Actinomycosis is not Frequent in the Periapex But is a Persistent Lesion.

Periapical actinomycosis caused by a gram-positive anaerobic pathogen characterizes a typical extra-radicular infection. This study determined the frequency and correlated the content of bacteria colonies with the of periapical actinomycosis size. The study comprised a total of 218 periapical lesions (PL) (cysts, granulomas or abscess). The specimens embedded in paraffin were sliced into 4-µm sections and stained with hematoxylin-eosin, Gram, Periodic Acid-Schiff (PAS) and Grocott's stain. The presence of bacterial colonies composed of filamentous structures labeled with the histochemical stains were described as Actinomyces, and for each case, the bacterial colonies were counted and measured. The correlation between the number and size of bacterial colonies and the size of PL was tested using Pearson's adjusted correlation coefficient. From 218 PL, bacterial colonies were identified in 64 biopsies. Seven cases (0.3%) fulfill the criteria for diagnosis of periapical actinomycosis. All of cases were therapy-resistant and did not showed periapical repair after 12 months of follow-up. Periapical surgery or dental extraction was performed. The correlation test indicated no correlation between the number of bacterial colonies and the lesion size (p=0.752, r=-0.148). However, a larger bacterial colony size generally resulted in a larger periapical lesion (P=0.000, r=0.657). The frequency of periapical actinomycosis was low, and this lesion should be included in the differential diagnosis of PL. The size of the Actinomyces colonies seemed to contribute to increase the size of the periapical lesion.

Actinomycosis is not Frequent in the Periapex But is a Persistent Lesion

Abstract Periapical actinomycosis caused by a gram-positive anaerobic pathogen characterizes a typical extra-radicular infection. This study determined the frequency and correlated the content of bacteria colonies with the of periapical actinomycosis size. The study comprised a total of 218 periapical lesions (PL) (cysts, granulomas or abscess). The specimens embedded in paraffin were sliced into 4-µm sections and stained with hematoxylin-eosin, Gram, Periodic Acid-Schiff (PAS) and Grocott's stain. The presence of bacterial colonies composed of filamentous structures labeled with the histochemical stains were described as Actinomyces, and for each case, the bacterial colonies were counted and measured. The correlation between the number and size of bacterial colonies and the size of PL was tested using Pearson's adjusted correlation coefficient. From 218 PL, bacterial colonies were identified in 64 biopsies. Seven cases (0.3%) fulfill the criteria for diagnosis of periapical actinomycosis. All of cases were therapy-resistant and did not showed periapical repair after 12 months of follow-up. Periapical surgery or dental extraction was performed. The correlation test indicated no correlation between the number of bacterial colonies and the lesion size (p=0.752, r=-0.148). However, a larger bacterial colony size generally resulted in a larger periapical lesion (P=0.000, r=0.657). The frequency of periapical actinomycosis was low, and this lesion should be included in the differential diagnosis of PL. The size of the Actinomyces colonies seemed to contribute to increase the size of the periapical lesion.

Resumo A actinomicose periapical causada por um patógeno anaeróbio Gram positivo caracteriza uma infecção extra-radicular típica. Esse estudo determinou a frequência e correlacionou o conteúdo das colônias bacterianas com o tamanho das actinomicoses periapicais. O estudo compreendeu um total de 218 lesões periapicais (LPs) (cistos, granulomas ou abscessos). Os espécimes embebidos em parafina foram cortados em secções de 4-µm e corados com hematoxilina-eosina, Gram, ácido periódico de Schiff (PAS) e coloração de Grocott. A presença de colônias bacterianas compostas por estruturas filamentosas marcadas com os corantes histoquímicos foram descritas como Actinomyces, e para cada caso, as colônias bacterianas foram contadas e mensuradas. A correlação entre o número e tamanho das colônias bacterianas e o tamanho das LPs foi testado usando o coeficiente de correlação ajustado de Pearson. De 218 LPs, colônias bacterianas foram identificadas em 64 biópsias. Sete casos (0,3%) preencheram os critérios para o diagnóstico de actinomicose periapical. Todos os casos foram resistentes à terapia e não mostraram reparo periapical após 12 meses de acompanhamento. Cirurgia periapical ou extração dental foi realizada. O teste de correlação indicou nenhuma correlação entre o número de colônias bacterianas e o tamanho da lesão (p=0.752, r=-0.148). Entretanto, uma maior colônia bacteriana geralmente resultou em uma maior lesão periapical (p=0.000, r=0.657). A frequência de actinomicose periapical foi baixa e esta lesão deve ser incluída no diagnóstico diferencial das LPs. O tamanho das colônias de Actinomyces pareceu contribuir para o aumento no tamanho da lesão periapical.

Preenchimentos estéticos na cirurgia ortognática: há indicações? / Aesthetic augmentation in orthognathic surgery: are there indications?

Introdução: resultados estéticos na cirurgia ortognática são um dos principais objetivos dos pacientes, ortodontistas e cirurgiões. A correção da deformidade óssea maxilomandibular, geralmente, restabelece as funções do sistema estomatognático e a estética facial. No entanto, nem sempre obtém-se simetria e projeção desejada dos tecidos moles somente com a movimentação óssea. Nesse sentido, o preenchimento com o polimetilmetacrilato (PMMA) atua como coadjuvante na tentativa de se obter contornos faciais que alcancem as expectativas estéticas dos pacientes e profissionais. Objetivo: o presente artigo revisa a utilização do metilmetacrilato como material de preenchimento na região craniofacial, abordando a sua perspectiva histórica, vantagens e aspectos biológicos. As principais indicações são ilustradas com figuras e casos clínicos

Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal Class III pattern using cone-beam computed tomography.

INTRODUCTION: It has been suggested that mandibular setback surgery, combined or not with maxillary advancement as a treatment alternative for patients with mandibular prognathism, can induce changes in upper airway space (UAS). Therefore, this study aimed to assess the response of the upper airway in the oropharynx region of patients with Class III skeletal pattern that underwent bimaxillary orthognathic surgery (maxillary advancement and mandibular setback) combined with mentoplasty. MATERIAL AND METHODS: The sample comprised 26 cone-beam computed tomography (CBCT) scans of 13 patients. The examination was taken before and after surgery. UAS volume, sagittal area, length and minimal axial area with its width, depth and location, were measured with the aid of Dolphin Imaging™ software version 11.5 Premium. Data were statistically treated by applying Shapiro-Wilk test and Student's paired t-test, considering as statistically significant the results of which p-value was lower than 0.05. RESULTS: No statistically significant differences were found in any measurements evaluated. CONCLUSIONS: No significant changes were observed in the oropharynx after bimaxillary orthognathic surgery and mentoplasty.

Why segment the maxilla between laterals and canines?

INTRODUCTION: Maxillary surgery on a bone segment enables movement in the sagittal and vertical planes. When performed on multiple segments, it further provides movement in the transverse plane. Typical sites for interdental osteotomies are between laterals and canines, premolars and canines, or between incisors. Additionally, osteotomies can be bilateral, unilateral or asymmetric. The ability to control intercanine width, buccolingual angulation of incisors, and correct Bolton discrepancy are some of the advantages of maxillary segmentation between laterals and canines. OBJECTIVE: This article describes important features to be considered in making a clinical decision to segment the maxilla between laterals and canines when treating a dentoskeletal deformity. It further discusses the history of this surgical approach, the indications for its clinical use, the technique used to implement it, as well as its advantages, disadvantages, complications and stability. It is therefore hoped that this paper will contribute to disseminate information on this topic, which will inform the decision-making process of those professionals who wish to make use of this procedure in their clinical practice. CONCLUSIONS: Segmental maxillary osteotomy between laterals and canines is a versatile technique with several indications. Furthermore, it offers a host of advantages compared with single-piece osteotomy, or between canines and premolars.

Why segment the maxilla between laterals and canines?

Introduction: Maxillary surgery on a bone segment enables movement in the sagittal and vertical planes. When performed on multiple segments, it further provides movement in the transverse plane. Typical sites for interdental osteotomies are between laterals and canines, premolars and canines, or between incisors. Additionally, osteotomies can be bilateral, unilateral or asymmetric. The ability to control intercanine width, buccolingual angulation of incisors, and correct Bolton discrepancy are some of the advantages of maxillary segmentation between laterals and canines. Objective: This article describes important features to be considered in making a clinical decision to segment the maxilla between laterals and canines when treating a dentoskeletal deformity. It further discusses the history of this surgical approach, the indications for its clinical use, the technique used to implement it, as well as its advantages, disadvantages, complications and stability. It is therefore hoped that this paper will contribute to disseminate information on this topic, which will inform the decision-making process of those professionals who wish to make use of this procedure in their clinical practice. Conclusions: Segmental maxillary osteotomy between laterals and canines is a versatile technique with several indications. Furthermore, it offers a host of advantages compared with single-piece osteotomy, or between canines and premolars.

Introdução: a cirurgia de maxila em um segmento ósseo possibilita sua movimentação nos planos sagital e vertical. Quando realizada em múltiplos segmentos, contempla também o plano transversal. A localização das osteotomias interdentárias pode ser: entre incisivos laterais e caninos, entre pré-molares e caninos, ou entre os incisivos centrais - podendo ser bilateral, unilateral ou assimétrica. A possibilidade de controle da distância intercaninos, da angulação vestibulolingual dos incisivos e da correção da discrepância de Bolton é uma das vantagens da segmentação da maxila entre incisivos laterais e caninos. Objetivo: o presente artigo descreve aspectos importantes, no tratamento das deformidades dentoesqueletais, a serem considerados na decisão clínica de segmentar-se a maxila entre os incisivos laterais e os caninos. Serão discutidas, também, a história dessa abordagem cirúrgica, as indicações para seu emprego clínico, a técnica para sua utilização, bem como suas vantagens, desvantagens, complicações e estabilidade. Desse modo, espera-se contribuir para o aumento das informações disponíveis sobre o assunto, subsidiando a decisão dos profissionais que queiram considerar o uso dessa técnica em suas atividades clínicas. Conclusão: a osteotomia segmentar de maxila entre os incisivos laterais e os caninos corresponde a uma técnica versátil com diversos tipos de indicações, e apresenta uma série de vantagens, quando comparada com as osteotomias em um segmento ou entre caninos e pré-molares.

Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal Class III pattern using cone-beam computed tomography

Introduction: It has been suggested that mandibular setback surgery, combined or not with maxillary advancement as a treatment alternative for patients with mandibular prognathism, can induce changes in upper airway space (UAS). Therefore, this study aimed to assess the response of the upper airway in the oropharynx region of patients with Class III skeletal pattern that underwent bimaxillary orthognathic surgery (maxillary advancement and mandibular setback) combined with mentoplasty. Material and Methods: The sample comprised 26 cone-beam computed tomography (CBCT) scans of 13 patients. The examination was taken before and after surgery. UAS volume, sagittal area, length and minimal axial area with its width, depth and location, were measured with the aid of Dolphin ImagingTMsoftware version 11.5 Premium. Data were statistically treated by applying Shapiro-Wilk test and Student's paired t-test, considering as statistically significant the results of which p-value was lower than 0.05. Results: No statistically significant differences were found in any measurements evaluated. Conclusions: No significant changes were observed in the oropharynx after bimaxillary orthognathic surgery and mentoplasty.

Introdução: tem sido sugerido que a cirurgia de recuo mandibular - que é uma das alternativas de tratamento para pacientes com prognatismo mandibular -, associada ou não ao avanço maxilar, pode promover alterações no espaço das vias aéreas superiores. Por esse motivo, o presente estudo teve como objetivo avaliar o comportamento das vias aéreas superiores, na região da orofaringe, em pacientes com padrão esquelético de classe III submetidos à cirurgia ortognática bimaxilar (avanço maxilar e recuo mandibular) e mentoplastia. Métodos: a amostra foi composta por 26 tomografias computadorizadas de feixe cônico de 13 pacientes, tomadas antes e após o procedimento cirúrgico. Usando o programa Dolphin Imaging(r) versão 11.5 Premium, foram mensurados o volume do espaço orofaringeano; sua área (em um corte sagital); a mínima secção transversal dessa região, com sua largura, profundidade e localização; além de seu comprimento. Os dados obtidos foram tratados estatisticamente, tendo-se utilizado os testes Shapiro-Wilk e T-student pareado, considerando-se significativos os resultados com p < 0,05. Resultados: não foram encontradas diferenças estatisticamente significativas em qualquer uma das medidas avaliadas. Conclusão: não foram observadas modificações significativas na orofaringe após a realização da cirurgia ortognática bimaxilar e mentoplastia.

Skeletal stability in orthognathic surgery: evaluation of methods of rigid internal fixation after counterclockwise rotation in patients with class II deformities.

Our aim was to assess the influence of internal fixation in skeletal stability on patients who had had counterclockwise rotation of the maxillomandibular complex and mandibular advancement procedures. We studied 60 records of 20 patients (14 female, 6 male), mean (range) age at operation 29 (16-50) years. The mean (range) postoperative follow-up was 15 (8-24) months. Sixty standard lateral cephalometric radiographs were randomly traced and digitised by one senior radiologist to estimate surgical and postoperative changes. Patients were divided into two groups, the first group (n=10) of which had fixation with only 2.0 system plates (2 plates with monocortical screws alone) and the second (n=10) of which had hybrid fixation (1 plate with monocortical screws and 2 or 3 bicortical bone screws). During operation the change in the mean occlusal plane with counterclockwise rotation was 9.4° (range -17.3 to -2.5mm). The maxilla moved forward and upward. All the anterior mandibular measurements had advanced horizontally, the mean (range) being 17 (6.4 to 9.9) mm for the pogonion, and 17.6 (6.0 to 30.7) mm for the menton. At the longest follow-up period, there were significant long-term changes, but these were clinically acceptable (<2mm). There was no significant difference between the two groups in postoperative stability or in the magnitude of the advancement and stability.

Assessment of skeletal stability after counterclockwise rotation of the maxillomandibular complex in patients with long-face pattern subjected to orthognathic surgery.

BACKGROUND: The aim of this study was to evaluate the long-term skeletal stability of counterclockwise maxillomandibular complex rotation in patients undergoing orthognathic surgery for long-face pattern. METHODS: This retrospective study consisted of 10 patients who underwent the procedure between September 2002 and April 2008. To assess the skeletal stability, 30 preoperative (T1), recent postoperative (T2), and late postoperative (T3) cephalometric radiographs of the 10 patients were digitized and traced. To measure the stability in the occlusal plane and mandibular plane, the cephalometric points and planes were determined 3 times. RESULTS: In the long term, on average, the A-point moved 0.21 mm backward (AYT3-AYT2), the B-point moved 0.57 mm backward (BYT3-BYT2), and the posterior nasal spine moved 0.31 mm backward (PNSYT3-PNSYT2). On average, the anterior maxillary area (A-point) moved 0.14 mm downward (AXT3-AXT2), the mandible (B-point) moved 0.07 mm downward (BXT3-BXT2), and the posterior nasal spine moved approximately 0.18 mm upward (PNSXT3-PNSXT2). The occlusal plane increased by 0.75 degrees (OPT3-OPT2), and the mandibular plane increased by 0.45 degrees (MPT3-MPT2). CONCLUSIONS: It was observed that the counterclockwise rotation of the maxillomandibular complex produces stable results in patients with long-face pattern undergoing orthognathic surgery.

Changes in occlusal plane through orthognathic surgery / Alteração do plano oclusal na cirurgia ortognática

INTRODUCTION: A conventional ortho-surgical treatment, although with good clinical results, does not often achieve the desired functional outcomes. Patients with dentofacial deformities, especially those with increased occlusal planes (OP), are also affected by muscle, joint and breathing functional disorders, as well as facial esthetic involvement. The surgical manipulation of the OP in orthognathic surgery is an alternative to overcome the limitations of conventional treatment. OBJECTIVE: To report the importance of assessing the occlusal plane during diagnosis, planning and ortho-surgical treatment of patients with facial skeletal deformities and its main advantages. CONCLUSION: Although both philosophies of ortho-surgical treatment (conventional and by surgical manipulation of the OP) have presented good results, the selective correction of the OP allows a full treatment of these patients, providing better esthetic and functional results.

INTRODUÇÃO: o tratamento ortocirúrgico convencional, embora apresente bons resultados clínicos, muitas vezes não alcança resultados funcionais desejáveis. Os pacientes com deformidades dentofaciais, principalmente os que possuem plano oclusal (PO) aumentado, são acometidos também por distúrbios funcionais musculares, articulares e respiratórios, além do comprometimento estético facial. A manipulação cirúrgica do PO na cirurgia ortognáticaé uma alternativa para suprir as limitações do tratamento convencional. OBJETIVO: relatar a importância da avaliação do plano oclusal nas fases de diagnóstico, planejamento e tratamento ortocirúrgico de pacientes com deformidades esqueléticas faciais, e suas principais vantagens. CONCLUSÃO: apesar de ambas as filosofias de tratamento ortocirúrgico (convencional e pela manipulação cirúrgica do PO) apresentarem bons resultados, a correção seletiva do PO permite um tratamento integral desses pacientes, propiciando melhores resultados estéticos e funcionais.

Orthodontic and surgical treatment of a patient with hemifacial microsomia.

This article describes the surgical and orthodontic treatment of a 12-year-old boy with a significant deformity and functional involvement caused by hemifacial microsomia. The left mandibular ramus and condyle were hypoplastic and abnormal in form and location. The lower third of the face was increased, with mandibular retrusion and significant facial asymmetry. He had difficulties in speaking and chewing and problems related to his facial appearance, which caused severe psychosocial disturbances. The patient received orthodontic treatment and temporomandibular joint reconstruction with a costochondral graft on the left side while he was still growing. Three-year follow-up records are presented.

Estudo comparativo da osteossíntese utilizando parafuso com a osteossíntese utilizando fios de aço nos avanços do mento: um estudo retrospectivo da estabilidade esquelética / A comparative study of screw osteosynthesis to with wire osteosynthesis in advancement genioplasty: a retrospective study of skeletal stability

Objetivo: Avaliar dois métodos de fixação empregados durante o avanço do mento, através de: (1) fio de aço e (2) parafusos posicionais. Método: A amostra constou de 20 pacientes submetidos a mentoplastia para o avanço através da osteotomia basilar deslizante por abordagem intra-oral onde em 10 pacientes foi empregado a fixação com fio de aço 1 (0,018 polegadas)- grupo 1 e 10 pacientes a fixação com parafuso posicional do sistema 2.0 mm - grupo 2. A comparação de estabilidade foi obtida a partir de medidas realizadas sobre radiografias cefalométricas de perfil feitas no pré-operatório (T0), no pós-operatório imediato á intervenção (T1) e 6 meses após a intervenção(T2). Foi comparada a posição vertical e horizontal do segmento avançado, nos três tempos de estudo, a partir de um traçado cefalométrico específico. Resultados: Para os indivíduos do grupo 1, o avanço médio observado foi de 6.6mm, entre T1 - T0, onde T0 médio foi de 9,8mm e T1 médio foi de 16,5mm. No acompanhamento de 6 meses houve recidiva de 0,4mm, T2 - T1, sendo que foi observado um valor médio de T2 16,0mm. Verticalmente houve recidiva de 0,5mm no acompanhamento tardio, entre T2 - T1 onde foram observados valores médios de T1 43,5mm e T2 de 45,7mm. No grupo 2 o avanço médio observado foi de 5.6mm, T1 - T0 onde os valores médio de T0 e T1 foram respectivamente 8,5mm e 14,1mm. A recidiva foi de 0,4mm no acompanhamento,T2 - T1 ,com valor de T2 médio de 13,6mm. Verticalmente houve recidiva de 0,2mm, T2 - T1,com valores médios de T1 e T2 respectivamente de 45,2mm e 45,7mm. Conclusão: Os achados permitem concluir que não houve diferença de estabilidade esquelética entre os grupos avaliados, sendo ambos os métodos de fixação eficazes nas mentoplastias para o avanço.

Objective: To evaluate two fixation methods used for the advancement of the chin, through: (1) steel wire and (2) positional screws. Method: The sample consisted of 20 patients who underwent genioplasty to advance through the slide basilar osteotomy for intra-oral approach which was employed in 10 patients with fixing a steel wire (0.018 inches) - group 1 and 10 patients with screw fixation positional System 2.0 mm - group 2. The comparison of stability was obtained from measurements on cephalometric x-rays taken preoperatively (T0), postoperative immediate intervention (T1) and 6 months after intervention (T2). We compared the vertical and horizontal segment of the advanced study of the three times from a specific cephalometric tracing. Results: For individuals in group 1, the increase observed was 6.6mm between T1 - T0, where T0 average was 9.8 mm and mean T1 was 16.5 mm. At 6 months follow up there was recurrence of 0.4 mm, T2 - T1, and observed an average of 16.0 mm T2. Vertically there was recurrence of 0.5 mm at late follow-up between T2 - T1 where average values were observed in T1 and T2 43.5 mm by 45.7 mm. In group 2 progress observed was 5.6mm, T1 - T0 where the average values of T0 and T1 were respectively 8.5 mm and 14.1 mm. The relapse was 0.4 mm in monitoring, T2 - T1, T2 average value of 13.6 mm. Vertically there was recurrence of 0.2 mm, T2 - T1, with average values of T1 and T2 respectively 45.2 mm and 45.7 mm. Conclusion: The findings support the conclusion that there was no difference in skeletal stability between the groups, both methods are effective in fixing genioplasty to advance.