Are There Differences in Fracture Patterns in Mandibular Ramus Sagittal Osteotomies Between Hunsuck/Epker, Wolford, and Posnick Modifications?

PURPOSE: Despite decades of study, the best technique for mandibular ramus sagittal osteotomy has not been definitively determined. The purpose of the present study was to compare fracture patterns, inferior alveolar nerve (IAN) visualization, and torque required for mandibular sagittal splitting using the Hunsuck/Epker, Wolford, and Posnick techniques. METHODS: This was a laboratory (ex vivo), randomized, a single-blind study performed to evaluate sagittal split osteotomies in porcine mandibles using a specifically designed test system. The study's predictor variable was the osteotomy technique, which was divided into 3 groups: Group Hunsuck/Epker (GHE), group Wolford (GW), and group Posnick (GP). The outcome variables were lingual fracture pattern, torque in newtons (N) required to separate the mandible, and IAN visualization. The covariates were mandibular radiodensity and time between dejection and the experiment. The Kolmogorov-Smirnov normality statistics and analysis of variance with Tukey post test statistics were performed. P value <.05 was considered statistically significant. RESULTS: The sample was composed of 120 equally divided porcine hemimandibles in each group. The torque forces were significantly lower (P < .001) when using the Posnick technique (2.07 ± 0.22 N) than when using the Hunsuck/Epker technique (4.45 ± 0.32 N) and Wolford (3.00 ± 0.21 N). GW (93.3%) and GHE (56.7%) showed a higher prevalence of lingual fracture in the posterior region of the mandibular canal (P < .001), while the GP (90%) had a higher frequency of lingual fracture pattern on the mylohyoid sulcus (P < .001). In more than 90% (P < .001) of the mandibles in GW and GHE, the IAN visualization was higher than 50%. In the GP, 90% (P < .001) of patients had IAN visualization of less than 50%. CONCLUSIONS: The Posnick technique required less torque to perform the sagittal osteotomy in a pig mandible and had good predictability (90%) for the less preferred lingual fracture pattern and minimal visualization of the nerve. The Wolford technique provided the best predictability (93%) for the preferred lingual fracture pattern and the best nerve visualization. Caution must be exercised when extrapolating the results from animal models to human applications.

Mini-Anchors to Surgically Treat the Chronic Mandibular Dislocation.

PURPOSE: Evaluate the feasibility of using mini-anchors for the treatment of chronic mandibular dislocation and to identify the variables that affect the success of this approach. PATIENTS AND METHODS: A retrospective cohort study evaluated 9 patients with bilateral recurrent dislocation of the mandible (18 operated joints), treated by a mandibular translation control system using the mini-anchor technique. Data was collected using a Visual Analog Scale (VAS) for subjective parameters and measurements for objective parameters prior to surgery (T1) and at the longest available follow-up (T2) with a minimum of a 12 months interval. Patients subjectively rated their facial pain/headache, jaw function, disability, temporomandibular joint (TMJ) pain and diet. Objective functional changes were determined by measuring the interincisal opening and lateral excursions at T1 and T2. RESULTS: Significant subjective improvements in pain and dysfunction (89 to 94%) were observed (P < .01) from T1 to T2 in all parameters. The comfortable and guarded interincisal opening without mandibular dislocation increased by 41%, the maximum interincisal opening reduced 12 mm, and lateral excursions improved by 43%. CONCLUSIONS: Patients with recurrent mandibular dislocations with or without disc dislocation can be treated effectively by the mini-anchor translation control system.

Treatment of the Temporomandibular Joint Ankylosis with a Customized Prosthesis in a Single Stage: The Use of 3D Cutting Guides and Virtual Surgical Planning.

BACKGROUND: Ankylosis of the temporomandibular joint (TMJ) is a debilitating condition and disabling as a result of craniomandibular fusion, which can result in trismus, pain and a poor quality of life. Current management includes interposition arthroplasty, gap arthroplasty, and reconstruction. Traditionally, the joints are reconstructed with pre-made prostheses (in stock), or the procedure is performed in two steps; with a computerized tomography scan, its design is observed between the respective and reconstructive procedures. STUDY DESIGN: A technical note about the customization management of ankylosis of the temporomandibular joint. OBJECTIVE AND METHODS: Describe a modification of technique using 3D surgical cutting and positioning guides digitally created to help determine the position and dimensions of the osteotomies as an auxiliary tool in the management of TMJ ankylosis, enabling the installation of personalized prostheses in a single stage. CONCLUSION: This technique has the advantage of allowing the installation of customized TMJ prostheses in a single stage, allowing greater predictability, less surgical time and less morbidity, in addition to being relatively simple and can be easily picked up by young surgeons.

Does Platelet-Rich Fibrin Prevent Hemorrhagic Complications After Dental Extractions in Patients Using Oral Anticoagulant Therapy?

PURPOSE: The number of anticoagulated patients requiring dental extractions and other minor dentoalveolar surgical procedures has increased significantly. The purpose of this study was to determine whether the use of platelet-rich fibrin (PRF) prevents hemorrhagic complications after dental extractions in patients being treated with oral anticoagulants. METHODS: A 2-phase PROSPERO-registered systematic review of published within-subject controlled trials (CRD42020186678) was conducted in accordance with the PRISMA statement. Searches were conducted through Medline via PubMed, Web of Science, LILACS, Central Cochrane, Scopus, DOSS, and Google Scholar, until May 2020. The predictor variable was the study group (PRF vs use/non-use of other hemostatic agents). The main outcome of interest was the risk of bleeding after tooth extraction and the covariates were postoperative complications. Data analysis included synthesis of results, risk of bias (RoB) evaluation, meta-analysis (random effects; I²-based heterogeneity; 95% confidence), and certainty of evidence assessment. RESULTS: From a total of 216 articles, 3 articles (low-moderate RoB) were included for evaluation in this systematic review and meta-analysis. A total of 130 patients were involved. The outcomes of the meta-analysis showed that the use of PRF in extraction wounds did not reduce the risk of bleeding after extraction in anticoagulated patients (P= .330; I² = 99%). Furthermore, the use of PRF did not improve pain scores (P = .470; I² = 96%) or the risk of postoperative alveolitis (P = .4300; I² = 38%) in anticoagulated patients. The certainty of the evidence ranged from moderate to low. CONCLUSIONS: The findings of this systematic review and meta-analysis suggest that PRF does not prevent hemorrhagic complications after tooth extraction in patients using oral anticoagulant therapy.

GOHAI and OHIP-EDENT Evaluation in Removable Dental Prostheses Users: Factorial Analysis and Influence of Clinical and Prosthetic Variables.

PURPOSE: To assess the degree of satisfaction and quality of life of patients with removable prostheses using the Geriatric Oral Health Assessment Index (GOHAI) and Oral Health Impact Profile in Edentulous Adults (OHIP-EDENT), in addition to evaluating the questionnaires for their validation. MATERIALS AND METHODS: Eighty patients participated in the study after completing prosthetic rehabilitation treatment. Patients were evaluated using the OHIP-EDENT and GOHAI questionnaires to assess the criteria for quality of life, esthetics, phonetics, masticatory function, stability, comfort, and alteration of taste and pain related to the completed prostheses. The results were subjected to the chi-squared test, Fisher's exact test, and a multinomial logistic regression model, with a significance level of 5%. RESULTS: The most commonly used removable prosthesis was mandibular removable partial denture (RPD) (n = 43, 53.8%), followed by maxillary RPD (n = 42, 52.5%), maxillary complete denture (CD) (n = 33, 41.3%), and mandibular CD (n = 31, 38.8%). Most patients had to have one (n = 29, 36.3%), two (n = 21, 26.3%), or none (n = 18, 23.8%) adjustments in their prostheses. Five (6.3%) patients' prostheses required three adjustments, and six (7.5%) required four or more adjustments. All reported improvement in esthetics after using the prostheses (p < 0.05). The validation of the questionnaire proved to be more viable when completed without the presence of specific domains. CONCLUSION: The results of this study indicated that removable prostheses improved the quality of life of rehabilitated patients. The questionnaires used need to be answered and evaluated in their entirety for validation.

Oral health in the analysis of patients with hearing disabilities / Saúde bucal na análise de pacientes com deficiência auditiva

Objective: To assess the degree of knowledge of deaf and hard of hearing patients about oral health and relate it to clinical and demographic variables. Methods: The target population was schoolchildren from the 6th to the 9th grade of Elementary School and the 1st year of High School. Data collection took place through a structured questionnaire previously validated. The expressed as absolute and percentage frequencies it was analyzed using Fisher's exact test or Pearson's chi-square test (p <0.05). Results: Assessing the relationship between oral health and quality of life, to 53 students, 32.1% of students never reported pain in their teeth, mouth, or jaws, 55.8% never missed school due to problems with their teeth or dental treatments, 71, 2% never avoided smiling or laughing due to problems with teeth or dental treatments, 53.8% never avoided opening their mouths or talking due to problems with teeth or dental treatments. Conclusion: Professional and patient communication should be emphasized with the deaf and hard of hearing to intensify the importance of monitoring with the dental surgeon, carrying out activities to promote, prevent, cure, and rehabilitate oral health.

Objetivo: Avaliar o grau de conhecimento de pacientes portadores de deficiência auditiva sobre a saúde bucal, e relacionar com as variáveis clínicas e demográficas. Métodos: A população alvo foram escolares do 6º ao 9º ano do Ensino Fundamental e do 1º ano do Ensino Médio. A coleta de dados ocorreu de agosto a novembro de 2018, por meio de um questionário estruturado previamente validado. A análise dos dados foi realizada por meio do programa SPSS (Statistical Package of the Social Sciences) e expressos em forma de frequência absoluta e percentual e analisados pelo teste exato de Fisher ou qui-quadrado de Pearson (p<0,05). Resultados: Avaliando a relação da saúde bucal com a qualidade de vida de 53 alunos; 32,1% dos alunos nunca relataram dores nos dentes, na boca, ou nos maxilares, 55,8% nunca faltaram à escola devido problemas com os dentes ou tratamentos dentários, 71,2% nunca evitaram sorrir ou rir devido a problemas com os dentes ou tratamentos dentários, 53,8% nunca evitaram abrir a boca ou falar devido a problemas com os dentes ou tratamentos dentários. Conclusão: A comunicação profissional e paciente deve ser enfatizada com os portadores de deficientes auditivos, com o intuito de intensificar a importância do acompanhamento com o cirurgião dentista, realizando atividades de promoção, prevenção, cura e reabilitação à saúde bucal

Is Bilateral Sagittal Split Osteotomy of the Mandible With no Step Possible? A Modification in the Technique.

The mandibular ramus sagittal osteotomy is a usual procedure used to correct deformities of the lower third of the face. Modifications of the procedure will be presented to avoid the presence of palpable gap at mandibular body, easily seen in greater movements.

Surgical Treatment of Polyostotic Craniomaxillofacial Fibrous Dysplasia Associated With Acromegalia: The McCune - Albright Syndrome.

INTRODUCTION: The McCune-Albright syndrome (MAS) is a complex congenital disorder caused by the embryonic post-zygotic somatic activating mutations in the GNAS1 gene. In such syndrome, phenotypes are heterogeneous and comprised polyostotic/monostotic fibrous dysplasia, café au lait macules, and hyperfunctioning endocrinopathies as the excess growth hormone. Likewise, acromegaly, as a manifestation of the endocrine hyperfunction, is unusual and affects about 20% of patients with MAS. CASE PRESENTATION: This research study describes a case of a 31-year-old female subject presenting polyostotic fibrous dysplasia with severe facial involvement, along with acromegaly and the MAS. The case was satisfactorily managed by surgical re-alignment and presented no clinical signs of relapse in a 12-year follow-up period. Finally, a literature review was conducted to discuss the standard protocols and the controversies when treating such cases. CONCLUSION: Patients with craniomaxillofacial fibrous dysplasia associated with acromegaly may present significant facial deformities that can be satisfactorily treated by cosmetic treatment, especially in patients with psychological problems and severe social acceptance.

CELL growth and viability analysis in poli membranes (L-lactic acid-CO-glycolic acid): an in vitro study / Análise do crescimento e viabilidade celular em membranas de poli (L-ácido láctico-CO-ácido glicólico): um estudo in vitro

ABSTRACT Objective: Performing an in vitro evaluation of the biological effects on cell growth and viability of fibroblasts in PLGA membranes with and without simvastatin. Methods: Two groups of resorbable synthetic polymeric membranes were used: PLGA, with and without simvastatin, cut into a suitable format to fit to 24 thermometric wells. Fibroblasts were grown on resorbable membranes and evaluated for proliferation and viability at 24, 48 and 72 hours after the beginning of cultivation, being the tests performed in triplicate. For the cell growth analysis, the Trypan blue exclusion method was applied, while cell viability was observed by the MTT test. The results were statistically analyzed applying the Two-Way ANOVA, followed by the Bonferroni test, with 95% confidence interval and P value smaller than 0.05 was accepted as statistically significant. Results: Statistical difference (p <0.01) was seen between the control group (2.16x104 ± 0.51 cells) and the PLGA group with simvastatin (1.58x104 ± 0.36 cells) in the 48-hour period. After 72 hours, statistical differences (p <0.001) were observed between the PLGA group with simvastatin (1.66x104 ± 0.49 cells) and the PLGA group without simvastatin (2.25x104 ± 0.2 cells) when compared to the control group (2.81x104 ± 0.33 cells) for cell proliferation. Statistical differences (p <0.05) were observed between the control group (0.27 ± 0.05) and the PLGA group with simvastatin (0.21 ± 0.03). Likewise, a statistical difference (p <0.001) was seen between the PLGA group without simvastatin (0.19 ± 0.02) and the control group after 24 hours. In the 48 - 72-hour period, statistical differences (p <0.001) were observed between the control group (0.36 ± 0.09 and 0.55 ± 0.05, after 48 and 72 hours respectively) and the PLGA group without simvastatin (0.26 ± 0.05 and 0.34 ± 0.07, after 48 and 72 hours respectively), as well as in the PLGA group with simvastatin (0.27 ± 0.04 and 0.31 ± 0, 04, after 48 and 72 hours respectively) for the cell viability test. Conclusion: The association of simvastatin to PLGA membranes had an inhibitory effect on fibroblast proliferation, as well as induced a reduction in cell viability. Thus, the use of PLGA along with simvastatin may assist in guided bone regeneration.

RESUMO Objetivo: Esse trabalho avaliou, in vitro, os efeitos biológicos no crescimento e viabilidade celular de fibroblastos em membranas de PLGA com e sem sinvastatina. Materiais e métodos: Foram utilizados dois grupos de membranas reabsorvíveis de polímeros sintéticos: PLGA com sinvastantina e sem sinvastantina, recortadas em formato apropriado para adaptar nas placas de 24 wells termométricas. Os fibroblastos foram cultivados em membranas reabsorvíveis, sendo avaliadas em relação à proliferação e viabilidade em 24, 48 e 72 horas após o início do cultivo, os testes foram realizados em triplicata. Para a análise do crescimento celular foi utilizado o método de exclusão vital azul de Tripan, enquanto a viabilidade celular foi observada pelo teste MTT. Os resultados obtidos foram estatisticamente analisados utilizando Two-Way ANOVA, seguido pelo teste de Bonferroni, com intervalo de confiança de 95% e um valor de P inferior a 0,05 foi aceito como estatisticamente significativo. Resultados: Foi observado diferença estatística (p<0,01) entre o grupo controle (2,16x104 ± 0,51 células) e o grupo PLGA com sinvastatina (1,58x104 ± 0,36 células) no período de 48 horas. Após 72 horas, diferenças estatísticas (p<0,001) foram observadas entre o grupo PLGA com sinvastatina (1,66x104 ± 0,49 células) e o grupo PLGA sem sinvastatina (2,25x104 ± 0,2 células) em comparação ao grupo controle (2,81x104 ± 0,33 células) quanto a proliferação celular. Diferenças estatísticas (p<0,05) foram observadas entre o grupo controle (0,27 ± 0,05) e o grupo PLGA com sinvastatina (0,21 ± 0,03), da mesma forma que, diferença estatística (p<0,001) foram observadas entre o grupo PLGA sem sinvastatina (0,19 ± 0,02) e grupo controle após 24 horas. No período de 48 horas e 72 horas diferenças estatísticas (p<0,001) foram observadas entre o grupo controle (0,36 ± 0,09 e 0,55 ± 0,05, após 48 e 72 horas respectivamente) e o grupo PLGA sem sinvastatina (0,26 ± 0,05 e 0,34 ± 0,07, após 48 e 72 horas respectivamente), assim como, o grupo PLGA com sinvastatina (0,27 ± 0,04 e 0,31 ± 0,04, após 48 e 72 horas respectivamente) quanto ao teste de viabilidade celular. Conclusão: A associação de sinvastatina às membranas de PLGA apresentou um efeito inibitório na proliferação de fibroblastos, bem como induziu uma redução da viabilidade celular destes, deste modo, sugere-se a utilização de PLGA associado à sinvastatina como uma ferramenta para auxiliar na regeneração óssea guiada.

Factors Associated With the Complexity of Facial Trauma.

INTRODUCTION: Facial fractures have their incidence, etiology, clinical presentation, and features influenced by variables such as economic, cultural, and demographic factors. A large number of these fractures require simple or more complex approaches, and it becomes important to understand their clinical and epidemiological profile and factors associated with the fracture event and surgical indication. OBJECTIVE: The objective of this research is to analyze the clinical and epidemiological profile of surgical fractures and their associations with causal factors such as alcohol consumption, day of the incident, and nonuse of helmet for motorcycle accidents. METHOD: A retrospective study was conducted with collection of data from medical records of patients operated for facial fractures at the Hospital Regional of Cariri, state of Ceara, the Northeast of Brazil. Records from 2012 to 2014 were acquired highlighting sex, age, occupation, etiology, anatomical sites of fractures, and surgeries of varying complexities for single or multiple fractures. The day of the event, report or signs of alcohol consumption, and the use of helmets in motorcycle accidents were named associated factors. RESULTS: As a result the authors had a total of 624 cases of surgical facial fractures. Out of these, 546 (87.5%) were male and the majority of them presented between 20 and 30 years of age (40.5%). It was also observed that as an etiological factor motorcycle accidents led to more cases of surgical facial fractures, with 357 cases (62.1%), followed by physical aggression with 72 cases (12.5%). CONCLUSIONS: It can be concluded that there is a high prevalence of surgical facial fractures in male patients between 20 and 30 years of age, caused by motorcycle accidents, and that there was a strong association between the consumption of alcohol, failure to wear a helmet, and the presence of surgical facial multiple fractures.