RESUMEN
Presentamos un caso clínico donde, utilizando implantes subperiósticos o supraóseos, es decir, estructuras metálicas tridimensionales personalizadas de titanio fabricadas de forma digital, hemos conseguido realizar dos objetivos a la vez: 1) la corrección de una severa deformidad facial, y 2) dotar a la paciente de fijaciones o implantes para la rehabilitación implantosoportada de su edentulismo maxilar completo. No tenemos constancia de ningún caso similar publicado en la literatura a día de hoy.Creemos que esta nueva técnica, relativamente sencilla, puede ser una alternativa a las cirugías complejas que involucran el empleo de complicados injertos óseos, con el consiguiente ahorro en tiempo y morbilidad para los pacientes que asocian hipoplasia maxilar y edentulismo con grave atrofia ósea. (AU)
We present a clinical case in which, using subperiosteal or supraosseous implants, that is to say, three-dimensional personalized metallic titanium structures manufactured digitally, we have managed to achieve two objectives at the same time: 1) correction of a severe facial deformity, and 2) furnish the patient with fixations or implants for the implant-supported rehabilitation of her complete maxillary edentulism. We are not aware of any similar case published in the literature to date.We believe that this new, relatively simple technique can be an alternative to complex surgeries that involve the use of complicated bone grafts, with the consequent savings in time and morbidity for patients who associate maxillary hypoplasia and edentulism with severe bone atrophy. (AU)
Asunto(s)
Humanos , Implantación Dental Subperióstica , Cirugía Ortognática , Trasplante Óseo/rehabilitación , Anomalías Congénitas , Maxilar/cirugíaRESUMEN
Antecedentes: Este estudio tenía como objetivo aclarar la aparición y las causas de complicaciones postoperatorias en pacientes con defectos mandibulares continuos, reconstruidos con injertos óseos ilíacos libres. Pacientes y métodos: Los pacientes con defecto de continuidad mandibular con pérdida de tejido óseo, que dio lugar a una brecha de 2 cm o más, se sometieron a reconstrucción con injerto óseo de cresta ilíaca no vascularizado. La variable de resultado fue el fracaso del injerto, que se definió como su pérdida por infección postoperatoria, exposición del injerto, reabsorción completa o no unión del injerto. Los factores predictivos fueron el momento de la reconstrucción, la longitud del defecto óseo, la presencia preoperatoria de defecto mucoso y/o dehiscencia y el método de fijación. Todas las variables explicativas y predictoras se analizaron mediante regresión logística binomial univariante.Resultados: El estudio incluyó los resultados de 50 reconstrucciones mandibulares con injerto óseo de cresta ilíaca no vascularizado que se observaron retrospectivamente. El seguimiento de los pacientes incluidos osciló entre 6 meses y 11 años. 34 pacientes (68 %) tuvieron resultados quirúrgicos satisfactorios. En 16 pacientes (32 %) se perdieron los injertos óseos. Todos ellos debido al desarrollo de infección, supuración y/o exposición del injerto durante los primeros 6 meses del periodo de observación. En el análisis univariante, las principales variables predictoras de fracaso fueron el tabaquismo (OR 5,8; IC: 1,48-22,7; p = 0,002), el momento de la reconstrucción (OR 7,94; IC: 1,88-33,5; p = 0,004) y el defecto o dehiscencia de la mucosa (OR 8,49; IC: 2,21-32,6; p = 0,002). El análisis multivariante también reveló la afectación sinfisaria del defecto (OR 5,63; IC: 1,14-27,8; p = 0,034) como factor predictivo significativo de fracaso en un caso de reconstrucción inmediata. ... (AU)
Background: This study aimed to clarify the occurrence and causes of postoperative complications in patients with continuous mandibular defects, reconstructed with free iliac bone grafts.Patients and methods: Patients with mandibular continuity defect with bone tissue loss, resulting in a 2 cm gap or more underwent reconstruction with non-vascularized iliac crest bone graft. The outcome variable was graft failure which was defined as its loss due to the postoperative infection, graft exposure, full resorption or non-unition of the graft. The predictors were timing of reconstruction, length of the bone defect, preoperative presence of mucosa defect and/or dehiscence and fixation method. All explanatory and predictor variables were analyzed with univariate binomial logistic regression.Results: The study included the results of 50 mandibular reconstructions with non-vascularized iliac crest bone graft which were observed retrospectively. The follow-up of included patients ranged from 6 months to 11 years. 34 patients (68 %) had successful surgery results. In 16 patients (32 %) the bone grafts were lost. All of them due to the infection development, suppuration and/or graft exposure during the first 6-months of the observation period. In univariate analysis, the main failure predictor variables were smoking (OR 5.8, CI 1.48-22.7, p = 0.002), timing of reconstruction (OR 7.94, CI 1.88-33.5, p = 0.004) and mucosa defect or dehiscence (OR 8.49, CI 2.21-32.6, p = 0.002). The multivariate analysis also revealed symphyseal involvement of defect (OR 5.63, CI 1.14-27.8, p = 0.034) as the significant failure predictor in a case of immediate reconstruction. The length of defect and fixators type remained statistically non-significant for mandibular reconstruction with NVICG (p < 0.05).Conclusion: ... (AU)
Asunto(s)
Humanos , Trasplante Óseo/efectos adversos , Trasplante Óseo/rehabilitación , Anomalías Maxilomandibulares/cirugía , Anomalías Maxilomandibulares/terapia , Estudios RetrospectivosRESUMEN
The postoperative rehabilitation team plays a crucial role in optimizing outcomes after articular cartilage surgery. A comprehensive approach to postoperative physical therapy that considers the type of surgery, location in the knee, concurrent procedures, and patient-specific factors is imperative. While postoperative rehabilitation protocols should be specific to the patient and type of surgery performed and include phased rehabilitation goals and activities, the key principles for postoperative rehabilitation apply across the spectrum of articular cartilage surgeries and patients. These key principles consist of preoperative assessments that include physical, mental, and behavioral components critical to recovery; education and counseling with respect to expectations and compliance; and careful monitoring and adjustments throughout the rehabilitation period based on consistent communication among rehabilitation, surgical, and imaging teams to ensure strict patient compliance with restrictions, activities, and timelines to optimize functional outcomes after surgery.
Asunto(s)
Cartílago Articular/cirugía , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/cirugía , Procedimientos Ortopédicos/rehabilitación , Artroplastia Subcondral/rehabilitación , Trasplante Óseo/rehabilitación , Cartílago Articular/lesiones , Trasplante de Células/rehabilitación , Condrocitos/trasplante , Humanos , Educación del Paciente como Asunto , Cuidados Posoperatorios , Periodo Posoperatorio , Cuidados Preoperatorios , Recuperación de la Función , Trasplante Autólogo/rehabilitación , Trasplante Homólogo/rehabilitaciónRESUMEN
Arthroscopic Latarjet is a relatively new, but viable option for the treatment of anterior shoulder instability. Arthroscopic Latarjet has the advantage of faster recovery, reduced stiffness, identification of additional shoulder pathology, and improved cosmesis when compared with open Latarjet. By the majority of clinical and radiographic parameters, arthroscopic Latarjet produces equivalent outcomes compared with open Latarjet. A relatively substantial learning curve for arthroscopic Latarjet exists at about 25 cases; however, multiple studies have demonstrated comparable outcomes and surgical time after the learning curve.
Asunto(s)
Artroscopía/métodos , Trasplante Óseo/métodos , Inestabilidad de la Articulación/cirugía , Articulación del Hombro/cirugía , Artroscopía/rehabilitación , Trasplante Óseo/rehabilitación , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Luxación del Hombro , Articulación del Hombro/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Introducción: En el presente estudio se evalúa la densidad ósea alcanzada, mediante las unidades Hounsfield, por un nuevo biomaterial, compuesto por fosfato cálcico con agregado de silicio, en comparación con la hidroxiapatita de origen bovino en la preservación alveolar pos-textracción. La preservación alveolar pos-textracción se presenta como una técnica quirúrgica dirigida a reducir el colapso del reborde alveolar tras la extracción dental mediante la utilización de un biomaterial. La finalidad del tratamiento es facilitar la posterior rehabilitación implantológica. Material y método: Se llevó a cabo un estudio sobre 6 pacientes procedentes de la Facultad de Odontología de la Universidad Complutense de Madrid a los que se les realizó la técnica de preservación alveolar postextracción. Se establecieron dos grupos: un grupo test en el que el alveolo se rellenó con fosfato cálcico con agregado de silicio y un grupo control en el que se rellenó con hidroxiapatita de origen bovino. Transcurridos 3 meses, se realizó una tomografía computerizada de haz de cono para evaluar la densidad ósea alcanzada por los biomateriales. Resultados: La densidad mineral media alcanzada en el grupo tratado con fosfato cálcico con agregado de silicio fue de 1.100,40 ± 111,19 unidades Hounsfield, mientras que en el grupo que fue tratado con hidroxiapatita de origen bovino fue de 1.029,46 ± 95,16 unidades Hounsfield. Conclusiones: Ambos biomateriales parecen presentar un comportamiento similar en cuanto a los resultados densitométricos obteniendo una densidad superior a 1.000 unidades Hounsfield, siendo el fosfato cálcico con agregado de silicio el que mayor densidad presenta
Introduction: In the present study, bone density from the new biomaterial composed by calcium phosphate and added silica is compared with bovine hydroxyapatite by means of Hounsfield units in alveolar ridge preservation. Alveolar ridge preservation is a surgical technique proposed to reduce bone resorption caused by dental extraction, using a bone graft. This technique ́s final goal is to facilitate implant insertion and rehabilitation. Materials and methods: A study was carried out on 6 patients from the Faculty of Dentistry of the Complutense University of Madrid performing the technique of alveolar ridge preservation. Two groups were established, a test group in which the alveolar socket was filled with calcium phosphate and added silica and a control group where the socket was filled with bovine hydroxyapatite. After 3 months, a cone-beam computed tomography was performed to evaluate the bone density achieved by both biomaterials. Results: The average bone density achieved in the group treated with calcium phosphate and added silica was 1100,40 ± 111,19 Hounsfield units whereas in the group treated with bovine hydroxyapatite the average bone density was 1029,46 ± 95,16 Hounsfield units. Conclusions: Both biomaterials seem to present a similar behaviour in terms of densitometric results obtaining a density greater than 1000 Hounsfield units, having the calcium phosphate and added silica the highest density
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Densitometría , Materiales Biocompatibles/uso terapéutico , Fosfatos de Calcio/uso terapéutico , Durapatita/uso terapéutico , Proyectos Piloto , Estudios de Cohortes , Densidad Ósea , Extracción Dental , Implantes Dentales , Trasplante Óseo/métodos , Trasplante Óseo/rehabilitación , Estudios RetrospectivosRESUMEN
PURPOSE: To report current data on return-to-sport rates and sports-specific patient-reported outcomes after osteochondral allograft (OCA) transplantation for cartilage defects of the knee. METHODS: We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines that included studies from 1975 to 2018 with a minimum 2-year mean follow-up that reported return-to-sport rates or sports-specific patient-reported outcomes. Outcomes, reoperations, and complications were provided in table format, and a subjective analysis was performed. RESULTS: This review included 13 studies with 772 patients who underwent OCA transplantation at a mean of 24 to 91 months' follow-up. The return-to-sport rate ranged from 75% to 82%. For patient-reported outcomes, the Knee Injury and Osteoarthritis Score Sport increased in 4 studies, the Tegner activity scale score increased in 3 studies but decreased in 1, and the Marx activity scale score increased in 1 study but decreased in 2. Studies reporting improvements in the Cincinnati Knee Score and Knee Injury and Osteoarthritis Score Sport reached the minimal clinically important difference. The reoperation rate was high (ranging from 34% to 53% in more than half of studies), with reoperations primarily performed for loose body removal or debridement. CONCLUSIONS: This systematic review of 13 studies suggests that OCA transplantation for cartilage defects allows most athletes to return to sport (range, 75%-82%). Most studies reported improvements in sports-specific patient-reported outcomes at follow-up and reached the minimal clinically important difference. However, the reoperation rate was high in several studies, with a large percentage of patients requiring loose body removal or debridement. The long-term survival of the allografts is largely unknown, but this study suggests OCA transplantation consistently improves function in athletes with chondral injuries. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.
Asunto(s)
Traumatismos en Atletas/cirugía , Trasplante Óseo/métodos , Cartílago Articular/lesiones , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/cirugía , Volver al Deporte , Traumatismos en Atletas/rehabilitación , Trasplante Óseo/efectos adversos , Trasplante Óseo/rehabilitación , Cartílago Articular/cirugía , Estudios de Seguimiento , Humanos , Cartílago Hialino/trasplante , Traumatismos de la Rodilla/complicaciones , Traumatismos de la Rodilla/rehabilitación , Escala de Puntuación de Rodilla de Lysholm , Osteoartritis de la Rodilla/etiología , Medición de Resultados Informados por el Paciente , Complicaciones Posoperatorias/etiología , Reoperación/estadística & datos numéricosRESUMEN
PURPOSE: The aim of this study was to describe the surgical technique of immediate dental implant placement in calvarial grafts for augmentation of the severely resorbed maxilla and to assess the treatment results. METHODS: In 13 patients the maxilla was augmented with calvarial bone followed by simultaneous dental implant placement (total: 68 implants). In the frontal "knife edge" region, implants were inserted in the buccal plated area. In the maxillary sinus area, implants were inserted into alveolar bone that was plated buccally or palatally through the sinus window. After 4 months, the implants were retrieved and subsequently loaded. Per-operative and post-operative variables were scored. One bone biopsy sample was taken for histological analysis. RESULTS: The surgical procedure and wound healing was uneventful. During abutment connection after 4 months, all implants were fully osseointegrated with no signs of graft resorption. Radiographically, the mean (±SD) peri-implant bone loss after 1 year of functional loading was 0.23 ± 0.44 mm. No implants were lost. Histological examination revealed vital calvarial and maxillary bone with active remodeling. CONCLUSION: Immediate dental implant placement in calvarial bone grafts to rehabilitate severely resorbed maxilla is technically feasible and seems to have a high success rate.
Asunto(s)
Trasplante Óseo/métodos , Trasplante Óseo/rehabilitación , Implantación Dental Endoósea/métodos , Implantes Dentales , Carga Inmediata del Implante Dental/métodos , Arcada Edéntula/cirugía , Maxilar/cirugía , Oseointegración , Anciano , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/patología , Aumento de la Cresta Alveolar/métodos , Biopsia , Pilares Dentales , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Femenino , Humanos , Arcada Edéntula/diagnóstico por imagen , Arcada Edéntula/patología , Masculino , Maxilar/diagnóstico por imagen , Maxilar/patología , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Cicatrización de HeridasRESUMEN
To prevent post-extraction resorption and preserve the integrity of the alveolar ridges, the placement of bone grafts at the time of extraction is recommended. Bovine bone grafts are biocompatibile and osteoconductive, allowing new bone apposition by osteoprogenitor cells. Although there are trademarks recognized internationally regarding bovine bone grafts, they are expensive and even difficult to acquire. Therefore, domestic industry development of high quality biomaterials will reduce the public health high costs in the dental field. Here, we evaluated and compared the effects of an Argentinean manufactured bovine bone graft (Synergy Bone Matrix) with a bovine bone graft recognized for its osteoconductive effects (Bio-Oss), on bone healing in an experimental model in rats. We created critical sized bone defects in rat tibiae and filled them with either one of the bovine bone grafts or control. Clinical responses, X-ray findings, bone mineral density, and histological parameters were evaluated. No abscess, encapsulation, suppuration or inflammation of lymphatic nodes were observed. Radiographically, all implants were amalgamated to the surrounding bony margins, suggesting proper healing. On the other hand, control tibiae exhibited no signs of recovery and remained either unfilled or showed fibrous tissue formation. No statistical differences were observed in BMC and BMD between tibiae filled with Synergy Bone Matrix or Bio-Oss. Histological analysis revealed particles of both bone grafts surrounded by laminar bone tissue indicating osteoconductivity, without any inflammatory sign. This preliminary study suggests that Synergy Bone Matrix, as well as Bio-Oss, present similar properties of biocompatibility and osteoconductivity. (AU)
Para prevenir la resorción post-exodoncia y preservar la integridad de los rebordes alveolares, se recomienda la colocación de injertos óseos en el momento de la extracción. Los injertos de hueso bovino son biocompatibles y osteoconductivos, permitiendo nueva aposición ósea por células osteoprogenitoras. Existen marcas internacionales de injertos de hueso bovino, pero resultan caros e incluso difíciles de adquirir. Por ello, la elaboración de biomateriales de alta calidad, nacionales, reduciría los altos costos de salud pública en odontología. En este estudio, se evaluaron y compararon los efectos de un injerto de hueso bovino fabricado en Argentina (Synergy Bone Matrix) versus un injerto de hueso bovino reconocido por sus efectos osteoconductivos (Bio-Oss), en el proceso de cicatrización ósea en un modelo experimental en ratas. Para ello, creamos un defecto óseo crítico en tibia de rata el cual se rellenó con uno de los injertos de hueso bovino o control. Se evaluó: respuesta clínica y radiográfica, densidad mineral ósea e histología. No se observaron abscesos, encapsulación, supuración o inflamación de los ganglios linfáticos. Radiográficamente, todos los implantes se integraron a los márgenes óseos circundantes, sugiriendo una cicatrización adecuada. Por el contrario, las tibias control no mostraron signos de recuperación con formación de tejido fibroso. No se observaron diferencias estadísticas en las BMC y BMD entre las tibias Synergy Bone Matrix o Bio-Oss. La histología reveló partículas de ambos injertos óseos rodeadas por tejido óseo laminar indicando osteoconductividad sin signos inflamatorios. Este estudio preliminar sugiere que Synergy Bone Matrix presenta propiedades similares de biocompatibilidad y osteoconductividad que Bio-Oss. (AU)
Asunto(s)
Animales , Ratas , Tibia/citología , Materiales Biocompatibles/uso terapéutico , Resorción Ósea/prevención & control , Trasplante Óseo/veterinaria , Argentina , Radiología , Cirugía Bucal , Desarrollo Óseo , Enfermedades del Desarrollo Óseo/inducido químicamente , Enfermedades del Desarrollo Óseo/diagnóstico por imagen , Densidad Ósea , Trasplante Óseo/rehabilitación , Ratas Wistar/anatomía & histología , Ratas Wistar/cirugía , Ketamina/administración & dosificación , Acepromazina/administración & dosificación , Ganglios Linfáticos/diagnóstico por imagenRESUMEN
The aim of the present study was to clinically evaluate whether the presence of subchondral cysts had an effect on the treatment results of autologous osteochondral graft transfer in osteochondral lesions of the talus. Patients were enrolled in the present study according to the inclusion criteria. In the evaluation, we divided the patients into 2 groups according to presence (n = 13 patients) or absence (n = 15 patients) of a subchondral cyst. The mean age, body mass index, follow-up period, and lesion size in each group were measured and compared, and no statistically significant differences were found between the 2 groups (p > .05). The clinical assessment was performed using the American Orthopaedic Foot and Ankle Society Hindfoot scoring system, visual analog scale, and International Knee Society scoring system. No statistically significant difference was found between the pre- and postoperative scores of the 2 patient groups (p > .05). The successful results in both groups after a 2-year follow-up period have demonstrated that treatment of osteochondral lesions of the talus with osteochondral graft transfer is a safe method that can be performed independently of the presence of a subchondral cyst.
Asunto(s)
Quistes Óseos/cirugía , Trasplante Óseo/métodos , Osteocondritis Disecante/cirugía , Astrágalo/cirugía , Adolescente , Adulto , Quistes Óseos/diagnóstico por imagen , Trasplante Óseo/rehabilitación , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Osteocondritis Disecante/diagnóstico por imagen , Dolor/fisiopatología , Dolor/cirugía , Dimensión del Dolor , Cuidados Posoperatorios/métodos , Estudios Retrospectivos , Medición de Riesgo , Férulas (Fijadores) , Estadísticas no Paramétricas , Astrágalo/diagnóstico por imagen , Trasplante Autólogo , Resultado del Tratamiento , Adulto JovenRESUMEN
This article demonstrates a technique for the treatment of scaphoid fracture waist and proximal pole nonunions with avascular necrosis using a free vascularized medial femoral condyle flap. We present our surgical technique and representative case examples in which the scapholunate ligament, a key structure required to preserve carpal kinematics, is spared.
Asunto(s)
Trasplante Óseo/métodos , Fracturas no Consolidadas/cirugía , Colgajos Tisulares Libres , Osteonecrosis/cirugía , Hueso Escafoides/cirugía , Adulto , Trasplante Óseo/rehabilitación , Fémur/irrigación sanguínea , Fémur/trasplante , Colgajos Tisulares Libres/irrigación sanguínea , Humanos , Ligamentos Articulares/cirugía , Masculino , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/rehabilitación , Hueso Escafoides/lesiones , Adulto JovenRESUMEN
A instalação de implantes em áreas com perda óssea pode estar associada a uma relação coroa-implante desfavorável, resultado estético insatisfatório e dificuldades de higienização, prejudicando o prognóstico do tratamento. O enxerto ósseo possibilita a instalação de implantes em uma posição tridimensional favorável. Alguns métodos têm sido estudados e propostos para a reconstrução do osso alveolar perdido: enxertos ósseos autógenos, homógenos, substitutos ósseos alógenos, xenógenos e aloplásticos. Ainda existe a regeneração óssea guiada, distração osteogênica, fatores de crescimento e as combinações destas referidas metodologias. Dentre os materiais disponíveis, o osso autógeno é tido como primeira opção para a reconstrução óssea,tido como padrão ouro em enxertia óssea, pois fornece as condições mais favoráveis de reparo pós-cirúrgico, por apresentar as propriedades de osteocondução, osteoindução e osteogênese,auxiliando na correção de defeitos de espessura, desde que haja um bom suprimento vascular no local. Neste trabalho é demonstrada uma técnica de enxertia óssea em bloco autógeno, através da realização de um caso clínico, para a reconstrução de maxila atrófica, visando o aumento do volume ósseo disponível para a instalação de implantes dentais.
The installation of implants in areas of bone loss may be associated with an unfavorable ratiocrown-implant, unsatisfactory aesthetic result and cleaning difficulties, impairing treatment prognosis. The bone graft allows the installation of implants in a favorable three-dimensional position. Some methods have been studied and proposed for the reconstruction of lost alveolar bone: autogenous bone grafts, homogeneous bone, allogenic, xenogenous and alloplasticbone substitutes. There is still the guided bone regeneration, distraction osteogenesis, growth factors and combinations of these referred methodologies. Among the materials available, the autogenous bone is considered as the first option for bone reconstruction, considered the gold standard in bone grafting because it provides the most favorable conditions for post-surgical repair, presenting the properties of osteoconductive, osteoinductive and osteogenesis, helping the correction of the defects of thickness, since there is a good blood supply in the area. Thiswork shows a bone grafting technique in autogenous block by performing a case for the reconstruction of atrophic maxilla, in order to increase bone volume available for the installation of dental implants.
Asunto(s)
Humanos , Masculino , Femenino , Trasplante Óseo/clasificación , Trasplante Óseo , Trasplante Óseo/efectos adversos , Trasplante Óseo/instrumentación , Trasplante Óseo/métodos , Trasplante Óseo/normas , Trasplante Óseo/rehabilitación , Trasplante ÓseoRESUMEN
La necesidad de una reconstrucción mandibular está dictada por la pérdida de hueso debido, entre otras causas, a trauma. El propósito de este trabajo es caracterizar un caso de reconstrucción mandibular de una deformidad posquirúrgica por trauma. Se trata de un paciente masculino de 34 años que acude a consulta por inconformidad estética y dificultad para masticar. Aproximadamente un año atrás había padecido un trauma facial, por lo cual fue atendido de urgencia e intervenido quirúrgicamente. Se realizó estabilización ósea y colocación de placa de reconstrucción mandibular. Presentaba asimetría facial, disminución del tercio inferior facial y movilidad de los segmentos óseos mandibulares, por tal motivo se decide realizar retirada de la placa existente, reacomodamiento de los segmentos óseos, colocación de injerto autólogo de cresta ilíaca y fijación. Se observó buena evolución posoperatoria. La repercusión estética y funcional, en un paciente joven con una deformidad posquirúrgica por trauma; motivó el planeamiento de una reconstrucción mandibular mediante placa rígida e injerto de creta ilíaca. El tratamiento de este caso constituyó un reto profesional por tratarse de una deformidad posquirúrgica provocada por un trauma de alta energía; pero el trabajo quirúrgico en equipo aseguró resultados satisfactorios(AU)
The need for mandibular reconstruction is dictated by bone loss due to trauma among other causes. The purpose of the study was to present a case of mandibular reconstruction of a post-surgical deformity due to trauma. A 34-year-old male patient presents with dissatisfaction with his dentofacial appearance and difficulty chewing. About one year before he had undergone facial trauma, for which had been cared for at the emergency service and had been operated on. Bone stabilization was performed as well as placement of a mandibular reconstruction plate. The patient presented facial asymmetry, a diminished lower facial third and mobility in mandibular bone segments. Therefore, it was decided to perform removal of the existing plate, rearrangement of the bone segments, placement of an autologous iliac crest bone graft and surgical fixation. Good post-operative evolution was observed. Esthetic and functional impairment in a young patient with a post-surgical deformity due to trauma led to planning a mandibular reconstruction with a rigid plate and an iliac crest graft. Treatment in this case was professionally challenging, for the post-surgical deformity had been due to high energy trauma, but the surgical work performed ensured satisfactory results(AU)
Asunto(s)
Humanos , Masculino , Adulto , Trasplante Óseo/rehabilitación , Traumatismos Faciales/cirugía , Reconstrucción Mandibular/efectos adversos , Dispositivos de Fijación Quirúrgicos/estadística & datos numéricosRESUMEN
Os implantes osseointegrados promoveram importantes mudanças nas formas de reabilitação de pacientes parcial ou totalmente desdentados. Os pacientes totalmente desdentados apresentam clara predileção pelas próteses fixas implantossuportadas, sobretudo porque estas proporcionam maior eficiência mastigatória e conforto, menos reparo e manu-tenção, além de favorecer o aspecto psicológico, uma vez que eliminam o caráter removível das overdentures. Dentre os possíveis desenhos de próteses fixas, as do tipo protocolo são as que apresentam maior aplicação clínica, e se caracterizam na maxila pela instalação de 6 a 8 implantes. Nesse tipo de prótese utiliza-se uma infraestrutura metálica e uma base de resina acrílica para juntá-la aos dentes artificiais. O objetivo deste trabalho foi relatar um caso clínico de reabilitação oral com prótese total fixa tipo protocolo superior e próteses unitárias metalocerâmicas inferiores, em que foram adotados critérios bem definidos de diagnóstico e planejamento, e empregadas técnicas cirúrgicas e protéticas com fundamentação científica.
Dental implants have promoted important changes on the rehabilitation of partial or complete edentulous patients. Edentulous patients have a clear preference for implantsupported prostheses, mainly because they provide greater masticatory efficiency and comfort with less repair and maintenance, besides the improvement of psychological aspect since they eliminate the removable character of overdentures. Among the possible designs of fixed prostheses, protocol-type prostheses are those with highest clinical application. This type of prosthesis in the jaw is characterized by the installation of 6 to 8 implants using a metal structure and an acrylic resin base to attach it to the artificial teeth. The objective of this study was to report a case of oral rehabilitation using a maxillary protocol-type fixed denture and mandibular metaloceramic single elements, performed with precise criteria for diagnosis and planning as well as science-based techniques.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Trasplante Óseo/rehabilitación , Implantes Dentales , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Rehabilitación Bucal , OseointegraciónRESUMEN
Objetivo. La artroplastia invertida se está convirtiendo en una herramienta útil para afecciones muy variadas en el hombro. Un defecto óseo importante de la glena puede afectar a la fijación del componente glenoideo. El propósito de nuestro estudio es evaluar a medio plazo los resultados de la artroplastia invertida de hombro asociados a una glenoplastia. Material y métodos. Se realizó un estudio retrospectivo de 5 pacientes de nuestro hospital con defectos glenoideos de distinta etiología que fueron tratados mediante artroplastia invertida de hombro asociada a glenoplastia. Resultados. El seguimiento mínimo de estos pacientes fue de un año (con una media de 30,4 meses). Todos los injertos estaban radiológicamente integrados, sin observarse signos de resorción o necrosis. A los 12 meses el test de Constant era de 66,75 de media y el EVA medio era de 1. Discusión. La glenoplastia es una intervención de alta demanda técnica que consigue restaurar el remanente óseo en pacientes con defectos estructurales, permitiendo así implantar una artroplastia invertida. De esa forma podemos mejorar la función y la clínica en pacientes con diversas afecciones glenohumerales, proporcionándoles una solución (AU)
Objective. Reverse shoulder arthroplasty is becoming a useful tool for many diseases of the shoulder. Any severe glenoid bone defect may affect the fixing of the glenoid component. The aim of this paper is to evaluate the medium-term outcomes of reverse shoulder arthroplasty associated with a glenoplasty. Materials and methods. A retrospective study was conducted on 5 patients from our hospital, selected due to glenoid defects of different etiology. All of them where treated with reverse shoulder arthroplasty associated with glenoplasty with bone graft. Results. The minimum follow-up was one year (mean 30.4 months). All grafts were radiologically integrated, with no signs of resorption or necrosis being observed. At 12 months, the Constant score was 66.75 and the mean EVA score was 1. Discussion. Glenoplasty surgery is technically demanding for restoring original bone size in patients with glenoid structural defects, enabling a reverse shoulder arthroplasty to be implanted. Thus improving both the function and clinical outcomes in selected patients with glenohumeral pathology and providing them with a solution (AU)
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Hombro/anomalías , Hombro/fisiopatología , Hombro/cirugía , Artroplastia/instrumentación , Artroplastia/métodos , Artroplastia de Reemplazo/métodos , Trasplante Óseo/instrumentación , Trasplante Óseo/métodos , Oseointegración/fisiología , Trasplante Óseo/rehabilitación , Trasplante Óseo , Cavidad Glenoidea/anomalías , Cavidad Glenoidea/trasplante , Articulación del Hombro/anomalías , Articulación del Hombro/cirugía , Estudios RetrospectivosRESUMEN
La necesidad de una reconstrucción mandibular está dictada por la pérdida de hueso debido, entre otras causas, a trauma. El propósito de este trabajo es caracterizar un caso de reconstrucción mandibular de una deformidad posquirúrgica por trauma. Se trata de un paciente masculino de 34 años que acude a consulta por inconformidad estética y dificultad para masticar. Aproximadamente un año atrás había padecido un trauma facial, por lo cual fue atendido de urgencia e intervenido quirúrgicamente. Se realizó estabilización ósea y colocación de placa de reconstrucción mandibular. Presentaba asimetría facial, disminución del tercio inferior facial y movilidad de los segmentos óseos mandibulares, por tal motivo se decide realizar retirada de la placa existente, reacomodamiento de los segmentos óseos, colocación de injerto autólogo de cresta ilíaca y fijación. Se observó buena evolución posoperatoria. La repercusión estética y funcional, en un paciente joven con una deformidad posquirúrgica por trauma; motivó el planeamiento de una reconstrucción mandibular mediante placa rígida e injerto de creta ilíaca. El tratamiento de este caso constituyó un reto profesional por tratarse de una deformidad posquirúrgica provocada por un trauma de alta energía; pero el trabajo quirúrgico en equipo aseguró resultados satisfactorios(AU)
The need for mandibular reconstruction is dictated by bone loss due to trauma among other causes. The purpose of the study was to present a case of mandibular reconstruction of a post-surgical deformity due to trauma. A 34-year-old male patient presents with dissatisfaction with his dentofacial appearance and difficulty chewing. About one year before he had undergone facial trauma, for which had been cared for at the emergency service and had been operated on. Bone stabilization was performed as well as placement of a mandibular reconstruction plate. The patient presented facial asymmetry, a diminished lower facial third and mobility in mandibular bone segments. Therefore, it was decided to perform removal of the existing plate, rearrangement of the bone segments, placement of an autologous iliac crest bone graft and surgical fixation. Good post-operative evolution was observed. Esthetic and functional impairment in a young patient with a post-surgical deformity due to trauma led to planning a mandibular reconstruction with a rigid plate and an iliac crest graft. Treatment in this case was professionally challenging, for the post-surgical deformity had been due to high energy trauma, but the surgical work performed ensured satisfactory results(AU)
Asunto(s)
Humanos , Masculino , Adulto , Reconstrucción Mandibular/efectos adversos , Traumatismos Faciales/cirugía , Dispositivos de Fijación Quirúrgicos , Trasplante Óseo/rehabilitaciónRESUMEN
The technique of osteochondral allograft (OCA) transplantation has been used to treat a wide spectrum of cartilage deficiencies in the knee. Its use has been supported by basic science and clinical studies that show it is a safe and effective treatment option. What sets fresh OCA transplantation apart from other cartilage procedures in the knee, is the ability to treat large defects with mature hyaline cartilage. Studies looking at transplantation of fresh OCAs in the general population have shown reliable pain relief and return to activities of daily living. Reports of cartilage injuries in athletes have risen over the years and more research is needed in evaluating the successfulness of OCA transplantation in the athletic population.
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Trasplante Óseo , Cartílago Hialino/trasplante , Articulación de la Rodilla/cirugía , Trasplante Óseo/rehabilitación , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/lesiones , Cartílago Articular/cirugía , Fémur/cirugía , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Imagen por Resonancia Magnética , Trasplante Homólogo/rehabilitaciónRESUMEN
Muitas vezes para a reabilitação por implantes na região posterior da maxila se faz necessária a elevação do seio maxilar e vários biomateriais podem ser utilizados. Sendo assim, o objetivo do estudo é avaliar, através de uma busca sistemática da literatura, a utilização do Bio-Oss® puro em procedimentos de enxerto em elevação de seio maxilar. A busca sistemática da literatura foi realizada pelos pesquisadores nas bases de dados eletrônica PUBMED (Biblioteca Nacional de Medicina, US), Bireme (Biblioteca Virtual em Saúde) e Biblioteca Cochrane. Os artigos incluídos foram avaliados para grau de qualidade por dois pesquisadores independentes. Seiscentos e vinte e dois artigos foram avaliados, destes, 616 foram excluídos, permanecendo 6 artigos. Dos 6 artigos incluídos todos apresentaram alto viés no grau de qualidade dos estudos. Concluiu-se que apesar do alto viés dos artigos incluídos, devido diversas falhas metodológicas, a busca sistemática da literatura mostrou que o Bio-Oss® é um biomaterial adequado para cirurgias de aumento de seio maxilar...
In order to achieve the rehabilitation using implants in the posterior maxillary region a maxillary sinus elevation is required and for this purpose there are various biomaterials that can be used. Thus, the aim of this study is to evaluate, through a systematic literature search, the use of Bio-Oss® in pure grafting procedures in maxillary sinus elevation. A systematic literature search was conducted in the electronic databases PUBMED (National Library of Medicine, US), Virtual Library Bireme-health and the Cochrane Library. The included articles were assessed for level of quality by two independent researchers. Six hundred and twenty-two articles were evaluated, and 616 of those were excluded, remaining 6 articles. All six articles included showed high degree of bias in the quality of studies. It was concluded that despite the high bias of the articles due to several methodological flaws, this systematic literature search showed that Bio-Oss® is a suitable biomaterial for augmentation of the maxillary sinus surgeries...
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Implantación Dental , Seno Maxilar/cirugía , Trasplante Óseo/rehabilitación , Materiales Biocompatibles/química , Interpretación Estadística de DatosRESUMEN
O enfisema subcutâneo consiste na entrada de ar nos tecidos moles e cavidades do corpo como resultado de um procedimento cirúrgico, patologia ou trauma. Em Odontologia representa uma condição rara. Os casos relatados geralmente têm relação com o uso de canetas de alta rotação, no entanto, também já foi descrito com o uso do jato de ar da seringa tríplice em procedimentos endodônticos e restauradores. Caracteriza-se pelo edema súbito e difuso que pode envolver a região periorbitária, bochechas, submandibular ou cervical. Este trabalho descreve um relato de caso clínico de enfisema subcutâneo em uma paciente submetida à remoção de enxerto autógeno de linha oblíqua mandibular com a utilização de caneta de alta rotação para reconstrução óssea de maxila previamente à colocação de implantes. No terceiro dia notou-se sensível melhora quanto ao inchaço periorbitário e regressão do mesmo nos dias subsequentes. Embora o enfisema subcutâneo seja pouco frequente e inócuo, normalmente se resolve sem sequelas de maneira espontânea dentro de alguns dias, pode migrar ao longo dos planos fasciais para estruturas profundas, podendo resultar em sérias complicações. O correto diagnóstico é fundamental a fim de evitar maiores complicações.
Subcutaneous emphysema is caused by the introduction of air into soft tissues and body cavities due to surgical procedure, disease or trauma. It is a rare condition in Dentistry. Cases of cutaneous emphysema are commonly associated with the use of high-speed handpieces, but cases associated with triple air syringes have also been described in endodontic and restorative procedures. It is characterized by a sudden and diffuse edema that may involve the periorbital region, cheeks, and submandibular and cervical regions. This study described a case report of subcutaneous emphysema that occurred during bone-graft harvesting from the oblique line for maxillary reconstruction prior to the placement of dental implants. Periorbital edema showed a marked improvement on the third postoperative day and gradual reduction on the subsequent days. Although subcutaneous emphysema is an uncommon and innocuous condition that usually resolves spontaneously in few days without leaving sequels, it may migrate along the fascial planes to deeper structures and result in serious complications. A correct diagnosis is extremely important to prevent major complications.
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Humanos , Femenino , Adulto , Enfisema Subcutáneo/patología , Equipo Dental , Implantes Dentales , Trasplante Óseo/rehabilitación , Tomografía Computarizada por Rayos X/instrumentaciónRESUMEN
OBJECTIVE: The aim of the study was to describe 3 cases of total auricular rehabilitation, including the novel use of iliac crest bone grafts to support bone-anchored auricular prostheses. STUDY DESIGN: This study is a retrospective case series from a single institution. RESULTS: Three cases with large lateral temporal bone and soft tissue defects were successfully treated with total auricular rehabilitation. Rehabilitation included the following: soft tissue coverage with an anterolateral thigh microvascular free flap, iliac crest-free bone graft with staged placement of a bone-anchored auricular prosthesis into the bone graft, and audiologic rehabilitation with a bone-anchored hearing aid (BAHA). All of the cases with grafts and flaps survived and were without significant donor site morbidity. Bone-anchored hearing aid abutment skin overgrowth was seen in 2 cases and was revised under local anesthesia. All of the patients had expected functional recovery on postoperative audiologic testing. Each patient continues to consistently wear his/her auricular prosthesis and BAHA during 3 years of follow-up. CONCLUSIONS: Total auricular rehabilitation is a complex task involving reconstruction of extensive soft tissue defects, bony defects, and the hearing apparatus. Acceptable cosmetic and functional outcomes and high patient satisfaction is possible in committed patients.