, compared to conventional surgery. Emphasis is placed on the importance of systematic and well-established protocols, for executing the procedures safely and predictably.
Subject(s)
Bone Screws , Maxilla , Minimally Invasive Surgical Procedures , Orthodontic Anchorage Procedures , Palatal Expansion Technique , Humans , Palatal Expansion Technique/instrumentation , Minimally Invasive Surgical Procedures/methods , Minimally Invasive Surgical Procedures/instrumentation , Adult , Orthodontic Anchorage Procedures/instrumentation , Orthodontic Anchorage Procedures/methods , Maxilla/surgery , Female , Male , Treatment Outcome , Young Adult , Maxillary Osteotomy/methods , AdolescentABSTRACT
OBJECTIVES: A systematic review was performed to analyze the current evidence on three-dimensional (3D) computed tomography (CT) superimposition protocols used to assess dentomaxillofacial changes after orthognathic and orthofacial surgery. Accuracy, reproducibility, and efficiency were evaluated. METHODS: The search was divided into Main Search (PubMed, EMBASE, Cochrane Library, LILACS, and SciELO), Grey Literature search (Google Scholar and Open Grey), and Manual search. Thirteen studies were included. Of these, 10 reported data on accuracy, 10 on reproducibility and five on efficiency. Seven proposed or evaluated methods of voxel-based superimposition, three focused on the surface-based technique, one compared surface- and voxel-based superimposition protocols, one used the maximum mutual information algorithm, and one described a landmark-based superimposition method. Cone-beam computed tomography (CBCT) was the most common imaging technique, being used in 10 studies. RESULTS: The accuracy of most methods was high, showing mean differences smaller than voxels' dimensions, ranging between 0.05 and 1.76 mm for translational accuracy, and 0.10-1.09° for rotational accuracy. The overall reproducibility was considered good as demonstrated by the small mean error (range: 0.01-0.26 mm) and high correlation coefficients (range: 0.53-1.00). Timing to complete virtual superimposition techniques ranged between a few seconds up to 40 min. CONCLUSIONS: Voxel-based superimposition protocols presented the highest accuracy and reproducibility. Moreover, superimposition protocols that used automated processes and involved only one software were the most efficient.
Subject(s)
Orthognathic Surgery , Clinical Protocols , Cone-Beam Computed Tomography/methods , Facial Bones , Humans , Imaging, Three-Dimensional/methods , Reproducibility of ResultsABSTRACT
INTRODUCTION: Segmental maxillary osteotomy enables correction of anterior open bites. However, the outcome can be somewhat unstable, particularly if pseudarthrosis occurs. Bone grafts can be used to prevent this complication. Among the many biomaterials available for grafting, Bio-oss(®) has been used successfully in a range of modalities, with studies to support several indications. This report describes a case of segmental maxillary osteotomy in which Bio-oss(®) granules were used as bone grafts in the surgical gap. PRESENTATION OF CASE: A 24-year-old female presented with anterior open bite, Angle class III posterior occlusion, and Angle class II anterior occlusion. Virtual surgical planning of the procedure predicted a gap of approximately 5mm in the region of the osteotomy, which was bridged with Bio-oss(®) granules. DISCUSSION: Although autogenous bone grafting is the gold standard due to its osteoconductive, osteoinductive, and osteogenic properties, it involves increased morbidity for the patient, unpredictable resorption rates, increased operative time, and risk of infection at the donor site. Use of the Bio-oss(®) material can provide good bone stability, osteoconduction, and biocompatibility, while reducing operative time and surgical morbidity. CONCLUSION: This is the first report of bone grafting with a granular biomaterial in segmental maxillary osteotomy. Successful formation of new bone with density greater than that of the surrounding tissue was achieved, preventing pseudarthrosis and postoperative instability.
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Objetivo: Definir o perfil do grupo de risco para leucoplasias bucais a partir do banco de dados dos casos diagnosticados no Laboratório de Patologia Bucal da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul no período 1999 a 2009. Metodologia: O estudo foi baseado nas fichas de biópsia do arquivo do Laboratório de Patologia da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul. Os dados dos 177 casos foram tabulados no programa SPSS 14.0®; realizou-se a análise descritiva e aplicou-se o teste estatístico qui-quadrado (x²) com nível de significância de 5%, a fim de se verificar possíveis relações estatísticas entre as variáveis. Resultados: Ao correlacionar a variável localização anatômica e diagnóstico histopatológico e localização anatômica e idade, obteve-se significância estatística. A maior prevalência das lesões encontra-se entre a quinta e a sexta décadas de vida. Conclusão: O grupo de risco para leucoplasias está entre a quinta e sexta décadas de vida, localizadas na gengiva inserida, e a característica histológica mais encontrada foi de hiperplasia epitelial com hiperceratose.
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Introdução e objetivo: A amigdalolitíase é uma calcificação distrófica rara na tonsila ou região peritonsilar que pode mimetizar diversas patologias ósseas radiopacas quando avaliadas por imagens bidimensionais ou superpostas. Tal fato pode levar a diagnósticos equivocados e a condutas invasivas desnecessárias. Relatamos um caso de amigdalolitíase inicialmente diagnosticado como odontoma. Relato de caso: Uma paciente com diagnóstico primário de presença de odontoma em ramo mandibular foi encaminhada para tratamento cirúrgico dessa lesão. Conclusão: Tomografias são de fundamental importância no estabelecimento de diagnóstico diferencial e tratamento adequado do paciente.
Introduction: Tonsillolith is a rare type of dystrophic calcification in the palatine tonsils or in the peritonsilar region, which can mimics several intraosseous radiopaque lesions when evaluated by two-dimensional or overlapping images. This may lead to an erroneous diagnosis and to invasive and unnecessary procedures. This study reports a case of tonsillolith that was wrongly diagnosed as an odontoma. Case report: A patient with primary diagnosis of odontoma in the mandibular ramus was referred to surgical treatment of this lesion. Conclusion: Computed tomography (CT) scans are fundamentally important to establish differential diagnosis and appropriate treatment for the patient.