Virtual Versus Conventional Planning in Orthognathic Surgery: A Systematic Review and Meta-analysis.

Objectives: The purpose of this study was to compare the accuracy of hard tissues movements planned to result of the maxillary and mandibular positions between conventional surgical planning (CSP) and virtual surgical planning (VSP) in patients undergoing orthognathic surgery. Methods: A systematic electronic search was carried out in six databases and gray literature with no restriction of publication date and language. Clinical observational studies that compared accuracy of maxillary position between CSP and VSP were included. Linear measurements of the mandible in the transverse plane and linear measurements of the maxilla in the vertical, horizontal and transverse planes were considered for analysis, comparing planned to postoperative outcomes of CSP and VSP. Cochrane tool was used to assess bias risk. A meta-analysis was performed to summarize similar results by using the Review Manager 5.3 software. Significance level was set at 5%. Results: Six studies (2 RCT and 4 retrospective cohorts) were included according to inclusion and eligibility criteria, involving 255 patients. The inter-rater reliability of selection and eligibility was excellent (k = 0.8315 and k = 0.9329, respectively). Two studies presented that VSP seemed to have better results than CSP regarding linear measurements of the mandible in the transverse plane. Results from CSP and VSP were similar in accuracy for hard tissue in vertical plane of maxillary position (I2 = 0%; p = 0.17), although VSP was more accurate in horizontal plane (I2 = 0%; p = 0.02). Conclusion: VSP presented better accuracy for transverse movements in mandible of asymmetric patients. VSP showed to be more accurate for movements in the horizontal plane, and qualitative analysis seemed to be more effective for transverse movements.

Multidisciplinary Treatment: Follow-Up of Dental Autotransplantation for 10 Years.

The objective is to present a clinical case of dental autotransplantation managed with surgery, orthodontics, endodontics, periodontics, and aesthetic rehabilitation. A 10-year-old boy sought treatment after avulsion of the maxillary left central incisor, which was not reimplanted. Based on anamnesis, clinical examination, and complementary examinations, agenesis of the maxillary and mandibular second premolars except the mandibular right second premolar was observed. After a multidisciplinary planning, the space in the maxillary left central incisor region was opened to receive the transplanted mandibular right second premolar. The receptor site was created in a single surgical procedure. Pulp necrosis was noted in the transplanted tooth, which was treated endodontically, and the agenesis spaces were closed using fixed orthodontic appliances. After removing the appliance, gingivectomy with osteotomy was performed in the maxillary right central incisor and the transplanted tooth regions to harmonize the height and shape of the gingival contour. Next, aesthetic readjustment was performed with tooth whitening, using office and home techniques, followed by microabrasion of the vestibular surface of the maxillary right central incisor. Direct composite resin restorations were placed in the maxillary incisors, and the teeth were rehabilitated using incisal and palatal guides. A multidisciplinary approach is essential for reestablishing the function and aesthetics of complex cases involving dental autotransplantation.

Radiographic Assessment of Different Autogenous Bone Grafts in the Alveolar Cleft: A Retrospective Longitudinal Study.

Objectives: To assess feasibility and maintenance of bone after alveolar cleft reconstructions using graft from iliac crest and mandibular symphysis. Methods: 51 alveolar clefts grafted with iliac crest and 51 ones grafted with mandibular symphysis bones were selected from patients aged between 7 and 12 years. At three (T1) and 12 months (T2) after surgeries, periapical radiographs were performed to measure the height of the grafted bone based on the modified Bergland scale. Chi-square and Mann-Whitney-Wilcoxon tests compared differences between T1 and T2 according to each bone graft. Results: From the clefts grafted with mandibular symphysis bone, 47 were classified as type I (92.5%) and 04 as type II (7.84%) at T1. At T2, 36 were classified as type II (25.49%) and 02 as type III (3.92%). In the analysis of the clefts grafted with iliac crest at T1, 48 were classified as type I (94.11%) and three as type II (5.88%). At T2, 37 classifieds as type I (72.54%), 12 as type II (23.52%) and two as type III (3.92%). There was no statistically significant difference between treatments. Conclusions: It was concluded that iliac crest and mandibular symphysis are adequate areas from which bone grafts can be obtained for reconstruction of alveolar cleft.

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.

Use of the Iliac Crest Cortex for Premaxilla Fixation in Patients With Bilateral Clefts.

The aim of the present study was to evaluate the effectiveness of fixation of the premaxilla to the remaining maxillary stumps using the iliac crest cortical bone and screws in 16 patients with bilateral alveolar clefts. The technique was used in patients who required surgical repositioning of the premaxilla owing to its severe anterior projection and mispositioning. Postoperative follow-up was performed using periapical and occlusal radiographs and clinical examinations at 3 and 6 months after surgery. Subsequently, the patients were referred for resumption of orthodontic treatment. Of the 16 patients evaluated, only 1 patient experienced unilateral loss of the graft, requiring further surgical intervention.

Temporal Flap as an Option for Buconasal Fistula Closure.

Maxillary defects with buconasal/businusal communications are situations difficult to manage and solve. Several treatment options are available on the literature, each one with its indication. Temporal muscle flap is one of these options, being a technique that requires more experience of the surgeon to be properly performed and that is mainly indicated for difficult cases, large defects and those nonresponsive to simpler techniques. The main purpose of this paper is to report 3 clinical patients of the application of the temporal muscle flap for the closure of extensive oral defects. None of the patients had necrosis, nervous deficits, or any long-term changes. The authors conclude that the use of this flap was shown to be a viable, safe technique with low complication and high success rates, which may contribute to the rehabilitation of well-indicated patients.

Pedicle Tongue Flap for Palatal Fistula Closure.

BACKGROUND: Palatal fistulae are common sequels that appear in patients after surgical procedures in the palate. Considering the difficulty to achieve an effective treatment, there are many techniques to surgically manage fistulae, that is, the pedicle tongue flap. OBJECTIVE: Being so, the main goal of this paper is to report cases of patients with palatal fistulae, from different etiologies, treated with anterior pedicle tongue flap. PATIENTS: Eleven patients, 8 male and 3 female, mean age of 32 years old with palatal fistulae surgically treated with anterior dorsal tongue flaps. No flap was completely lost. There was 1 partial loss and 1 residual buconasal communication. The most common complaints of the patients were difficulty to perform oral hygiene and mild pain. CONCLUSION: The use of anterior pedicle tongue flap for closing palatal fistulae demonstrates to be a safe procedure with high success rates (81% in this paper) when correctly indicated.

A importância do planejamento estético para a correção de deformidades dentofaciais / The importance of esthetic planning when correcting dentofacial deformities

A cirurgia ortognática tem como objetivos estabelecer a função mastigatória e melhorar a estética facial, dando harmonia e proporcionalidade à face. A estética, sem dúvida, é a questão mais importante para o paciente, pois geralmente é a queixa principal para o tratamento. No presente trabalho, será apresentado um caso de uma paciente que se apresentou insatisfeita com o resultado da cirurgia ortognática, pois o planejamento foi feito priorizando apenas a correção da má oclusão de Classe III, sem atentar-se à repercussão estética. Apesar da oclusão tratada, a paciente foi submetida a nova cirurgia, para dar-lhe o resultado que esperava no primeiro procedimento. Com isso, percebemos que, em pacientes ortodôntico-cirúrgicos, devemos observar com atenção a queixa principal e os problemas faciais, e não ater-se somente à oclusão, pois o paciente está mais preocupado com a aparência da face do que com a posição dos dentes

Glossectomy as an adjunct to correct an open-bite malocclusion with shortened maxillary central incisor roots.

A young man, 19 years of age, with the chief complaint of an anterior open bite, came for orthodontic treatment with a skeletal Class I relationship, anterior open bite, shortened maxillary incisor roots, and relative macroglossia. The malocclusion was treated by extracting the maxillary first premolars and using a fixed edgewise appliance. A partial glossectomy was performed before the orthognathic surgery with a 3-piece segmental LeFort I mandibular setback, and advancement was achieved with a reduction genioplasty. A functional and esthetic occlusion with an improved facial profile was established, and the apex of the maxillary left central incisor became slightly rounded after prolonged and significant tooth movement. Four years after treatment, there was occlusal stability of the results, and no further root shortening was observed.

Social integration and inclusion after pre-maxilla surgical repositioning in patients with bilateral cleft palate and lip.

UNLABELLED: Bilateral alveolar process fissure causes important functional and aesthetical limitations and thus difficulties in terms of social and family integration and interaction for these patients. AIM: (A) to assess motivations and expectations Treatment-wise and (B) to assess social inclusion and integration brought about by the surgery. MATERIALS AND METHODS: retrospective observational study involving 50 participants recruited among the patients submitted to the pre-maxilla repositioning procedure from January of 2003 to July of 2005 at the Centro de Atendimento Integral ao Fissurado Lábio-Palatal in Curitiba (CAIF), Paraná, and an assessment questionnaire was used. RESULTS: as far as the care protocol is concerned, results show a 90% success rate of surgeries. As to surgical and personal satisfaction rates are concerned, 76% sought treatment for personal satisfaction reasons and 86% reported having had more self-confidence after the surgery. CONCLUSIONS: Most of the patients submitted to the maxilla repositioning saw surgery as a continuation of the care previously given, with the expectation of better looks and self-confidence and, 96% of them were pleased with the results attained, which facilitated their social inclusion and re-integration.

Social integration and inclusion after pre-maxilla surgical repositioning in patients with bilateral cleft palate and lip / A inclusão e a integração social pós-reposicionamento cirúrgico da pré-maxila em portadores de fissura lábio palatal bilateral

Bilateral alveolar process fissure causes important functional and aesthetical limitations and thus difficulties in terms of social and family integration and interaction for these patients. AIM: (A) to assess motivations and expectations Treatment-wise and (B) to assess social inclusion and integration brought about by the surgery. MATERIALS AND METHODS: retrospective observational study involving 50 participants recruited among the patients submitted to the pre-maxilla repositioning procedure from January of 2003 to July of 2005 at the Centro de Atendimento Integral ao Fissurado Lábio-Palatal in Curitiba (CAIF), Paraná, and an assessment questionnaire was used. RESULTS: as far as the care protocol is concerned, results show a 90 percent success rate of surgeries. As to surgical and personal satisfaction rates are concerned, 76 percent sought treatment for personal satisfaction reasons and 86 percent reported having had more self-confidence after the surgery. CONCLUSIONS: Most of the patients submitted to the maxilla repositioning saw surgery as a continuation of the care previously given, with the expectation of better looks and self-confidence and, 96 percent of them were pleased with the results attained, which facilitated their social inclusion and re-integration.

A fissura alveolar bilateral determina limitações funcionais e estéticas, determinando dificuldades de interação e integração no âmbito familiar e social. OBJETIVO: (A) avaliar as motivações e expectativas em relação ao tratamento e (b) avaliar a inclusão e integração social obtida pelo procedimento. MATERIAL E MÉTODO: Estudo observacional, retrospectivo em 50 participantes recrutados dentre os pacientes submetidos ao procedimento de reposicionamento de pré-maxila, no período de janeiro de 2003 a julho de 2005, no Centro de Atendimento Integral ao Fissurado Lábio-Palatal em Curitiba (CAIF), Paraná, sendo aplicado questionário de avaliação RESULTADOS: Com relação ao protocolo de atendimento, os resultados evidenciaram sucesso em 90 por cento das cirurgias. Quanto às expectativas cirúrgicas e de integração social, estas mostraram que 76 por cento procuraram tratamento em busca de satisfação pessoal e, 86 por cento relataram maior autoconfiança após a cirurgia. CONCLUSÕES: A maioria dos pacientes submetidos ao reposicionamento de maxila percebeu a avaliação pós-cirúrgica como continuidade dos cuidados dispensados previamente, com expectativa da aparência e melhora da autoconfiança e, 96 por cento deles manifestaram satisfação com os resultados obtidos, o que facilitou sua inclusão e reintegração social.

Distração osteogênica mandibular em paciente tráqueo-dependente / Mandibular osteogenic distraction in a tracheo-dependent patient

Objetivo: Descrever o caso clínico e o acompanhamento pós-operatório de uma paciente de 18 anos de idade que apresentava um quadro de micrognatia severa, causada por anquilose de ATM devido a trauma durante o parto. Relato do caso: A paciente foi primeiramente tratada da anquilose de ATM por meio de liberação das ATMs e rotação de retalho músculo/fáscia temporal. Em seguida, foi realizada a instalação de um distrator osteogênico em cada lado da mandíbula e realizadas osteotomias. O distrator foi ativado a partir do 6º dia de pós-operatório a uma média de 0.5 mm ao dia, chegando até o avanço de 25mm. A paciente obteve um perfil facial mais aceitável, e as vias aéreas posteriores se expandiram, permitindo a remoção da traqueostomia. Considerações finais: A distração osteogênica mandibular é uma boa opção para pacientes com micrognatia que necessitem de grandes avanços mandibulares, permitindo, além de uma melhor harmonia facial, um aumento do espaço aéreo superior.

Objective: To describe the clinical case and postoperative follow-up of an 18-year-old patient with a picture of severe micrognatia caused by anchylosis of the temporomandibular joint (TMJ) due to trauma during childbirth. Method: The patient was initially treated for the anchylosis by means of the release of the TMJs and rotation of the temporal musculo-fascial flap, following which an osteogenic distractor was placed on either side of the mandible and osteotomies performed. The distractor was activated from the 6th postoperative day at an average of 0.5 mm per day up to a distance of 25 mm. The patient achieved a more acceptable facial profile and the airways expanded, allowing the removal of the tracheostomy. Final considerations: Mandibular osteogenic distraction is a good option for patients with micrognatia who require major mandibular remodelling, thus permitting, in addition to a better harmony of the face, an increase in the upper air space.

O impacto na qualidade de vida após o reposicionamento cirúrgico da pré-maxila em portadores de fissura lábio palatal bilateral - estudo de 50 casos / The life quality impact after surgical pre maxilla repositioning in patients with bilateral lip palatal cleft - study of 50 cases

OBJETIVO: Descrever o protocolo de tratamento no Centro de Atendimento Integral ao Fissurado Lábio-Palatal em Curitiba (CAIF); (b) avaliar as motivações e expectativas em relação ao tratamento e (c) avaliar a percepção de inclusão e integração social obtida pelo procedimento. MÉTODO: Estudo observacional, retrospectivo com todos os 50 participantes recrutados entre os pacientes submetidos ao procedimento de reposicionamento de pré-maxila, no período de janeiro de 2003 a julho de 2005, no Centro de Atendimento Integral ao Fissurado Lábio-Palatal em Curitiba (CAIF), Paraná. Foi aplicado questionário de avaliação RESULTADOS: Com relação ao protocolo de atendimento, os resultados evidenciaram sucesso em 90 por cento das cirurgias. Quanto às expectativas cirúrgicas e de integração social, estas mostraram que 76 por cento procuraram a cirurgia por motivos de insatisfação pessoal e, 86 por cento relataram maior confiança em si mesmo, após a cirurgia. CONCLUSÃO: O protocolo de reposicionamento cirúrgico da pré-maxila é uma técnica viável para o tratamento dos pacientes portadores de fissura bilateral do processo alveolar; a maioria dos pacientes submetidos ao tratamento de reposicionamento de pré-maxila percebeu o tratamento como continuidade dos cuidados dispensados, participou por indicação médica, com expectativa de melhora no aspecto pessoal e melhora da autoconfiança e, 96 por cento deles, manifestaram satisfação com os resultados obtidos, o que facilita a inclusão e integração social dos mesmos.

ABSTRACT BACKGROUND: To describe the assistance protocol, at the Center for Integral Assistance of Cleft Lip and Palate Patients (CAIF); to assess the expectations and motivations in respect to treatment; to evaluate the social integration and inclusion obtained through the procedure. METHODS: a retrospective study with all the 50 patients recruited among those submitted to the procedure of premaxilla repositioning, at the period from January 2003 to july 2005, at the Center for Integral Assistance of Cleft Lip and Palate Patients (CAIF), Paraná. A questionnaire was applied. RESULTS: regarding the assistance protocol, the results showed success in 90 percent of surgeries. Concerning surgical and social integration expectations, it was showed that 76 percent looked after surgery for personal satisfaction reasons and, 86 percent related better self trust after surgery. CONCLUSION: the surgical protocol of premaxilla repositioning is a viable technique for the treatment of patients with bilateral cleft of the alveolar process; the majority of patients submitted to premaxilla repositioning perceived the treatment as continuity of the care received, participated due to medical indication, expecting improvement at personal aspect and in self trust and, 96 percent of them, related satisfaction with results, which facilitates integration and social inclusion.

Use of allogeneic bone graft in maxillary reconstruction for installation of dental implants.

The aim of this study is to evaluate the efficacy of the application of allogenous bone at the maxillomandibular reconstructions for future rehabilitation with dental implants. The patients were submitted to reconstruction of maxilla, using allogeneic bone grafts, in 3 different techniques: onlay grafts for lateral ridge augmentation, onlay and particulate bone for sinus lift grafting, and particulate alone for sinus lift grafts. Clinical and radiographic control was done at the postoperative phase for at least 8 months, until the patient could be submitted to the installation of dental implants. The results showed success in the majority of the cases, and dental implants could be installed. This can be considered an excellent alternative when compared with the use of autogenous grafts; because handling is easier, there is a great amount of material available and a possibility of using local anesthesia, and consequently there is a reduction of patient morbidity.

Correção das deficiências transversas e ântero-posteriores da maxila em pacientes adultos / Maxillary anteroposterior and transverse problems correction in adult patients

OBJETIVO: a finalidade deste trabalho é avaliar os resultados de tratamento de pacientes com desarmonias esqueléticas Classe III e discrepâncias transversas, tratados com a técnica de expansão maxilar assistida cirurgicamente, associada à mecânica de tração reversa. METODOLOGIA: Foram avaliados 10 pacientes portadores de Classe III esquelética e discrepância transversal, submetidos à expansão maxilar assistida cirurgicamente e ao uso de máscara facial. A avaliação das alterações ortodônticas e ortopédicas foram realizadas por meio dos exames clínico e radiográfico. CONCLUSÃO: os resultados clínicos e radiográficos demonstraram eficiência nestes procedimentos, evitando nova cirurgia de maxila, diminuindo a morbidade do tratamento e o seu custo.

AIM: The purpose of this article is to evaluate the correction of anteroposterior and transverse maxillary deficiency in adult patients with the use of facial mask and surgically assisted RME (SARME). METHODS: Reverse traction of the maxilla was applied to 10 subjects through a facial mask after a SARME. All individuals presented a Class III skeletal malocclusion. Cephalometric tracings were used to access the amount of anterior maxillary displacement during treatment. RESULTS AND CONCLUSION: The association of these procedures promoted transverse correction and anterior displacement of the maxilla. This approach avoided a two step correction - one for SARME and other for maxillary advancement, reducing morbidity and costs of treatment.

Diagnóstico e tratamento das assimetrias dentofaciais / Diagnosis and treatment of dentofacial asymmetry

A assimetria facial é uma característica humana comum, que muitas vezes não é notada pelo próprio paciente nem pelas pessoas com quem ele convive. Entretanto, ela se torna relevante quando o próprio paciente relata alguma alteração. A avaliação profissional deve ser requisitada para que a etiologia seja estabelecida através de diversos métodos de diagnóstico. A deformidade poderá decorrer de fatores genéticos, como encontrado em pacientes portadores de microssomia hemifacial, ou adquirida em traumas e patologias. O tratamento das assimetrias faciais tem como objetivo um resultado estético satisfatório e, principalmente, estabilidade oclusal e funcional. O plano de tratamento é elaborado de acordo com a etiologia, a severidade da deformidade, a idade do paciente e as áreas afetadas, corrigindo a deformidade instalada ou impedindo sua evolução. O propósito deste trabalho é revisar a literatura no que diz respeito à etiologia, métodos de diagnóstico e às formas de tratamento das assimetrias faciais, exemplificando com casos clínicos as diferentes formas de abordagem das assimetrias

Controle químico da microflora oral em pacientes fissurados labiopalatais durante o tratamento ortodôntico-cirúrgico: estudo piloto / Oral microflora chemical control in cleft lip and palate patients during orthodontic-surgical treatment pilot study

G risco de infecção é uma preocupação durante o tratamento ortodôntico-cirúrgico, principalmente em pacientes como os fissurados lábio palatais, pois as condições anatômicas e oclusais contribuem para a proliferação microbiana. Métodos manuais para o controle da microflora oral são muitas vezes insuficientes para a obtenção de uma higiene satisfatória. Técnicas alternativas, como agentes químicos, têm sido propostas como procedimentos auxiliares. O objetivo deste estudo foi comparar a eficiência de dois agentes químicos como auxiliares no controle da microflora, em pacientes ortodôntico-cirúrgicos (fissurados lábio-palatais). O delineamento da pesquisa foi um estudo exploratório, microbiológico (piloto), duplo-cego, para testar os seguintes agentes químicos: triclosan 0,03 por cento (Plax-Colgate Palmolive) e clorexidina digluconada 0,12 por cento (Duplak-Herpro/Dentsply). A amostra foi composta por 30 voluntários divididos em 3 grupos: Grupo I (controle), Grupo II (teste - clorexidina digluconada 0,12 por cento) e Grupo III (teste - triclosan 0,03 por cento). Todos os grupos receberam orientação de higiene bucal prévia à primeira coleta de material. Depois de sete dias de uso dos agentes químicos uma segunda coleta foi realizada e o uso do agente foi suspenso. Uma terceira coleta foi realizada após sete dias a partir da suspensão do agente. A técnica semiquantitativa proposta por Pilonetto e Pilonetto foi adotada para avaliar o crescimento de colônias bacterianas. Os resultados mostraram diferenças entre a eficácia dos agentes químicos, sendo que o Grupo II mostrou uma redução mais significativa da microflora quando comparado ao Grupo III

Reconstrução do seio maxilar atrófico com enxerto autólogo de crista ilíaca: avaliação por tomografia computadorizada e radiografia panorâmica / Autologus crest iliac graft in the reconstruction of resorbed maxillary sinus: evaluation through computed tomography and panoramic radiography

OBJETIVOS: As dificuldades para a utilização de implantes dentários osteointegrados em pacientes portadores de atrofia do seio maxilar justificaram o emprego de enxerto autólogo não vascularizado de crista ilíaca isolado ou associado à hidroxiapatita (HA) em 14 pacientes submetidos a 25 procedimentos no Hospital das Nações, Curitiba, Paraná, portadores de atrofia do sinus maxilar. O objetivo foi avaliar comparativamente a precisão da tomografia computadorizada e da radiografia panorâmica, através da quantificação da neoformação óssea nesta estrutura. MÉTODOS: Foram selecionadas pacientes edentados, com altura óssea residual do rebordo gengival ao soalho do seio maxilar menor que 5mm. O enxerto medular de crista ilíaca fragmentada isolado ou misturado com HA foi colocado através da parede lateral no soalho atrófico da cuba maxilar por via submucosa. A avaliação quantitativa e qualitativa foi feita através da radiografia panorâmica e tomografia computadorizada, sendo utilizado na análise estatística a distribuição t de Student (prevalência de 0,05) para análise das variâncias, considerado que a leitura dos laudos radiológicos foi feita por dois especialistas, medindo a distância entre os pontos inferiores e superiores do enxerto no soalho do seio maxilar. RESULTADOS: Tivemos um ganho médio de 14,8mm em todos os procedimentos, com um erro maior que 3mm em 16 procedimentos (64 por cento) e incorporação satisfatória do enxerto ósseo suficiente para futuro implante dentário. CONCLUSÕES: A tomografia computadorizada foi o método de escolha na avaliação qualitativa e quantitativa da incorporação de enxerto autólogo não vascularizado em seio maxilar atrófico.

BACKGROUND:There are different methods to evaluate bone grafts in the maxillary sinus. Panoramic radiography is the most common one, even though assessment could be difficult. Occasionaly computerized tomography (CT)is another option but cost and radiation in excess should be considered. Our objective is to compare these two imaging methods. METHODS: Both panoramic radiogrphy and CT scan methods were used on 25 procedures in 14 patients on post-operative sinus lift with autogenous bone graft from the iliac crest. Two radiologists evaluated the quantity of the newly formed bone and the quality of the exam for each patient, through different imaging groups. RESULTS: The quantitative bone evaluation between the two types of exam showed a statistically significant difference (Student t-test=0,05) In some cases the difference was up to 14,8 mm between exams on the same patient, having an error of more than 3mm in 16 procedures (64 percent). CONCLUSIONS: It can be concluded that the quality of the image on the computerized tomography is superior and it is the most reliable method to determine the area of bone augmentation of the maxillary sinus after an antroplasty.

Enxerto autógeno de crista ilíaca na reconstrução do processo alveolar em portadores de fissura labiopalatina: estudo de 30 casos / Iliac crest autogenous graft in reconstruction of alveolar process in cleft patients: study of 30 cases

A reconstrução do processo alveolar em pacientes portadores de fissuras labiopalatais (FLP) é fundamental para erupção de dentes permanentes e para o restabelecimento estético através de implantes osteointegrados. Assim, considerado o alto grau de reabsorção do enxerto de osso autógeno puro e triturado, optou-se no Centro de Atendimento Integral ao Fissurado Labiopalatino, Curitiba, Paraná (1997 a 1999), pelo estabelecimento de dois grupos de 15 pacientes. No primeiro, foi utilizada crista ilíaca triturada e no outro combinada com hidroxiapatita biorreabsorvível. Ao fim de seis meses, os resultados cirúrgicos foram avaliados através de radiografia periapical digital, determinando quatro linhas limites para a reconstrução óssea. A primeira linha foi traçada na região cervical do dente adjacente à fissura que apresentava menor distorção. As outras linhas foram traçadas paralelamente à linha 1, distando 3mm entre cada uma delas. O espaço entre as linhas 1 e 2 foi denominado de A, entre 2 e 3 de B e 3 e 4 de C. Para critérios de avaliação, quando o enxerto permaneceu no espaço A, foi considerado de sucesso, em contraposição aos espaços B e C, quando foram denominados de procedimentos malsucedidos. Como resultados finais, o espaço A foi constatado em 46,7% dos pacientes submetidos ao procedimento controle com crista ilíaca e 80% para o grupo experimental, quando o enxerto ósseo foi empregado conjuntamente com o material aloplástico (hidroxiapatita).

The reconstruction of alveolar process in cleft lip palate patients is mandatory to enable the eruption and movement of permanent teeth through the clefted area by orthodontic procedure, beside the establisment of aesthetics with prostetic procedure by osteointegrated implants. Considering that autogenous bone grafts provide a high reabsortion level determining a reduction of orthodontic movement or making impossible to place implants, to minimize this problem, we developed a protocol by which the bone (anterior iliac crest) is mixed with alloplastic material (hydroxyapatite) to keep the bone matrix framework, reducing the absotion degree at the clefted area. We selected 30 patients at the Centro de Atendimento Integral ao Fissurado Lábio-Palatino (Center of Integral Care of Cleft Lip and Palate Patients), in Curitiba, Paraná (from 1997 to 1999). The patients were divided in two groups: at the first one, we utilized grated autogenous iliac crest and in the last one, the same bone combined with bio-reabsorbable hydroxyapatite. After 6 months, we compared for both procedures, the results through digital periapical X ray, concerning the height of the alveolar bone of the adjacent teeth, and 4 limiting lines for bone reconstruction as follow: line 1 was drawn at the cervical region of the adjacent tooth to the less distorted cleft and lines 2,3 and 4, parallel to line 1, being 3mm apart from each other. It was successfull considered the grafts whose greatest concavity was between lines 1 and 2 (space A) and for grafts between lines 2 and 3 (space B) or 3 and 4 (space C), surgical failure. The control group (grated bone) had 46,7% of the patients in space A while the study group (bone plus alloplastic material) 80% of patients in this space, being the determining factor of sucess the patient age.

Uso dos anestésicos locais em Odontologia / The anesthetics local in dentistry

A preocupaçäo do cirurgiäo-dentista em promover a analgesia fez com que houvesse uma evoluçäo dos anestésicos locais. Com isso, muitas dúvidas surgiram como toxicidade, efeito dos vasoconstritores e dosagem que os anestésicos locais podem gerar no paciente. Seräo discutidos os conceitos e a utilizaçäo dos anestésicos locais (AL), visando melhor eficiência e segurança para o paciente