Análise do reparo ósseo da superfície de implante revestida com raloxifeno através das análises topográfica, biomecânica, histológica, histométrica e imunoistoquímica / Analysis of bone repair of the implant surface coated with raloxifene through topographic, biomechanical, histological, histometric and immunohistochemical analyzes

Introdução: A fim de melhorar a osseointegração, pesquisas tem buscado tratamentos para superfícies de implantes. Objetivo: Avaliar resposta óssea na interface osso/implante, em modelo padronizado em tíbia de rato, de superfícies de implantes de titânio comercialmente puro (Ti-cp) tratadas com raloxifeno (RLX). Materiais e Métodos: Foram utilizados 144 implantes de Ti-cp, divididos em dois grupos (n=36) de acordo com o tratamento de superfície: 1-Controle (CRT); e 2-RLX. Após tratamentos, cada animal recebeu um implante em cada tíbia. Os animais foram eutanaziados após 7, 15, 30 e 40 dias para análises histológica, histométrica e imunoistoquimica. Dados quantitativos foram submetidos à ANOVA dois fatores e pós-teste de Tukey (α=0,05). Resultados: A análise histológica aos 7 dias do grupo RLX apresentou maior quantidade de tecido conjuntivo comparada ao grupo CRT. Nos demais períodos, a modelação óssea foi semelhante. A análise histométrica, em relação à área óssea neoformada (AON), apresentou diferença significante entre RLX e CRT após 7 (p=0,005) e 40 (p=0,04) dias. Em relação à análise de extensão linear de contato entre tecido ósseo e superfície do implante (ELCOI), houve diferença significante entre RLX e CRT após 7 e 15 dias (p=0,003). Na análise imunoistoquímica aos 40 dias, RLX apresentou menos matriz óssea mineralizada e AON em relação ao CRT. Conclusão: Uso do RLX para modificação de superfície de implante demonstrou características de AON semelhantes ao CRT(AU)

Background: To improve osseointegration, researches have sought implant surface treatments. Purpose: To evaluate bone response at bone/implant interface, in standardized rat tibia model, of commercially pure titanium (cp-Ti) implant treated with raloxifene (RLX). Materials and Method: 144 cp-Ti implants were divided into two groups (n=36) according to the surface treatment: 1-Control (CRT); and 2-RLX. After treatments, each animal received one implant in each tibia. The animals were euthanized after 7, 15, 30 and 40 days for histological, histometric and immunohistochemical analysis. Quantitative data were submitted to two-way ANOVA and Tukey's test (α=0.05). Results: Histological analysis at 7 days in RLX showed greater amount of connective tissue compared to CRT. In other timepoints, bone remodeling was similar. Histometric analysis, regarding the newly formed bone area (NBA), showed significant difference between RLX and CRT after 7 (p=0.005) and 40 (p=0.04) days. Regarding the analysis of linear extension of contact between bone tissue and implant surface (LECBI), there was significant difference between RLX and CRT after 7 and 15 days (p=0.003). In the immunohistochemical analysis at 40 days, RLX showed less mineralized bone matrix and NBA compared to CRT. Conclusion: Use of RLX to modify implant surface demonstrated NBA characteristics similar to CRT(AU)

Influence of surgical ultrasound used in the detachment of flaps, osteotomy and odontosection in lower third molar surgeries. A prospective, randomized, and "split-mouth" clinical study

BACKGROUND: As third molar surgery is the most commonly procedure performed in Dentistry and has been accompanied by serious postoperative disorders such as pain, edema and trismus, the study aimed to evaluate if ultrasound device would be able to reduce such postoperative features. The aim of this study was to assess the effects of soft tissue flap elevation, osteotomy and odontosection using piezosurgery versus conventional technique in mandibular third molar extractions. MATERIAL AND METHODS: Twenty patients with impacted mandibular third molars underwent tooth extractions using two different methods. Ten patients were included in the Piezo Flap Group (PFG - the flap was elevated using piezosurgery) and ten patients were part of the Piezo Ostectomy Group (POG - osteotomy and odontosection were carried out with ultrasound tips). The contralateral tooth was included in the Control Group (CG - conventional technique). The patients were evaluated at postoperative periods of 1, 3, 7 and 14-days. The measured parameters were duration of surgery, pain, trismus and swelling. RESULTS: The mean duration of surgery for the PFG was 17.21 minutes (CG 10.07 minutes) and POG was 40.09 minutes (CG 15.97 minutes). There was no statistically significant difference in pain and trismus for any of the postoperative periods evaluated in PFG and POG (p > 0.05). There was a statistically significant difference in swelling between the PFG and POG, presenting less swelling at the 3-day postoperative period (p = 0.038; p < 0,05). However, for the remaining analyzed periods there was no difference (p > 0.05). CONCLUSIONS: Piezosurgery for tissue elevation of the surgical flap, osteotomy and dental sectioning in mandibular third molar extraction surgery promoted less edema in the early postoperative stages in mandibular third molar extractions despite the longer surgical duration

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Cervicofacial Necrotizing Fasciitis and Drugs.

Necrotizing fasciitis (NF) is a devastating disease that typically affects immunocompromised patients, chronically debilitated patients or drug users, but can also affect healthy patients. Necrotizing fasciitis can rapidly produce septic shock and requires immediate surgical management of the necrotic tissue. It is a bacterial infection that progresses rapidly and has a high mortality generally caused by aerobic and anaerobic bacteria. The patient was immunocompromised and drug user. During treatment, a combination of broad-spectrum antibiotic therapy with Ciprofloxacin and Metronidazole, besides the use of activated charcoal dressing composed of carbonized fabric and impregnated with 0.15% silver nitrate enveloped by layer of fabric without activated carbon, chemical-mechanical debridement with hydrogen peroxide, 0.9% saline, and povidone iodine. According to the patient presented, for the treatment of NF there is a need for broad-spectrum antibiotic therapy associated with surgical debridement, use of activated charcoal for antiseptic compression and general intensive care.

Influência do número de roscas e da densidade dos blocos de poliuretano na estabilidade primária de implantes do sistema intraoss / The influence of implant thread number and polyurethane block density on primary stability values of the Intraoss implant system

Objetivo: avaliar e comparar a estabilidade primária dos implantes cilíndricos de 3,75 mm x 11 mm Titaoss e Titaoss dupla rosca, do Sistema Intraoss, instalados em blocos de poliuretano com baixa densidade. Material e métodos: foram realizadas 32 cavidades em dois blocos de poliuretano, simulando as densidades de ossos tipo III e IV. As estabilidades dos implantes foram mensuradas por meio do torque de inserção e frequência de ressonância. Resultados: os implantes Titaoss instalados no osso tipo III apresentaram valores de torque de inserção de 43,1 ± 14,87 Ncm, enquanto os valores dos implantes Titaoss dupla rosca foram 46,9 ± 5,3 Ncm. No osso tipo IV, os implantes Titaoss apresentaram valores de 30 ± 0,0 Ncm e os dupla rosca de 29,4 ± 1,77 Ncm. Não houve diferença significante na estabilidade primária entre os grupos dos implantes (p > 0,05) instalados no mesmo tipo de osso. Os implantes Titaoss instalados no osso tipo III apresentaram valores de ISQ de 57,3 ± 4,69, ao passo que os valores para os implantes Titaoss dupla rosca foram 54,9 ± 3,98. No osso tipo IV, os implantes Titaoss apresentaram valores de 48,4 ± 4,07 ISQ e os dupla rosca de 50,8 ± 3,98 ISQ. As estabilidades primárias dos implantes foram maiores no osso tipo III quando comparado ao IV (p < 0,05). Conclusão: os dois desenhos de implantes permitem a obtenção da estabilidade primária para a técnica da carga mediata. No entanto, para submeter esses tipos de implante à carga imediata, indica-se a técnica da subfresagem.

Objectives: this in vitro study aimed to evaluate and compare the primary stability of the cylindrical implants (3.75 mm x 11 mm) Titaoss and Titaoss double thread from Titaoss System placed in cavities made of low-density polyurethane blocks. Material and methods: 32 cavities were made in two types of polyurethane blocks simulating the type III and IV bone densities. The implant stability values were measured using the final insertion torque and resonance frequency analysis. Results: the Titaoss implants placed in type III bone achieved 43.1 ± 14.87 Ncm, while the double-thread values were 46.9 ± 5.3 Ncm. For bone type IV, the Titaoss implants reached 30Ncm and the double thread 29.4± 1.77 Ncm. No statistically significant differences on implant stability were seen for both groups (p > 0.05) for the same bone type. the Titaoss implants in bone type III had 57.3 ± 4.69 and the double thread 54.9 ± 3.98 ISQ values. In type IV bone, Titaoss reached 48.4 ± 4.07 and the double thread 50.8 ± 3.98 ISQ units. The primary stability values were greater at type III than type IV bone (p < 0.05). Conclusion: both implant designs allow for primary stability. However, the use of an underpreparation technique is recommended in cases of immediate loading protocols.

Respiratory Obstruction Due to Richards Type 4 Fracture.

Facial fractures can be potentially fatal in polytraumatized patients due to retropositioning tissues to upper airway obstruction. In the first aids, this situation can be reversed using a tracheostomy procedure to break out the airways. However, fractures leading to airway obstruction are rare and according to Richards Classification can be classified into 5 types. The purpose of this article is to report a clinical patient with a bilateral condylar and mandibular symphysis fractures that resulted in airway obstruction and severe mandibular rear projection.

Partial Glossectomy as an Adjunctive Method to Ortho-Surgical Treatment.

The macroglossia is a rare condition, congenital or acquired, characterized by hypertrophy of the lingual muscles that can cause both aesthetic and functional changes such as mandibular prognathism and malocclusion. Diagnosis is through clinical examination. Treatment consists of excision of part of the tongue and different surgical techniques have been described in the literature. The keyhole lingual resection technique has shown satisfactory results in reducing the volume and preservation of the neurovascular bundles of the tongue. This work aims to present a clinical report of true macroglossia associated with dental-skeletal discrepancies, submitted to partial glossectomy previously to orthognathic surgery.

Avaliação histológica, histométrica e imunoistoquímica do reparo de cavidades ósseas em calvárias de ratos preenchidas por proteínas derivadas da matriz de esmalte / Histological, histometric and immunohistochemical evaluation of bone cavity repair in calvaries of rats filled with proteins derived from the enamel matrix

As Proteínas Derivadas da Matriz de Esmalte (PDME) são uma mistura heterogênea de proteínas derivadas da amelogenina produzidas durante o desenvolvimento do dente que tem a capacidade de modular vias de diferenciação de células no ligamento periodontal em adulto, e seu efeito age sobre o gene de expressão osteogênico promovendo uma adesão celular. O objetivo do presente estudo foi avaliar o processo de reparo ósseo de defeitos padronizados em calvária de ratos albinos Wistar tratados com EMDOGAIN® (STRAUMANN®, São Paulo, São Paulo, Brasil), BONE CERAMIC® (STRAUMANN®, São Paulo, São Paulo, Brasil) e a combinação dos dois, em grupos experimentais de 30 e 60 dias, através de analises histométrica e imunoistoquímica. Para o período de 60 dias, foi observada tendência para maior neoformação óssea, havendo diferença estatisticamente significante entre os grupos EMD + BC vs Bio-Oss (p= 0,036) e autógeno vs Bio-Oss (p= 0,001) testes estatíscos ANOVA e Tukey. Dessa forma, apesar das limitações deste estudo pré-clínico em animais, foi possível observar boa propriedade biológica na associação do EMDOGAIN® com o BONE CERAMIC®. No entanto, mais estudos laboratoriais devem ser realizados para avaliar propriedades osteoindutoras destes materiais, bem como o comportamento destes biomateriais em humanos, através de estudos clínicos(AU)

Enamel Matrix Derived Proteins (PDME) are a heterogeneous mixture of amelogeninderived proteins produced during tooth development that has the ability to modulate cell differentiation pathways in the adult periodontal ligament, and their effect on the gene of Osteogenic expression promoting cell adhesion. The objective of the present study was to evaluate the bone repair process of standardized calvarial defects of Wistar albino rats treated with EMDOGAIN® (STRAUMANN®, São Paulo, Brazil), BONE CERAMIC® (STRAUMANN®, São Paulo, São Paulo, Brazil) and the combination of the two, in experimental groups of 30 and 60 days, through histometric and immunohistochemical analyzes. For the 60-day period, there was a trend towards greater bone neoformation, with a statistically significant difference between the groups EMD + BC vs Bio-Oss (p = 0.036) and Autogene vs Bio-Oss (p = 0.001) ANOVA and Tukey. Thus, despite the limitations of this preclinical study in animals, it was possible to observe good biological properties in the association of EMDOGAIN® with BONE CERAMIC®. However, further laboratory studies should be performed to evaluate osteoinductive properties of these materials, as well as the behavior of these biomaterials in humans, through clinical studies(AU)

Intubação submento-orotraqueal: estudo retrospectivo de 2 anos / Orotraqueal submental intubation: two years retrospective study

As lesões e mortes no trânsito configuram-se como um grande problema de Saúde Pública, determinando números elevados de pacientes politraumatizados. Muitos deles apresentam injúrias severas na face, tais como as fraturas panfaciais, em que se faz necessário um procedimento cirúrgico bucomaxilofacial. Em muitos desses casos, exista a impossibilidade de manutenção da via aérea oral ou nasal. A intubação submento-orotraqueal (ISMOT) torna-se um procedimento seguro e efetivo para o manejo das vias aéreas. Este trabalho tem como objetivo realizar um estudo epidemiológico, retrospectivo dos prontuários dos pacientes atendidos no Serviço de Cirurgia e Traumatologia Bucomaxilofacial do Hospital de Base de Bauru no período de janeiro de 2011 a janeiro de 2013. A prevalência da ISMOT foi de 2,36%. O gênero masculino foi o mais acometido, com 72%, e a faixa etária da terceira década de vida (42,85%). Em pacientes submetidos à ISMOT, a etiologia mais presente foram acidentes de trânsito (78,56%), sendo as fraturas de mandíbula associadas a fraturas nasais aquelas mais prevalentes (35,71%). Não foi verificada nenhuma complicação. A ISMOT é um procedimento cirúrgico importante para pacientes com fraturas severas da face, em que a intubação orotraqueal e anasotraqueal estão contraindicadas, apresentando baixa morbidez e um índice de complicações mínimo... (AU)

Injuries and traffic deaths are characterized as a major public health problem determing a large number of polytrauma patients. Many of them have severe injuries on the face, such as panfactials fractures where it is necessary an oral and maxillofacial surgical procedure. In many of these cases there is the impossibility of maintaining the oral or nasal airway. The submental intubation(ISMOT), intubation becomes a safe and effective procedure for airway management. This paper aims to performing an epidemiological retrospective of patients treated at the Surgery and Traumatology Maxillofacial the Base Hospital of Bauru from January 2011 to January 2013. The prevalence of ISMOT was 2.36 %. Male gender was the most affected, with 72 %, and the age of the third decade of life (42.85 %). In patients undergoing ISMOT, the etiology was more present traffic accidents (78.56 %), and fractures of the jaw associated with nasal fractures those most prevalent (35.71 %). There was no any complication. The ISMOT is a major surgical procedure for patients with severe fractures of the face, where oro tracheal intubation and nasotracheal intubation are contraindicated, with low morbidity and complication rate minimum... (AU)