Virtual Versus Conventional Planning in Orthognathic Surgery: A Systematic Review and Meta-analysis.

Objectives: The purpose of this study was to compare the accuracy of hard tissues movements planned to result of the maxillary and mandibular positions between conventional surgical planning (CSP) and virtual surgical planning (VSP) in patients undergoing orthognathic surgery. Methods: A systematic electronic search was carried out in six databases and gray literature with no restriction of publication date and language. Clinical observational studies that compared accuracy of maxillary position between CSP and VSP were included. Linear measurements of the mandible in the transverse plane and linear measurements of the maxilla in the vertical, horizontal and transverse planes were considered for analysis, comparing planned to postoperative outcomes of CSP and VSP. Cochrane tool was used to assess bias risk. A meta-analysis was performed to summarize similar results by using the Review Manager 5.3 software. Significance level was set at 5%. Results: Six studies (2 RCT and 4 retrospective cohorts) were included according to inclusion and eligibility criteria, involving 255 patients. The inter-rater reliability of selection and eligibility was excellent (k = 0.8315 and k = 0.9329, respectively). Two studies presented that VSP seemed to have better results than CSP regarding linear measurements of the mandible in the transverse plane. Results from CSP and VSP were similar in accuracy for hard tissue in vertical plane of maxillary position (I2 = 0%; p = 0.17), although VSP was more accurate in horizontal plane (I2 = 0%; p = 0.02). Conclusion: VSP presented better accuracy for transverse movements in mandible of asymmetric patients. VSP showed to be more accurate for movements in the horizontal plane, and qualitative analysis seemed to be more effective for transverse movements.

Radiographic Assessment of Different Autogenous Bone Grafts in the Alveolar Cleft: A Retrospective Longitudinal Study.

Objectives: To assess feasibility and maintenance of bone after alveolar cleft reconstructions using graft from iliac crest and mandibular symphysis. Methods: 51 alveolar clefts grafted with iliac crest and 51 ones grafted with mandibular symphysis bones were selected from patients aged between 7 and 12 years. At three (T1) and 12 months (T2) after surgeries, periapical radiographs were performed to measure the height of the grafted bone based on the modified Bergland scale. Chi-square and Mann-Whitney-Wilcoxon tests compared differences between T1 and T2 according to each bone graft. Results: From the clefts grafted with mandibular symphysis bone, 47 were classified as type I (92.5%) and 04 as type II (7.84%) at T1. At T2, 36 were classified as type II (25.49%) and 02 as type III (3.92%). In the analysis of the clefts grafted with iliac crest at T1, 48 were classified as type I (94.11%) and three as type II (5.88%). At T2, 37 classifieds as type I (72.54%), 12 as type II (23.52%) and two as type III (3.92%). There was no statistically significant difference between treatments. Conclusions: It was concluded that iliac crest and mandibular symphysis are adequate areas from which bone grafts can be obtained for reconstruction of alveolar cleft.

Clinical outcomes of the discopexy using suture anchors for repositioning disc displacement in temporomandibular joints: Systematic review and meta-analysis.

The present study evaluated the literature regarding the clinical outcomes after discopexy using suture bone anchors for repositioning disc displacement. A systematic review was conducted according to the PRISMA statement and applied for the PROSPERO platform. The database searches were performed in the PubMed, Scopus, Web of Science, EMBASE, The Cochrane Library, and LILACS for full articles published from no restrictions of the initial period time to April 2022. Selection criteria included clinical studies in humans comparing maximal inter-incisal opening (MIO), pain by visual analogue scale (VAS), and protrusive and lateral excursions before and after discopexy. The screening process was performed by two independent reviewers, and if they did not agree with each other, a third reviewer was consulted before proceeding. The meta-analysis was carried out by Comprehensive Meta-Analysis software. Eleven studies met the inclusion criteria. A total of 327 patients were diagnosed with disc displacement, and 142 patients were refractory to conservative and minimally surgical therapies. Preauricular and endaural approaches were performed to place suture bone anchors on the posterior area of the condyle. A significant difference was found in MIO, which ranged from 15.5 mm pre-opeatively to 41.6 mm post-operatively (p = 0.001). Pain scores using the VAS ranged from 7.42 to 0.28 indicating improvement post-operatively (p = 0.001). Mandibular excursions were underestimated. The available results have shown that discopexy using suture anchors seemed to decrease pain and improve mouth opening. Clinical studies are required in a larger sample and lower variability of follow-up time to predict actual benefits.

The Radiographic Management for Surgical Planning and Implant Placement: a Case of Atypical Antral Artery Position / Avaliação Radiográfica no Planejamento Cirúrgico para Instalaçào de Implante Dentário: um Caso de Posição Atípica da Artéria Antral

O conhecimento do suprimento sanguíneo do seio maxilar, em particular da parede lateral, é de considerável importância devido à possibilidade de rompimento acidental de uma artéria durante os procedimento de elevação do assoalho do seio maxilar. Paciente do sexo feminino, 65 anos de idade, com histórico de complicação pós-operatória, após procedimento de elevação do seio maxilar realizado há três anos. Após avaliação tomográfica, foi observada a presença da artéria antral em posição atípica. Identificar e reconhecer essa estrutura anatômica pelo exame radiográfico pré-operatório, evita possíveis complicações hemorrágicas, durante e após o procedimento cirúrgico.(AU).

It is very important the knowledge of the maxillary sinus blood supply, in particular of the lateral maxillary wall, due to the possibility of accidental rupture of a vessel during the sinus floor augmentation. A case report is described of a 65-year-old female, who reported a postoperative complication after a sinus augmentation that she had had 3 years before. After radiographic evaluation, it was observed the presence of antral artery in atypical position. The identification of this anatomical structure is very important, by preoperative radiographic examination, avoiding possible bleeding complications, during and after the surgical procedures.(AU).

Temporal Flap as an Option for Buconasal Fistula Closure.

Maxillary defects with buconasal/businusal communications are situations difficult to manage and solve. Several treatment options are available on the literature, each one with its indication. Temporal muscle flap is one of these options, being a technique that requires more experience of the surgeon to be properly performed and that is mainly indicated for difficult cases, large defects and those nonresponsive to simpler techniques. The main purpose of this paper is to report 3 clinical patients of the application of the temporal muscle flap for the closure of extensive oral defects. None of the patients had necrosis, nervous deficits, or any long-term changes. The authors conclude that the use of this flap was shown to be a viable, safe technique with low complication and high success rates, which may contribute to the rehabilitation of well-indicated patients.

Pedicle Tongue Flap for Palatal Fistula Closure.

BACKGROUND: Palatal fistulae are common sequels that appear in patients after surgical procedures in the palate. Considering the difficulty to achieve an effective treatment, there are many techniques to surgically manage fistulae, that is, the pedicle tongue flap. OBJECTIVE: Being so, the main goal of this paper is to report cases of patients with palatal fistulae, from different etiologies, treated with anterior pedicle tongue flap. PATIENTS: Eleven patients, 8 male and 3 female, mean age of 32 years old with palatal fistulae surgically treated with anterior dorsal tongue flaps. No flap was completely lost. There was 1 partial loss and 1 residual buconasal communication. The most common complaints of the patients were difficulty to perform oral hygiene and mild pain. CONCLUSION: The use of anterior pedicle tongue flap for closing palatal fistulae demonstrates to be a safe procedure with high success rates (81% in this paper) when correctly indicated.

Experiências de aprendizagem mais efetivas segundo acadêmicos de Odontologia / Most effective learning experiences for dental students

O ensino centrado no professor ainda é amplamente abordado na maioria das Instituições de Ensino Superior brasileiras. Este método não prioriza a participação ativa do aluno no processo de construção do conhecimento. O objetivo desta pesquisa foi conhecer as experiências de aprendizagem consideradas mais significativas pelos acadêmicos de odontologia. Foi realizada uma pesquisa quantitativa, com análise descritiva e analítica utilizando questionário previamente testado. A amostra foi composta por 274 acadêmicos, regularmente matriculados no ano de 2014. Do total de alunos, 209 (76,3%) era do sexo feminino, com média de idade de 21,3±2,5 anos. Os resultados demonstraram que a estratégia de ensino que mais colaborou para a aprendizagem do aluno foram as atividades desenvolvidas em aulas práticas (186, 67,9%), contribuindo, segundo 171 (92,3%) alunos, de maneira intensa para sua formação. A segunda estratégia de ensino mais citada foi a participação em projetos de extensão (17, 6,2%). Observou-se tendência na preferência pelas atividades extraclasse entre acadêmicos do sexo feminino. Não houve diferença estatisticamente significativa entre o tipo de estratégia de ensino e idade (p=0,211). Atividades em aulas práticas foram as que mais contribuíram para o aprendizado do acadêmico no âmbito universitário. Espera-se que os resultados deste estudo, em conjunto com as Diretrizes Curriculares Nacionais, contribuam para a discussão sobre a necessidade de melhorias e inovação no ensino em odontologia (AU).

The teacher-centered method is still widely used in most universities in Brazil. This method does not prioritize the active participation of the student in the knowledge construction process. The objective of this research was to identify the most significant learning experience according dental students. A quantitative study, with descriptive and analytical analysis using pre-tested questionnaire was conducted. Of the total students, 209 (76.3%) were female, with a mean age of 21.3±2.5 years. The results showed that the teaching strategy that most contributed to student learning activities were developed in practical classes, 186 (67.9%), contributing for 171 (92.3%) students, intensively for their training. The second most cited teaching strategy by dental students was to participate in extension projects (17 / 6.2%). There was a trend in preference for extracurricular activities among female dental students. There was no statistically significant difference between learning experience preference and age (p=0.211). Activities in practical lessons were the ones that most contributed to learning for dental students. It is expected that the results of this study, together with the National Curriculum Guidelines could contribute in the discussion about the need of improvement and innovation in dental education (AU).

A importância do planejamento estético para a correção de deformidades dentofaciais / The importance of esthetic planning when correcting dentofacial deformities

A cirurgia ortognática tem como objetivos estabelecer a função mastigatória e melhorar a estética facial, dando harmonia e proporcionalidade à face. A estética, sem dúvida, é a questão mais importante para o paciente, pois geralmente é a queixa principal para o tratamento. No presente trabalho, será apresentado um caso de uma paciente que se apresentou insatisfeita com o resultado da cirurgia ortognática, pois o planejamento foi feito priorizando apenas a correção da má oclusão de Classe III, sem atentar-se à repercussão estética. Apesar da oclusão tratada, a paciente foi submetida a nova cirurgia, para dar-lhe o resultado que esperava no primeiro procedimento. Com isso, percebemos que, em pacientes ortodôntico-cirúrgicos, devemos observar com atenção a queixa principal e os problemas faciais, e não ater-se somente à oclusão, pois o paciente está mais preocupado com a aparência da face do que com a posição dos dentes

Correção das deficiências transversas e ântero-posteriores da maxila em pacientes adultos / Maxillary anteroposterior and transverse problems correction in adult patients

OBJETIVO: a finalidade deste trabalho é avaliar os resultados de tratamento de pacientes com desarmonias esqueléticas Classe III e discrepâncias transversas, tratados com a técnica de expansão maxilar assistida cirurgicamente, associada à mecânica de tração reversa. METODOLOGIA: Foram avaliados 10 pacientes portadores de Classe III esquelética e discrepância transversal, submetidos à expansão maxilar assistida cirurgicamente e ao uso de máscara facial. A avaliação das alterações ortodônticas e ortopédicas foram realizadas por meio dos exames clínico e radiográfico. CONCLUSÃO: os resultados clínicos e radiográficos demonstraram eficiência nestes procedimentos, evitando nova cirurgia de maxila, diminuindo a morbidade do tratamento e o seu custo.

AIM: The purpose of this article is to evaluate the correction of anteroposterior and transverse maxillary deficiency in adult patients with the use of facial mask and surgically assisted RME (SARME). METHODS: Reverse traction of the maxilla was applied to 10 subjects through a facial mask after a SARME. All individuals presented a Class III skeletal malocclusion. Cephalometric tracings were used to access the amount of anterior maxillary displacement during treatment. RESULTS AND CONCLUSION: The association of these procedures promoted transverse correction and anterior displacement of the maxilla. This approach avoided a two step correction - one for SARME and other for maxillary advancement, reducing morbidity and costs of treatment.