What Do We Know Beyond Reliability in Voxel-Based Registration? Validation of the Accuracy of Regional Voxel-Based Registration (R-VBR) Techniques for Orthognathic Surgery Analysis.

PURPOSE: Despite having excellent reproducibility, the accuracy of regional voxel-based registration (R-VBR) techniques used for postoperative orthognathic surgical analysis has not been validated. The purpose of this study was to validate the accuracy of R-VBR. METHODS: Preoperative (T0) and postoperative (T1) cone beam computed tomography (CBCT) of consecutive patients treated at a single center with nonsegmental LeFort I and bilateral sagittal split osteotomy were included. T1 CBCTs were oriented to match that of the standardized T0, and thus were assigned a known rotational transformation matrix in pitch/roll/yaw (P/R/Y), to create T1-prime (T1'). A copy of T1 (cT1) was made and was superimposed to T1' using R-VBR for 4 regions of interest (ROI): maxilla, distal mandible, right proximal mandible, and left proximal mandible, to create cT1'. The transformation matrix for each of the ROI was compared to those of T1' using paired t test and Bland-Altman analysis. RESULTS: Twenty-eight eligible subjects' CBCTs were analyzed. Mean difference between T1' and cT1' ranged from -0.08 to 0.14° (maximum 0.73°), with no statistically significant differences (P = 0.216 to 1). Mean absolute difference ranged from 0.13 to 0.31° (maximum 0.73°). Bland-Altman analysis showed good agreement between T1' and cT1', indicating excellent accuracy. CONCLUSIONS: R-VBR using the maxilla, distal mandible, and the bilateral proximal mandibular segments as ROI has excellent accuracy in terms of rotational measurements.

Condição de saúde bucal, estado nutricional e perfil socioeconômico de pacientes com necessidades especiais / Oral health condition, nutritional status and socio-economic profile of patients with special needs

Introdução: A abordagem odontológica precoce dos pacientes com deficiência é importante para determinar a sua qualidade de higiene bucal, estimular a realização de higiene periódica e capacitar o núcleo familiar, que será o responsável por tal tarefa. Uma relação entre saúde bucal e estado nutricional existe, mas ainda não se encontram na literatura muitos estudos que fundamentem essa afirmação adequadamente. Objetivo: Avaliar e relacionar a idade, o sexo, a condição de saúde bucal, o estado nutricional e o perfil socioeconômico dos pacientes com necessidades especiais da Associação de Pais e Amigos dos Excepcionais (APAE), de um município gaúcho. Método: Trata-se de um estudo observacional, transversal, de análise descritiva, realizado no Centro Ocupacional Santa Rita de Cássia em Caxias do Sul - RS, relacionando variáveis como dados obtidos com aplicação do índice CPO-D (dentes cariados, perdidos e obturados) na investigação da condição bucal, questionário semiestruturado para avaliação do perfil socioeconômico e avaliação antropométrica do estado nutricional. Resultados: 40% da amostra foram classificados com sobrepeso; 63,3% obtiveram CPO-D satisfatório e 30% são de classe econômica C1. Houve relação significativa entre idade e condição bucal. Conclusão: Neste estudo, a condição de saúde bucal dos pacientes com necessidades especiais foi positiva na maioria dos usuários, tendo relação com a idade.

Introduction: The early dental approach of patients with disabilities is important to determine the quality of oral hygiene of this population, to stimulate the periodic hygiene, to empower the family nucleus, which will be responsible for this task. A relationship between oral health and nutritional status exists, but many studies are not yet found in the literature to substantiate this claim adequately. Objective: To evaluate and to correlate the age, gender, oral health condition, nutritional status and socio-economic profile of patients with special needs at APAE ­ Associaçao de Pais e Amigos dos Excepcionais, in a city in the state of Rio Grande do Sul, in the South of Brazil. Method: This is an observational, cross sectional study of descriptive analysis, performed at Santa Rita de Cássia Occupational Center, in Caxias do Sul, in the South of Brazil, relating variables such as data obtained using the DMF-T index (decayed, lost and filled teeth) in the investigation of the oral condition; semi-structured questionnaire to evaluate the socio-economic profile, and anthropometric evaluation of the nutritional status. Results: The results show that 40% of the sample were classified as overweight; 63.3%) demonstrated satisfactory DMF-T, and 30% were in C1 socio-economic class. There was a significant relationship between age and oral condition. Conclusion: In this study the oral health condition of patients with special needs was positive for most of the patients, and it's related to their age.

Enucleação associada à solução de Carnoy no tratamento de tumor odontogênico ceratocístico / Enucleation associated to Carnoy's solution on treatment of keratocistic odontogenic tumor

Tumor Odontogênico Ceratocístico (TOC) é classificado como uma lesão intraóssea benigna, de origem odontogênica. Apresenta comportamento biológico agressivo e alta taxa de recidiva. Por sua heterogeneidade clínica e histológica, gera controvérsias em relação ao tipo de tratamento. Técnicas, como marsupialização, descompressão, enucleação, ou mesmo, ressecção cirúrgica, são algumas opções de tratamento, podendo associar com outras formas de terapias. O presente trabalho tem por objetivo relatar o caso de um paciente do gênero masculino que apresentava lesão osteolítica na região posterior direita da mandíbula, diagnosticada como tumor odontogênico ceratocístico. O tratamento proposto foi enucleação associada à aplicação de solução de Carnoy. Após 4 anos de pós-operatório, a técnica cirúrgica associada à terapia química mostrou-se eficaz, apresentando resultados satisfatórios. O paciente segue em acompanhamento, sem referir queixas álgicas e funcionais, além de não apresentar alterações estéticas... (AU)

Keratocystic odontogenic tumor is classified as a benign intraosseous and odontogenic lesion. It presents an aggressive biological behavior and great tendency to relapse. Also, it is a pathology that is noteworthy due to its clinical and histological heterogeneity. This diversity reflects on controversies in defining the adequate treatment for these lesions, opting for surgical techniques such as marsupialization, enucleation or resection, even associate with other conservative treatment. By upgrading the knowledge of cell biology, development of diagnostic tests and the improvement of surgical techniques, the treatment of oral diseases suffered major changes in recent decades, making it safer and leading to more predictable results. This study aims to report the case of a male patient, suffering from osteolytic lesion in the posterior mandible, diagnosed as keratocystic odontogenic tumor, which was treated by enucleation associated to application of Carnoy's solution, which is an alternative treatment already described. After 4 years follow-up, proposed treatment has been shown efficient presenting satisfactory results. Patient remains accompanied with no pain and functional complaints as well as no aesthetics alterations... (AU)

Le Fort III osteotomy for severe dentofacial deformity correction associated with hypoplasia of the midface / Osteotomia Le Fort III para correção de deformidade dentofacial severa associada a hipoplasia de terço médio da face

ABSTRACT The combination of orthodontic therapy and orthognathic surgery is a well-established treatment modality for the correction of dentofacial deformities. When these deformities are more severe, involving hypoplastic midface, surgical techniques not used routinely in the treatment of facial changes are required, such as the Le Fort III osteotomy or variations of this technique. Few studies have reported the use of this technique or its modifications in non-syndromic patients. This paper demonstrates the orthodontic-surgical resolution of a patient with dentofacial deformity with severe malocclusion Class III, involving midface hypoplasia, with a modification technique of a Le Fort III osteotomy associated with Le Fort I and sagittal of the rami osteotomies. After three years of postoperative follow-up, the patient demonstrates significant improvement in chewing ability, no functional complaints, and high satisfaction with the aesthetics and improved quality of life.

RESUMO A combinação da terapia ortodôntica com a cirurgia ortognática é uma modalidade de tratamento bem estabelecida para a correção de deformidades dentofaciais. Quando estas deformidades apresentam maior severidade, envolvendo a hipoplasia do terço médio da face, exigem técnicas cirúrgicas não utilizadas como rotina no tratamento das alterações faciais, como a osteotomias Le Fort III ou as variações destas técnicas. Poucos estudos relatam o uso desta técnica ou de suas modificações em pacientes não sindrômicos. Este trabalho tem como objetivo demonstrar uma resolução ortodôntica-cirúrgica de um paciente apresentando deformidade de face com má-oclusão Classe III severa, envolvendo hipoplasia do terço médio facial, com a realização de uma técnica modificada da osteotomia Le Fort III, associada as osteotomias Le Fort I e osteotomia sagital dos ramos mandibulares. O paciente encontra-se com três anos de acompanhamento pós-operatório, com melhora significativa na sua habilidade mastigatória, sem queixas funcionais, relatando alta satisfação com a estética e melhora na qualidade de vida.

Resection of Gingival Fibromatosis with High-power Laser.

Hereditary gingival fibromatosis (HGF), also known as hereditary gingival hyperplasia, idiopathic gingival fibromatosis, and hereditary gingival overgrowth, is a rare condition but the most common form of gingival hyperplasia. Overgrowth of gingival tissue is usually slow and progressive and may delay or prevent tooth eruption, resulting in cosmetic and functional impairments. Hypertrichosis, epilepsy, and intellectual disability may be associated with HGF, which can occur in isolation or as part of a syndrome. The purpose of this case report is to describe a diode laser resection of gingival hyperplasia in a seven-year-old patient with nonsyndromic HGF and hypertrichosis. The diode laser enabled efficient removal of hypertrophic gingival tissue with good healing and minimal postoperative discomfort.

Use of resorbable screws for autogenous onlay block graft fixation: a histological analysis in rabbits.

The aim of the present in vivo study is to histologically evaluate and compare the use of resorbable screws based on poly(L-co-D,L lactide) 70:30 for fixation of autogenous bone grafts in rabbit tibiae. As control group, titanium (Ti-6Al-4V Grade V) screws were used. For this purpose, 15 white New Zealand male rabbits, aged 6 months and weighing between 3.8 and 4.5 kg, were used. From each animal, 2 total-thickness bone grafts were removed from the cranial vault: one was stabilized with a resorbable screw while the other was stabilized with a metallic one. Animals were divided into 3 groups, according to the sacrifice period: 3, 8, and 16 weeks postoperatively. After histological processing, cuts were stained with hematoxylin and eosin and submitted for descriptive histological analysis under light microscopy. It was found that the fixation system based on the polymer showed a histological behavior similar to metallic screws. For both groups, the bone graft was incorporated, with the presence of bone formation between the graft and receptor site. In none of the groups were undesirable inflammatory responses or foreign body reactions observed. Based on histological findings and on this experimental model, it is possible to conclude that the internal fixation system based on the poly(L-co-D,L lactide) 70:30 polymer is effective for fixation of autogenous bone grafts, with results that are comparable to the titanium fixation system.

Effect of Recombinant Human Growth Hormone on Osseointegration of Titanium Implants: A Histologic and Biomechanical Study in Rabbits.

To evaluate the action of recombinant human growth hormone (rhGH) on osseointegration of titanium implants in rabbits. Fourteen adult New Zealand rabbits, aged 30 weeks, were used in the study, and randomly divided into 2 groups. In each animal, 2 (2.2 mm × 6 mm) pure titanium implants were placed in the left tibia. In one group (test group), 1 IU (0.3 mg) of rhGH as a lyophilized powder was applied to each osteotomy site prior to implant placement. Only titanium implants were placed in osteotomy sites of the other group (control). Animals were humanely killed at 14 and 42 days after surgery, and samples were then prepared for histologic analysis and biomechanical test. The biomechanical test showed tensile pull-out stress values of 33.88 N/cm(2) for controls and 59.26 N/cm(2) for the rhGH group at 14 days and 25.99 N/cm(2) and 29.69 N/cm(2) for the control and the test group, respectively, at 42 days. Scanning electron microscope analysis showed more uniform and abundant bone tissue in contact with the implants for the test group at 14 days, and no differences between groups at 42 days. Furthermore, histologic analysis also showed accelerated bone repair in 14 days and a more advanced stage of bone remodeling for the rhGH-treated group when compared to controls after 42 days of repair. Such results show that the topical use of rhGH induces new bone formation in the early stages of bone repair and hence accelerates osseointegration of titanium dental implants.

Osteotomia sagital e terceiros molares inferiores: mudança de paradigma / Sagittal Split Osteotomy and Lower Third Molars: a Paradigm Shift

Objetivo: O objetivo deste artigo é uma associação de revisão da literatura sobre a realização de osteotomias sagitais na presença de terceiros molares inclusos, com o relato de um caso de cirurgia ortognática em que as osteotomias sagitais dos ramos mandibulares foram realizadas na presença desses elementos dentários. Relato dos Casos: O caso a seguir demonstra a sequência cirúrgica de um paciente portador de deformidade dento-facial submetido à cirurgia ortognática. A cirurgia realizada envolveu ambos os maxilares, com realização de osteotomia Le Fort I para a maxila e ostetomias sagitais dos ramos mandibulares. A peculiaridade do caso foi a realização das osteotomias mandibulares na presença de terceiros molares inclusos, as quais não causaram qualquer dificuldade ou complicação para a realização dos cortes ósseos e separação dos fragmentos. Conclusão: A osteotomia sagital do ramo mandibular pode ser realizada na presença dos terceiros molares inferiores de forma segura, sem aumento dos riscos cirúrgicos e otimizando o tempo de tratamento orto-cirúrgico... (AU)

Purpose: The aim of this article was to compare the effects of the presence or absence of third molars from a literature review about currents of different authors, with an association of two cases related which the sagittal split osteotomy was performed in the presence of mandibular third molars. Cases report: The following cases describe two patients, of both genders, with dentofacial deformities, these which there was the need for orthognathic surgery by the use of sagittal mandibular osteotomy. Both patients had third molars in your mouth at the time of osteotomy. There were no major complications trans and postoperative. Conclusion: The sagittal split osteotomy of the ascending ramus can be performed in the presence of third molars, and it could lead to the time optimization in the ortho-surgical treatment... (AU)

Osteoctomia sagital e terceiros molares inferiores: mudança de paradigma / Sagittal Split Osteotomy And Lower Third Molars: A Paradigm Shift

Objetivo: O objetivo deste artigo é uma associação de revisão a literatura sobre a realização de osteotomias sagitais na presença de terceiros molares inclusos, com o relato de um caso de cirurgia ortognática em que as osteotomias sagitais dos ramos mandibulares foram realizadas na presença destes elementos dentários. Relato dos casos: O caso a seguir demonstra a sequência cirúrgica de um paciente portador de deformidade dento-facial submetido a cirurgia ortognática. A cirurgia realizada envolveu ambos os maxilares, com realização de osteotomia Le Fort I para a maxila e ostetomias sagitais dos ramos mandibulares. A peculiaridade do caso foi a realização das osteotomias mandibulares na presença de terceiros molares inclusos, as quais não causaram qualquer dificuldade ou complicação para a realização dos cortes ósseos e separação dos fragmentos. Conclusão: A osteotomia sagital do ramo mandibular pode ser realizada na presença dos terceiros molares inferiores de forma segura, sem aumento dos riscos cirúrgicos e otimizando o tempo de tratamento orto-cirúrgico... (AU)

The aim of this article was to compare the effects of the presence or absence of third molars from a literature review about currents of different authors, with an association of two cases related which the sagittal split osteotomy was performed in the presence of mandibular third molars. Case description: The following cases describe two patients, of both genders, with dentofacial deformities, these which there was the need for orthognathic surgery by the use of sagittal mandibular osteotomy. Both patients had third molars in your mouth at the time of osteotomy. There were no major complications trans and postoperative. Conclusion: The sagittal split osteotomy of the ascending ramus can be performed in the presence of third molars, and it could lead to the time optimization in the ortho-surgical treatment... (AU)

Analysis of incision effects on upper lip height and thickness after maxillary surgically assisted expansion: a randomized clinical trial.

PURPOSE: To evaluate changes from maxillary circumvestibular incision performed with a #15 scalpel blade versus electrocautery on the height and thickness of the upper lip (UL) after surgically assisted maxillary expansion. MATERIALS AND METHODS: Twenty-three patients who underwent surgically assisted maxillary expansion for transverse maxillary deficiency from April 2011 through April 2012 were included in the study. In group 1 (n = 11), the incision was performed with a Bard-Parker #15 scalpel blade. In group 2 (n = 12), the incision was performed with monopolar electrocautery (blend function, 1; power, 20 Watts; frequency, 480 kHz). Clinical measurements for UL height and radiographic measurements for UL height and thickness were performed preoperatively and postoperatively (mean, 6 months). The collected data were subjected to statistical analysis to test the hypotheses of the study. RESULTS: After excluding 2 patients, 21 patients were included in the sample. For UL height, clinical and radiographic measurements showed shortening of the UL, and the differences between pre- and postoperative values were statistically significant (P < .05) in the 2 groups. However, there was no statistically significant difference between groups 1 and 2 for UL height (P > .05) by clinical or radiographic measurements. For UL thickness, the 2 groups showed slight UL thickening in the lower portion, with no statistical difference between pre- and postoperative values (P > .05). Moreover, these results were not statistically different between the 2 groups (P = .754). In the uppermost portion of the UL, there was significant thinning in group 2 (P = .001), but not in group 1 (P = .076), and no statistical difference between groups (P = .535). CONCLUSIONS: Maxillary circumvestibular incision causes significant shortening of the UL and thinning of the uppermost portion when using a #15 scalpel blade or electrocautery. However, there is no difference in UL dimensional changes when using either technique for maxillary circumvestibular incision.

Bone repair is influenced by different particle sizes of anorganic bovine bone matrix: a histologic and radiographic study in vivo.

PURPOSE: The aim of this study was to analyze histologically and radiographically the influence of particle size of anorganic bovine bone matrix (ABBM) on bone repair. MATERIALS AND METHODS: Four calvarial defects of 8 mm each were prepared in 18 adult New Zealand rabbits. The defects were then filled with either particulate autogenous bone (control group) or ABBM of large, medium, and small size granules. The animals were sacrificed at 15, 30, and 60 days after surgery. The samples were radiographically examined before being submitted to histological processing. RESULTS: Autogenous bone showed a slight radiopacity at the beginning, which was increased at the final period, being very similar to the adjacent bone tissue. The large and medium size ABBM particles maintained the same radiographic behavior, showing a radiolucent area in the central portion of the defect at 60 days. ABBM of small size granules showed a slight radiolucity at the initial period, which was increased at the subsequent periods. More intense bone formation occurred in the control group (autogenous bone). All 3 particle sizes of the biomaterial resulted in inflammatory infiltration at 15 and 30 days. ABBM of small size granules lead to a greater amount of osteoid tissue, and the particles were almost totally reabsorbed within 60 days of implantation. CONCLUSIONS: Autogenous bone graft lead to the best result in terms of bone defect repair; ABBM of large and medium size granules are not totally reabsorbed at the observed period; ABBM of small size granules was more intensively reabsorbed and led to a greater osteoid tissue formation when compared to the medium and large ABBM granules.

Estudo comparativo da inclinação do plano oclusal de modelos para cirurgia ortognática montados em dois tipos de articuladores semiajustáveis / Comparative study of occlusal plane angulation of dental casts for orthognathic surgery mounted in two types of semi-adjustable articulators

Objetivo: este estudo busca comparar a inclinação do plano oclusal obtida em dois tipos diferentes de articuladores semiajustáveis com aquela obtida na telerradiografia em norma lateral. Metodologia: 20 pacientes a serem submetidos à cirurgia ortognática tiveram seus modelos de gesso montados em 2 diferentes articuladores semiajustáveis por meio da transferência com arcos faciais da posição da maxila e registro oclusal para a mandíbula. Após montagem, à inclinação do plano oclusal nos articuladores foi mensurada e comparada com a inclinação mensurada nas telerradiografias cefalométricas laterais e entre os articuladores entre si. Os resultados obtidos foram submetidos a análise estatística pertinente. Resultados: os valores médios dos ângulos obtidos nos articuladores Bio Art (7,55º) e Kavo (-5,70º) diferem entre si em 13,25º, sendo essa diferença estatisticamente significante (p=0,00). Quando comparados individualmente à telerradiografia (5,075º), o articulador Bio Art apresentou valor mais próximo, com uma diferença de 2,475º, enquanto que o articulador Kavo apresentou uma diferença de 10,775º. Conclusão: os dois modelos de articuladores semiajustáveis testados não reproduzem, com fidelidade, a inclinação do plano oclusal maxilar de pacientes portadores de deformidades dentofaciais; a diferença encontrada entre o articulador Bio Art e a telerradiografia foi menor do que aquela encontrada entre o articulador Kavo e a telerradiografia.

Purpose: The aim of this study was to compare occlusal plane angulation measured in two different types of semi-adjustable articulators with that obtained on the lateral cephalometric radiograph. Materials and Methods: 20 patients due to undergo orthognathic surgery had dental casts mounted in two different types of semi-adjustable articulators through face bow transfer from the position of the maxilla and occlusal recording to the mandible. After mounting, the inclination of the occlusal plane in the articulators was measured and compared with the inclination measured at on both articulators and compared with the inclination measured on the lateral cephalometric radiographs and between the articulators themselves. The results obtained werestatistically analyzed. Results: Mean angulation values for the Bio Art (7.55º) and Kavo (-5.70º) articulators differ by 13.25º, which is statistically significant (p=0.00). When individually compared to the lateral cephalometric radiograph (5.075º), the Bio Art articulator showed more similar angulation values, with a difference of 2.475º, while the Kavo articulator presented a difference of 10.775º. Conclusion: Neither of the models of semi-adjustable articulators accurately reproduced the inclination of the maxillary occlusal plane of patients with dentofacial deformities; the difference between the two articulators tested and the lateral cephalometric radiograph was lower for the Bio Art than for the Kavo articulator.

Avaliação radiográfica da fusão das corticais lateral e medial do ramo mandibular. Estudo em mandíbulas secas / Radiographic fusion of the lateral cortical and medial ramus. Study on dry mandibles

Objetivo: Avaliar radiograficamente a distância da língula da mandíbula até o ponto onde ocorre a fusão das corticais ósseas vestibular e lingual no ramo mandibular. Materiais e Métodos: 54 mandíbulas secas, divididas em 3 subgrupos (SG1: dentada, SG2: parcialmente dentada e SG3: desdentada), foram utilizadas neste estudo. A posição da língula foi demarcada com esfera metálica, e tomadas radiográficas foram obtidas. As distâncias entre a incisura e a língula mandibular (I/L) e entre a língula mandibular e o ponto onde ocorre a fusão das corticais ósseas no ramo mandibular (L/FC) foram mensuradas. Análise estatística pertinente foi aplicada aos valores obtidos. Resultados: a média dos valores obtidos para L/FC foram de 8,18mm, 7,30mm e 8,98mm para SG1, SG2 e SG3, respectivamente. Entretanto, os valores de I/L foram de 14,02mm, 13,90mm e 12,34mm para SG1, SG 2 e SG3, respectivamente. Os resultados também demonstram que a fusão das corticais ocorreu na metade da distância I/L em 28,57% das mandíbulas em SG1, em 46,67% das mandíbulas em SG2 e em 9,09% das peças em SG3. Conclusões: não houve diferenças significativas nas alturas em que ocorreram as fusões nos 3 subgrupos. No SG3, a correlação do valor médio de L/FC com o valor médio observado para I/L (12,34 mm) sugere uma diminuição da densidade óssea e da massa óssea, que pode estar relacionada com uma idade avançada das mandíbulas avaliadas nesse subgrupo.

Purpose: to radiographically evaluate the distance between mandibular lingula and the exact spot where buccal and lingual cortical bone plates merge in the mandibular ramus. Materials and Methods: 54 dry mandibles, divided into 3 subgroups (SG1: dentate, SG2: partially dentate and SG3: edentulous) were used in this study. Lingula position was marked with a metallic sphere and radiographs were taken. The distance between mandibular notch and lingula (I/L) and the distance between mandibular lingula and cortical bone plates fusion (L/FC) were measured. Statistical analysis was applied to the values obtained. Results: mean values for L/FC were 8,18mm, 7,30mm and 8,98mm for SG1, SG2 e SG3 respectively. Moreover, mean values for I/L were 14,02mm, 13,90mm and 12,34mm for SG1, SG 2 and SG3 respectively. The results also showed that cortical bone plates fusion took place in half I/L distance in 28,57% of the mandibles in SG1, in 46,67% of the mandibles in SG2 and in 9,09% of the pieces in SG3. Conclusions: there were no statistically significant differences in the height where cortical bone plates took place in all 3 subgroups. In SG3, the correlation between the mean value for L/FC and the mean value for I/L suggests a reduction in bone density and bone mass, which can correlate to the evaluation of older mandibles in this subgroup.

Management of osteonecrosis of the jaws in patients with history of bisphosphonates therapy.

Bisphosphonates are compounds used in the treatment of various metabolic and malignant bone diseases. The relation between the use of bisphosphonates and ostenonecrosis of the jaws as an adverse effect of the drug has been intensely discussed during the last few years, and up to this moment, there is no consensus concerning an ideal treatment modality for this condition. Nevertheless, there is an agreement among researchers that the standard goal for controlling jaw osteonecrosis is to prevent it. Otherwise, the rationale for a randomized controlled trial is that current treatment has proven to be suboptimal, and no consensus has been reached yet on the best strategies to repair the exposed bone once bone necrosis is developed. This article is focused on reporting a case of moderate osteonecrosis of the upper jaw induced by bisphosphonates and discusses a possible role for surgical debridement associated to platelet-rich plasma, hyperbaric oxygen therapy, and the cessation of the bisphosphonate use in managing this type of lesion. Moreover, the dentist, the oral surgeon, and the oncologist need to work together to reach better outcomes.

Quarto molar retido nos quatros quadrantes: revisão da literatura e relato de caso / Fourth molar restrained in four quadrants: revision of literature and describe a case

A presença de um ou mais dentes excedentes nas arcadas superiores e inferiores são chamados de dentes supranumerários. A razão pela qual isto ocorre ainda não está completamente entendida, porém acredita-se ser consequência de uma hiperatividade da lâmina dentária. Ocorre na maioria dos casos na dentição permanente, com maior prevalência no sexo masculino. Estes dentes podem gerar alterações como falhas no inrrompimento dos dentes adjacentes, cistos e tumores odontogênicos além de deslocamento dentário. São classificados por sua forma e localização. Na maioria dos casos são assintomáticos e são descobertos através de exames radiográficos de rotina. Este trabalho tem por objetivo realizar uma breve revisão da literatura e relatar um caso onde o paciente possuía quatro supranumerários tanto em maxila como mandíbula, removidos cirurgicamente

The presence of one or more teeth exiting in the superior and inferior arcade is known as supernumeraries’ teeth. The reason which this occurs is not complete understudied so far, however it believes to be a consequence of a hyperactivity of the lamina dental. Occur in the majority of the cases in permanent teeth, with predominant in males. These teeth can generate alterations like faults interruptions of the adjacent teeth, cyst and odontogenics tumors including dentary dislocation. They are classifying in your way of location. In the majority of the cases they are symptoms free and are found through the routine radiography exams. This aim of this study is to realize a brief literature revision and describe a clinical case where a patient had supernumeraries in the chain, surgical remove