In vitro resistance of titanium and resorbable (poly L-co-DL lactic acid) osteosynthesis in mandibular body fracture.

This study was a comparative evaluation of the bending resistance of metallic and resorbable plates and screws in a mandibular body fracture model. Forty polyurethane synthetic hemimandibles were used; a vertical linear cut was made between the second and first premolars. These 40 hemimandibles were divided into four groups of 10 and were fixed with titanium plates and screws or resorbable plates and screws, with monocortical screws in the upper sector and bicortical screws in the lower sector. Bending resistance tests were done on a universal testing machine with a linear displacement speed of 1mm/min, a cell load of 500 N, and a load cell on the lower central incisor or on the lower second premolar. Results were analyzed using the Student's t-test, with the significance level set at 5%. No statistically significant differences were observed between the groups studied, either in the analysis of the osteosynthesis materials or related to the load-bearing points. The variables of displacement and peak load did not present any significant differences. In this in vitro model of a mandibular body fracture, the mechanical behaviour of a resorbable osteosynthesis was similar to that of a titanium osteosynthesis.

Segmental osteotomy with interpositional bone grafting in the posterior maxillary region.

Tooth loss is followed by a natural bone resorption process that often leads to defects in the alveolar ridge, making the installation of dental implants unfeasible. Correction of such bone defects, especially loss of height of the ridge or associated loss of thickness, is a great challenge to dental surgeons. The technique of segmental osteotomy accompanied by interpositional bone grafting has been shown to be a viable option for addressing the problem. This report describes a successful application of the technique in the treatment of vertical dimension deficiency in the posterior maxillary region. Four months after graft surgery, 3 implants were successfully placed in accordance with the original reverse planning.

Prospective study of soft tissue contour changes following chin bone graft harvesting.

This study sought to evaluate changes in the soft tissue contour after chin bone graft harvesting. Thirty selected patients underwent chin bone graft harvesting and evaluations were made using lateral cephalograms preoperatively and postoperatively at 30 and 180 days. Fixed points and lines were established on cephalometric tracings and used to measure the selected vertical and sagittal parameters. Results showed statistically significant alterations to the vertical position values of the vermilion (V-VPV) which increased from 9.70 to 11.01 and the exposure of lower incisors (V-ELI) which increased from 1.85 to 3.5, showing an increase in their distance from the plane of reference and a lowering of their position, the clinical equivalent of a labial ptosis condition. None of the sagittal parameters analysed showed any statistically significant variation in the final evaluation. The study concluded that the alterations to patients' soft tissue contours resulted mainly from failure to ensure precise reattachment of the mentalis muscles and identified the need for further investigation of that aspect.

Atención odontológica a pacientes con enfermedad de Von Willebrand / Odontologic attention for patients with von Willebrand Disease de Miranda

La enfermedad de Von Willebrand, coagulopatía causada por la deficiencia de un gen que modifica la capacidad del organismo de producir factores suficientes que genere la coagulación, tienen un protocolo de tratamiento poco difundido entre los cirujanos-dentistas. El profesional debe estar alerta en pacientes con hemorragias mucocutáneas repetidas, especialmente si son asociadas a un patrón familiar, e iniciar su tratamiento multidisciplinar con el hematólogo, quien debería programar la reposición de factores que el paciente necesita para el tratamiento odontológico. En este trabajo presentamos un caso clínico de un paciente con enfermedad de Von Willebrand y discutimos el manejo odontológico para este paciente (AU)

The von Willebrand disease is a coagulopathy caused by the deficiency of the gene that modifies the organism’s ability to produce sufficient factors that promotes coagulation. What is yet unknown by dental surgeons are the means to treat these patients. This patient has au functional abilities, but a coagulation disturbs is observed. It’s a normal patient, but he bleeds excessively. The dentist showed always be attentive to the patient’s familiar and pathological background, so he can initiate the dental treatment in synergy with the hematologist; who wile program the necessity or not of factor reposition that the patient might need during the treatment. In this article we present a clinical case of von Willebrand disease and we discuss the management odontological of this patient (AU)

Análisis fotoelástico descriptivo de dos diferentes diseños de implantes endoóseos sometidos a carga decompresión vertical / Descriptive photoelastical analysis of two different dental implants design submitted to vertical compression load

El objetivo de este estudio fue analizar la distribución de las tensiones generadas en los modelos fotoelásticos posterior a la aplicación de cargas verticales a 7,5 N, en dos diferentes diseños de implantes endoóseos. Fueron seleccionados 2 implantes con diferentes configuraciones: Implante(Máster Conect Cônico® 4,13×13 mm) e Implante (Titamax Ti Medula® 3,75×13 mm). Para el análisis de la distribución de tensiones fueron confeccionados 2 modelos en resinas fotoelástica con dimensiones de 40×10 mm de base y 30 mm de altura. Cada implante posicionado en los modelos recibieron carga vertical a 7,5 N, siendo posible visualizar las franjas isocromáticas generadas en los modelos, a través del polariscopio. El implante Máster Conect Cônico® con hexágono interno largo, porción cervical pulida, tope de las roscas redondeadas, pasos de las roscas continuas, distancia entre estas de 0,5 décimas de milímetros, espirales angulados y ápice cónico presento concentración de las tensiones en la región apical. El implante cilíndrico, Titamax Ti Medula®, con hexágono externo, porción cervical pulida, con tope de las roscas en forma de v, paso de roscacontinuo, con distancia entre las roscas de 0.5 décimas de milímetros, espirales angulados y ápicere dondeado presento distribución de las tensiones en la región apical medio y cervical del implante. Basado en los resultados de este estudio puede concluirse que: el implante de configuración cónica concentró las tensiones en región apical, siendo que el implante de configuración cilíndrica concentro las tensiones en la región apical medio y cervical del implante (AU)

The objective of this study was to analyze the subsequent tensions distribution generated in the photoelastic models after application 7.5 N vertical loads, in two different dental implant designs. It were selected two different configuration implants, being one conic (Másters Conect Cônico®4.13×13 mm) and the other cylindrical (Titamax Ti Medula® 3.75×13 mm). For the analysis of the tensions distribution it were made two photoelastic resin models with dimensions of 40×10 mm of base and 30 mm of height. Each implant was positioned in the model and received vertical loads to7,5 N, being possible to visualize the isochromatic strips generated in it, through the polariscope. The Másters Conect Cônico® implants, that have long internal hexagon, polished cervical portion, top of spirals rounded, continuous passage of the spirals, distances between these of 0.5 tenth of millimeters, angled spirals and conical apex, presented the concentration of the tensions in the apical region. The cylindrical implants (Titamax Ti Medula®) with external hexagon, polished cervical portion, with top of the spirals in form of a “v”, continuous passage of spiral, with distance between the spirals of 0,5 tenth of millimeters, angled spirals and rounded apex, presented the distribution of the tensions on apical and cervical regions of the implants. Based on the results of this study it is possible to conclude that: the conical implants configuration concentrated the tensions in apicalregion, being the cylindrical configuration tensions concentrated on the apical and cervical region of the implants (AU)

Lingual cyst with respiratory epithelium: a histopathological and immunohistochemical analysis of two cases.

Cysts of the tongue are rare, usually derived from epithelia of the embryonic gastrointestinal and respiratory tracts, and classified according to the predominant epithelium lining. These cysts are usually discovered during infancy, more frequently in males, but they may not appear until well into adulthood. The authors report two lingual cysts lined mainly with respiratory, and focally by squamous, epithelium. Periodic acid-Schiff and mucicarmine staining revealed focal positivity in intracystic mucoid material and goblet cells. Immunohistochemical analysis with vimentin, cytokeratins (AE1/AE3, 34betaE12, CK1, CK5, CK6, CK7, CK8, CK10, CK13, CK14, CK16, CK18, and CK19), E-cadherin, beta-catenin, and epithelial membrane antigen showed a similar profile of normal respiratory epithelium, suggesting well-differentiated states. Owing to their controversial origin, these cysts should be named descriptively, as suggested by Manor et al., as lingual cysts with respiratory epithelium.

A retrospective study of the potential complications during alveolar distraction osteogenesis in 55 patients.

The aim of this retrospective study was to analyse the outcome of alveolar distraction osteogenesis for the correction of vertical defects in a large series of 55 cases. The existing bone deficiencies were secondary to atrophy after periodontal disease or tooth extraction. The overall success rate of this technique was 89.1%. The complications presented during treatment were divided into minor (no effect on final result, but immediate intervention required) 14/55 patients (25.4%), and major (lead to technique failure) 6/55 patients (10.9%). The frequency of minor complications was 8/27 in the anterior maxillary region, 1/27 in the anterior mandibular region and 15/27 in the posterior mandibular region. The frequency of major complications was 5/6 in the posterior mandibular region and 1/6 in the anterior maxillary region. The mean alveolar height achieved was 6mm. The overall rate was 36.3%. On the basis of these results it was concluded that alveolar distraction osteogenesis is an effective technique to treat vertical alveolar ridge deficiencies.

Evaluación clínica y radiográfica de la técnica de distracción osteogénica en la reconstrucción de rebordes alveolares atróficos en la región anterior del maxilar superior / No disponible

Este estudio tiene como objetivo evaluar clínica y radiográficamentela técnica de distracción osteogénica alveolar en la región anteriordel maxilar superior y las posibles complicaciones que pueden aparecerdurante el tratamiento. Fueron evaluados 15 pacientes, sometidos a reconstrucciónalveolar del maxilar superior en la región anterior con distracciónosteogénica, usando un distractor yuxtaóseo. Del total de 15 pacientesencontramos que 13 pacientes (86,6%) obtuvieron un éxito total de la técnica,obteniendo una ganancia ósea real media de 7,04 mm; en 1 paciente(6,66%) fue parcial (2,62 mm) y en 1 paciente (6,66%) se evidenció unfracaso en la técnica, al alcanzar solo 0,76 mm debido a problemas en laactivación del distractor. En cuanto a las complicaciones surgidas duranteel tratamiento fueron divididas en complicaciones menores, toda aquellaque no interfirió en el éxito del tratamiento, y que estuvieron presentesen 8 pacientes (53,33%), y complicaciones mayores aquellas que no permitieronla rehabilitación con implantes, y que fue encontrado solo en 1paciente (6,66%). La técnica de distracción osteogénica alveolar, demostróser eficaz en la reconstrucción de rebordes alveolares atróficos con unéxito de 93,33%, presentado pequeñas complicaciones que pueden sersolventadas por medio de un seguimiento por parte del profesional

This study evaluates clinically and radiographicallythe distraction osteogenesis technique for the reconstructionof atrophic alveolar ridges in the anterior maxilla region, andthe possible complications that arise during treatment. Fifteenpatients were evaluated, clinically and radiographically, thathad been treated with alveolar distraction osteogenesis inthe anterior region, using a juxta-osseous distractor. In 13patients (86.6%) the technique was completely successful,there being an effective bone gain of 7,04 mm. In 1 patient(6.66%) this was partial (2.62 mm) and in 1 patient (6.66%)the technique failed, as there was a gain of just 0,76 mmbecause of problems during the activation. The complicationsarising during the alveolar distraction osteogenesis weredivided into minor complications that did not compromisethe success of the technique, and which were found in 8patients (53.33%), and major complications that did notpermit rehabilitation, which were found in 1 patient (6.66%).The alveolar distraction osteogenesis technique proved to bean effective technique for the reconstruction of atrophicalveolar ridges with a success rate of 93.33%. There wereminor complications but the surgeon intervened in time andthese were solved

A retrospective evaluation of rigid fixation in orthognathic surgery using a biodegradable self-reinforced (70L:30DL) polylactide.

OBJECTIVE: This study was designed to evaluate clinical and radiological evidence of osteotomy site healing in orthognathic surgery after rigid fixation using a biodegradable plating system. STUDY DESIGN: A follow up of 30 patients who underwent orthognathic surgery using a biodegradable self-reinforced (70L:30DL) polylactide plating system was presented. The follow-up schedule for all patients consisted of regular appointments at 1-180 days after surgery. Clinical evaluation involved notation of any abnormal swelling, infection, discoloration, or discharge at the osteotomy sites. Stability was evaluated by manual palpation. For radiographic evaluation, panoramic radiographs were taken immediately after surgery, and again at 7-180 days. The radiographs were analyzed for any visual changes in osteotomy fragments, resorptive changes in osteotomy fragments, callus formation, and union of the osteotomy segments. RESULTS: No clinical complications and no radiological changes in the osteotomy sites were observed. Regarding the clinical usefulness of the biodegradable fixation system, fixation at the time of operation was considered as excellent in all 30 cases. CONCLUSIONS: The conclusions of this study were that self-reinforced (70L:30DL) polylactide was considered to be comparable to other forms of rigid internal fixation for orthognathic surgery.

Distracción osteogénica alveolar: una alternativa en la reconstrucción de rebordes alveolares atróficos. Descripción de 10 casos / Alveolar distraction osteogenesis an alternative in the reconstruction of atrophic alveolar ridges. Report of 10 cases

La distracción osteogénica alveolar (DOA) es un método alternativo para la reconstrucción de rebordes alveolares atróficos que ofrece un resultado previsible y que disminuye los tiempo de espera entre lareconstrucción del reborde alveolar atrófico y la colocación de los implantes óseo-integrados, en comparación con los métodos tradicionalmente utilizados. Fueron atendidos 10 pacientes que presentaban deficiencia de reborde alveolar mandibular y/o maxilar por medio de distracciónosteogénica, utilizando un dispositivo yuxtaoseo (Conexión Implant System® - SP-Brasil). Todos los pacientes fueron atendidos de forma ambulatoria, bajo anestesia local y sedación conciente, comenzando la activación del dispositivo a los 7 días posteriores a la instalación, con un patrón deactivación de 1 mm diarios hasta alcanzar la altura ósea deseada. Posteriormente se aguardaron 10 semanas como parte del periodo de consolidación ósea y se realizo la colocación de los implantes oseointegrados y local y el retiro del dispositivo de distracción, pudiéndose comprobarclínica y radiográficamente la ganancia de la altura y volumen óseo necesario para la rehabilitación por medio de implantes (AU)

No disponible

Long-term evaluation of arthroscopic discectomy of the temporomandibular joint using the Holmium YAG laser.

PURPOSE: The goal of this study was to evaluate the clinical results with arthroscopic discectomy using a Holmium YAG laser for treatment of patients with pain and dysfunction and large disc perforations resulting by advanced internal derangement. PATIENTS AND METHODS: The subjects comprised 30 patients (38 joints) who underwent arthroscopic discectomy with Holmium YAG laser. All patients had chronic pain, restricted range of motion, and a diagnosis of disc perforation (Wilkes stage IV to V of internal derangement). All patients had not responded to conventional nonsurgical treatment (eg, appliance therapy, nonsteroidal anti-inflammatory drugs, physical therapy) or previous temporomandibular joint (TMJ) arthroscopy. All patients filled out a questionnaire preoperatively and postoperatively for assessment of their signs and symptoms. The questionnaire consisted of a visual analog scale (VAS) with items on pain and diet. RESULTS: The overall success rate for arthroscopy discectomy using a Holmium YAG laser was 93.33% (28 of 30 patients) in a mean follow-up of 31.7 months. No complications were observed in this study. Maximal interincisal opening improved from a mean of 25.40 to 39.96 mm after 18 months or more from surgery. The subjective data elicited from VAS scores showed a significant improvement in pain score, in interference of pain with normal diet, and effect of pain on life in general. All preoperative scores were significantly different from postoperative scores (P <.05). CONCLUSIONS: On the basis of this follow-up study, arthroscopic discectomy for treatment of large disc perforations seems to provide an effective treatment for TMJ pain and dysfunction, decreasing the pain and improving the range of motion.