Alveolar morphometry in young adults with and without agenesis of the upper lateral incisor: A retrospective study.

INTRODUCTION: We aimed to compare alveolar morphometry in young adults with agenesis of the upper lateral incisor versus the side without agenesis and versus matched controls. MATERIAL AND METHODS: In this observational retrospective study, cone beam computed tomography scans were obtained of 36 upper hemiarches from young adults aged 15 to 30 years. The hemiarches were distributed into three groups: group 1: 12 upper hemiarches presenting agenesis of the upper lateral incisor; group 2: 12 upper hemiarches from the opposite side without agenesis of the upper lateral incisor (control group 1); and group 3: 12 upper hemiarches without agenesis of the upper lateral incisor matched for age and sex with respect to the affected group (control group 2). A trained and calibrated investigator performed all the alveolar measurements at two different times, including sagittal, coronal and axial slices of each hemiarch. Paired Student's t-tests, Chi-square and repeated measures ANOVA with Bonferroni correction were used, (P<0.05). RESULTS: Apical mesial evaluation of group 1 (4.22±1.19mm) was significantly lower (P<0.001) than that of groups 2 (6.72±1.17mm) and 3 (7.58±1.67mm). Apical distal evaluation also showed differences (P<0.001) among the three groups, with the dimension being smaller in group 1 with agenesis (4.53±1.14mm), followed by group 2 without agenesis (6.23±1.55mm) and the healthy control group 3 (7.73±1.71mm). CONCLUSIONS: Lateral incisor agenesis significantly reduces the alveolar dimensions of the affected area. In cases of unilateral agenesis, the unaffected side also shows sequelae, with decreased dimensions compared to cases without agenesis. This condition should be taken into account when making therapeutic decisions regarding rehabilitation with implants or canine replacement.

Volumetric assessment of alveolar clefts: a literature review.

OBJECTIVE: To conduct a review of the literature on methods for volumetric assessment of alveolar clefts and ascertain which methods are most precise to guide future research. METHODS: The PubMed and MEDLINE databases were searched for English-language reports of clinical and in vitro studies with detailed descriptions of imaging modality, sample characteristics, and method for measurement of alveolar cleft volume. RESULTS: The search strategy yielded 34 articles, of which 14 were selected for in-depth analysis. According to the findings of computed tomography (CT)-based studies, the CT modalities and software employed for assessment were deemed reliable and satisfactory. CONCLUSIONS: Measurement of alveolar cleft volume by the proposed methods and using the equipment and software employed in the analyzed studies has high efficacy and efficiency and can be safely used for cleft lip and palate treatment planning.

Implantes de diâmetro reduzido (< 3 mm) para reabilitação oral de espaços edêntulos atrésicos em pacientes adolescentes ­ relato de caso com acompanhamento de um ano / Reduced diameter dental implants (< 3 mm) for oral rehabilitation of edentulous atresic spaces

Reabilitações estéticas em áreas anteriores com limitação de espaço mesiodistal tornam-se um desafio. Entretanto, implantes dentários de diâmetros reduzidos (< 3 mm) têm sido utilizados nestes casos. Este relato de caso apresenta a utilização de dois implantes de diâmetro reduzido (2,8 mm) e conexão morse no tratamento de agenesia de laterais superiores. Após planejamento cirúrgico-protético, os implantes foram restaurados imediatamente e acompanhados por um período de um ano. Dentro das limitações deste trabalho, sugere-se que implantes de diâmetro reduzido podem ser utilizados com sucesso para a restauração imediata de laterais superiores, oferecendo um bom perfil de emergência protética e estética para dentes estreitos.

Esthetic rehabilitations in the anterior zones with limited mesiodistal spaces are a great challenge. However, dental implants with reduced diameters (< 3 mm) with a morse taper connection have been used in cases os lateral incisor agenesis. After a detailed surgical-prosthetic planning, the dental implants were immediately restored and followed-up for one year. Within the limits of this paper, it can be suggested that narrower dental implantes can be used with success in such situations, providing a good emergence profile and esthetics to for narrower dental spaces.

Correction of Unilateral Congenital Zygomatico-Mandibular Fusion.

Sygnathia, or fusion of the jaw, is a rare condition in children, occurring either in isolation or as part of a larger overall syndrome. Consequences of this bony fusion may range from feeding difficulties to a complete inability to protect the airway. Owing to the uncommon nature of this problem and the high recurrence of bony fusion, standardized treatment protocols do not yet exist, making individual reports particularly useful for guiding the first-time management of such patients. In this report, we describe the case of a male infant with complete bony fusion of the right zygomatic maxillary complex to the mandible. Fusion was separated by osteotomy, repair of soft tissue with acellular dermal matrix/grafting, and plate separation. Serial jaw manipulation and operative stretching was necessary to prevent refusion of syngnathia even in the long term.

Comparison of different methods to assess alveolar cleft defects in cone beam CT images.

OBJECTIVES: This study aimed to evaluate the accuracy of three different methods for assessing the volume of cleft defects in CBCT images. The influence of field of view (FOV) and voxel sizes was also assessed. METHODS: Using three radio-opaque plastic skulls, unilateral defects were created to mimic alveolar clefts and were filled with wax following the contralateral side contours. They were scanned in a CBCT unit using four different acquisition protocols, varying FOV and voxel sizes. Using three different methods, the defect/wax volume was evaluated on the images by defining: (1) the width, height and facial-palatal length of the defect in maximum intensity projection; (2) the areas of the defect on axial slices; and (3) the threshold and segmentation of the region of interest. The values obtained from each method using different acquisition protocols were compared with the real volume of the wax (gold standard) using ANOVA and Tukey's test. RESULTS: Methods 2 and 3 did not differ from the gold standard (p > 0.05). Conversely, Method 1 presented statistically significant overestimated values (p < 0.01). No differences were found among the different FOV and voxel sizes (p > 0.05). CONCLUSIONS: CBCT volumes proved reliable for the volumetric assessment of alveolar cleft defects, when using Methods 2 and 3 regardless of FOV and voxel sizes. It may be possible to improve surgical planning and outcomes by knowing the exact volume of grafting material needed prior to the surgical intervention.

Expressão da Osteopontina após utilização de matriz dentinária humana desmineralizada em alvéolos de ratos: análise imunohistoquímica / Osteopontin expression after use of demineralized human dentin matrix in rats alveoli: immunohistochemistry analysis

Apesar de sua capacidade de reparo, o tecido ósseo pode ser submetido a alguns tipos de fraturas, cirurgias ou patologias que podem levar a grandes defeitos ósseos. As principais estratégias de tratamento de defeitos ósseos são baseados em osteoindução ou osteocondução. Matriz dentinária desmineralizada humana (MDDH) é uma alternativa biocompatível para preencher defeitos ósseos, melhorando a qualidade e quantidade de osso produzido. 24 Ratos Wistar foram selecionados, submetidos à extração de ambos os segundos molares superiores (direito e esquerdo). Os alvéolos foram separados em dois grupos: controle (direita) preenchido com coágulo sanguíneo e experimental (esquerda) preenchido com MDDH. Os animais foram sacrificados aos 5, 10 e 21 dias. Foram realizadas análises histológicas, histomorfométricas (análise de variância - ANOVA e teste de Tukey) e imunohistoquímica para osteopontina (OPN) como indicador de osteogênese. Aos 5 dias MDDH foi incorporada pelas novas trabéculas ósseas. Aos 10 dias observou-se organização do tecido conjuntivo e trabéculas no grupo experimental. Detectou-se coloração intensa para OPN em área adjacente à MDDH no grupo experimental. Aos 21 dias no grupo experimental verificou-se trabéculas maduras. Houve diferença estatísticamente significatva (p <0,05). Maior número de trabéculas em grupos experimentais que nos grupos controle em todos os períodos de análise. MDDH implantadas em alvéolos de ratos, induz a aceleração da osteogênese. Presença OPN observada mais intensamente aos 10 dias próximo à MDDH

BACKGROUND - Despite its good capacity for regeneration, bone tissue subjected to some types of fractures or surgery that can lead to large bone defects. The major bone defects treatment strategies are based in osteoinduction or osteoconduction. Demineralized human dentin matrix (DHDM) is a biocompatible alternative to fill bone defect, improving the quantity and quality of bone produced. METHODS - Wistar rats were selected, submitted to the extraction of both second molars (right and left). Alveoli were separated into two groups: control (right) filled with blood clot and experimental (left) filled with DHDM. Animals were sacrificed at 5, 10 and 21 days. Histological and histoquantitative analyzes (analysis of variance - ANOVA, and Tukey's test) were performed and immunostaining for osteopontin (OPN) as osteogenesis indicator. RESULTS - 5 days - DHDM incorporated by new trabeculae. 10 days - connective tissue organization and new trabeculae in the experimental group. Intense staining for OPN close to DHDM in the experimental group. 21 days - experimental group showing mature trabeculae. Statistical difference observed (p<0.05). Higher number of trabeculae in experimental groups in all periods of analysis. CONCLUSIONS - DHDM implanted in alveoli induces the acceleration of osteogenesis. Presence of OPN observed more intensely at 10 days close to DHDM

Dual embryonic origin of maxillary lateral incisors: clinical implications in patients with cleft lip and palate.

INTRODUCTION: Cleft lip and palate are craniofacial anomalies highly prevalent in the overall population. In oral clefts involving the alveolar ridge, variations of number, shape, size and position are observed in maxillary lateral incisors. The objective of this manuscript is to elucidate the embryonic origin of maxillary lateral incisors in order to understand the etiology of these variations.Contextualization: The hypothesis that orofacial clefts would split maxillary lateral incisor buds has been previously reported. However, recent studies showed that maxillary lateral incisors have dual embryonic origin, being partially formed by both the medial nasal process and the maxillary process. In other words, the mesial half of the lateral incisor seems to come from the medial nasal process while the distal half of the lateral incisor originates from the maxillary process. In cleft patients, these processes do not fuse, which results in different numerical and positional patterns for lateral incisors relating to the alveolar cleft. In addition to these considerations, this study proposes a nomenclature for maxillary lateral incisors in patients with cleft lip and palate, based on embryology and lateral incisors position in relation to the alveolar cleft. CONCLUSION: Embryological knowledge on the dual origin of maxillary lateral incisors and the use of a proper nomenclature for their numerical and positional variations renders appropriate communication among professionals and treatment planning easier, in addition to standardizing research analysis.

Dual embryonic origin of maxillary lateral incisors: clinical implications in patients with cleft lip and palate

Introduction:Cleft lip and palate are craniofacial anomalies highly prevalent in the overall population. In oral clefts involving the alveolar ridge, variations of number, shape, size and position are observed in maxillary lateral incisors. The objective of this manuscript is to elucidate the embryonic origin of maxillary lateral incisors in order to understand the etiology of these variations.Contextualization: The hypothesis that orofacial clefts would split maxillary lateral incisor buds has been previously reported. However, recent studies showed that maxillary lateral incisors have dual embryonic origin, being partially formed by both the medial nasal process and the maxillary process. In other words, the mesial half of the lateral incisor seems to come from the medial nasal process while the distal half of the lateral incisor originates from the maxillary process. In cleft patients, these processes do not fuse, which results in different numerical and positional patterns for lateral incisors relating to the alveolar cleft. In addition to these considerations, this study proposes a nomenclature for maxillary lateral incisors in patients with cleft lip and palate, based on embryology and lateral incisors position in relation to the alveolar cleft.Conclusion:Embryological knowledge on the dual origin of maxillary lateral incisors and the use of a proper nomenclature for their numerical and positional variations renders appropriate communication among professionals and treatment planning easier, in addition to standardizing research analysis.

Introdução:as fissuras de lábio e palato são malformações de alta prevalência na população. Nas fissuras que envolvem o rebordo alveolar, o incisivo lateral superior mostra variações de número, forma, tamanho e posição, o que o torna objeto de estudo, na tentativa de elucidar sua origem embrionária para compreender a etiologia dessas alterações.Contextualização:existia a hipótese de que a fissura orofacial seria capaz de segmentar o botão embrionário do incisivo lateral. No entanto, estudos recentes evidenciaram que o incisivo lateral superior possui dupla origem embrionária, sendo formado parcialmente pelo processo nasal medial e pelo processo maxilar. Em outras palavras, a metade mesial do incisivo lateral provém do processo nasal medial, enquanto a metade distal do incisivo lateral origina-se do processo maxilar. No paciente com fissura, não há fusão desses processos, o que resulta nos diferentes padrões numéricos e posicionais do incisivo lateral em relação à fissura. Além dessas considerações, propõe-se também uma nomenclatura para o incisivo lateral em pacientes com fissura labiopalatina, com embasamento na Embriologia, considerando-se sua posição em relação à fissura alveolar.Conclusão:o conhecimento embriológico da dupla origem do incisivo lateral superior e o emprego de uma nomenclatura adequada para as suas variações numéricas e posicionais facilita a comunicação entre profissionais, o planejamento dos casos e possibilita a realização de estudos clínicos comparativos.

The influence of orotracheal intubation on the oral tissue development in preterm infants.

PURPOSE: Preterm children may not be prepared for extra-uterine life and thus need neonatal intensive care, such as artificial ventilation through orotracheal intubation. Oral tissue development changes as a result of the use of an orotracheal tube and its mechanical influence in preterm neonates has not been intensively studied. The purpose of the present study was to determine the association of orotracheal intubation with incidence of oral alterations in preterm infants. MATERIALS AND METHODS: A retrospective cohort of 117 subjects who were born during the period 2002-2003 in Brazil were evaluated and the data were analysed using the Fisher and Mann-Whitney exact tests. A 95% confidence interval was calculated for observed oral conditions. RESULTS: The cohort revealed that the most frequent oral conditions included anterior crossbite, superior alveolar contour and palatal deformation. CONCLUSIONS: The association between the intubated-infant group and the non-intubated-infant group suggested that mechanical trauma had an influence on the oral structure development.

Alveolar bone morphology in patients with bilateral complete cleft lip and palate in the mixed dentition: cone beam computed tomography evaluation.

OBJECTIVES: To verify the thickness and level of alveolar bone around the teeth adjacent to the cleft by means of cone beam computed tomography (CBCT) in patients with complete bilateral cleft lip and palate prior to bone graft surgery and orthodontic intervention. METHOD: The sample comprised 10 patients with complete bilateral cleft lip and palate (five boys and five girls) in the mixed dentition. The mean age was 9.5 years, and all subjects showed a G3 interarch relationship according to the Bauru index. The thickness of alveolar bone surrounding the maxillary incisors and the maxillary canines was measured in CBCT axial section using the software iCAT Xoran System. The distance between the alveolar bone crest and the cement-enamel junction (CEJ) was measured in cross sections. RESULTS: The tomography images showed a thin alveolar bone plate around teeth adjacent to clefts. No bone dehiscence was observed in teeth adjacent to clefts during the mixed dentition. A slight increase in the distance between the alveolar bone crest and the CEJ was observed in the mesial and lingual aspects of canines adjacent to cleft. CONCLUSION: In patients with BCLP in the mixed dentition, teeth adjacent to the alveolar cleft are covered by a thin alveolar bone plate. However, the level of alveolar bone crest around these teeth seems to be normal, and no bone dehiscence was identified at this age.

Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate.

The aim of this study was to determine the applicability of multislice and cone-beam computerized tomography (CT) in the assessment of bone defects in patients with oral clefts. Bone defects were produced in 9 dry skulls to mimic oral clefts. All defects were modeled with wax. The skulls were submitted to multislice and cone-beam CT. Subsequently, physical measurements were obtained by the Archimedes principle of water displacement of wax models. The results demonstrated that multislice and cone-beam CT showed a high efficiency rate and were considered to be effective for volumetric assessment of bone defects. It was also observed that both CT modalities showed excellent results with high reliability in the study of the volume of bone defects, with no difference in performance between them. The clinical applicability of our research has shown these CT modalities to be immediate and direct, and they is important for the diagnosis and therapeutic process of patients with oral cleft.

Secondary alveolar bone grafting: our experience with olecranon bone graft.

Management of alveolar cleft has dramatically changed during the last century: secondary alveolar bone grafting is now an integral part of cleft palate and craniofacial center's protocols. The objectives of alveolar repair and bone grafting are as follows: providing a continuous and stable maxillary dental arch, closure of oronasal fistulae, adequate bone for tooth eruption or orthodontic movement, and nasal base support, improving facial aesthetic. Although cancellous iliac bone is the donor site selected more frequently, bone grafts harvested from different sites have been advocated to decrease donor site morbidity.The aim of this study was to propose and evaluate the use of olecranon as a donor site in 24 patients with secondary alveolar cleft. The graft is taken as a single piece to fit the alveolar cleft defect, and it includes periosteum and corticocancellous bone to improve early vascularization and greater volume maintenance.

Rapid maxillary expansion after secondary alveolar bone grafting in patients with alveolar cleft.

OBJECTIVE: To test the hypothesis that it is possible to perform rapid maxillary expansion (RME) after alveolar bone grafting in patients with clefts of the lip and palate (CLP) without compromising the final result of the bone graft. DESIGN: Occlusal and periapical radiographs of the grafted area of 17 unilateral and 11 bilateral patients with CLP (n = 28) were obtained before and after RME. SETTING AND SAMPLE POPULATION: Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo. Twenty-eighty patients with CLP who had undergone RME. INTERVENTIONS: RME was performed in patients with CLP who had already undergone RME before secondary bone grafting but with relapse of the maxillary dental arch constriction, as well as in patients with CLP who had never undergone expansion before bone grafting. OUTCOME MEASURE: Qualitative evaluation in occlusal and periapical radiographs after alveolar bone grafting. RESULTS: Findings showed opening of the midpalatal suture in 42.8% of patients in this study. Regardless of the success rate of RME, the alveolar bone grafting was not affected when the procedures were inverted. CONCLUSION: The hypothesis was accepted. RME can be performed after secondary alveolar bone grafting without affecting it.

The Tessier number 5 facial cleft: surgical strategies and outcomes in six patients.

The Tessier no. 5 facial cleft is an extremely rare congenital malformation. Only 26 cases have been described in the English-language literature. The cleft begins in the upper lip just medial to the oral commissure, extending across the cheek as a groove ending at the junction of the middle and lateral thirds of the lower eyelid. The bone involvement usually includes an alveolar cleft in the premolar region, extends across the maxilla lateral to the infraorbital nerve, up to the infraorbital rim and orbital floor. The goals of the surgical procedure include reconstructing the lower eyelid, repositioning the lateral canthus, closure of the labiomaxillary cleft, and restoration of the skeletal continuity (including the orbital floor defect) with bone grafts. We present six patients with the Tessier no. 5 facial cleft who have been treated in our combined centers and discuss the surgical options and difficulties faced in the reconstruction of this rare and challenging craniofacial malformation. To date, we have treated six patients (two with bilateral and four with unilateral clefts). Three of the patients with unilateral clefting had an associated no. 4 cleft and one patient with a bilateral cleft had an associated no. 3 cleft. This paper represents the largest series to date documenting surgery for patients with the Tessier no. 5 facial cleft.

Particulate inlay nasal graft with immediate dental implant placement in a patient with repaired alveolar cleft: case report.

Primary bone grafts in congenital cleft alveolus do not always provide sufficient bulk or height of bone for ideal placement of endosseous implants. Thus, maxillary sinus or nasal floor elevation and inlay bone grafts in previously grafted areas are not exceptions in the daily routine. This case report stresses the need of a detailed treatment plan and careful surgical management of nasal floor elevation with particulate autogenous bone graft to successfully provide the patient with osseointegrated prostheses.

Prevalence of a Simonart's band in patients with complete cleft lip and alveolus and complete cleft lip and palate.

OBJECTIVE: To investigate the prevalence of the presence of a soft tissue bridge (Simonart's band) in patients with complete cleft lip and alveolus and complete cleft lip and palate. DESIGN: Cross-sectional. SAMPLE: We assessed 407 consecutive unoperated patients first attending the Hospital for Rehabilitation of Craniofacial Anomalies of University of São Paulo, in Bauru, São Paulo, Brazil, in the year 2000. The patients were classified as presenting complete cleft of the primary palate or of the primary and secondary palate, unilateral or bilateral, as follows: unilateral cleft lip, bilateral cleft lip, unilateral cleft lip and palate, and bilateral cleft lip and palate. METHOD: Clinical examination. The band was considered as present whenever there was a soft tissue bridge between the separated alveolar ridges, regardless of volume and position. Results were analyzed by descriptive statistics and were expressed as percentages, according to the type of cleft. CONCLUSION: 31.2% of patients presented with Simonart's band. The band was observed more frequently in patients with unilateral clefts than in patients with bilateral clefts, and in patients with complete cleft lip and alveolus than in patients with complete cleft lip and palate.

Long-term radiographic assessment of secondary alveolar bone grafting outcomes in patients with alveolar clefts.

OBJECTIVE: The objective of this study was to assess the outcomes of secondary alveolar bone grafting (SABG) in patients with complete, unilateral cleft lip and palate (UCLP) operated on before eruption of the permanent canine. STUDY DESIGN: Sixty-five periapical radiographs from 41 patients with left UCLP and 24 with right UCLP (9 to 12 years old at SABG), were analyzed retrospectively for the amount of bone in the cleft site according to the Bergland and Chelsea scales, and for the occurrence of canine eruption (CE) through the neoformed bone. RESULTS: Of the cases, 71% were classified as Bergland type I and Chelsea type A; 15% as types II/C, and 14% could not be classified. CE was observed in 95% of the cases operated on 4 years before the study. CONCLUSIONS: SABG performed before CE is a procedure with a high rate of success. The radiographic scales proved to be important instruments for assessing surgical outcomes.

Reduction of bone resorption by the application of fibrin glue in the reconstruction of the alveolar cleft.

A major complication in 30% to 75% of cases of surgical treatment of alveolar cleft is resorption of the bone graft. A treatment alternative is the application of fibrin glue, which has the capacity to favor the integration of the graft. The main objective of the study was to evaluate if the use of the fibrin glue reduces bone resorption when it is applied locally. The authors designed a randomized clinical trial. Patients were divided into two groups: group 1, fibrin glue; and group 2, control. Pre- and postoperative graft volume, bone density, bone quality (Lekholm and Zarb, and Norton and Gamble classifications), and postoperative complications were evaluated. The follow-up for all patients was 3 months after discharge. Twenty-seven patients were surgically treated, 13 in group 1 and 14 in group 2. Group 1 had increased graft volume compared with group 2 (64.32 cm v 21.70 cm; P < 0.0001). Bone density was higher in group 1 than in group 2 (396.57 v 245.68; P > 0.076). Bone quality was type 1, 2 and 3 and 4 in group 1. Resorption in group 2 was 62.26%; in group 1, it was 29.72% (P > 0.081). The observed complications were infection and dehiscence of sutures (P > 0.537). The authors conclude that the fibrin glue significantly diminishes bone resorption, allowing improved graft integration and quality.