Reabilitação protética bucomaxilofacial: um estudo retrospectivo de base universitária / Maxillofacial prosthetic rehabilitation: an university-based retrospective study

A Prótese bucomaxilofacial (PBMF) é a especialidade da Odontologia que reabilita proteticamente pacientes com perda de estrutura na região da face. Entende-se por PBMFs aquelas utilizadas na reabilitação de pacientes que apresentam deformidades por etiologia congênita, traumática ou patológica. Objetivo: Avaliar retrospectivamente o perfil dos pacientes bem como as características das reabilitações protéticas realizadas em um Projeto de Extensão em Prótese Bucomaxilofacial de uma Universidade no sul do Brasil.Materiais e métodos:Foram analisados 90 prontuários de pacientes atendidos no período de agosto de 2017 a dezembro de 2018, e coletados os seguintes dados: gênero, cor/etnia, idade, etiologia da deformidade, tipo de prótese reabilitadora realizada e referenciamento do paciente ao Projeto. Resultados:Observou-se que pacientes do gênero masculino e cor branca foram os mais frequentemente reabilitados com a maioria dos tipos de prótese, com exceção da prótese nasal. A idade dos pacientes variou de 5 a 81 anos. A prótese ocular foi a mais confeccionada. A etiologia patológica foi a que mais exigiu tratamento reabilitador. Médicos e equipes hospitalares foram os que mais referenciaram pacientes para o Projeto de Extensão.Discussão: A maior prevalência de atendidos foi de pacientes do gênero masculino, etiologia patológica, com idade 60 anos ou mais, o que reforça a sobrevida das pessoas que são diagnosticadas com câncer e necessitam reabilitação bucomaxilofacial. Conclusão: A grande procura por atendimento no Projeto de Extensão em PBMF mostra uma carência desse serviço e poucas pesquisas para esclarecer o perfil do paciente que mais procura atendimento PBMF.

Bucomaxillofacial Prosthesis (BMFP) is a specialty of Dentistry that rehabilitates patients with loss of structure in the face region. BMFP are known to be used in the rehabilitation of patients who present deformities due to congenital, traumatic or pathological etiology. Aim:In retrospect, to assess the profile of patients, as well as the features of clinical cases of rehabilitations performed at the Buccomaxillofacial Prosthesis Extension Project, at the Faculty of Dentistry of the Universidade Federal do Rio Grande do Sul, UFRGS. Materials and methods:from August 2017 to December 2018, 90 charts were cataloged with the following data: gender, ethnicity, age, etiology of the deformity, type of rehabilitation prosthesis, how the patient came to the Project. Results:It was concluded that white male patients were the predominant group to be benefited with prosthesis. The age gap was from 5 to 81 years. Ocular prosthesis was the most prevalent one. The pathological etiology was the one that most required rehabilitation treatment. Doctors and hospital staff were the ones who most referred patients to the Project.Discussion:The prevalence of patients attended was male, pathological etiology, aged 60 years or more, which reinforces the survival of people who are diagnosed with cancer and need oral and maxillofacial rehabilitation. Conclusion:The great demand for care in the BMFP Extension Project shows a lack of this service and little research to clarify the profile of the patient who most seeks BMFP care.

Puricelli biconvex arthroplasty: an experimental study in sheep.

BACKGROUND: The aim of this study was to establish a sheep model of the Puricelli biconvex arthroplasty (ABiP) technique in sheep for evaluating its functional, biological and histological parameters. METHODS: Ten Corriedale black sheep were submitted to TMJ total reconstruction with poly(methyl methacrylate) (PMMA) using ABiP and euthanized after 45 (n = 5) or 90 (n = 5) days. Control animals (n = 2) underwent sham operations and were euthanized after 45 days. Variables were assessed before the surgery (T0), immediately after (T1) and at 45 or 90 postoperative days (T2). RESULTS: Histological analyses showed regression of inflammatory cells over the follow-up period. PMMA showed reduced porosity and roughness in the articular contact area. PMMA temporal components showed linear and volumetric wear in comparison to control, but no foreign body reaction was observed. The reconstructions were stable in all animals. The amplitude of mouth opening and left lateral movements were maintained, except for a reduction in the range of right lateral movements at day 90 in the experimental group. Clinical, macroscopic and radiographic observations showed that the reconstructions were stable. CONCLUSIONS: The analysis of functional, biological and histological parameters in sheep submitted to ABiP showed stable results of the procedure, with maintenance of body weight and all mandibular movements, save contralateral mandibular movement, suggesting that joint function was completely maintained following the procedure. This experimental study provides support for clinical results previously reported of the ABiP technique in TMJ reconstruction procedures.

Autotransplante dentário: da previsibilidade à técnica cirúrgica e resultados do tratamento / Dental Autotransplantation: from predictability to surgical technique and treatment results

Objetivo: apresentar o relato de duas pacientes com agenesias dentárias em que cinco dentes autotransplantados foram utilizados como modalidade de tratamento. Além disso, objetiva-se mostrar questões sobre a técnica cirúrgica, suas indicações e previsibilidade. Relato de caso: Neste estudo, foram relatados 5 casos de autotransplante dentário em duas pacientes jovens, em que a equipe realizou os procedimentos e o acompanhamento clínico e radiográfico por 5 e 7 anos. Devido à alta sensibilidade da técnica, foram seguidos princípios previamente estabelecidos na literatura envolvendo o autotransplante dentário. Durante o período de acompanhamento, os dentes se mantiveram em posição e em função e as pacientes não apresentavam queixas associadas. Considerações finais: a técnica do autotransplante dentário, quando bem indicada e executada, é capaz de promover resultados bastante satisfatórios, sendo uma ótima alternativa reabilitadora, com taxas de sucesso elevadas e custos reduzidos. No entanto, critérios em relação aos sítios doadores e receptores e a habilidade do cirurgião devem ser levados em conta para o sucesso do técnica.

Objective: presenting the report of two patients with tooth agenesis in which five autotransplanted teeth were used as a treatment modality. Furthermore, the aim is to show questions about the surgical technique and its indications and predictability. Case report: In this study, 5 cases of dental autotransplantation were reported in two young patients, in which the team performed procedures and had clinical and radiographic follow-up for 5 and 7 years. Due to the high sensitivity of the technique, principles previously established in the literature involving dental autotransplantation were followed. During the follow-up period, the teeth remained in position and function and the patients had no associated complaints. Final considerations: the dental autotransplantation technique, when well indicated and executed, is capable of achieving very satisfactory results, being a great rehabilitative alternative, with high success rates and reduced costs. However, criteria regarding donor and receptor sites and the surgeon's skill must be taken into account for the success of the technique.

Retrospective Study of the Epidemiological Profile of Facial Trauma Related to Violence.

ABSTRACT: Facial trauma is now considered an epidemic due to its high incidence. This type of injury represents an impact on the social, psychological and professional life of the victim. It may be associated with poor protection and exposure of this region of the body, as well as with the attempt to disfigure the face of victims of aggression, to affect their identity and self-image. This study aims to carry out an epidemiological survey on the profile of facial trauma related to violence at the First Aid Hospital of Porto Alegre from November 2015 to July 2016. In this retrospective descriptive cross-sectional study, data such as age and sex of the patient, type of trauma, anatomical region, etiology, and reasons for the aggression of patients' records were analyzed using the Chi-Square test in Paws Statistics 18 software, evaluating P  < 0.05. During the period evaluated, 1224 cases were recorded. The most prevalent sex was male. The age group with the most injuries varied from 21 to 40. The most affected type of lesion was soft tissue injury. Scalp regions (parietal, occipital, temporal) and multiple regions were the most affected in males, differing from females, where the frontal and nasal regions were the most predominant. Violence is a major risk factor for facial trauma in adult patients and it is from epidemiological studies like this that we have the possibility to know the magnitude and severity of the results of violence, allowing the definition of public policies for coping.

Can CBCT change the level of confidence of oral maxillofacial surgeons in mandibular third molar management?

This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.

Can CBCT change the level of confidence of oral maxillofacial surgeons in mandibular third molar management?

Abstract This study analyzed the impact of CBCT on the level of confidence in diagnostic and treatment thinking in mandibular lower molar (M3M) clinical management. Thirty cases for which panoramic radiographs and CBTC images were available were selected and classified according to radiologic signs indicating the proximity of the M3M to the mandibular canal (interruption of the radiopaque borders of the canal of the mandibular canal wall, darkening of the roots, and diversion or narrowing of the canal, n = 10 for each classification). Twelve oral and maxillofacial surgeons (OMS) contributed to this study by answering two questionnaires. The first questionnaire contained a clinical description of the case and a panoramic radiograph. After 30 days, a second questionnaire with the same clinical illustrations and tomographic multiplanar reconstruction images was administered. Both questionnaires asked specialists to rate diagnostic confidence, the surgical complexity, chosen treatment, and surgical confidence. In approximately 40% of answers, CBCT images had a positive impact on ratings of diagnostic confidence and treatment thinking confidence, and in 24.4%, they increased the surgical complexity score. There was no change in the treatment plan following the use of CBCT, but the CBCT examination was a determining factor for diagnosis and treatment planning in 72.8% of the answers CBCT improved the confidence level in diagnostic and treatment thinking of the M3M management while also increasing the perceived level of surgical complexity. The findings of this study support the need to consider using CBCT in diagnosis and treatment planning for M3Ms with radiographic signs such as darkening of the roots, interruption of the radiopaque borders of the mandibular canal, or deviation of the mandibular canal and narrowing of the roots.

Redução de dor, edema e trismo: benefícios do uso da dexametasona via intramuscular como medicação preemptiva na cirurgia oral / Reduction of pain, swelling and trismus: benefits of using intramuscular dexamethasone as preemptive medication in oral surgery / Reducción del dolor, edema y trismo: beneficios del uso de dexametasona intramuscular como medicación preventiva en cirugía oral

Complicações pós-operatórias como edema, dor e trismo são comuns em cirurgias orais. Terapias, como o uso de analgésicos e anti-inflamatórios, são indicadas para estas complicações. No entanto, intervenções pré-operatórias podem ser alternativas. Desta forma, o presente estudo avaliou o efeito da dexametasona no edema, intensidade de dor e abertura de boca (trismo) no pós-operatório de retirada de terceiros molares inferiores. Pacientes (n=14, 9 mulheres) foram incluídos em um estudo clínico, cruzado, cego, randomizado, placebo-controlado e boca dividida. Pacientes receberam aleatoriamente medicação preemptiva (dexametasona 8mg, intramuscular, músculo masseter) ou placebo (soro fisiológico) uma hora antes da primeira cirurgia. O procedimento contralateral foi realizado 21 dias após. Avaliou se o edema e a abertura bucal nos momentos pré-operatórios e no 3º e 7º dias pós-operatórios, além de dor espontânea (imediatamente, 2 e 24 horas, 3 dias e 7 dias). Os dados foram analisados usando anova de medidas repetidas seguida do teste post hoc LSD de Fisher. Comparado ao placebo, a medicação reduziu edema (3 dias), dor (2 e 24 horas) e trismo (3 dias). Os resultados sugerem que o uso preemptivo da dexametasona intramuscular é capaz de aumentar o bem-estar dos pacientes submetidos a cirurgias orais, tendo o potencial de reduzir os custos pós-operatórios... (AU)

Postoperative complications such as edema, pain, and trismus are common in oral surgery. Therapies, such as the use of painkillers and anti inflammatory drugs, are indicated for the reversal of these complications. However, preoperative (preemptive) interventions can be alternatives. Thus, the present study aimed to evaluate the effect of dexamethasone on edema, pain intensity, and mouth opening (trismus) in the postoperative period of removal of impacted lower third molars. Patients (n = 14, 9 women) were included in a clinical, crossover, blinded, randomized, placebo-controlled, and divided mouth study. Preemptive mediation (dexamethasone 8mg, intramuscular, masseter muscle) or placebo (saline) was randomly given before the first surgery. The contralateral procedure was performed 21 days later. In the postoperative period, edema, mouth opening (preoperative, 3 and 7 days), and spontaneous pain (immediately, 2 and 24 hours, 3 days and 7 days) were analyzed. The data were analyzed using the one-way repeated measures ANOVA followed by Fisher's LSD post hoc. Compared to placebo, the medication reduced edema (3 days), pain (2 and 24 hours), and trismus (3 days). The results suggest that the preemptive use of dexamethasone is able to increase the well-being of patients undergoing oral surgeries, with the potential to reduce postoperative costs... (AU)

Las complicaciones posoperatorias como hinchazón, dolor y trismo son comunes en las cirugías orales. Las terapias, como el uso de analgésicos y antiinflamatorios, están indicadas para estas complicaciones. Sin embargo, las intervenciones preoperatorias pueden ser alternativas. Así, el presente estudio evaluó el efecto de la dexametasona sobre el edema, la intensidad del dolor y la apertura de la boca (trismo) en el postoperatorio de remoción del tercer molar inferior. Los pacientes (n = 14, 9 mujeres) se incluyeron en un estudio clínico, cruzado, ciego, aleatorizado, controlado con placebo y de boca dividida. Los pacientes recibieron aleatoriamente medicación preventiva (8 mg de dexametasona, intramuscular, músculo masetero) o placebo (solución salina) una hora antes de la primera cirugía. El procedimiento contralateral se realizó 21 días después. Se evaluó el edema y la apertura de la boca en el preoperatorio y en el tercer y séptimo días postoperatorios, además del dolor espontáneo (inmediato, 2 y 24 horas, 3 días y 7 días). Los datos se analizaron utilizando anova de medidas repetidas seguido de la prueba post hoc de LSD de Fisher. En comparación con el placebo, el medicamento redujo el edema (3 días), el dolor (2 y 24 horas) y el trismo (3 días). Los resultados sugieren que el uso preventivo de dexametasona intramuscular puede aumentar el bienestar de los pacientes sometidos a cirugía oral, con el potencial de reducir los costos posoperatorios... (AU)

Management of excessive gingival display using botulinum toxin type A: a descriptive study.

Botulinum toxin is a protease used by the bacterium Clostridium botulinum that causes chemical denervation of skeletal muscles, producing a temporary weakening of muscle activity. Despite having a transitory effect, the application of botulinum toxin has been identified as an alternative for correcting an excessive gingival display (EGD). However, studies evaluating the maintenance of long-term results of botulinum toxin remain scarce. This study aimed to evaluate the effectiveness and duration of botulinum toxin type A in the treatment of anterior EGD. Botulinum toxin Type A was applied to 15 patients with EGD. The measurement was performed in triplicate, using a Castro Viejo dry point compass, between the central cervical portion of the upper lateral incisors to the lower portion of the upper lip, bilaterally. The measurements were performed before the application of the toxin and repeated on days 7, 14, 90, 120, and 180 after the procedure. The data were analyzed using repeated-measures ANOVA, followed by a Bonferroni. There was a statistically significant reduction between the measurements performed on the Baseline and seven days after the application of the botulinum toxin. After 180 days, approximately one-quarter of the patients in the sample did not presented EGD. Mild adverse effects were reported by 46.7% of the patients. The use of botulinum toxin type A was effective to treat EGD. After 180 days, it was still possible to observe a significant effect compared to the initial gingival exposure.

Perfil epidemiológico dos pacientes e dos atendimentos realizados no ambulatório de exodontia (FO-UFRGS) / Epidemiological survey of patients seeking dental care in the tooth extraction outpatient clinic (FO-UFRGS)

Objetivo: Realizar um levantamento epidemiológico dos pacientes que buscaram atendimento no ambulatório de Exodontia da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul (FO-UFRGS).Métodos: Estudo descritivo retrospectivo no qual foram reunidos e tabulados 1905 relatórios cirúrgicos preenchidos pelos alunos da graduação nas atividades referentes à disciplina de Exodontia, entre os anos de 2011 e 2015.Resultados: Os pacientes eram na maioria mulheres, entre 30 e 59 anos, cor de pele branca, com ensino fundamental incompleto e renda familiar entre 2 e 3 salários mínimos, 30,9% dos pacientes relatavam fumar e 27,8% disseram consumir bebidas alcoólicas pelo menos uma vez por semana. Quanto à história clínica, 24,4% dos pacientes relataram sofrer de hipertensão, 7,9% eram diabéticos. Em relação aos procedimentos, 24,9% estavam indicados por serem restos radiculares, 9% dos procedimentos foram suspensos, sendo a hipertensão a principal razão para tal (42,6%). Em 59,8% dos procedimentos não houve nenhum tipo de complicação pós-operatória. Conclusão: A partir dos dados obtidos foi possível conhecer o perfil epidemiológico e a situação de saúde da população atendida, identificando suas principais necessidades, fornecendo informações estratégicas para a organização e qualificação do serviço. (AU)

Aim: To conduct an epidemiological study of patients seeking dental care in the Tooth Extraction Outpatient Clinic, School of Dentistry, Federal University of Rio Grande do Sul (FO-UFRGS). Methods: This research was a retrospective descriptive study on 1,905 surgical reports filled out by undergraduate students during the activities related to the Exodontics (Tooth Extraction) classes held between 2011 and 2015.Results: Patients were mostly women from 30 to 59 years of age, white, with an incomplete elementary school education, and a household income between 2 and 3 minimum salaries; 30.9% of the patients claimed to be smokers and 27.8% reported that they consumed alcohol at least once a week. In relation to the clinical history, 24.4% of the patients reported suffering from hypertension, and 7.9% were diabetic. Regarding the procedures, 24.9% had been referred due to the existence of root fragments; in 9% of the cases, procedures were suspended, mainly due to hypertension (42.6%). In 59.8% of the procedures, no postoperative complications were observed.Conclusion:From the obtained data, it was possible to access the epidemiological profile and the health status of the population who received dental care, identifying their main needs and providing strategic information for the organization and qualification of the service and the health care of these patients. (AU)

Dental consultation requests to oral and maxillofacial surgery in a hospital in Brazil

Introduction: This study analyzed dental consultation requests to the division of oral and maxillofacial surgery in a Brazilian tertiary hospital. Methods: A cross-sectional study with data collected retrospectively from inpatients' electronic medical records containing dental consultation requests made between January 2013 and December 2017. Results: 327 consultation requests were analyzed. Mean (SD) patient age was 38.71 (24.4) years; 164 (50.2%) were male and 267 (81.7%) were Caucasian. Regarding systemic conditions, 34 (10.4%) were classified as ASA I, 86 (26.3%) as ASA II, 182 (55.7%) as ASA III, and 25 (7.6%) as ASA IV. Dental consultations were mostly requested by the internal medicine team (n = 42, 12.8%). The most common reason for consultation was septic teeth (n = 131, 40.1%). Complementary tests were required in 188 (57.5%) cases. Surgical intervention was required in 82 (25.0%), with tooth extraction as the most prevalent procedure (20.2%). The most demanding service was inpatient care, with 276 (84.4%) requests. Cases were resolved in 249 (76.1%). Conclusions: The division of oral and maxillofacial surgery in our hospital deals with a great amount of consultations, contributing with surgical procedures to the adequacy of patients' oral health with a high effectiveness rate. Our data illustrate the contribution of dentists in a hospital setting, assisting the medical team in providing comprehensive care for inpatients. (AU)

Efetividade de agentes químicos na desinfecção de tubetes anestésicos

Avaliar a efetividade da desinfecção de tubetes anestésicos, in vitro, para procedimentos cirúrgicos ambulatoriais, utilizando álcool 70% (A), composto de iodo (I) solução aquosa de digluconato de clorexidina 0,12% (CA 0,12%), solução aquosa de digluconato de clorexidina 2% (CA 2%), solução alcoólica de digluconato de clorexidina 0,12% (CAL 0,12%), solução alcoólica de digluconato de clorexidina 2% (CAL 2%). Materiais e método: como grupos controle utilizou-se a água destilada (D) e nenhum agente (SN). Após os tempos de exposição de 5, 10 e 15 minutos aos agentes desinfetantes realizou-se coleta das amostras com swab que foram embebidas em caldo de tripticase de soja (TSB) e os tubos incubados a 37°C por 24 horas. As amostras foram inoculadas em placas de Petri contendo meio tripticase de soja ágar (TSA) e incubadas a 37°C por 48 horas, verificando a presença ou ausência de Unidades Formadoras de Colônias (CFU). Resultados: o estudo revelou que A e CA 0,12% foram efetivos apenas após 15 minutos de exposição. As soluções CA 2%, CAL 0,12%, CAL 2% e I foram efetivos nos tempos experimentais de 5, 10 e 15 minutos. Nos grupos controles (D e SN) houve crescimento bacteriano em todos os tempos experimentais. Conclusões: os agentes testados que demonstraram eficácia de desinfecção já em 5 minutos, associada ao baixo custo e facilidade de manipulação, foram: I, CA 2%, CAL 0,12%, CAL 2%. O resultado do grupo controle evidencia a necessidade de desinfecção dos tubetes previamente ao seu uso.

Repair of bone defects using adipose-derived stem cells combined with alpha-tricalcium phosphate and gelatin sponge scaffolds in a rat model.

OBJECTIVES: This study aimed to evaluate the potential of adipose-derived stem cells (ASCs) combined with a modified α-tricalcium phosphate (α-TCP) or gelatin sponge (GS) scaffolds for bone healing in a rat model. MATERIAL AND METHODS: Bone defects were surgically created in the femur of adult SHR rats and filled with the scaffolds, empty or combined with ASCs. The results were analyzed by histology and histomorphometry on days seven, 14, 30, and 60. RESULTS: Significantly increased bone repair was observed on days seven and 60 in animals treated with α-TCP/ASCs, and on day 14 in the group treated with GS/ASCs, when compared with the groups treated with the biomaterials alone. Intense fibroplasia was observed in the group treated with GS alone, on days 14 and 30. CONCLUSIONS: Our results showed that the use of ASCs combined with α-TCP or GS scaffolds resulted in increased bone repair. The higher efficacy of the α-TCP scaffold suggests osteoconductive property that results in a biological support to the cells, whereas the GS scaffold functions just as a carrier. These results confirm the potential of ASCs in accelerating bone repair in in vivo experimental rat models. These results suggest a new alternative for treating bone defects.

Repair of bone defects using adipose-derived stem cells combined with alpha-tricalcium phosphate and gelatin sponge scaffolds in a rat model

Abstract Objectives This study aimed to evaluate the potential of adipose-derived stem cells (ASCs) combined with a modified α-tricalcium phosphate (α-TCP) or gelatin sponge (GS) scaffolds for bone healing in a rat model. Material and Methods Bone defects were surgically created in the femur of adult SHR rats and filled with the scaffolds, empty or combined with ASCs. The results were analyzed by histology and histomorphometry on days seven, 14, 30, and 60. Results Significantly increased bone repair was observed on days seven and 60 in animals treated with α-TCP/ASCs, and on day 14 in the group treated with GS/ASCs, when compared with the groups treated with the biomaterials alone. Intense fibroplasia was observed in the group treated with GS alone, on days 14 and 30. Conclusions Our results showed that the use of ASCs combined with α-TCP or GS scaffolds resulted in increased bone repair. The higher efficacy of the α-TCP scaffold suggests osteoconductive property that results in a biological support to the cells, whereas the GS scaffold functions just as a carrier. These results confirm the potential of ASCs in accelerating bone repair in in vivo experimental rat models. These results suggest a new alternative for treating bone defects.

Influence of a Magnetic Field and Laser Therapy on the Quality of Mandibular Bone During Distraction Osteogenesis in Rabbits.

PURPOSE: This study evaluated the use of low-level laser therapy (LLLT) and exposure to a magnetic field (MF) during distraction osteogenesis. MATERIALS AND METHODS: The sample consisted of 18 rabbits divided into 3 groups of 6 animals each: control, MF exposure (briefly, magnetized gold-coated washers were placed next to the distractor device), and LLLT exposure (830 nm applied every 48 hours over 4 points [dose, 5 J/cm2] during the consolidation period). The same distraction osteogenesis protocol was used in all 3 groups (0.5 mm every 12 hours for 1 week). RESULTS: Quantitative microscopic analysis of sections stained with hematoxylin and eosin showed a statistically significant difference in the amount of newly formed bone in the MF group compared with the LLLT group (P = .006). The number of cells with more than 3 argyrophilic nucleolar organizer regions also was significantly different between the LLLT and control groups (P = .038). CONCLUSION: Distraction osteogenesis effectively promoted bone lengthening. The LLLT group exhibited a larger amount of newly formed bone and a larger number of osteoblasts in the cell division phase, but the difference was not statistically relevant compared with the control group.

Rabbit model for osteoarthrosis of the temporomandibular joint as a basis for assessment of outcomes after intervention.

Osteoarthritis can be induced in the temporomandibular joint (TMJ) by primary or secondary trauma, or overloading of the joint. We have therefore systematically evaluated the histological progression of experimental osteoarthritis induced by a high concentration of monosodium iodoacetate into the rabbit TMJ. These findings may contribute to the establishment of a protocol to investigate the benefits of treatment of osteoarthritis of the TMJ. We used 21 male New Zealand rabbits; the 15 in the test group were given an intra-articular injection of monosodium iodoacetate 10mg/ml into the right TMJ and were killed after 60 (n=5), 80 (n=5), and 100 days (n=5). The six in the control group were given an injection of saline into the right TMJ. The assessment system for osteoarthritis based on six grades was used for the histological analysis of severity. The model was effective in producing histological changes in the cartilage consistent with those found in osteoarthritis at all time points. The within-group analysis indicated that the disease did not progress after 60 days. The successful induction of osteoarthritis in this way, its stabilisation after 60 days, and the appropriate size of the animal suggest that this experimental model is ideal for future studies of the effectiveness of treatment in osteoarthritis of the TMJ.

Abordagens técnicas inovadoras em Cirurgia e Traumatologia Bucomaxilofacial / Innovative technique approaches in Oral and Maxillofacial Surgery

Ao longo da história, a ciência tem colaborado com o desenvolvimento de terapias que suprem as novas demandas da sociedade, sempre com o objetivo de manter a saúde e a integridade do ser humano. Avanços tecnológicos em áreas afins, como a anestesia geral e a introdução dos biomateriais, impulsionaram a evolução da Odontologia. Particularmente a Cirurgia e Traumatologia Bucomaxilofaciais (CTBMF) tem desenvolvido técnicas cirúrgicas mais elaboradas que geram benefícios a uma parcela da população que não possuía alternativas terapêuticas anteriormente. Equipes cirúrgicas brasileiras têm assumido papel de destaque na busca de suprir limitações terapêuticas. Como por exemplo, retenções dentárias sem possibilidades de tratamentos conservadores, hoje podem ser tratadas através de técnicas como a Apicotomia e a Laçada Dupla. Similarmente, pacientes portadores de anquilose da articulação temporomandibular (ATM) possuem opção de serem tratados com a Artroplastia Biconvexa de Puricelli. Esta técnica requer menor exérese tecidual, utiliza material aloplástico de baixo custo e restaura a função articular. E por fim, técnicas desenvolvidas no Brasil têm colaborado ao aperfeiçoamento de metodologias mundialmente consagradas, como é o caso da Osteotomia Mandibular de Puricelli que confere maior estabilidade entre os fragmentos ósseos nas cirurgias para correção de deformidades dentofaciais. Desta forma, o presente trabalho tem por objetivo a exposição e discussão da colaboração científica e técnica destas terapias cirúrgicas (desenvolvidas no Departamento de Cirurgia e Ortopedia da Universidade Federal do Rio Grande do Sul) nos diferentes procedimentos, onde são indicadas.

Throughout history, the development of science has collaborated with the progress of new therapies based on society's demands to maintain public health and its physical integrity. Technological development in basic areas (i.e. general anesthesia and biomaterials) helped the progress of Dental Science. For example, the Oral and Maxillofacial Surgery (OMS) was able to develop novel and more advanced surgical techniques bringing clinical benefits that did not exist earlier. Brazilian research groups have played an important role in the development of new alternatives to surpass these therapeutic limitations. For instance, some cases of tooth impaction, which could only be treated by dental extraction, are currently resolved through alternative surgical techniques such as Apicotomy and Double Traction, preventing tooth loss. Likewise, patients with temporomandibular joint (TMJ) ankylosis can be favored by a surgical treatment called Puricelli Biconvex Arthroplasty. This procedure has minimally invasive osteotomy, uses a financial affordable alloplastic material, and maintains joint stability. Finally, Brazilian techniques have contributed to improve other well-established surgical treatments. This is the case of the Puricelli Osteotomy, which provides a more stable position for the mandible during orthognathic surgery. Therefore, the aim of the present paper is to summarize and discuss the scientific and methodological contributions of these surgical techniques (developed by the Department of Surgery and Orthopedic of Universidade Federal do Rio Grande do Sul) and their indications.

Clinical-surgical treatment of temporomandibular joint disorder in a psoriatic arthritis patient.

INTRODUCTION: Condylotomy is a surgical procedure that has been used as an option to treat temporomandibular disorder (TMD) patients. This technique has the advantage of avoiding intra-capsular alterations that might be found involving other surgical procedures. Its use, even when unilateral, has positive effect on treatment of both joints. METHODS: In order to better evaluate the benefits of a clinical-surgical treatment for TMD, the present report describes the case of a psoriatic arthritis patient. The case was clinically characterized by dental malloclusion, and imaging exams showed joint degeneration of the right mandibular condyle. The patient was treated by condylotomy technique after a prosthetic oral rehabilitation. RESULTS: No clinical-radiological signs or symptoms of progression of articular disease were observed within a period of 16 months after surgery. Furthermore, there was functional stability of the temporomandibular joint, total absence of local pain and improvement of mouth opening. CONCLUSION: The present study suggests that condylotomy can be considered as a valid option for the management of TMD, since it has low surgical morbidity and favorable clinical outcomes. In this case, the patient had a medical diagnosis of systemic disease presenting general pain and pain at the temporomandibular joint (TMJ), in addition of causal agent of TMD (dental malloclusion). The difficulty of finding a single etiology (malocclusion vs. systemic disease) did not exclude the indication of a clinical-surgical treatment to re-establish the balance of TMJ.

Histomorphometric analysis of the temporal bone after change of direction of force vector of mandible: an experimental study in rabbits.

OBJECTIVES: The present study aimed at performing a histological evaluation of the response of temporal bone tissue to a change of direction of the force vector of the mandible in relation to the base of the skull. MATERIAL AND METHODS: Adult rabbits were assigned into four groups with two control and four experimental animals in each group. experimental animals underwent surgery, which resulted in a change of direction of the force vector on the right temporomandibular joint. Samples were collected after 15, 30, 60 and 90 days for histological analysis. RESULTS: In the two-way analysis of variance, the effect of group and time was statistically significant (p<0.001). Additionally, a statistically significant interaction between group and time was observed (p<0.001). Control animals showed normal growth and development of the temporal region. In the experimental group, the change in direction of the force vector of the mandible induced significant changes in the temporal bone, with a bone modeling process, which suggests growth of this cranial structure. CONCLUSIONS: The methodology used in this experiment allows us to conclude that the change in direction of the force vector of the mandible in relation to the skull base induces remodeling and modeling processes in the temporal bone. The resumption of normal oral functions after bone healing of the mandibular fracture appears to increase cell activation in the remodeling and modeling of the temporal bone structure. The observation of areas of temporal bone modeling shows the relevance of further investigation on the correlation between the joint structures and craniofacial growth and development.

Histomorphometric analysis of the temporal bone after change of direction of force vector of mandible: an experimental study in rabbits

OBJECTIVES: The present study aimed at performing a histological evaluation of the response of temporal bone tissue to a change of direction of the force vector of the mandible in relation to the base of the skull. MATERIAL AND METHODS: Adult rabbits were assigned into four groups with two control and four experimental animals in each group. experimental animals underwent surgery, which resulted in a change of direction of the force vector on the right temporomandibular joint. Samples were collected after 15, 30, 60 and 90 days for histological analysis. RESULTS: In the two-way analysis of variance, the effect of group and time was statistically significant (p<0.001). Additionally, a statistically significant interaction between group and time was observed (p<0.001). Control animals showed normal growth and development of the temporal region. In the experimental group, the change in direction of the force vector of the mandible induced significant changes in the temporal bone, with a bone modeling process, which suggests growth of this cranial structure. CONCLUSIONS: The methodology used in this experiment allows us to conclude that the change in direction of the force vector of the mandible in relation to the skull base induces remodeling and modeling processes in the temporal bone. The resumption of normal oral functions after bone healing of the mandibular fracture appears to increase cell activation in the remodeling and modeling of the temporal bone structure. The observation of areas of temporal bone modeling shows the relevance of further investigation on the correlation between the joint structures and craniofacial growth and development.