What are the Consequences of Incorrect Handling in the Treatment of Blunt-Cut Lip Injuries?

This study aimed report two cases of blunt-cut lip injury which occurred in postoperatory dehiscence. Patients were referred to the emergence attendance and the clinical examination revealed extensive laceration on the upper and lower lips of both patients, highly contaminated with asphalt residue. The affected regions were properly cleaned with saline and antiseptic solution, and, under local anesthesia, suturing was performed in layers in the muscle and oral mucosa region with 4-0 resorbable thread and in the skin region with 6-0 non-absorbable thread. Patients presented different levels of dehiscence on post-operatory evaluation. Thus, it was prescribed antibiotic and healing ointments for decontamination and improvement of the healing process. Third days post-operatory one of the patients presented a great healing of external lips and vermilion lip. However, the other patient presented aesthetic sequelae in the vermilion region of the lip, with a line of fibrosis and misalignment in the region, but not function sequelae. Thus, it was concluded that blunt injuries on the lip must strictly follow the established treatment protocols and must begin aiming for favorable results in the first intervention. Moreover, the postoperative care of the patient and the surgeon are as important as the procedure itself.

Successful Management of Ludwig's Angina due to Dental Implant Displacement: A Rare Case Report.

Dental implant surgery is a common procedure in oral and maxillofacial surgery practices. Extensive training, skill, and experience allow this procedure to be performed with an atraumatic approach, but like any surgical technique, it is subject to accidents and complications. This is an unusual clinical case of an accidental displacement of an implant into the submandibular space that progressed to Ludwig's angina, and it has not yet been described in the literature. This case report describes a clinical case of dental implant displaced into the submandibular space after healing cap removal. After seven days, it progressed to Ludwig's angina. The removal was performed through extraoral access in the submandibular area by using hemostatic forceps and radioscopic technique. After implant removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical planning to achieve an appropriate treatment plan, which is essential for a favorable prognosis. Therefore, prevention and management of displaced objects requires proper planning and surgical technique.

Reabilitação estético funcional em paciente maxilectomizado ­ acompanhamento de quatro anos / Functional and aesthetic rehabilitation in maxilectomized patients ­ 4-years follow up

O ameloblastoma é um tumor odontogênico benigno, localmente invasivo, capaz de infiltrar-se pelos espaços medulares do osso e, quando em estágio inicial, geralmente não apresenta indícios radiográficos ou macroscópicos. Muitas vezes, pacientes submetidos a tratamento ressectivo perdem grande parte da maxila ou mandíbula, necessitando de uma alternativa de tratamento para restabelecer a função e a estética. O objetivo deste relato de caso foi apresentar um acompanhamento de quatro anos de uma reabilitação com implantes zigomáticos em paciente submetido à ressecção de maxila anterior devido a um tumor odontogênico do tipo ameloblastoma. Quatro meses após a realização da cirurgia de ressecção do ameloblastoma na região anterior de maxila, foram instalados dois implantes com ancoragem zigomática no lado esquerdo, um implante com ancoragem zigomática no lado direito e dois implantes regulares hexágono externo no lado direito. Em seguida, foi feita uma prótese provisória imediata. Seis meses depois, os implantes foram carregados com a prótese final em resina acrílica. Após quatro anos de acompanhamento, não foram observados sintomas dolorosos, inflamação ou infecção peri-implantar, instabilidade do implante ou reabsorção óssea. No presente caso, a reabilitação da maxila atrófica com implantes no osso zigomático proporcionou bons resultados funcionais e estéticos a longo prazo. Assim, o uso de implantes zigomáticos associados a implantes padrão oferece vantagens na reabilitação de maxilares severamente reabsorvidos, principalmente quando a indicação é feita corretamente e com o conhecimento da técnica cirúrgica. (AU)

Ameloblastoma is a benign, locally invasive odontogenic tumor capable of infiltrating the bone marrow spaces, and when at the initial stage, it generally does not show radiographic or macroscopic evidence. Patients undergoing resection treatment lose a large part of the maxilla or mandible, requiring an alternative treatment to re-establish the function and aesthetics. The objective of this case report was to present a 4-years follow-up of a rehabilitation with zygomatic implants in a patient submitted to anterior maxillary resection due to an odontogenic tumor of the ameloblastoma type. After 4 months of the ameloblastoma resection surgery in the anterior maxillary region, 2 implants were placed with zygomatic anchoring on the left side, 1 implant with zygomatic anchoring on the right side and 2 regular external hexagon implants placed on the right side and then it was done an immediate provisional prosthesis. Six months later, the implants were loaded with the fi nal acrylic resin prosthesis. After 4-years of follow-up no painful symptoms, inflammation or peri-implant infection, implant instability or bone resorption were observed. In the present case, the atrophic maxilla rehabilitation with implants in the zygomatic bone provided long-term functional and aesthetic results. Thus, the zygomatic implants associated with standard implants offers advantages in severely reabsorbed maxillae rehabilitation, especially when the indication is made correctly and also with the knowledge of the surgical technique. (AU)

The Effect of Osteotomy Dimension on Implant Insertion Torque, Healing Mode, and Osseointegration Indicators: A Study in Dogs.

PURPOSE: This study investigated the effect of the osteotomy diameter for implant placement torque and its effect on the osseointegration. MATERIALS AND METHODS: Eight male beagle dogs received 48 implants (3.75 mm × 10 mm) in their right and left radius, 3 implants per side and allowed to heal for 3 weeks. Three experimental groups were evaluated. Group 1: implant with an undersized osteotomy of 3.0 mm; group 2: osteotomy of 3.25 mm, and group 3: osteotomy of 3.5 mm. The insertion torque was recorded for all implants. Histological sectioning and histometric analysis were performed evaluating bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). RESULTS: Implants of group 1 presented statistically higher insertion torque than those of groups 2 and 3 (P < 0.01). No differences in BIC or BAFO were observed between the groups. From a morphologic standpoint, substantial deviations in healing mode were observed between groups. CONCLUSION: Based on the present methodology, the experimental alterations of surgical technic can be clinically used with no detrimental effect over the osseointegration process.

Effects of ovariectomy on periodontal tissues following tooth replantation.

OBJECTIVES: The aim of the study was to analyze the effects of ovariectomy on periodontal tissues following immediate tooth replantation by histomorphometric, immunohistochemistry, and µCT analysis. MATERIALS AND METHODS: Eighty wistar rats (Rattus norvegicus albinos) with normal estrous cycles were randomly divided into two groups: ovariectomized (OVX) and Sham. Two months after surgery, the rats' upper right incisor was extracted followed by immediate reimplantation. The animals were sacrificed after 28, 45, and 60 days healing time. Histomorphometric and immunohistochemical analysis were performed by evaluation of PCNA and TRAP straining. RESULTS: The periodontal ligament was reinserted into the bone and cementum in the both groups. The immunohistochemical analysis revealed PCNA positive cells on the periodontal ligament in both groups at 28 days. Root resorption was noted at 45 days with immunoreactive cells for TRAP present in bone and tooth surface however no statistical differences between the groups were noticed. Histomorphometric analysis showed significant difference between groups in the periodontal ligament and root resorption parameters for the sub-items: intensity of chronic inflammatory infiltrate at 60 days (p<0.01), the organization of the periodontal ligament at 28 days (p<0.05), depth of root resorption at 45 days (p<0.05) and at 60 days (p<0.001). The µCT analysis showed multiple areas of bone resorption in association with OVX at 28 and 60 days with no significant differences between times in vivo. CONCLUSION: The ovariectomy did not have significant influence in periodontal tissue parameters following tooth reimplantation.

The Synergistic Effect of Leukocyte Platelet-Rich Fibrin and Micrometer/Nanometer Surface Texturing on Bone Healing around Immediately Placed Implants: An Experimental Study in Dogs.

Aims. This study evaluated the effects of L-PRF presence and implant surface texture on bone healing around immediately placed implants. Methods. The first mandibular molars of 8 beagle dogs were bilaterally extracted, and implants (Blossom™, Intra-Lock International, Boca Raton, FL) were placed in the mesial or distal extraction sockets in an interpolated fashion per animal. Two implant surfaces were distributed per sockets: (1) dual acid-etched (DAE, micrometer scale textured) and (2) micrometer/nanometer scale textured (Ossean™ surface). L-PRF (Intraspin system, Intra-Lock International) was placed in a split-mouth design to fill the macrogap between implant and socket walls on one side of the mandible. The contralateral side received implants without L-PRF. A mixed-model ANOVA (at α = 0.05) evaluated the effect of implant surface, presence of L-PRF, and socket position (mesial or distal), individually or in combination on bone area fraction occupancy (BAFO). Results. BAFO values were significantly higher for the Ossean relative to the DAE surface on the larger mesial socket. The presence of L-PRF resulted in higher BAFO. The Ossean surface and L-PRF presence resulted in significantly higher BAFO. Conclusion. L-PRF and the micro-/nanometer scale textured surface resulted in increased bone formation around immediately placed implants.

Evaluation of Crystallized Biosilicate in the Reconstruction of Calvarial Defects.

INTRODUCTION: The objective of this study was to assess the bone repair process of crystallized Biosilicate in surgically created defects on rats' calvaria. This biomaterial was recently developed for odontological use. MATERIALS AND METHODS: We used fifteen rats (rattus norvegicus albinus, Wistar), and two 5 mm surgical defects were performed on each of them; the defects were made with trephine drill on the calvarium region prior to the biomaterial placement. Groups were divided as follows: Group 1-defect filled with clot; Group 2-defect filled with crystallized Biosilicate. After 7, 14 and 28 days the animals were killed, the parts were retrieved and slides were prepared for histological studies. RESULTS: Bone formation was satisfactory in all groups, with direct contact between biomaterial surface and bone and absence of infection signs. The 28 days periods showed better results, and statistically significant difference between Clot Group (90.2 %) and Biosilicate (58 %; p = 0.002) was seen, regarding presence of bone tissue on the surgical defects. CONCLUSION: Our study revealed that defects filled with clot present better results on bone formation compared to crystallized Biosilicate, which is considered a biocompatible material with favorable osteoconductive properties.

Delayed tooth replantation following root canal filling with calcium hydroxide and MTA: Histomorphometric study in rats.

OBJECTIVE: The aim of this study was to perform a histomorphometric evaluation of the repair process in rat teeth replanted after root canals were filled with calcium hydroxide (CH) and mineral trioxide aggregate (MTA). DESIGN: Upper right incisors were extracted from 30 rats divided into three groups (n=10). The teeth were stored dry for 60min, after which the pulp and periodontal ligament (PDL) were removed and immersed in acidulated-phosphate sodium fluoride solution. In Group I, the root canals were filled with saline; in Group II, they were filled with CH; and in Group III, they were filled with CH, and the foramen was sealed with an MTA plug. The teeth were replanted, and the animals were sacrificed after 60 days. The sections with teeth were removed for histological preparation (haematoxylin and eosin, H&E). The characteristics of the PDL, cementum, dentine, and alveolar bone, as well as the occurrence of inflammatory and replacement root resorption and apical sealing, were subjected to histological and morphometric analysis (P<0.05). RESULTS: Group I was the most affected by root resorption (mean=67.05%). In Groups II and III, the resorption averaged 42.2% and 11.7%, respectively. Group III was less affected by inflammatory resorption and presented more areas of apical sealing by mineralized tissue (P<0.05). CONCLUSION: An apical MTA plug improved the repair of the replanted tooth by decreasing surface resorption and repairing mineralized tissue in the periapical region.

Effect of the treatment of root surface-adhered necrotic periodontal ligament with propolis or fluoride in delayed rat tooth replantation.

OBJECTIVES: The purpose of this study was to evaluate the application of 15 % propolis and 2 % acidulated-phosphate sodium fluoride solutions on the root surface-adhered necrotic cemental periodontal ligament in delayed tooth replantation. MATERIALS AND METHODS: Thirty Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. After this period, the dental papilla, enamel organ, and pulp tissue were removed, and the animals were randomly assigned to three groups: group I = immersion in saline for 10 min; group II = immersion in a 2 % acidulated-phosphate sodium fluoride solution for 10 min; and group III = immersion in a 15 % propolis and propylene glycol solution for 10 min. The root canals were filled with a calcium hydroxide paste and the teeth were replanted. RESULTS: Inflammatory resorption, replacement resorption, and ankylosis were observed in all groups without a statistically significant difference (p > 0.05) among them. CONCLUSIONS: Under the tested conditions, the application of fluoride or propolis on root surface-adhered necrotic periodontal ligament did not favor the healing process in delayed tooth replantation.

Histological and immunohistochemical analyses of the chronology of healing process after immediate tooth replantation in incisor rat teeth.

Dental tissues have special characteristics, and its regenerative capacity is noteworthy. However, understanding the circumstances that lead to regeneration is challenging. In this study, the chronology of the healing process after immediate replantation of rat incisor teeth was examined by histological and immunohistochemical analyses within a 60-day period. Thirty-six male Wistar rats had their maxillary right incisors extracted and replanted after 15 min in saline storage. The rats were sacrificed immediately 3, 7, 15, 28, and 60 days after replantation. The histological analysis showed rupture of the periodontal ligament and formation of a blood clot, which started being replaced by a connective tissue after 3 days. At 7 days, the gingival mucosa epithelium was reinserted and areas of root resorption could be seen. At 15 days, the periodontal ligament was repaired. At 3 days, the pulp presented an absence of the odontoblast layer, which started being replaced by a connective tissue. This tissue suffered gradual calcification, filling the root canal at 28 and 60 days. The root ends were closed. The immunohistochemical analysis revealed greater expression of OP, OPG, and RANK proteins in the initial periods (0 and 3 days), while TRAP expression predominated at 28 and 60 days (P < 0.05). In conclusion, in delayed tooth replantation, there is great new bone formation activity in the earlier periods of the repair process, while a predominance of bone resorption and remodeling is observed in the more advanced periods.

Efeito da ovariectomia sobre os tecidos periodontais após o reimplante dentário imediato: análise histomorfométrica, imunoistoquímica e micro-ct em ratas / Effects of ovariectomy on periodontal tissues following immediate tooth replantation: analysis histomorphometric, immunohistochemistry and micro-ct in rats

Recentes investigações sugerem que a deficiência de estrógeno, contribue para alteração nos tecidos periodontais. Considerando o estudo do traumatismo dento-alveolar em indivíduos com essa condição, o objetivo do trabalho foi analisar o efeito da ovariectomia sobre os tecidos periodontais após o reimplante dentário imediato por meio da análise histomorfométrica, imunoistoquímica e micro-ct em ratas. Oitenta ratas Wistar (Rattus norvegicus, albinus) com ciclos estrais normais foram divididas aleatoriamente em dois grupos: Grupo ovariectomizadas (OVX), e Grupo Sham (grupo controle). Após 2 meses da ovariectomia, foi realizado extração dos incisivos superiores seguido de reimplante dentário imediato e os animais sofreram eutanásia aos 28, 45 e 60 dias após o reimplante. Foi realizada a análise histomorfométrica e imunoistoquímica com avaliação das proteínas PCNA, OPG, CASPASE-3, RUNX-2 e TRAP. Em todos os grupos houve reinserção do ligamento periodontal no tecido ósseo e cemento e a imunorreatividade à PCNA foi evidente em células periodontais independente do grupo Sham ou OVX. A reabsorção radicular externa esteve mais acentuada a partir dos 45 dias com células imunorreativas à TRAP presentes na superfície óssea e dentária. Todavia, uma considerável parcela também estava dispersa no ligamento periodontal em todos os grupos. Não houve diferença estatisticamente significante entre os grupos para as proteínas PCNA e TRAP. Já a análise histomorfométrica revelou diferença estatisticamente significante entre os grupos nos detalhes histomorfométricos do ligamento periodontal e raíz dentária para os sub-itens de intensidade do processo inflamatório crônico aos 60 dias (p<0.01), organização do ligamento periodontal aos 45 dias (p<0.05) e profundidade da reabsorção radicular aos 45 dias (p<0.05) e aos 60 dias (p<0.001). A análise da micro tomografia computadorizada (μCT) revelou maior reabsorção óssea e dentária nos tempos tardios independente dos grupos e não houve...

Recent researchs suggest estrogen deficiency leads to changes in periodontal tissues. In order to study dental traumatology under this condition, the aim of the study was analyze the effects of ovariectomy on periodontal tissues following immediate tooth replantation through histomorphometric, immunohistochemistry and μ-ct analysis in rats. Eighty Wistar rats (Rattus norvegicus albinos) with normal estrous cycles were randomly divided into two groups (n = 20 per group): 1) Group ovariectomized (OVX), and 2) Sham group (control group). After two months, the rats were followed by extraction of upper right incisor and immediate replantation. The rats were sacrificed immediately 28, 45 and 60 days after tooth reimplantation. Histomorphometric and immunohistochemical analysis was performed by evaluation of PCNA, OPG, CASPASE-3, RUNX-2 and TRAP proteins. Periodontal ligament was reinseted in the bone and cementum and the immunohistochemical analysis revealed PCNA expression in the periodontal ligament independent of Sham or OVX group. At 45 days, the external root resorption was greater with expression of TRAP proteins in the bone and tooth surface. However, in both groups, were also dispersed in the periodontal ligament. There was no statistically significant difference between the groups for the PCNA and TRAP proteins. The histomorphometric analysis showed statistically significant difference between groups in the histomorphological details of periodontal ligament and root resorption for the sub-items: intensity of chronic inflammatory infiltrate at 60 days (p <0.01), the organization of the periodontal ligament at 45 days (p <0:05) and depth of root resorption at 45 days (p <0.05), and at 60 days (p <0.001).The μCT analysis showed multiple areas of bone resorption in association with OVX 30 and 60 days without statistically significant difference between groups. In conclusion, the ovariectomy did not have significant influence in immediate tooth replantation repair

Efeito da ovariectomia sobre os tecidos periodontais após o reimplante dentário imediato: análise histomorfométrica, imunoistoquímica e micro-ct em ratas / Effects of ovariectomy on periodontal tissues following immediate tooth replantation: analysis histomorphometric, immunohistochemistry and micro-ct in rats

Recentes investigações sugerem que a deficiência de estrógeno, contribue para alteração nos tecidos periodontais. Considerando o estudo do traumatismo dento-alveolar em indivíduos com essa condição, o objetivo do trabalho foi analisar o efeito da ovariectomia sobre os tecidos periodontais após o reimplante dentário imediato por meio da análise histomorfométrica, imunoistoquímica e micro-ct em ratas. Oitenta ratas Wistar (Rattus norvegicus, albinus) com ciclos estrais normais foram divididas aleatoriamente em dois grupos: Grupo ovariectomizadas (OVX), e Grupo Sham (grupo controle). Após 2 meses da ovariectomia, foi realizado extração dos incisivos superiores seguido de reimplante dentário imediato e os animais sofreram eutanásia aos 28, 45 e 60 dias após o reimplante. Foi realizada a análise histomorfométrica e imunoistoquímica com avaliação das proteínas PCNA, OPG, CASPASE-3, RUNX-2 e TRAP. Em todos os grupos houve reinserção do ligamento periodontal no tecido ósseo e cemento e a imunorreatividade à PCNA foi evidente em células periodontais independente do grupo Sham ou OVX. A reabsorção radicular externa esteve mais acentuada a partir dos 45 dias com células imunorreativas à TRAP presentes na superfície óssea e dentária. Todavia, uma considerável parcela também estava dispersa no ligamento periodontal em todos os grupos. Não houve diferença estatisticamente significante entre os grupos para as proteínas PCNA e TRAP. Já a análise histomorfométrica revelou diferença estatisticamente significante entre os grupos nos detalhes histomorfométricos do ligamento periodontal e raíz dentária para os sub-itens de intensidade do processo inflamatório crônico aos 60 dias (p<0.01), organização do ligamento periodontal aos 45 dias (p<0.05) e profundidade da reabsorção radicular aos 45 dias (p<0.05) e aos 60 dias (p<0.001). A análise da micro tomografia computadorizada (μCT) revelou maior reabsorção óssea e dentária nos tempos tardios independente dos grupos e não houve...

Recent researchs suggest estrogen deficiency leads to changes in periodontal tissues. In order to study dental traumatology under this condition, the aim of the study was analyze the effects of ovariectomy on periodontal tissues following immediate tooth replantation through histomorphometric, immunohistochemistry and μ-ct analysis in rats. Eighty Wistar rats (Rattus norvegicus albinos) with normal estrous cycles were randomly divided into two groups (n = 20 per group): 1) Group ovariectomized (OVX), and 2) Sham group (control group). After two months, the rats were followed by extraction of upper right incisor and immediate replantation. The rats were sacrificed immediately 28, 45 and 60 days after tooth reimplantation. Histomorphometric and immunohistochemical analysis was performed by evaluation of PCNA, OPG, CASPASE-3, RUNX-2 and TRAP proteins. Periodontal ligament was reinseted in the bone and cementum and the immunohistochemical analysis revealed PCNA expression in the periodontal ligament independent of Sham or OVX group. At 45 days, the external root resorption was greater with expression of TRAP proteins in the bone and tooth surface. However, in both groups, were also dispersed in the periodontal ligament. There was no statistically significant difference between the groups for the PCNA and TRAP proteins. The histomorphometric analysis showed statistically significant difference between groups in the histomorphological details of periodontal ligament and root resorption for the sub-items: intensity of chronic inflammatory infiltrate at 60 days (p <0.01), the organization of the periodontal ligament at 45 days (p <0:05) and depth of root resorption at 45 days (p <0.05), and at 60 days (p <0.001).The μCT analysis showed multiple areas of bone resorption in association with OVX 30 and 60 days without statistically significant difference between groups. In conclusion, the ovariectomy did not have significant influence in immediate tooth replantation repair

Importance of clinical examination in dentoalveolar trauma.

Dental injuries are often the result of direct trauma. The most affected teeth are the upper incisors, and the most frequent lesions are coronal fractures, contusions, and lip and alveolar mucosa lacerations. The objective of this study was to draw attention to the importance of the correct management of cases of crow fractures associated with soft tissue lacerations when the fragment is not located. This is a clinical case of crown fracture, the fragment of which remained lodged inside the lip. After fragment removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical examination to achieve a correct diagnosis and an appropriate treatment plan, which is essential for a favorable prognosis.

Periapical tissue reactions to calcium hydroxide and MTA after external root resorption as a sequela of delayed tooth replantation.

Clinical experience has shown that most avulsed teeth are replanted after a long extra-alveolar time and dry or inadequate wet storage, causing necrosis of periodontal ligament cells. This condition invariably leads to development of external root resorption, leaving the filling material in contact with the periapical connective tissues. In this study, the periapical tissue reactions to calcium hydroxide (CH) and mineral trioxide aggregate (MTA) were evaluated after occurrence of external root resorption as an expected sequela of delayed tooth replantation. Twenty male Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. Then, the dental papilla, enamel organ, pulp tissue, and periodontal ligament were removed, and the teeth were immersed in a 2% acidulated phosphate sodium fluoride solution, pH 5.5, for 10 min. The teeth were randomly assigned into two groups (n = 10), in which the canals were filled with either a CH and saline paste (CH group) or MTA (MTA group). The sockets were irrigated with saline, and the teeth were replanted. After 80 days, it was possible to observe large areas of replacement root resorption and some areas of inflammatory root resorption in both groups. More severe inflammatory tissue reaction was observed in contact with calcium hydroxide compared with the mineral trioxide aggregate. New bone formation was more intense at the bottom of the socket in the MTA group. In conclusion, as far as periapical tissue compatibility is concerned, intracanal MTA can be considered as a viable option for root canal filling in delayed tooth replantation, in which external root resorption is an expected sequela.

Occurrence of odontogenic infections in patients treated in a postgraduation program on maxillofacial surgery and traumatology.

This study assessed the occurrence and characteristics of oral and maxillofacial infections in patients treated at a Brazilian oral and maxillofacial emergency service during a 7-year period. The clinical files of all patients treated at the Oral and Maxillofacial Surgery and Traumatology Service of the Araçatuba Dental School, São Paulo State University, Brazil, between 2002 and 2008 were reviewed. From a population of 3645 patients treated in this period, the study sample consisted of 93 subjects who presented odontogenic infections. Data referring to the patients' sex, age, medical history, and the etiology, diagnosis, complications, drug therapy/treatment, and evolution of the pathologic diseases were collected and analyzed using the Epi Info 2000 software. Of these patients, 54 were men (58.1%) and 39 were women (41.9%). Most patients were in the 31- to 40-year-old (20.7%) and 21- to 30-year-old (19.6%) age groups. The most frequent etiology was pulp necrosis due to caries (80.6%). Regarding the treatment, antibiotics were administered to all patients, surgical drainage was done in 75 patients (82.4%), and 44 patients (47.3%) needed hospital admission. First-generation cephalosporin alone or combined with other drugs was the most prescribed antibiotic (n = 26) followed by penicillin G (n = 25). Most patients (n = 85, 91.4%) responded well to the treatment. Five cases had complications: 3 patients needed hospital readmission, 1 case progressed to descending mediastinitis, and 1 patient died. Odontogenic infections can be life-threatening and require hospital admission for adequate patient care. Complications from odontogenic infections, although rare, may be fatal if not properly managed.

Use of titanium mesh for reconstruction of extensive defects in fronto-orbito-ethmoidal fracture.

Traumatic injuries treatment of the fronto-naso-orbito-ethmoidal region has been one of the most challenging treatments within maxillofacial surgery, particularly of extensive orbital defects, very common in this type of pathologic condition. A 48-year-old man involved in a car collision presented an extensive bilateral fracture of the orbit medial wall, nasal bones, the nasal septum, and the frontal anterior table. The clinical and tomographic findings concluded the diagnosis of a maxilla and fronto-naso-orbito-ethmoidal fracture. Among the variety of biomaterials, the titanium mesh was elected because of the extension and magnitude of the bone defect, obtaining this way esthetic and functional results with better prognosis.

Análise do MTA e do Ca(OH)2 no interior dos tecidos após o processo de reabsorção radicular externa em reimplante dentário tardio / MTA and Ca(OH)2 analysis within the tissues after the process of external root resorption in delayed replantation

A clínica tem mostrado que a maioria dos reimplantes dentários é tardia e nessa condição há necrose das células do ligamento periodontal e as reabsorções patológicas podem se instalar e levar à perda do dente. O objetivo do trabalho foi avaliar o MTA e o Ca(OH)2, no interior dos tecidos, após a reabsorção radicular externa em reimplante tardio de dente de rato. Foram utilizados 20 ratos (Rattus norvegicus albinus) machos que tiveram o incisivo direito extraído e mantido em meio seco por 60 minutos. Em seguida, a papila dentária, o órgão do esmalte, a polpa dentária e o ligamento periodontal foram removidos. Os dentes foram imersos em solução de fluoreto de sódio fosfato acidulado a 2% pH 5,5, por 10 minutos. Em seguida os canais foram secos e divididos em 2 grupos: Grupo I - canais radiculares foram preenchidos com pasta de Ca(OH)2 e soro fisiológico e Grupo II - com MTA. Os alvéolos foram irrigados com soro fisiológico e os dentes reimplantados. Após 80 dias foi possível observar extensas áreas de reabsorção por substituição e algumas inflamatória nos dois grupos experimentais. Houve uma reação inflamatória mais intensa em contato com o Ca(OH)2 quando comparado ao MTA. No fundo do alvéolo houve maior neoformação óssea no grupo do MTA, porém não houve diferença estatisticamente significante entre os grupos. É possível concluir que o MTA pode ser uma opção clínica viável para a obturação de dentes tardiamente reimplantados sujeitos à reabsorção radicular externa devido a sua biocompatibilidade com os tecidos

Clinical practice has shown that most of reimplanted teeth are late, this condition produce necrosis of periodontal ligament cells and the pathological resorption may occur and produce dental loss. The aim of this study was to assess the biological behavior of MTA and Ca(OH)2, within the tissues after external root resorption in delayed late reimplanted rat teeth. Twenty male rats (Rattus norvegicus albinus) were used. The upper right incisor was extracted and was kept in a dry environment for 60 minutes. Then, the dental papilla, the enamel organ, the dental pulp and the periodontal ligament were removed. The teeth were immersed in 2% acidulous sodium fluoride solution pH 5.5 for 10 minutes. After that, the canals were dried and divided into 2 groups: Group I - the canals were filled with Ca(OH)2 and saline and Group II - with MTA. Sockets were irrigated with saline solution and the teeth were reimplanted. After 80 days was possible to observe large areas of replacement resorption and some inflammatory root in both groups There was more intense inflammatory reaction in contact with Ca(OH)2 when compared to MTA. At the bottom of the alveolar socket, bone neoformation was greater in the group of MTA, but there was no statistically significant difference between the groups. It’s possible to conclude that MTA may be a viable clinical option for filling of late dental reimplanted subject to external root resorption due to its biocompatibility with the tissues

Implantes mal posicionados: correção estética pela associação de dois sistemas de retenção para próteses implantossuportadas / Mal-positioned Implants: aesthetic management with two retention systems for implant-supported prostheses

A reposição das perdas dentárias, antes limitadas ao uso de próteses convencionais, atualmente, podem ser feitas por próteses implantossuportadas. Com a aplicação dos conceitos de planejamento reverso, é possível obter resultados protéticos satisfatórios, tendo uma previsão dos insucessos que podem ocorrer durante o tratamento. Assim, através de um caso clínico, o presente artigo tem como objetivo demonstrar a associação de duas técnicas de retenção de prótese implantossuportada, associada ao planejamento reverso, para a resolução de um caso de falha estética e funcional do conjunto implante-prótese. Paciente do sexo feminino, 63 anos, portando no arco superior uma prótese do tipo protocolo e no arco inferior uma prótese parcial removível Classe I, modificação 2 de Kennedy. A queixa principal da paciente era o constante mau cheiro e a estética precária de ambas as próteses. O plano de tratamento estabelecido foi a confecção de duas próteses tipo protocolo, sendo a inferior imediata e a superior uma associação de prótese cimentada e parafusada. Após a resolução do plano de tratamento, todos os anseios da paciente foram alcançados, recuperando estética, função e sorriso.

In the past, treatment of tooth loss was limited to the use of conventional total prostheses. Nowadays, the use of implant-supported prostheses has brought new horizons. It is possible to provide satisfactory esthetic results according to a reverse planning philosophy. Through a clinical case, the present article aims to demonstrate the association of two retention techniques for the resolution of aesthetic and functional drawbacks in both maxillary arches. A female 63 years-old patient presented with her maxillary total implant-supported prosthesis and mandibular conventional removable prosthesis (Kennedy´s Class I, modification 2). Her main complaints were oral malodor and unacceptable aesthetics. For this, screw-cemented (hybrid) and immediate prostheses were provided in the maxillary and mandibular arches. Thus, esthetics, function, and smile were improved to achieve all patient´s desires.