Macromorphometric Analysis of Metastatic Lesions in Bones due to Breast Cancer: Contribution to Human Identification.

OBJECTIVE: This study aimed to report the metastatic lesions observed in identified skeletons whose deaths were caused by breast cancer complications to provide information and evidence that can be used in cases of human identification forensics. METHODS: The research was conducted at the Centre for Forensic Anthropology Studies of the Faculty of Odontology of the University of Pernambuco (CEAF/FOP/UPE), Recife, Brazil. The data bank of the CEAF/FOP/UPE was searched for skeletons with the cause of death reported as due to breast cancer, resulting in five cases. The skeletons were arranged in anatomical positions and macroscopically inspected to register, describe and measure the lesions present to establish the macroscopic patterns of bone destruction caused by breast cancer. RESULT: Of the five skeletons, two presented metastatic lesions. In the first, lesions were observed in a disseminated form, affecting almost all bones. The lesions were predominantly osteolytic and ellipsoid-shaped; however, mixed and circular lesions were also found. The second skeleton presented four lesions of mixed characteristics. The finding of bone lesions in the macroscopic analysis of skeletons may reveal a more advanced stage of the neoplasm, as well as its dissemination in areas little rich in hematopoietic tissue, such as the diaphyses of long bones, a situation widely observed in the first reported case. CONCLUSION: Besides providing more excellent knowledge of their macroscopic presentation, bone metastatic lesions may act as an individualizing factor in human identification cases, narrowing the sample of possible victims.

A judicialização de cirurgia bucomaxilofacial e o sistema de assistência à saúde dos servidores públicos de Pernambuco / The judicialization of oral and maxillofacial surgery and the Health Assistance System of Public Servants in Pernambuco

A CF/88 foi pioneira ao dispor sobre o direito à saúde como direito fundamental e regular o sistema suplementar de saúde. Vários estados brasileiros criaram planos voltados exclusivamente para seus servidores; Pernambuco foi o pioneiro a concebê-los, através do Sistema de Assistência à Saúde dos Servidores do Estado de Pernambuco. Os avanços tecnológicos, o aumento da expectativa de vida (e a consequente perda dentária precoce) e os traumas provocaram aumento do uso de órteses, próteses e materiais especiais em procedimentos invasivos ­ proporcionando, dentre outros benefícios, a reparação estética. Porém, há entraves ao uso desses materiais, entre eles seu alto custo e a ausência de cobertura dos planos de saúde para procedimentos estéticos. Foram analisados os processos judiciais envolvendo órteses, próteses e materiais especiais em cirurgia bucomaxilofacial contra o Sistema de Assistência dos Servidores de Pernambuco, entre janeiro de 2009 e dezembro de 2017. O propósito foi defender que a indicação do material a ser utilizado pelo cirurgião-dentista não pode ser considerada critério absoluto e que o Poder Judiciário não deve acatar tal opinião sem questioná-la. Verificou-se a necessidade de franquear maior estrutura aos magistrados, com a criação de núcleos de assistência técnica em saúde e/ou investimentos nos já existentes, a fim de subsidiar os julgadores e assegurar uma maior eficiência na solução das demandas. A metodologia aplicada foi a do estudo transversal, baseado na análise de dados quantitativos e qualitativos extraídos dos processos. Como variáveis, traçaram-se o perfil dos autores das ações e os parâmetros adotados nas decisões judiciais.

The Brazilian Federal Constitution of 1988 was a pioneer in providing the right to health as a fundamental right and regulating the supplementary health system. Several states have created plans aimed exclusively at their servants, and Pernambuco was the pioneer to conceive them, through the Health Assistance System of the Servants of the State of Pernambuco. The technological advances, the increase of life expectancy (and the consequent early tooth loss) and the traumas have caused an increase in the use of orthoses, prostheses and special materials in invasive procedures - providing, among other benefits, esthetic repair. However, there are obstacles to the use of these materials, including their high cost and the lack of private health insurance coverage for esthetic procedures. The judicial proceedings involving orthoses, prostheses and special materials in oral and maxillofacial surgery against the Health Assistance System of the Servants of the State of Pernambuco were analyzed, from January 2009 to December 2017. The purpose was to defend that the indication of the material to be used by the dental surgeon cannot be considered as an absolute criterion and that the Judiciary should not accept such an opinion without questioning it. It was verified the need to open a larger structure to the magistrates, with the creation of centers for technical assistance in health and/or investments in the existing one, in order to subsidize the judges and ensure a greater efficiency in the solution of the demands.

Do Type of Helmet and Alcohol Use Increase Facial Trauma Severity?

PURPOSE: Facial trauma caused by motorcycle accidents has become a major issue because of its high prevalence and morbidity, causing death and esthetic and functional sequelae in many individuals. This work evaluated helmet and alcohol use and severity of facial fractures in motorcyclists treated at public hospitals in Pernambuco, Brazil. PATIENTS AND METHODS: This prospective study was conducted from December 2016 to December 2018 and submitted to statistical and descriptive analysis. Variables such as gender, age, helmet use and type, previous accidents, and duration of hospitalization were collected. The Facial Injury Severity Scale was used to classify the facial fractures. The Alcohol Use Disorders Identification Test was used to verify alcohol dependence. RESULTS: The sample was composed of 455 patients. Most were male patients (90.8%) and were aged 18 to 29 years (54.5%). Of the patients, 36.5% reported no helmet use and 31.6% reported wearing an open helmet. Alcohol use was reported in 38.7% of the group. In 79.8% of the sample, alcohol use was classified as low risk. There was a greater likelihood of having severe facial trauma if patients were aged between 30 and 39 years and had harmful or at-risk alcohol use. These patients also tended to remain hospitalized for more than 10 days. No statistically significant relationship was found with the type of helmet. CONCLUSIONS: The individuals most affected by facial trauma were young male patients (aged 18 to 29 years). Patients aged 30 to 39 years with high-risk use and dependence on alcohol were more likely to have more complex facial trauma. The type of helmet used was not effective in reducing the severity of facial fractures.

Avaliação do padrão morfológico de rugoscopia palatal em uma população brasileira / Evaluation of the morphological pattern of palatal rugoscopy in a brazilian population

Objetivo: Este estudo teve por objetivo avaliar o perfil do padrão morfológico de rugosidade palatal de alunos de graduação da Faculdade de Odontologia de Pernambuco FOP-UPE. Metodologia: A pesquisa foi do tipo prospectiva, sendo a amostra constituída de um total de 105 (cento e cinco) indivíduos. Foi realizada a moldagem do arco superior e modelos de gesso foram confeccionados. A partir dos mesmos, a análise morfológica das rugas palatais foi realizada, por um único examinador. Os parâmetros de morfologia das rugas primárias, forma da papila incisiva, direção de alinhamento das rugas, rafe palatina mediana e força das rugas foram analisados. Os dados foram computados numa planilha do Excel, sendo posteriormente, submetidos a análise estatística. Resultados: A idade variou de 18 a 35 anos, a faixa etária mais prevalente foi 21 a 23 anos, maioria de cor branca e IMC (índice de massa corporal) normal (64,8%). A morfologia das rugas primárias mais frequente foi a curva (39,0%). Sobre a forma papila incisiva, aproximadamente metade (49,5%) foi classificada na categoria mínima seguido da cilíndrica (35,2%). Pouco mais da metade (52,4%) teve a classificação de Carrea irregular. Os dois maiores percentuais da rafe palatina foram: não bifurcada (43,8%) e bifurcada posterior (32,4%). Conclusão: pode-se concluir que, foi possível identificar um tipo morfológico específico mais prevalente dentro da população estudada. Diferenças significativas entre as classificações do IMC foram verificadas na dimensão anteroposterior, secundária esquerda e transversal. Foi observada associação significativa entre a classificação do IMC com as inicial e complementar da classificação de Santos

Objective: The purpose of this study was to evaluate the profile of the morphological pattern of palatal roughness of undergraduate students of the College of Dentistry of Pernambuco FOP-UPE, through the various proposed parameters. Methodology: The research was of the prospective type, being the sample constituted of a total of 105 (one hundred and five) individuals. Upper arch molding was performed and plaster models were made. From these, the morphological analysis of the palatal wrinkles was performed by a single examiner. The morphological parameters of the primary wrinkles, incisal papilla shape, direction of alignment of wrinkles, median raphe palatine and wrinkle strength were analyzed. The data were computed in an Excel spreadsheet, and then submitted to statistical analysis. Results: Age ranged from 18 to 35 years, the most prevalent age group was 21 to 23 years, mostly white and normal BMI (body mass index) (64.8%). The most frequent primary wrinkle morphology was the curve (39.0%). About the incisive papilla, approximately half (49.5%) was classified in the minimum category followed by the cylindrical (35.2%). Just over half (52.4%) had the classification of Carrea irregular. The two highest percentages of Rafe palatine were: non-bifurcated (43.8%) and posterior bifurcated (32.4%). Conclusion: It can be concluded that, it was possible to identify a specific morphological type most prevalent in the studied population. Significant differences between BMI classifications were found in the anteroposterior, secondary left and transverse dimensions. Significant association was observed between BMI classification with Santos' initial and supplemental classifications.

Avaliação da espessura de tecido mole facial em uma população brasileira in vivo "a espessura do tecido mole facial em Brasileiros" / Evaluation of the facial soft tissue thickness in a Brazilian in vivo population "facial soft tissue thickness in Brazilians"

Introdução: Hoje em dia há uma enorme demanda para identificação individual tanto no campo da justiça civil e criminal. Existem várias maneiras de identificar indivíduos, dependendo se ele está vivo ou morto (cadáver ou esqueleto). Esta pesquisa teve o objetivo de criar um banco de dados para a espessura do tecido mole facial em indivíduos vivos de uma determinada população brasileira, de acordo com idade, sexo e índice de massa corporal. Métodos: medições da espessura de tecidos moles faciais foram realizadas em 101 pacientes (62 homens e 39 mulheres, com idade entre 18 e 106 anos). TC foi realizado tendo em conta 20 pontos craniométricos selecionados previamente. A espessura dos tecidos moles nestes pontos foram inicialmente medida e comparada com a idade, sexo e estado nutricional e com dados de outras populações em todo o mundo. Resultados: De acordo com o sexo não houve diferenças significativas nos pontos: násio, rínion, meio do filtro labial midphiltrum , supradentale, e órbita lateral. Distâncias com diferenças significativa para ambos os sexos entre as diferentes populações foram: supradentale; infradentale; supramentale; órbita lateral; arco zigomático e linha oclusal. Alguns pontos antropométricos mostraram diferenças significativas entre sexo, faixa etária e estado nutricional. Entre os sexos, os homens apresentaram médias maiores. Entre os grupos etários, houve também diferenças significativas em algumas distâncias. Em relação ao estado nutricional, as distâncias foram menores entre peso normal e maior entre os obesos. Conclusão: Ao considerar várias populações, a espessura do tecido mole mostrou diferenças significativas em muitos pontos craniométricos destacando como eles podem ser distintas.

Introduction: Nowadays there is a huge demand for individual identification in both civil and criminal justice fields. There are several ways to identify individuals, depending on whether he is alive or dead (cadaver or skeleton). This research aimed to create a database for facial soft tissue thickness in living individuals of a specific Brazilian population, according to age, sex and body mass index. Methods: Measurements of facial soft tissues thickness were done in 101 patients (62 men and 39 women, aged 18 to 106 years). CT scans were performed taking into account 20 craniometric points previously selected. The soft tissue thickness in these points were initially found and compared with age, sex and nutritional status, and with another populations data worldwide. Results: According about sex was no significant difierence in points: nasion, rhinion, midphiltrum, supradentale and lateral orbit. Distances with significant difference for both sexes between the diferent populations were: supradentale; infradentale; supramentale; lateral orbit; zygomatic arch and occlusal line. Some anthropometric points showed significant differences between sex, age groups and nutritional status. Between sexes, men had greater means. Among age groups, there was also significant differences in some distances. In relation to nutritional status, the distances were lower among normal weight and higher among the obese. Conclusion: When considering various populations, soft tissue thickness had significant differences in many craniometric points highlighting how distinct they might be.

Avaliação da utilização do capacete e do risco de dependência para utilização de bebidas alcoólicas nos motociclistas internados no Hospital da Restauração / Evaluation of the helmet use and the risk of dependence for the use of alcoholic beverages in the motorcyclists in the Hospital da Restauração

O objetivo deste trabalho foi avaliar o uso do capacete e o risco de dependência para utilização de bebida alcoólica nos motociclistas internados no HR. A metodologia aplicada nessa pesquisa é de natureza epidemiológica, quantitativa, descritiva e prospectiva. As seguintes variáveis foram estudadas: sexo, idade, tipo de capacete, potência da moto, finalidade de uso, ossos e fraturas, complexidade das fraturas e risco de dependência do uso álcool. Foram analisados dados de 100 pacientes, dos quais o sexo mais acometido foi o masculino na faixa etária entre 18-29 anos; a potência da moto disparadamente mais procurada pelos pacientes encontra-se acima de 50 cc, tendo sido o tipo de capacete mais utilizado o integral com viseira, porém com uma deficiência muito grande na utilização de capacete pelos motociclistas; a maior finalidade para o uso da moto pelos pacientes foi para o trabalho. O osso mais fraturado foi o zigomático. A maioria dos pacientes foi classificada com uso de baixo risco do álcool na classificação do AUDIT... (AU)

The purpose of this work was to evaluate the use of helmet and the risk of addiction to the use of alcoholic beverage in motorcyclists admitted at the HR hospital. The methodology applied in this research is epidemiological, quantitative, descriptive and prospective. The following variables were studied: gender, age, type of helmet, motor power, purpose of use, bones and fractures, fracture complexity and risk of dependence on alcohol use. Data from 100 patients were analyzed, in which male was the most affected gender in the age group 18-29 years old; The motorcycle's power most frequently sought by the patients is above 50 cc and the type of helmet most used was the integral with visor, but with a great deficiency in the use of helmets by the motorcyclists; The major purpose for motorcycle use by patients was to work. The most fractured bone was the zygomatic. The majority of patients were classified as having been included in the use of alcohol risk in the AUDIT classification... (AU)

Treatment of circumferential defects with osseoconductive xenografts of different porosities: a histological, histometric, resonance frequency analysis, and micro-CT study in dogs.

BACKGROUND: Finding the most effective method of minimizing the gap effect in alveolar crest remodeling constitutes a clinical challenge for immediate implant technique. PURPOSE: To evaluate the effectiveness of osseoconductive xenografts with different porosities in the crestal bone region, with and without guided bone regeneration, over immediate implant installation. MATERIALS AND METHODS: Five bone defects (6 mm in diameter/4 mm depth) were prepared on one side of the mandibles of twelve dogs. Implants of 3.3 × 10 mm were installed on the mesial side of each defect, providing a 2.7-mm distal gap. Defects were randomly filled with autogenous bone, coagulum, a deproteinized bovine bone mineral (DBBM) block, a DBBM sponge, or DBBM granules. The same procedures were performed on the opposite side after 8 weeks. Collagen membranes were used to cover the defects on half of the sides. The animals were sacrificed after 8 weeks. The outcomes were evaluated by histology, histomorphometric analysis, resonance frequency analysis, and micro-CT analysis. RESULTS: The histomorphometry showed the DBBM sponge to provide similar bone formation to autogenous bone at 8 weeks without a membrane. The coagulum rendered better bone formation at 16 weeks (membrane) (p < .05). The DBBM block exhibited the poorest results between treatments (8 and 16 weeks, with or without membrane). Micro-CT analysis revealed increasing bone surface values in sites with DBBM granules, followed by the DBBM sponge (8 weeks without membrane) and autogenous bone at 8 weeks with membrane (p < .05). Porosity analysis of the biomaterials showed the highest number, volume, and surface area of closed pores in DBBM granules. The DBBM block presented the highest volume of open pores, open porosity, and total porosity. CONCLUSIONS: The high-porosity block (DBBM block) failed to provide greater bone repair within the defect. Biomaterials with lower porosity (DBBM sponge and granules) showed similar or higher bone formation when compared with autogenous bone.

Early Osseointegration Events on Neoss® ProActive and Bimodal Implants: A Comparison of Different Surfaces in an Animal Model.

BACKGROUND: Cell interactions, adherence, and osseointegration at the bone-implant interface can be directly influenced by the surface properties of the titanium implant. PURPOSE: To characterize osseointegration of Neoss® implants with conventional (control group) and hydrophilic (test group) surface treatments. MATERIALS AND METHODS: Six Labrador dogs received Neoss implants with conventional and hydrophilic surfaces. The bone-implant interfaces were evaluated 1 and 4 weeks after implantation, and osseointegration was evaluated using histological, histomorphometric, fluorescence, and resonance frequency analyses. The surfaces were also subjected to topographic and hydrophilicity analyses. RESULTS: The topographic analyses revealed increased surface roughness in the test group compared with the control group (surface area roughness 0.42 and 0.78 µm, respectively, for control and test group surfaces; p ≤ .05). The wettability values were higher in the test group (contact angles 67.2° and 27.2° for the control and test group surfaces, respectively; p ≤ .05). Implants in the test group also exhibited better stability, more bone-implant contact, and increased bone area compared with implants in the control group. CONCLUSION: Neoss implants in the test group improved bone formation in the early stages of osseointegration compared with implants in the control group.

Avaliação do trauma da face sob as perspectivas do Código Penal e das inovações trazidas com a Lei Maria da Penha / Evaluation of facial trauma from the perspective of the Penal Code and the innovations resulting from the Maria da Penha Act: a case report

Objetivo: Analisar os traumas da face sob a ótica do Código Penal Brasileiro caracterizando as qualificadoras da lesão corporal em decorrência de violência doméstica, artigo 129 do Código Penal, e de suas alterações com a Lei Maria da Penha. Metodologia: Um caso de violência contra a mulher foi relatado e, partindo deste caso, foi realizada uma discussão com base na legislação brasileira vigente, referente ao tema. Conclusão: Conclui-se que mesmo com todas essas mudanças na legislação, o Brasil avançou muito pouco. A violência domestica contra a mulher ainda tem muito a ser vencida, até mesmo por estar ligada a um fator cultural muito forte e difícil de desprender na sociedade... (AU)

Obective: To analyze facial traumas from the perspective of the Brazilian Penal Code, characterizing the bodily injury caused by domestic violence, Article 129 of the Penal Code, and its changes resulting from the Maria da Penha Act. Methodology: A case of violence against a woman was reported, which served as the starting point for a discussion on the current Brazilian legislation on the issue. Conclusion: It was concluded that despite all the changes in the legislation, Brazil has made very little progress in this area. Much remains to be done in the fight against domestic violence targeting women, particularly since the latter involves a strong cultural factor that is difficult to eliminate from Brazilian society... (AU)

Extensive cervical necrotizing fasciitis of odontogenic origin.

Necrotizing fasciitis (NF) is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of necrotizing fasciitis from odontogenic origin in a patient with uncontrolled diabetes mellitus. The initial diagnosis was based on clinical information, in which multiple necrosis areas in cervical and thoracic regions were observed. Wide antibiotic therapy was applied, followed by surgical drain age and debridement. Culture was positive for methicillin-resistant Staphylococcus aureus. Although the treatment is established, the patient dies after sepsis and failure of vital organs. Clearly, the morbidity associated to this infection, even in diabetic patients, can be minimized if an early diagnosis and effective debridement are done.

Cytotoxicity testing of methyl and ethyl 2-cyanoacrylate using direct contact assay on osteoblast cell cultures.

PURPOSE: Cyanoacrylate has been used as a commercial tissue adhesive. Recently, ethyl 2-cyanoacrylate has been suggested for the fixation of onlay autogenous bone graft. However, ethyl 2-cyanoacrylate must be biocompatible with bone tissue. This study evaluated the cytotoxicity of cyanoacrylate adhesives using a direct contact assay on human oral osteoblast cells. MATERIALS AND METHODS: Osteoblastic cells derived from human alveolar bone of the mandible were cultured with or without cyanoacrylate. The CA1 group contained methyl 2-cyanoacrylate, the CA2 group contained ethyl 2-cyanoacrylate, and the CA3 group did not contain cyanoacrylate (control). This study investigated cell morphology, which included the inhibition zone, and cytotoxicity was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, which was measured as optical density. Data from the MTT assay were tested statistically using SigmaStat 3.5. RESULTS: Dead cells found around the CA1- and CA2-treated cells constituted inhibitory zones that varied from 200 to 500 µm. There was no inhibitory zone in the CA3 group. Cell viability evaluated by the MTT assay showed that the CA2 and CA3 optical densities were not significantly different. The CA1 optical densities differed significantly from the CA3 optical densities. CONCLUSIONS: Within the limits of this study, the MTT method supported the conclusion that ethyl 2-cyanoacrylate is biocompatible according to a direct contact assay on human osteoblast cell cultures and suggests its usefulness in bone graft fixation.

Immunohistochemical, tomographic, and histological study on onlay bone graft remodeling. Part III: allografts.

OBJECTIVE: In the last decades aroused the interest for bone tissue bank as an alternative to autogenous grafting, avoiding donor sites morbidity, surgical time, and costs reduction. The purpose of the study was to compare allografts (ALg) with autografts (AUg) using histology, immunochemistry, and tomographic analysis. MATERIAL AND METHODS: Fifty-six New Zealand White rabbits were submitted to surgical procedures. Twenty animals were donors and 36 were actually submitted to onlay grafting with ALg (experimental group) and AUg (control group) randomly placed bilaterally in the mandible. Six animals of each group were sacrificed at 3, 5, 7, 10, 20, and 60 postoperative days. Immunolabeling was accomplished with osteoprotegerin (OPG); receptor activator of nuclear factor-k ligand (RANKL); alkaline phosphatase (ALP); osteopontin (OPN); vascular endothelial growth factor (VEGF); tartrate-resistant acid phosphatase (TRAP); collagen type I (COL I); and osteocalcin (OC). Density and volume of the grafts was evaluated on tomography obtained at the surgery and sacrifice. RESULTS: The ALg and AUg exhibited similar patterns of density and volume throughout the experiments. The intra-group data showed statistical differences at days 7 and 60 in comparison with other time points (P = 0.001), in both groups. A slight graft expansion from fixation until day 20 (P = 0.532) was observed in the AUg group and then resorbed significantly at the day 60 (P = 0.015). ALg volume remained stable until day 7 and decreased at day 10 (P = 0.045). The light microscopy analysis showed more efficient incorporation of AUg onto the recipient bed if compared with the ALg group. The immunohistochemical labeling picked: at days 10 and 20 with OPG in the AUg group and at day 7 with TRAP in the ALg group (P = 0.001 and P = 0.002, respectively). CONCLUSIONS: ALg and AUg were not differing in patterns of volume and density during entire experiment. Histological data exhibit more efficient AUg incorporation into recipient bed compared with the ALg group. Immunohistochemistry outcomes demonstrated similar pattern for both ALg and AUg groups, except for an increasing resorption activity in the ALg group mediated by TRAP and in the AUg group by higher OPG labeling. However, this latter observation does not seem to influence clinical outcomes.

Tooth embedded in lower lip following dentoalveolar trauma: case report and literature review.

One of the most frequent consequences of trauma to the maxillofacial region is damage to teeth and supporting structures. Such damage can occur either in isolation or in conjunction with other fractures and soft tissue lacerations. In emergency situations, the harm caused to teeth could go unnoticed during the clinical examination, depending on the nature and complexity of the trauma and the primary care team's awareness of orofacial injuries. Fractured incisors often cause lacerations to the soft tissues at the time of trauma. During the diagnosis, particular care must be taken when such a fracture is associated with a soft tissue injury.

Mandibular angle fracture treated with new three-dimensional grid miniplate.

Fractures of the mandibular angle deserve particular attention because they represent the highest percentage of mandibular fractures and have the highest postsurgical complication rate, making them the most challenging and unpredictable mandibular fractures to treat. Despite the evolution in the treatment of maxillofacial trauma and fixation methods, no single treatment modality has been revealed to be ideal for mandibular angle fractures. Several methods of internal fixation have been studied with great variation in complications rates, especially postoperative infections. Recently, new studies have shown reduction of postsurgical complications rates using three-dimensional plates to treat mandibular angle fractures. Nevertheless, only few surgeons have used this type of plate for the treatment of mandibular angle fractures. The aim of this clinical report was to describe a case of a patient with a mandibular angle fracture treated by an intraoral approach and a three-dimensional rectangular grid miniplate with 4 holes, which was stabilized with monocortical screws. The authors show a follow-up of 8 months, without infection and with occlusal stability.

Cirurgia de elevação da mucosa do seio maxilar: o uso de biomaterial é necessário? / Surgical elevation of maxillary sinus mucosa: is it necessary to use biomaterials?

A reabsorção óssea que ocorre após a extração dos dentes posteriores da maxila pode resultar em perdas ósseas severas verticais e/ou horizontais, comprometendo, assim, o planejamento de reabilitação com implantes naquela região. Inúmeras técnicas de enxertia têm sido descritas e utilizadas no intuito de restabelecer volume ósseo adequado para posterior instalação dos implantes. A técnica mais rotineira para restaurar a anatomia dessa região é o procedimento de aumento do assoalho do seio maxilar.

The bone resorption that occurs after extraction of maxillary posterior teeth may result in severe vertical and/or horizontal bone loss, compromising the planning of rehab with implants in that region. Numerous grafting techniques have been described and used aiming to restore adequate bone volume for posterior implants installation. The most used technique to restore the anatomy of this region is the procedure of maxillary sinus floor augmentation.

Guided surgery in unusual palatal torus.

Palatine torus is a benign congenital outgrowth of bone that affects the hard palate and palatine processes, resulting from the "overworking" of osteoblasts and bone deposition along the line of the palatine fusion. Surgical excision is the only treatment for torus, and such patients are susceptible to intraoperative and postoperative complications of a traumatic, functional, or infectious nature. This article describes an atypical case of torus palatinus measuring 20.31 × 27.25 × 59.20 mm, which is the largest size ever described in the literature. This case required the use of a surgical guide in the intraoperative phase, with viable use in the postoperative phase as well. This guide proved versatile in reducing the risk of undercorrection and complications, offering greater patient comfort.

Foreign body ingestion during dental implant procedures.

Two cases of swallowing of foreign material related to dental implants during dental practice are described. A conservative approach by clinical-radiographic follow-up was performed in both cases; however, one of the patients required colonoscopy under general anesthesia for the removal of the impacted foreign body from the intestinal region. These complications not only have associated economic cost but also carry the risk of malpractice litigation against the professional; thus, the surgeon was responsible for all the costs of hospital and surgery management of this case. Details of the clinical signs, radiographic examinations, type of treatment, and follow-up are presented.

Brain abscess of odontogenic origin.

Brain abscess is a rare and threatening infection, which is in a suppuration area, caused either by trauma, neurosurgical complication, or by a secondary infection of dental origin complication. The infectious process spread from the start focus can occur in 2 ways: hematogenous or by contiguity. The treatment should ideally be based on the etiological factor excision, combined with drainage and antibiotics as adjuvant; this philosophy is not observed in the reports described in the 1960s, 1970s, and 1980s. This study's goal was to report a case of brain abscess consequent of an odontogenic outbreak, where an adequate treatment was set up, but it was already in advanced stages and had as a result the lethal outcome. Complications from the odontogenic infections have a low incidence, but should never be disregarded, because they can lead to death, as described in this manuscript.

Anquilose temporomandibular: uma rara manifestação da espondilite anquilosante / Temporomandibular ankylosis: a rare manifestation of ankylosing spondylitis

Espondilite anquilosante é considerada uma condição crônica do grupo de doenças inflamatórias sistêmicas, de padrão reumático, que acomete os tecidos conectivos, afetando, primariamente, o esqueleto axial, sendo incomum nas articulações periféricas. A doença traz limitações no cotidiano, através da atividade motora reduzida, em virtude da rigidez, comprometendo o estado emocional e a qualidade de vida. Apesar de ser pouco comum a queixa de sintomas na articulação temporomandibular, o envolvimento dessa articulação, em alguns casos, pode ocasionar sintomas graves. Episódios de cefaleia frequentes e de longa duração além de dor maxilar ao movimento de abertura bucal são os sintomas mais frequentes do acometimento temporomandibular. No início da doença, os sintomas são geralmente unilaterais e intermitentes. Conforme a doença avança, estes são mais severos, podendo chegar à rara ocorrência da anquilose temporomandibular. Os primeiros sinais clínicos da anquilose temporomandibular é a limitação dos movimentos mandibulares, sendo essencial o diagnóstico prematuro do acometimento dessa articulação, possibilitando uma abordagem precoce. Este artigo tem como objetivo relatar um caso raro de anquilose da articulação temporomandibular secundária à espondilite anquilosante, abordando seus aspectos clínicos e terapêuticos.

Ankylosing spondylitis is considered to be a chronic condition from the group of systemic inflammatory diseases of rheumatic pattern. It affects connective tissues and particularly the axial skeleton, but it is unusual for it to develop in peripheral joints. It poses limitations to the patients? daily life because of restrictions to motor activity caused by rigidity, thus compromising their emotional condition and quality of life. Although complaints about symptoms in the temporomandibular joint are not frequent, in some cases the involvement of this joint may lead to severe symptoms. Episodes of frequent, long-lasting headaches and maxillary pain when patients open their mouths fully are the most frequent symptoms of temporomandibular involvement. At the onset of the disease, symptoms are usually unilateral and intermittent. As the disease progresses, symptoms may become more severe, possibly leading to the rare occurrence of temporomandibular ankylosis. The first clinical sign of temporomandibular ankylosis is limited jaw movement. An early diagnosis of the involvement of this joint is essential so that an early approach can be made. The purpose of this paper is to report a rare case of ankylosis of the temporomandibular joint, secondary to ankylosing spondylitits, and to discuss its clinical and therapeutic aspects.

Oral and maxillofacial myiasis: a case series and literature review.

OBJECTIVE: The aim of this study was to describe a series of 10 cases of oral-maxillofacial myiasis, discussing its main features, demographic distribution, and treatment aspects. STUDY DESIGN: A retrospective study was carried out involving male and female patients of any age with oral-maxillofacial myiasis. The sample was determined by spontaneous demand at the emergency ward of a hospital between January 2005 and January 2011 (6 years). After treatment of each case, data were gathered on the presence of associated systemic disorders, time elapsed since onset of the disease, and treatment established. A review of the literature on this topic was also carried out. RESULTS: The sample was made up of 10 patients, all treated with surgical debridement whether or not associated with the use of oral ivermectin. Mean time elapsed since the onset of the disease ranged from 4 to 36 months. The middle third of the face was the most frequently affected region (7 cases). Oral-maxillofacial myiasis predominantly affected the male gender (70%). CONCLUSIONS: Oral-maxillofacial myiasis affects individuals with poor hygiene and neurologic and/or psychologic alterations. It occurs predominantly in countries near the tropics. The treatment of choice is surgical debridement.