The Influence of Tactile Perception on Classification of Bone Tissue at Dental Implant Insertion.

BACKGROUND: Various ways of using the Lekholm and Zarb (L&Z) classification have added to the lack of scientific evidence of the effectiveness of this clinical method in the evaluation of implant treatment. PURPOSE: The study aims to assess subjective jawbone classifications in patients referred for implant treatment, using L&Z classification with and without surgeon's hand perception at implant insertion. The association between bone type classifications and quantitative parameters of primary implant stability was also assessed. MATERIALS AND METHODS: One hundred thirty-five implants were inserted using conventional loading protocol. Three surgeons classified bone quality at implant sites using two methods: one based on periapical and panoramic images (modified L&Z) and one based on the same images associated with the surgeon's tactile perception during drilling (original L&Z). Peak insertion torque and implant stability quotient (ISQ) were recorded. RESULTS: The modified and original L&Z were strongly correlated (rho = 0.79; p < .001); Wilcoxon signed-rank test showed no significant difference in the distribution of bone type classification between pairs using the two methods (p = .538). Spearman correlation tested the association between primary stability parameters and bone type classifications (-0.34 to -0.57 [p < .001]). CONCLUSIONS: Tactile surgical perception has a minor influence on rating of subjective bone type for dental implant treatment using the L&Z classification.

Maxillary protraction after surgically assisted maxillary expansion.

This case report describes the orthodontic treatment of a 32-year-old woman with a Class III malocclusion, whose chief compliant was her dentofacial esthetics. The pretreatment lateral cephalometric tracings showed the presence of a Class III dentoskeletal malocclusion with components of maxillary deficiency. After discussion with the patient, the treatment option included surgically assisted rapid maxillary expansion (SARME) followed by orthopedic protraction (Sky Hook) and Class III elastics. Patient compliance was excellent and satisfactory dentofacial esthetics was achieved after treatment completion.

Maxillary protraction after surgically assisted maxillary expansion

This case report describes the orthodontic treatment of a 32-year-old woman with a Class III malocclusion, whose chief compliant was her dentofacial esthetics. The pretreatment lateral cephalometric tracings showed the presence of a Class III dentoskeletal malocclusion with components of maxillary deficiency. After discussion with the patient, the treatment option included surgically assisted rapid maxillary expansion (SARME) followed by orthopedic protraction (Sky Hook) and Class III elastics. Patient compliance was excellent and satisfactory dentofacial esthetics was achieved after treatment completion.

Fasceíte necrotizante em região maxilofaxial: relato de caso / Necrotizing fasciitis in maxilofacial region: case report

A fasceíte necrotizante de cabeça e pescoço é um processo infeccioso incomum, de origem polimicrobiana, que se caracteriza por extensa necrose e formação gasosa no tecido subcutâneo e fáscia superficial, levando a quadros de toxicidade sistêmica podendo ser fatal. Apesar de pouco frequente, essa condição, na sua grande maioria, evolui como complicação de infecções ou tratamentos dentários, o que aumenta a responsabilidade do cirurgião-dentista frente ao diagnóstico precoce e ao tratamento adequado.

Necrotizing Fasciitis of head and neck is an uncommon infectious process of polymicrobial origin characterized by extensive necrosis and gas formation in the subcutaneous tissue and superficial fascia, leading to systemic toxicity, multisystem organ failure and eventual death. Although little frequent, this pathology it evolves with a complication of infection or dental treatment, what it increases the responsibility of the dentist front the early diagnosis and the adequate treatment with antibiotics, surgery debridament of all necrotic tissue, culture and support therapy.

Passagem de corpos estranhos pela orofaringe durante tratamento odontológico: abordagem clínica e odontolegal / Passage of foreign bodies through the oropharynx during dental treatment: a clinical and forensic dental approach

A passagem de corpos estranhos pela orofaringe durante o tratamento odontológico constitui um acidente que pode colocar em risco a vida do paciente. Dependendo da via seguida, o objeto pode ser deglutido ou aspirado. Na primeira situação, a maioria dos casos passa sem maiores problemas pelo trato gastrointestinal. Por outro lado, os objetos aspirados normalmente resultam em quadros agudos, como as obstruções das vias aéreas que podem ou não necessitar de uma intervenção invasiva. Além das complicações clínicas, outras questões de natureza ético-legais podem ser levantadas acerca da responsabilidade do Cirurgão-Dentista, tais como eventuais despesas médicas e possibilidade de processos. Dessa forma, o presente trabalho tem como objetivo apresentar um caso clínico de deglutição de corpo estranho durante a execução de tratamento odontológico, discutindo as principais implicações numa abordagem clínica e odontolegal. Considerando que a prevenção constitui o principal fator para se evitar esse tipo de acidente, os autores propõem um fluxograma de condutas a serem observadas pelo cirurgião-dentista, em que este deve possuir o conhecimento necessário para estabelecer um rápido diagnóstico e pronto-atendimento ao paciente, minimizando as possíveis repercussões de natureza clínica e legal.

The accidental falling of a foreign body into the oropharynx during dental treatment may put the patient?s life at risk. Depending on where the foreign body is lodged, it will be swallowed or inhaled. If the first case, it will most commonly travel through the gastrointestinal tract without problems. In the second, it will most probably cause acute injuries such as obstruction of the airway, which may require an invasive intervention. In addition to clinical complications, other questions of legal and ethical nature may be raised concerning the dentist?s liability for professional misconduct, such as reimbursement of medical expenses incurred by the patient and the possibility of facing legal action. This paper, thus, set out to present a clinical case of deglutition of a foreign body during dental treatment and discuss its main clinical and legal implications. Considering that prevention is the main factor in avoiding this sort of accident, the authors propose a flow chart with the steps to be followed by the dentist, who should possess the necessary knowledge to ensure the prompt diagnosis and treatment of the patient, thereby minimizing possible clinical and legal repercussions.

Comparative study of the mechanical resistance of 2 separate plates and 2 overlaid plates used in the fixation of the mandibular condyle: an in vitro study.

PURPOSE: The objective of this study was to carry out a comparative evaluation of the mechanical resistance of 2 rigid internal fixation techniques for fractures of the mandibular condyle using miniplates. MATERIALS AND METHODS: Forty polyurethane resin replicas of human hemimandibles were used. The hemimandibles were sectioned to simulate a high subcondylar fracture and then stabilized with 2 fixing techniques using 2.0-mm system plates and screws. The fixation techniques were 2 separate 4-hole plates with 8 screws, and 2 overlaid 4-hole plates with 4 screws. Each system was submitted to load tests, with the application of the load in mediolateral and anteroposterior directions in an Instron 4411 universal assay machine (Instron, Norwood, MA). RESULTS: Load values and peak displacement were measured. Means and standard deviations were evaluated by analysis of variance (P < .05) and Tukey tests, in which it was verified that the antero-posterior peak load value was affected by the arrangement of the plates on the models, although no differences were observed between the groups for the mediolateral peak load. The arrangement of the plates did not have any influence on peak displacement. Similarly, the final value of the mediolateral load was not affected by the arrangement of the plates on the model. CONCLUSION: The experimental model with 2 separate plates was statistically superior to the model with 2 overlaid plates only in relation to anteroposterior peak load. Despite showing superiority in mediolateral peak load and peak displacement, there was no statistical difference between the groups for these parameters.

Levantamento epidemiológico das fraturas do complexo zigomático no Serviço de Residência em Cirurgia e Traumatologia Bucomaxilofacial da UEM, no período de 2005 e 2006 / Epidemiological surveying of the fractures of the zigomatic complex in the Residence Service in Surgery and Bucomaxillofacial Traumatology of UEM in the period of 2005 to 2006

Neste trabalho, foi realizado um levantamento epidemiológico das fraturas do complexo zigomático no serviço de Cirurgia e Traumatologia Bucomaxilofacial da Universidade Estadual de Maringá - UEM, levando-se em conta os anos de 2005 e 2006. O objetivo deste trabalho consistiu em analisar aspectos destas ocorrências, como: gênero, idade, etiologia do trauma, classificação da fratura e tipo de tratamento. Nos 250 prontuários analisados, foram observadas 95 fraturas dos ossos zigomáticos, 49 fraturas nasais, 46 fraturas mandibulares, 31 fraturas maxilares e 29 foram classificadas como outras fraturas. Os pacientes mais afetados foram os do gênero masculino, na proporção de aproximadamente 2,5:1, na faixa etária entre 31 e 40 anos. As fraturas do zigomático foram classificadas segundo o grau de complexidade e divididas em classes de 1 a 5. A mais frequente foi a de classe 1. A etiologia mais frequente foram as agressões físicas, seguida dos acidentes de trânsito, em sua maioria causados por motos. O tratamento mais frequente foi o cirúrgico, com 55,84% dos casos, realizado com a utilização de fixação interna rígida, com placas e parafusos de titânio do sistema 1,5 e 2,0 mm.

In this work it was made an epidemiological research of the fractures of the zigomatic complex in the service of surgery and bucomaxillofacial traumatology of the Universidade Estadual de Maringá - UEM taking into account the period of 2005 and 2006. The analyzed aspects were:gender, age, etiology of the trauma, classification of the fracture and type of treatment. Of the 95 analyzed handbooks, it was observed 95 fractures of the zigomatic bone, 49 nasal fractures, 46 mandibular fractures, 31 maxillary fractures and 29 other fractures. The most affected patients were the male ones in the proportion of about 2.5:1, at the age of 31 to 40 years. The zigomatic fractures were classified according to degree complexity and divided into classes 1 through 5. Themost frequent was the class 1. The most frequent etiology was the physical assault followed by car crash, on its majority caused by motorcycles. The most frequent treatment was the surgical one,which took place with the utilization of rigid internal fixation with plates and screws of titanium of the 1.5 and 2.0 system.

Treatment of oral myiasis caused by Cochliomyia hominivorax: two cases treated with ivermectin.

The term myiasis is applied to the injurious action that larvae of certain diptera cause to the organism of vertebrate animals in the living or dead tissue in which they grow. Because of its great destructive potential, appropriate and preventative treatment are necessary. Among the sites of infestation, the human mouth is a common site, mainly in tropical countries. We present two cases of oral myiasis caused by Cochliomyia hominivorax spp. Ivermectin is an extremely effective semi-synthetic macrolides, in the treatment of this condition.

Avaliação da percepção estética entre leigos e profissionais da retrusão gradual da mandíbula / Evaluation of the aesthetic perception among lay people and professionals of the gradual retrusion of the mandible

Alterações na harmonia facial com implicações estéticas podem afetar o aspecto psicossocial de forma significativa, causando prejuízo ao desenvolvimento emocional e dificuldade nas interações sociais. Por causa dessas complicações, o aspecto estético tem se tornado a principal queixa daqueles que procuram o tratamento ortodôntico e a cirurgia ortognática. Devido a esse fato, o estudo da estética tem adquirido crescente importância entre ortodontistas e cirurgiões bucomaxilofaciais. Devido à necessidade de identificar anseios e expectativas dos pacientes e analisar se há correspondência aos modelos estéticos profissionais, esse trabalho objetivou a análise da percepção estética entre leigos e profissionais quanto à retrusão gradual da mandíbula. Para isso foi selecionado um paciente do gênero feminino, que se submeteu a uma telerradiografia lateral e teve seu perfil fotografado, o qual foi modificado através da digitalização e do uso do aplicativo Dolphin Imaging Software (Version 8.0). Obteve-se, então, cinco perfis diferentes de retrusão da mandíbula (0, 1, 2, 4 e 6mm), os quais foram analisados por ortodontistas (n=10), cirurgiões bucomaxilofaciais (n=8) e leigos (n=30). Para a análise estatística utilizou-se o teste do qui-quadrado. Os resultados demonstraram uma maior preferência pelo perfil reto, tanto entre profissionais quanto entre leigos, não havendo diferença estatisticamente significante entre as populações analisadas. Concluindo-se, assim, que há correspondência entre profissionais e leigos quanto à percepção estética da retrusão mandibular.