Análise das vias aéreas superiores pós cirurgia ortognática bimaxilar: estudo retrospectivo / Upper airway analysis after bimaxillary orthognathic surgery: retrospective study / Análisis de la vía aérea superior después de la cirugía ortognática bimaxilar: estudio retrospectivo

Objetivo: O objetivo do presente estudo foi avaliar retrospectivamente as mudanças ocorridas nas vias aéreas superiores (VAS) pós cirurgia ortognática bimaxilar. Metodologia: A amostra compreendeu 14 pacientes, que foram divididos em dois grupos, conforme o tipo de movimentação realizada na cirurgia: grupo 1 (n = 6), avanço bimaxilar; grupo 2 (n = 8) cirurgia de avanço de maxila e recuo de mandíbula. Foram realizadas tomografias computadorizadas no pré-operatório (T0) e pós-operatório de 1 ano (T1). Através do software Dolphin Imaging procedeu-se a análise das VAS em três parâmetros: área total (AT), volume total (VT) e área axial mínima (AAM), que foram comparadas entre T0 e T1 em um mesmo grupos pelo Teste de Wilcoxon e entre grupos pelos Teste de Mann-Whitney (p < 0.05). Resultados: Ambos os grupos apresentaram aumento significativo de AT, VT e AAM entre T0 e T1. Contudo, essas variações foram estatisticamente maiores no grupo 1 quando comparadas ao grupo 2. Conclusão: As cirurgias bimaxilares promoveram o aumento da AT, VT e AAM das VAS e essas mudanças foram significativamente superiores nos pacientes submetidos ao avanço bimaxilar... (AU)

Objective: The objective of the present study was to retrospectively evaluate the changes that occurred in the upper airways (UAS) after bimaxillary orthognathic surgery. Methodology: The sample comprised 14 patients, who were divided into two groups, according to the type of movement performed in the surgery: group 1 (n = 6), bimaxillary advancement; group 2 (n = 8) maxillary advancement and mandibular setback surgery. Computed tomography scans were performed preoperatively (T0) and 1 year postoperatively (T1). Through the Dolphin Imaging software, the analysis of the UAS was carried out in three parameters: total area (TA), total volume (TV) and minimum axial area (MAA), which were compared between T0 and T1 in the same groups by the Wilcoxon Test and between groups by the Mann-Whitney test (p < 0.05). Results: Both groups showed a significant increase in TA, TV and MAA between T0 and T1. However, these variations were statistically higher in group 1 when compared to group 2. Conclusion: Bimaxillary surgeries promoted an increase in the TA, TV and MAA of the UAS and these changes were significantly higher in patients undergoing bimaxillary advancement... (AU)

Objetivo: El objetivo del presente estudio fue evaluar retrospectivamente los cambios ocurridos en las vías aéreas superiores (VAS) después de la cirugía ortognática bimaxilar. Metodología: La muestra estuvo compuesta por 14 pacientes, quienes fueron divididos en dos grupos, según el tipo de movimiento realizado en la cirugía: grupo 1 (n = 6), avance bimaxilar; grupo 2 (n = 8) cirugía de avance maxilar y retroceso mandibular. Las tomografías computarizadas se realizaron antes de la operación (T0) y 1 año después de la operación (T1). A través del software Dolphin Imaging se realizó el análisis de la VAS en tres parámetros: área total (AT), volumen total (VT) y área axial mínima (AAM), los cuales fueron comparados entre T0 y T1 en los mismos grupos por el Prueba de Wilcoxon y entre grupos por la prueba de Mann Whitney (p < 0,05). Resultados: Ambos grupos mostraron un aumento significativo de AT, VT y AAM entre T0 y T1. Sin embargo, estas variaciones fueron estadísticamente mayores en el grupo 1 en comparación con el grupo 2. Conclusión: Las cirugías bimaxilares promovieron un aumento de la AT, VT y AAM de las VAS y estos cambios fueron significativamente mayores en los pacientes sometidos a avance bimaxilar... (AU)

Allogeneic Bone Application in Association with Platelet-Rich Plasma for Alveolar Bone Grafting of Cleft Palate Defects.

AIM: The aim of this study is to compare allogeneic bone grafts associated with platelet-rich plasma (ALBGs-PRP) to autogenous bone grafts (ATBGs) for alveolar reconstructions in patients with cleft lip and palate (CLP). MATERIALS AND METHODS: The Maxillofacial Surgery Service of the Comprehensive Care Center for CLP (CCCLP) in Curitiba (Paraná, Brazil). PATIENTS: Thirty out of 46 patients with 8-12 years of age and pre- or trans-foramen unilateral clefts were operated by the same surgeon. Groups were selected randomly after coin-toss for the first surgery to be ALBG-PRP. INTERVENTIONS: Pre- and post-surgery cleft defect severity was registered by a score system using superimposed digitalized peri-apical radiographs. The hypothesis indicated ABG-PRP to be similar to the ABG was proved. RESULTS: There was no statistically significant difference (P < 0.05) in bone augmentation for the ABG-PRP group (79.88%) when compared to the ABG group (79.9%). CONCLUSION: ABG-PRP is indicated as a successful treatment modality to reduce the need for additional donor sites and reduce morbidity and hospital stay.

Treatment of odontogenic myxoma: a multidisciplinary approach-6-year follow-up case.

The most aggressive diseases that affect the oral environment are considered tumors of the jaw. The surgical treatment is preferably done by surgical resection of the lesion, resulting in a great loss of tissue and esthetics. Multidisciplinary planning is required for the rehabilitation of these cases. Autogenous grafting techniques or vascularized flaps allow ridge reconstruction for implant placement, restoring function, and esthetics. This paper reports a 6-year follow-up case of an odontogenic myxoma treated with wide resection and mandibular bone reconstruction for posterior rehabilitation with dental implants.

Osteonecrose maxilo-mandibular induzida por bisfosfonato: revisão bibliográfica / Maxillomandibular osteonecrosis induced by bisphosphonate: a literature review

Diante da necessidade de novas tecnologias farmacêuticas para o tratamento de diversos tipos de lesões malignas, surgiram os bisfosfonatos, medicamentos amplamente administrados a pacientes portadores de câncer de mama e próstata com metástases ósseas, mieloma múltiplo, osteoporose, doença de Paget, hipercalcemia maligna e outras lesões ósseas metastáticas. Várias reações adversas oriundas do uso desse medicamento têm surgido, destacando-se a osteonecrose dos maxilares (ONM). Mediante de uma revisão bibliográfica, o objetivo deste trabalho é o de realizar uma abordagem objetiva acerca das principais características desse fármaco, suas complicações, prevenção e terapêutica da ONM. Diante da ausência de um protocolo de tratamento efetivo para a ONM, a prevenção apresenta-se como melhor opção. Faz-se pertinente frisar que os pacientes submetidos à quimioterapia com os bisfosfonatos devem ser encaminhados ao serviço odontológico para criteriosa avaliação de possíveis fatores predisponentes ao aparecimento da ONM. O tratamento de pacientes com osteonecrose maxilo-mandibular bisfosfonatoassociado, além da natural dificuldade, apresenta resultados imprevisíveis.

The need for new pharmaceutical technologies in the treatment of several types of malignant lesions led to the emergence of the bisphosphonates, a drug widely administered to patients with breast and prostate cancer with bone metastases, multiple myeloma, osteoporosis, Paget's disease, hypercalcemia and other malignant metastatic bone lesions. Several adverse reactions have emerged, in particular osteonecrosis of the jaw (ONJ). This paper sets out to objectively address some of the main characteristics of this drug, its complications and role in the prevention and treatment of ONJ. Given the absence of a protocol for the effective treatment of ONJ, prevention is seen to be the best option. It is important to note that patients undergoing chemotherapy with bisphosphonates should be referred to a dental unit for careful evaluation of possible predisposing factors. Apart from the inherent difficulty of the treatment of patients with biphosphonate-associated maxillomandibular osteonecrosis, its results are unpredictable.

Medial canthal region as an external reference point in orthognathic surgery.

PURPOSE: The aim of this investigation was to evaluate the effectiveness of using the medial canthal region (MCR) as an external reference point to determine the vertical dimension during maxillary repositioning as planned in model surgery and predictive tracing. MATERIALS AND METHODS: The analyzed group consisted of 43 consecutive patients who underwent maxillary or bimaxillary orthognathic surgery. Before downfracture, the vertical height was established from the distance of the MCR to the incisal edge of the right upper central incisor (UCI). The vertical dimension was obtained with frequent measurements by use of calipers as desired during cephalometric tracing and model surgery. After rigid fixation, the vertical height was verified again. The UCI was traced from the postoperative cephalogram and predictive tracing onto a preoperative tracing. Repositioning of the maxilla and postsurgical movements of the UCI were registered at the horizontal and vertical planes. Comparison was made between the predicted maxillary position on the cephalometric tracing and the actual position, as well as between the planned maxillary position in model surgery and the actual position. RESULTS: The mean difference between the planned UCI position on predictive tracing and postsurgical position was 0.30 mm (SD, 0.21 mm; P > .05) in the vertical plane. The variation between the planned maxillary position in model surgery and the actual position was 0.37 mm (SD, 0.31 mm; P > .05) in the vertical plane. CONCLUSIONS: Good surgical accuracy in positioning the mobilized maxilla can be achieved by use of the MCR as an external reference point.

Analysis of 185 maxillofacial fractures in the state of Santa Catarina, Brazil.

A retrospective study was performed to assess maxillofacial fractures in patients treated at a public hospital from 2002 to 2006. The data collected included age, gender, etiology, type of injury, treatment modalities and period of treatment. Causes were grouped into seven categories: road traffic collisions, sports accidents, occupational accidents, gunshot fractures, falls, violence and other causes. The analyses involved descriptive statistics, the Chi-squared Test and the Fisher Exact Test. Records from 132 patients sustaining 185 maxillofacial fractures were evaluated. The mandible (54.6%) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (27.6%). The mean age of the patients was 37.7 years, and the male:female ratio was 4.3:1. Most fractures occurred in adults with ages ranging from 18 to 39 years. A significant statistical relation was found between the age and the etiology of the trauma (p < 0.05), and between the number of fractured sites and the age of the patient (p < 0.05). Considering the age groups, accidents were the most frequent cause of maxillofacial fractures in the age group between 18 to 39 years, and interpersonal violence was the most frequent cause of maxillofacial fractures in the age group between 40 to 59 years. Treatment was performed on the same day as the diagnosis in 44.7% of the patients. Open surgery with internal stable fixation was indicated for most of the patients. Facial fractures occurred primarily among men under 30 years of age, and the most common sites of fractures in the face were the mandible and the zygomatic complex. Traffic road collisions were the main etiologic factor associated with maxillofacial trauma.

Analysis of 40 cases of intraoral verticosagittal ramus osteotomies to treat dentofacial deformities.

PURPOSE: The aim of the present study was to report the experience of 40 patients who had undergone intraoral verticosagittal ramus osteotomy (IVSRO) to treat dentofacial deformities. PATIENTS AND METHODS: The charts of 40 consecutive patients who had undergone IVSRO were analyzed regarding the diagnosis, amount of mandibular movement, and complications. RESULTS: Eighty IVSROs were performed in 40 patients. The mean follow-up was 18 months. Mandibular protrusion in both genders was the main preoperative diagnosis (25 patients), and the treatment was 2-jaw surgery in 36 patients. The mean amount of movement was 2 mm for the mandible setback and advancement, 3 mm for mandible counterclockwise rotations, and 2 mm for mandible clockwise rotations. The mean period of maxillomandibular fixation was 15 days, followed by a period of heavy elastics. The rate of complications was 2%, including 2 bad splits, and 2 cases of intraoperative bleeding. No nerve injury was observed in the 40 patients studied. CONCLUSIONS: The IVSRO is efficient and versatile, with low morbidity, and is an option for the oral and maxillofacial surgeon to treat patients with mandibular dentoskeletal discrepancies.

Surgically assisted palatine expansion in adult patients: evaluation of a conservative technique.

PURPOSE: This study was conducted to assess a conservative technique for surgically assisted palatine expansion (SAPE) done under local anesthesia and conscious sedation in adults. Dental inclination, uniformity of expansion, and satisfaction of orthodontist were evaluated. PATIENTS AND METHODS: Twenty-seven consecutive patients, ranging in age from 25 to 42 years, underwent SAPE under local anesthesia. The surgical procedure involved osteotomy of the lateral wall of the maxilla, from the maxillary tuberosity to the nasal cavity, with the nasal septum and the ptyerigoid plates left intact. Cast models were obtained before surgery and 1 year after surgery. Cuspid inclinations were assessed, with intercanine distance in 2 points, the incisal and cervical borders, measured before and after surgery. Molar inclination was obtained by measuring intermolar distance at the cervical margin and occlusal table. The results were statistically analyzed by analysis of variance. A questionnaire with 4 questions was addressed to the orthodontists to evaluate the level of satisfaction with the procedure. RESULTS: Cuspid and molar inclination occurred, but there was no statistically significant difference (P < .05) in dental inclination before and after surgery. The expansion was greater at the molar level than at the canine level, but this difference also was not statistically significant (P > .05). According to the questionnaire, 100% of the procedures allowed the expansion, 100% of the orthodontists were satisfied, and 68.75% observed dental inclination, but this inclination was not excessive in 100% of the cases. CONCLUSIONS: The proposed technique is a safe, predictable, and reliable method for SAPE in adult patients. Although ptyerigoid plate and nasal septum fractures were not performed, the maxillary bone exhibited uniform expansion. Dental inclination was not significant, either clinically or during cast model analysis. Orthodontists could achieve treatment objectives with this surgical procedure.

Histomorphometric evaluation of alumina-blasted/acid-etched and thin ion beam-deposited bioceramic surfaces: an experimental study in dogs.

PURPOSE: In an attempt to overcome the potential long-term limitations observed with plasma-sprayed hydroxyapatite-coated implants, nanothickness bioceramic coatings have been processed onto previously grit-blasted/acid-etched surfaces. Our objective was to evaluate the bone response to alumina-blasted/acid-etched and a thin ion beam-deposited bioceramic (Test) implant surfaces at 2 and 4 weeks in vivo with a dog tibia model. MATERIALS AND METHODS: Plateau root form implants (5 x 6 mm) were placed bilaterally along the proximal tibia of 6 Doberman dogs and remained for 2 and 4 weeks in vivo (n=6 per implant type and time in vivo). After euthanization, the implants were processed in a nondecalcified form and reduced to approximately 30 mum-thickness plates. Transmitted light optical microscopy at various magnifications was used to qualitatively evaluate the bone healing patterns. Bone-to-implant contact (BIC) was determined and 1-way ANOVA at 95% level of significance with Tukey's post-hoc multiple comparisons was used for statistical analysis. RESULTS: Histomorphology showed new bone formation filling the spaces between the plateaus at both in vivo time intervals through large quantities of woven bone formation. A higher degree of bone organization was observed between the plateaus of Test implants at 4 weeks in vivo than the alumina-blasted/acid-etched implants. No significant differences in BIC were observed for the different groups (P> .86). CONCLUSION: Despite nonsignificant differences between BIC for the different implant surfaces and times in vivo, higher degrees of bone organization were observed for the Test implants at 4 weeks, and biomechanical testing is suggested to verify its biomechanical fixation effectiveness.

Analysis of 185 maxillofacial fractures in the state of Santa Catarina, Brazil

A retrospective study was performed to assess maxillofacial fractures in patients treated at a public hospital from 2002 to 2006. The data collected included age, gender, etiology, type of injury, treatment modalities and period of treatment. Causes were grouped into seven categories: road traffic collisions, sports accidents, occupational accidents, gunshot fractures, falls, violence and other causes. The analyses involved descriptive statistics, the Chi-squared Test and the Fisher Exact Test. Records from 132 patients sustaining 185 maxillofacial fractures were evaluated. The mandible (54.6 percent) was the most commonly fractured bone in the facial skeleton, followed by the zygoma (27.6 percent). The mean age of the patients was 37.7 years, and the male:female ratio was 4.3:1. Most fractures occurred in adults with ages ranging from 18 to 39 years. A significant statistical relation was found between the age and the etiology of the trauma (p < 0.05), and between the number of fractured sites and the age of the patient (p < 0.05). Considering the age groups, accidents were the most frequent cause of maxillofacial fractures in the age group between 18 to 39 years, and interpersonal violence was the most frequent cause of maxillofacial fractures in the age group between 40 to 59 years. Treatment was performed on the same day as the diagnosis in 44.7 percent of the patients. Open surgery with internal stable fixation was indicated for most of the patients. Facial fractures occurred primarily among men under 30 years of age, and the most common sites of fractures in the face were the mandible and the zygomatic complex. Traffic road collisions were the main etiologic factor associated with maxillofacial trauma.

Teste de remoção ao torque e caracterização de superfície entre implantes com adição de biocerâmica absorvível e duplo ataque ácido / Removal torque test and surface characterization between implants with absorbable bioceramic addition and double acid etching

O objetivo deste estudo foi comparar a fixação biomecâmica e a caracterização de superfície entre a superfície de implante com jateamento com biocerâmica absorvível e ataque ácido (JBA/AA- Experimental) e uma superfície com duplo ataque ácido (controle) em cães Beagle. Três implantes do grupo controle e três do grupo experimental foram destinados a testes de caracterização físico/química de superfície através de microscopia eletrônica de varredura (MEV), microscopia de força atômica (MFA) e espectroscopia Auger (EA). O modelo animal compreendeu a colocação de 36 implantes na porção proximal da tibia (18 por superfície, seis por membro) que permaneceram por duas e quatro semanas após a colocação dos implantes. Após a eutanásia os espécimes foram destinados ao teste biomecânico (torque de remoção) Anova com 95% de intervalo de confiança e o teste Tukey para comparações múltiplas foram utilizados. A MEV e MFA mostraram diferenças qualitativas e quantitativas na microtextura e a superfície JBA/AA apresenta maiores valores submicrométricos de Ra e RMS comparadas ao grupo controle Ca e P foram encontrados apenas na superfície JBA/AA pela EA. Diferença significativa nos valores de torque de remoção foram encontrados entre os grupos JBA/AA(p< 0.0001). O estudo clínico concluiu que de acordo com o teste biomecânico, os períodos iniciais da osseointegração foram afetados positivamente pela superfície JBA/AA, comparados ao grupo controle.

Tendências atuais para aprimorar o processo de osseointegração / Current trends for osseointegration enhancement

O uso de implantes osseointegráveis no tratamento do edentulismo é hoje uma das técnicas mais previsíveis e bem sucedidas no âmbito da odontologia contemporânea. Entretanto, o protocolo mais utilizado para utilização destes implantes requer um período de osseointegração de alguns meses antes que a restauração protética seja efetivamente instalada. Muitas vezes, até mesmo de maneira empírica, para reduzir este tempo de espera, o protocolo original é alterado diminuindo-se o período de osseointegração. O objetivo deste manuscrito é apresentar de maneira sucinta o estágio atual de aprimoramento dos implantes dentários para aperfeiçoar o processo de osseointegração, com relação às alterações de superfície e da forma destes dispositivos.

The use of endosseous implants in the edentulism treatment is one of the most successful treatments in implantology and dentistry. The most utilized protocol for implant therapy requires a period of osseointegration of several months before prosthetic restoration is fabricated and placed in function. While substantial interest lies on decreasing the osseointegration period, its rationale has been primarily empirical. This manuscript presents the current trends in surface modification and device design in an attempt to decrease the time frame for biological integration of endosseous implants.

Manejo gengival em maxilas totalmente reconstruídas por enxertos e implantes / Gingival management in totally reconstructed maxilla by grafts and implants-case report

Os tecidos moles desempenham um importante papel para o resultado das cirurgias com implantes. Várias técnicas estão reportadas na literatura para aumentar a quantidade de gengiva ceratinizada ao redor dos implantes. Este artigo apresenta uma técnica de avanço do retalho palatal realizada durante a cirurgia de reabertura dos implantes em maxilas totalmente edêntulas reconstruídas com blocos de crista ilíaca.

Periimplantite: revisão de literatura / Peri-implantitis: literature review

A periimplantite é um processo inflamatório dos tecidos periimplantares associado à reabsorção óssea que pode levar à perda do implante. Este estudo tem como objetivo fazer uma revisão de literatura a respeito da anatomia dos tecidos periimplantares, dos critérios de sucesso da osseointegração, da avaliação da saúde periimplantar, da etiologia e do tratamento da periimplantite para facilitar a conduta clínica.

Avaliação histológica de osso bovino inorgânico em seio maxilar: relato de caso / Histological evaluation of inorganic bovine bone graft in maxillary sinus: a case report

Este artigo revisa as bases científicas para a utilização do enxerto ósseo bovino inorgânico associado ao plasma rico em plaquetas (PRP) e relata o uso desta combinação no levantamento de seio maxilar para permitir a posterior colocação de implante. O enxerto xenógeno foi realizado e, após seis meses, ocorreu a colocação de um implante e a coleta do tecido para análise histológica.

Protocolo cirúrgico para extração de germes de terceiros molares inferiores / Surgical protocol for extraction of lower third molar germs

A remoção de terceiros molares é uma intervenção cirúrgica comum em cirurgia bucomaxilofacial e, como qualquer procedimento, é passível de complicações. A criação e a permanência de um defeito periodontal no segundo molar adjacente podem causar a perda desse dente a longo prazo, portanto, novas técnicas de incisão e osteotomia devem ser avaliadas para minimizar ou mesmo evitar essa complicação. Este artigo propõe um protocolo de conduta para a remoção de terceiros molares capaz de facilitar a técnica e reduzir o tempo de cirurgia. Além disso, a técnica reduz o risco de formação de defeitos na região dos segundos molares, devido à modificação na incisão e na remoção óssea reduzida na distal do segundo molar.

Avaliação de uma técnica de confecção de um tampão apical com hidróxido de cálcio e de sua eficácia em evitar a extrusão de material obturador em canais radiculares sobre instrumentados / Evaluation of a technique for apical plug formation with calcium hydroxide and its efficacy to avoid extrusion of filling material in over-instrumented root canals

Tendo como objetivo avaliar, in vitro, uma técnica de formação de um tampão apical com hidróxido de cálcio e a sua eficácia em evitar a extrusão de material obturador, 60 dentes humanos, unirradiculares, foram selecionados e divididos em 4 grupos. Realizado o acesso endodôntico e determinado o comprimento dos dentes, os canais foram sobreinstrumentados 1mm além do forame até as limas K # 25 (Grupos 1 e 3) ou # 35 (Grupos 2 e 4), sob irrigação de hipoclorito de sódio. Os ápices radiculares foram revestidos com cera e as raízes embutidas em gesso pedra. Apos o desgaste de uma das paredes do bloco de gesso e da remoção da cera, os canais dos dentes dos Grupos 1 e 2 foram preenchidos com hidróxido de cálcio e os dos Grupos 3 e 4 permaneceram vazios. Os dentes foram mantidos a 370C e, decorridas 72 horas, limas de calibre 30 ou 40 foram levadas até 1mm aquém do comprimento dos dentes dos Grupos 1 e 2, respectivamente, com a intenção de remover o hidróxido de cálcio e de deixar um remanescente de pasta no milímetro final do canal. Solução de hipoclorito de sódio, depositada na entrada dos canais, auxiliou na remoção da pasta. Feita a secagem dos canais, os dentes foram radiografados para verificar a presença do tampâo. Os canais foram, então, obturados pelo sistema Themafil e os dentes radiografados para verificar a ocorrência de sobreoturação. A análise das radiografias evidenciou que, independentemente do diâmetro da abertura foraminal, a técnica proposta foi efetiva na formação de um tampão e que ele reduziu, significativamente (p<0,05), a ocorrência de sobreoturação