Assessment of Passiflora incarnata L for conscious sedation of patients during the extraction of mandibular third molars: a randomized, split-mouth, double-blind, crossover study.

OBJECTIVE: The aim of the present study was to evaluate the efficacy of Passiflora incarnata L for the control of anxiety during third mandibular molar extraction and compare it to midazolam, the most used benzodiazepine in dentistry. METHOD AND MATERIALS: The investigators implemented a prospective, randomized, double-blind, split-mouth study. The degree of anxiety of the patients was assessed before the surgical procedure. The surgeries took place in two sessions: one on each side of the hemi-mandible and, on each of them, the patient received one of the drugs, crosswise. Anxiety control was measured through physical parameters, at the following periods during the surgery: (1) immediately administration of anxiolytic medication, (2) 30 minutes after anxiolytic medication, (3) after extraoral antisepsis, (4) after local anesthesia, (5) during incision, (6) during osteotomy, (7) between osteotomy and odontosection, (8) during odontosection, (9) during surgical store curettage, (10) during suture, and (11) immediately after postoperative care guidelines. Lastly, the volunteers received a self-assessment form in order to report their experience. Statistical analysis was performed using the Wilcoxon test. RESULTS: The final sample was composed of 20 patients, with a mean age of 22.5 years. The results of the physical parameters showed statistically significant differences (P < .05) for certain times and physical parameters, especially heart rate (P = .036), which showed the highest control for Passiflora at time point (3). The undesirable effects reported by patients such as drowsiness, muscle relaxation, and dizziness were greater with benzodiazepine. CONCLUSION: The results of this study suggest that Passiflora may be considered as an alternative to midazolam in controlling anxiety in dentistry. Future studies will focus on other benzodiazepines and herbal medicines.

Oral Rehabilitation With Dental Implants and the Importance of a Preventive Evaluation for Osteonecrosis of the Jaws Associated With Medications.

Osteonecrosis of the jaw is a possible oral complication resulting from antiresorptive therapies, such as bisphosphonates (Bfs). Although the etiology is not entirely clear, it has been shown to be dependent on several factors, with the traumatic stimulation caused by the placement of teeth implants indicated as one of the predisposing factors to this pathology. The indications and preventive methods for performing these procedures have been questioned, making it essential to determine the proper protocols. Thus, the present study aims to discuss the risks of the development of osteonecrosis in patients undergoing dental implant surgery who use Bfs as well as to discuss related local and systemic factors and possible methods for preventing this side effect. The study also aims to present a clinical case of an osteopenic patient who used Bfs and underwent rehabilitation through implants according to specific protocols, which resulted in successful treatment.

Effect of alendronate on healing of bone defect and gingival tissue in osteopenic rats / Efecto del alendronato en la reparación de defectos óseos y tejido gingival en ratas con osteopenia

The aim was to evaluate bone repair and gingival tissue repair in osteopenic rats. Fifteen female wistar rats were included; in all of them ovariectomy was realized to induce osteopenia; after 45 days, the animals were submitted to 2 surgical techinques 1) dental extraction of the upper central incisor with no socket preservation and 2) 5 mm cranial defect in the calvarium; 5 rats were included in the control group (G1) withput alendronate application; in the group 2 (G2) was used subcutenous alendronate (0.5 mg/kg) once for three weeks and then was realizd the both surgical techniques. In group 3 (G3), after ovariectomy was realized the both dental extraction and the calvarium defect and after that was realized the alendronate protocol. In each group, after six week was realized euthanasia and descriptive histological analysis of the surgical areas involved. In bone formation of the 5 mm cranial defect was observed with good progression in the 3 experimental models and no modification in quality of bone repair was observed. For the gingival tissue in the extraction socket, no differences were observed between G1 and G3. On other hand, in G2 a thinner and reduced gingival epithelium was found. Our results showed that alendronate was not an obstacle for bone repair; deficiencies in re-epithelialization of oral mucosa show the impact of alendronate before dental extraction.

El objetivo fue evaluar la reparación ósea y gingival en ratas con osteopenia. Quince ratas wistar hembras fueron incluidas; en todas ellas se realizo ovarectomia y fue realizada la inducción de osteopenia; después de 45 días, los animales fueron sometidos a dos técnicas quirúrgicas 1) extracciones dentales del incisivo central superior sin preservación alveolar y 2) creación de un defecto craneano de 5 mm en la calota; 5 animales fueron incluidos como grupo control (G1) sin la aplicación de alendronato; en el grupo 2 (G2) se utilizó alendronato subcutáneo (0,5 mg/kg) una vez a la semana durante 3 semanas. En el grupo 3 (G3), después de la ovarectomia se realizó la exodoncia y el defecto en el cráneo y después de ello se inicio el protocolo con alendronato. En cada grupo, después de seis semanas se realizó la eutanasia con descripción histológica de los hallazgos. En el hueso formado en el defecto craneano de 5 mm se observó una adecuada progresión de reparación en los 3 modelos experimentales y no se observó cambios importantes en el modelo de reparación. Para el tejido gingival en el sitio de extracción, no se observaron diferencias entre el grupo G1 y G3. Por otra parte, el G2 presentó un tejido mas delgado con reducción del epitelio gingival; nuestros resultados demuestran que el alendronato no fue un obstáculo en la reparación ósea; deficiencias en la re epitelización de la mucosa oral muestran el impacto del alendronato después de la exodoncia.

Tratamento conservador da fratura do côndilo mandibular após injúria por projétil de arma de fogo: inter-relaçao entre cirurgia e Ortodontia / Conservative treatment of mandibular condo fracture after firearm injury: inter-relationship between surgery and Orthodontics

Resumo Introdução: O tratamento das fraturas condilares causadas por um projétil de arma de fogo possui controvérsias na literatura. Objetivo: Descrever um caso clínico de fratura do côndilo mandibular causado por ferimento de arma de fogo que foi tratado com elasticoterapia e fisioterapia. Discussão: A região maxilofacial tem sido alvo constante desse tipo de trauma, refletindo a alta violência urbana. Frequentemente, esses traumas envolvem fraturas cominutivas na região e a abordagem terapêutica para esses casos depende do deslocamento, grau de cominação da fratura e cooperação do paciente. Apesar das diferentes possibilidades de tratamento das fraturas mandibulares, o tratamento não cirúrgico é uma opção válida como primeira escolha, principalmente nos casos de fraturas favoráveis, sem grandes deslocamentos ósseos e associadas à adesão do paciente ao tratamento. Considerações finais: A combinação de bloqueio maxilo-mandibular e elasticoterapia como tratamento conservador é preconizada para a restauração da funcionalidade estomatognática, seguida de acompanhamento periódico. (AU)

Abstract Introduction: The treatment of condylar fractures caused by firearm projectile has controversies in the literature. Objective: This study aimed to describe a clinical case of mandibular condyle fracture caused by firearm injury and treated with elastic therapy and physiotherapy. Discussion: The maxillofacial region has been a constant target for this type of trauma, reflecting the high urban violence. Frequently these traumas involve comminuted fractures in the region and the therapeutic approach for these cases depends on the displacement, degree of fracture comminution and patient cooperation. Despite the different possibilities for treatment of mandibular fractures, non-surgical treatment is a valid option as first choice, especially in cases of favorable fractures, without large bone displacements and associated with patient adherence to treatment. Final considerations: The combination of maxillo-mandibular block and elastic therapy as a conservative treatment is recommended for the restoration of stomatognathic functionality, followed by periodic follow-up (AU)

Use of osseointegrated implants in the intermaxillary suture in a patient with microstomia: Case report with a 2-year follow-up.

AIM: To report the rehabilitation of a female patient, 40 years old, with a microstomia. CASE REPORT: The Z-plasty surgery was performed in the region of the labial commissure to increase the mouth opening. In the mandible, two implants were installed in the interforaminal region and an overdenture with bar/clip attachment system was made. The maxilla was atrophic, with the presence of two bone sites in the intermaxillary suture region: the first one anterior to the incisive foramen and the second one in the middle of the hard palate. Two implants were placed without a graft in those sites. The conventional maxillary denture was converted into an overdenture with ball attachments system. CONCLUSION: Based on the presented case, with a 2-year follow-up, it can be concluded the validity of the use of the techniques of surgeries to increase the mouth opening, implants in intermaxillary suture and overdentures as rehabilitation therapy for patients with microstomia.

Assessment of Valeriana officinalis l. (Valerian) for Conscious Sedation of Patients During the Extraction of Impacted Mandibular Third Molars: A Randomized, Split-Mouth, Double-Blind, Crossover Study.

PURPOSE: The objective of the present study was to evaluate the effectiveness of an herbal drug (valerian) to control anxiety during mandibular third molar extraction compared with a reference benzodiazepine drug commonly used in dental procedures (midazolam). MATERIALS AND METHODS: Twenty anxious patients with an indication for bilateral extraction of mandibular third molars were selected. The patients received capsules containing valerian 100 mg or midazolam 15 mg orally 60 minutes before the procedures in a randomized, split-mouth, crossover design. Changes in the physiological parameters (eg, oxygen saturation, heart rate, blood pressure, respiratory rate) were assessed at specific times during surgery, and the patients completed a questionnaire postoperatively. The data were analyzed using the Wilcoxon and paired t tests, with a significance level of 5%. RESULTS: No statistically significant differences in oxygen saturation were observed, regardless of the drug used. However, the other physiological parameters were significantly lower when the patients had taken midazolam compared with valerian. Somnolence was the most common side effect reported with both drugs. CONCLUSIONS: Although midazolam was more effective in reducing the physiological parameters studied, valerian seemed to provide the comfort and relaxation required, with no sedation and less somnolence than midazolam, during third molar extraction. Further studies are necessary before valerian can be clinically recommended.

Estudo epidemiológico de pacientes portadores de infecção do complexo bucomaxilofacial tratados no Hospital Universitário de Maringá: estudo retrospectivo ao longo de 8 anos / Epidemiological study of patients with oral maxillofacial infection treated at Universitary Hospital of Maringá: retrospective study about 8 years

Infecções agudas bucomaxilofaciais podem ser condições clínicas graves e de ocorrência comum, caracterizadas pela disseminação do processo infeccioso a tecidos adjacentes e espaços faciais da região de cabeça e pescoço, podendo resultar em várias complicações, até mesmo em óbito, embora seja raro. Objetivo: realizar uma análise epidemiológica de infecções maxilofaciais, relacionando os dados ao tratamento instituído e à sua efetividade, bem como analisar dados referentes a idade, sexo, principais dentes envolvidos e tempo total de internação. Sujeito e método: foram analisados retrospectivamente 240 prontuários de pacientes admitidos no Hospital Universitário de Maringá com infecção odontogênica, atendidos pela equipe de Cirurgia e Traumatologia Bucomaxilofacial no período de janeiro de 2009 a janeiro de 2017. Resultados: a média de idade dos pacientes foi de 38 anos, com 57 mulheres e 54 homens. A média de temperatura de admissão foi 38,5°C. A região mais acometida foi o ramo posterior da mandíbula, tendo uma média de duração de infecção e hospitalização de 6,1 dias. A principal conduta foi drenagem e antibioticoterapia, sendo que cerca de 13 pacientes não precisaram desse tipo de intervenção, e um paciente evoluiu a óbito. Conclusão: com base nestes resultados e na literatura, infecções odontogênicas merecem atenção, pois podem ser fatais e requerem internação rápida e tratamento adequado. Esse, portanto, é um assunto de grande importância para o cirurgião- -dentista, que exerce papel fundamental na prevenção e no tratamento. A resolução precoce ainda é a forma mais adequada para evitar complicações mais graves. (AU)

Acute Oral maxillofacial infections can be serious and relatively common clinical conditions, characterized by the spread of the infectious process to adjacent tissues and facial spaces of the head and neck region, which can result in several complications and lead to even death, although it is rare. Objective: the objective of this study was to perform an epidemiological analysis of maxillofacial infections and relate their data to the treatment instituted and the effectiveness of the same, as well as to analyze data regarding the age, sex, main teeth involved and total time of hospitalization. Subjects and method: in order to carry out study, 240 medical recordswere analyzed retrospectivelyat the University Hospital of Maringá of the patients with odontogenic infection attended by the Oral Maxillofacial Surgeon in the period of January 2009 to January 2017. Results: as a result, mean age was 38 years, with 57 women and 54 men and mean intake temperature was 38.5 °. The most affected region was the posterior branch of the mandible, with a mean duration of infection and hospitalization of 6.1 days. The main conduct was drainage and antibiotic therapy, and about 13 patients did not need this intervention and only 1 died. Conclusion: Based on these results and in literature, attention should be paid to odontogenic infections, which can be fatal and require proper treatment. This is a subject of great importance for the dentist, who plays a key role in prevention and proper treatment, its early resolution is still the most appropriate way to avoid serious complications. (AU)

Toxina Botulínica para el Tratamiento de los Desórdenes Temporomandibulares / Botulinum Toxin for the Treatment of Temporomandibular Disorders

RESUMEN: Los Trastornos Temporomandibulares (TTM) consisten en un conjunto de condiciones patológicas que afectan la articulación temporomandibular (ATM), los músculos de la masticación y las estructuras asociadas. Estudios epidemiológicos estiman que 40 % a 75 % de la población adulta presenta por lo menos un signo de TTM, como ruido articular y 33 % por lo menos un síntoma, como dolor facial o en la ATM. La toxina botulínica (BoNT) es una neurotoxina producida por la bacteria anaerobia Clostridium botulinum, solo la toxina A y B son utilizadas en la práctica clínica después de la aprobación de la Food and Drug Administration en 1989 y 2000; actualmente continúan siendo utilizadas para tratar varias condiciones de dolor, incluyendo la espasticidad muscular, distonia, dolor de cabeza y dolor miofascial. Las propuestas del mecanismo de acción fueron sugeridas a mediados de 1950 manifestando que esta neurotoxina posee alta afinidad con la sinapsis colinérgicas, ocasionando un bloqueo en la liberación de acetilcolina de esos terminales nerviosos, sin alterar la conducción neural de las señales eléctricas o en la síntesis de almacenamiento de acetilcolina. La inyección intramuscular en dosis y localización apropiada, provoca denervación química parcial y disminución de la contractura, sin ocasionar parálisis completa a lo que se le atribuye ser un innovador y eficaz método de tratamiento para el dolor crónico asociada con hiperactividad de los músculos masticatorios. La toxina botulínica tipo A es ser una alternativa para el control de la sintomatología dolorosa presente en los TTMs de etiología miogénica. Los autores recomiendan realizar un correcto diagnóstico, ya que la indicación de este tipo de tratamiento con diagnósticos incorrectos lleva a resultados inciertos.

ABSTRACT: Temporomandibular Disorders (TMD) is a term that was used to describe a set of pathological conditions that affect temporomandibular joint (TMJ), muscles of mastication and associated structures. Epidemiological studies estimates that 40 % to 75 % of the adult population has at least one sign of TMD, such as joint noise and 33 % presented some symptom such as facial or joint pain. Botulinum toxin is a neurotoxin produced by the anaerobic bacterium Clostridium botulinum. There are two types of toxin (A and B) used in clinical practice that were approved by Food and Drug Administration in 1989 and 2000. These medications are in use to treat various diseases including muscle spasticity, dystonia, headache and myofascial pain. The mechanisms of action were suggested in the mid-1950s, this neurotoxin seems to have an action at cholinergic synapses, causing a block in the release of acetylcholine from the nerve terminals without altering the neural conduction of the electrical signals. The synthesis and storage of acetylcholine were preserved. Intramuscular injection in appropriate doses and location causes partial chemical denervation and decreased contracture, without causing complete paralysis of muscles. Due to this features, it has been considered an innovative and effective method to treat chronic pain associated with hyperactivity of masticatory muscles. The botulinum toxin type A appears to be an alternative method for pain control present in TMDs that have myogenic etiology. The authors recommend a correct diagnosis, since the indication of this type of treatment associated with an incorrect diagnosis leads to uncertain outcomes, creating false conclusions.

Associated aneurysmal bone cyst and cemento-osseous dysplasia: a case report and review of the literature.

The purpose of this case report is to describe a previously unpublished association between focal cemento-osseous dysplasia (FCOD) and an aneurysmal bone cyst (ABC) and review the literature with regard to associated benign fibro-osseous lesions and cysts. A 41-year-old woman without a history of trauma presented with asymptomatic swelling in the right side of the mandible. Radiographs of the region revealed a unilocular radiolucent area with radiopaque foci. After aspiration of the lesion was positive for serosanguineous fluid, complete excision of the lesion was performed. Microscopic examination revealed a hybrid ABC and FCOD. The 12-month follow-up showed significant bone repair and no signs of recurrence. A review of the English-language literature from 1980 to 2012 revealed 1 retrospective study, 4 case series, and 18 single-case reports on the topic of cemento-osseous dysplasias, fibro-osseous lesions, and aneurysmal bone cysts. Of 59 cases, none reported an association between an ABC and FCOD. Although fibro-osseous lesions do not require intervention, surgical excision is recommended when they are associated with cysts. This case, in which an ABC and FCOD were associated, reinforces the need for a careful diagnostic process in radiographically mixed lesions that respond positively to aspiration biopsy.

Vancomycin-induced thrombocytopenia: a rare adverse effect in a patient -submitted to bone graft in the jaw.

INTRODUCTION: Thrombocytopenia is the reduction in the number of blood -platelets, which may be caused by -several different conditions such as sepsis, disseminated intravascular -clotting, and large blood losses. Additionally, in rare situations, thrombocytopenia may also be induced by the use of medicaments. One of these drugs is the vancomycin, a glycopeptide presently used against -serious infections involving Gram-positive bacteria such as the methicillin-resistant Staphylococcus aureus and penicillin-resistant Streptococcus. OBJECTIVE: The objective of this study is to report on a case of serious vancomycin-induced thrombocytopenia in a patient infected with methicillin-resistant S. aureus after mandibular reconstruction with autogenous bone graft, and to draw attention to the importance of this clinically rare adverse effect. CONCLUSION: Vancomycin-induced thrombocytopenia is a rare condition, which is also a significant disorder that demands attention and the rapid identification and replacement of the antimicrobial agent.

Exodontias múltiplas em paciente radioterápico: indicações, risco de osteorradionecrose e possível reabilitação oral: relato de caso / Multiple tooth extractions in radiotherapy patients: indications, osteoradionecrosis risk and possible oral rehabilitation: case report

A osteorradionecrose (ORN) é uma das complicações bucais mais graves pós-tratamento de câncer de cabeça e pescoço, sendo a extração dentária, por meio de sua estimulação traumática, apontada como um importante fator predisponente. As indicações e métodos preventivos para a realização destes procedimentos em pacientes irradiados são questionados, se tornando fundamental o conhecimento de protocolos adequados. O presente artigo relata um caso de exodontias múltiplas em um paciente oncológico em fase terminal, cujas medidas preventivas foram realizadas, não ocorrendo desenvolvimento de complicações. Por meio de revisão de literatura, explana as possíveis indicações deste procedimento, o risco de desenvolvimento de osteorradionecrose e as possibilidades de prevenção para esta sequela. Além disso, aborda uma alternativa de reabilitação oral viável após este tipo de cirurgia, por meio de overdenture sobre dentes em mandíbula. (AU)

Osteoradionecrosis (ORN) is one of the most severe oral complications after the head and neck cancer treatment. Tooth extraction, through its traumatic stimulation, is identified as an important predisposing factor. Indications and preventive methods for carrying out these procedures in irradiated patients are questioned, thus, knowledge of appropriate protocols is essential. This article reports a case of multiple tooth extractions in a cancer patient in terminal stage whose preventive measures were taken without the occurrence of complications. Based on a literature review, this paper accounts the possible indications of this procedure, the risk of developing osteoradionecrosis, and the prevention possibilities for this sequela. In addition, this report addresses a viable oral rehabilitation alternative after this kind of surgery by using overdenture on the lower jaw teeth. (AU)

Inflammatory collateral cyst associated with a palatoradicular groove: report of a case and discussion of nomenclature.

The aims of this article are to present a case demonstrating the connection between palatoradicular grooves and inflammatory collateral cysts and to discuss the related nomenclature. Radiographs in a 21-year-old man revealed a radiolucent, unilocular, well-defined area near the vital maxillary right lateral incisor and canine. Palatal swelling was present, and a 6-mm-deep periodontal pocket was found at the palatal surface of the right lateral incisor. The differential diagnoses were keratocystic odontogenic tumor, developmental lateral periodontal cyst, and inflammatory lateral periodontal cyst. The area was explored surgically, and the lesion was excised. Surgical exploration revealed a palatoradicular groove, which was scaled and planed with the aid of manual curettes with the intention of creating a flat surface to promote insertion of the periodontal fibers. Histopathologic analysis revealed that the lesion was an inflammatory cyst. The presence of a palatoradicular groove can put the periodontium at risk because a resulting lack of fiber insertion makes oral hygiene difficult. This established inflammatory process can initiate development of an inflammatory collateral cyst that may be misdiagnosed, hindering successful management. In this case, bone grafting and placement of a resorbable membrane were used to promote bone formation and subsequent sealing of the periodontal space.

Hipertratamento de miíase decorrente de trauma facial complexo / Treatment of myiasis resulting from complex facial trauma

Miíase é uma infestação em tecidos e órgãos ou ocasionada por larvas de dípteros, em humanos ou em animais, por depositarem os seus ovos em tecidos do corpo. Acomete, na maioria das vezes, pessoas de nível socioeconômico baixo, de regiões de clima tropical, imunocomprometidas e com desordens psiquiátricas. Devido ao grande potencial destrutivo, prevenção e tratamento apropriado em tempo hábil são necessários. Apresentamos um caso de miíase em paciente vítima de acidente automobilístico há 08 dias, o qual apresentava múltiplas fraturas e extensos ferimentos faciais não tratados devido à difícil localização e falta de estrutura hospitalar locais. Os ferimentos em face estavam infestados por larvas do díptero Cochliomyia hominivorax spp. As fraturas foram tratadas cirurgicamente, e os tecidos infestados pelas larvas, por meio do debridamento cirúrgico e terapia com o antiparasitário ivermectina.

Myiasis is an infestation of tissues and organs caused by Diptera larvae, in humans or animals, when they deposit their eggs on body tissues. It affects mostly people living in poor socioeconomic conditions in tropical regions, who are immunocompromised and suffering from psychiatric disorders. Due to the great destructive potential of myiasis, its prevention and timely appropriate treatment are of the utmost importance. We present a case of myiasis in a patient involved in a road accident eight days previously, who had multiple fractures and extensive facial injuries not treated because of the difficult location and lack of local hospital facilities. The wounds in the face were infested by Diptera larvae of Cochliomyia hominivorax spp. The fractures were treated surgically and larva-infected tissues infested by surgical debridement and therapy using the antiparasitic drug ivermectin.

Surgical management of impacted teeth using three-dimensional computed tomography.

The surgical removal of impacted, supernumerary, or ectopic teeth is a routine procedure to the dental surgeon. Because any and all surgical interventions involve anatomic considerations that predispose the patient to a high risk of incidents or complications, it is absolutely necessary to precisely determine the location of the enclosed teeth, to better plan the procedure. Even though the conventional radiographic techniques are commonly used to detect the presence of such teeth, they can present deficiencies. In those situations, additional examinations can be requested. In this article, we are reporting the case of a 12-year-old patient, whose third superior molars appeared in a very atypical position. We chose to request a computed tomography and three-dimensional manipulation of the obtained images. This article, as its main goal, highlighted the importance of computed tomography and of three-dimensional reconstructions as a tool to precisely determine the location of enclosed teeth, thus allowing for a better planning of the surgery and a safer surgical intervention.

Comunicação bucossinusal através do ligamento periodontal:relato de caso / Oroantral communication through the periodontal ligament: case report

Comunicações ou fístulas bucossinusais são espaços patológicos criados entre o seio maxilar e a cavidade bucal, geralmente associadas a exodontias em região posterior de maxila. A literatura cita inúmeros fatores etiológicos e métodos de fechamento, que dependem do bom diagnóstico e de indicação adequada, variando tais comunicaçõesem relação a tamanho, duração, associação com patologias sinusais e localização. O objetivo do presente artigo é relatar uma comunicação bucossinusal de difícil diagnóstico, através do ligamento periodontal do primeiro molar, após tentativas de enxerto gengival no local.

Communications or oroantral fistulas are pathological spaces created between maxillary sinus and the oral cavity, which are usually associated with tooth extraction in the area of posterior maxilla. The literature suggests several etiological factors and of hard diagnosis through the first molar periodontal ligament, after attempts of methods torepair it, that rely on an appropriate diagnosis and indication. Change according to the size, duration and association with sinus conditions and location. The purpose of this current report is to relate an oroantral communication gingival graft in the affected site.

Reconstrução de rebordo alveolar com osso homógeno em bloco: uma revisão sistemática / Alveolar ridge augmentation with homogenous bone block: a systematic review

A utilização de próteses implantossuportadas é, nos dias de hoje, uma alternativa segura e viável para reabilitação de áreas edêntulas. Porém, muitas vezes a instalação de implantes osseointegrados pode ser comprometida ou impossibilitada devido a reabsorções extensas dos rebordos alveolares. O objetivo deste trabalho foi revisar sistematicamente a literatura relacionada à reconstrução de rebordo alveolar com osso homógeno em bloco para subsequente instalação de implantes. O levantamento bibliográfico sistemático foi realizado na base de dados Pubmed e na Bibliografia Brasileira de Odontologia (BBO) entre os anos de 1966 e outubro de 2009. Além disso, foi realizada uma busca manual nas referências dos artigos incluídos na revisão. O resultado dessa revisão de literatura identificou apenas 7 estudos relacionados a essa técnica que preenchiam os critérios de inclusão. A espessura do rebordo aumentou significativamente com uso do enxerto homógeno, apresentando padrões de reabsorção dentro de limites aceitáveis. Os enxertos homógenos e os implantes instalados nas áreas enxertadas apresentaram altos índices de sucesso nos artigos incluídos. Esses demonstraram a previsibilidade da utilização dos enxertos homógenos e posterior instalação de implantes por um período de até 3 anos. No entanto, não há na literatura dados histológicos que confirmem existir uma osseointegração satisfatória com o uso desse material. São, portanto, necessários mais estudos controlados com avaliações histológicas para confirmar a eficiência e a segurança da utilização dos enxertos homógenos.

The use of implant-supported prosthesis is nowadays a safe alternative for rehabilitation of edentulous areas. But most of the time the implant placement can be compromised because of extensive alveolar resorption. The purpose of this study was to systematic review the literature related to the reconstruction of alveolar ridge with homogenous bone block for implant placement. The systematic review was performed on Pubmed and Brazilian Bibliography of Odontology (BBO) from 1966 to October 2009. Therefore, a hand-search in dental journals was done on the references of the selected articles. The results of this literature review identified only 7 studies related to this technique that filled the criteria of inclusion. The alveolar ridge width increased significantly with the use of block allograft, showing acceptable resorption standards. Allografts and implants inserted on grafted areas presented high success rates on the included articles. These ones showed the predictability of using allograft and implants placed after 3 years. However, there is no histological data on the literature that assures a satisfactory osseointegration using this kind of material. Controlled trials with histological evaluation are necessary to confirm the efficacy and security of allografts.

Análise comparativa entre aparelhos de pressão arterial (digital e aneróide) e entre glicosímetros de diferentes marcas na detecção de pacientes hipertensos e diabéticos / Comparative analysis of blood pressure devices (aneroid and digital) and between different brands of glucometers in detecting hypertension and diabetes patients

Objetivo: O objetivo do presente estudo foi comparar e testar a confiabilidade e eficiência de dois aferidores de pressão arterial, aneróide (BD®) e digital (G-Tech®) e dois aparelhos medidores de glicemia capilar (Accu-Chek Active® e Optium Xceed®), em uma situação de pré-cirúrgico odontológico. Métodos: A amostra total de 60 pacientes foi avaliada por um único examinador calibrado. As aferições da pressão arterial foram realizadas com ambos os aparelhos (aneróide e digital) com o paciente em repouso e o braço ao nível do coração, e em seguida, as mensurações de testes de glicemia capilar foram realizadas por meio de dois glicosímetros (Accu-Chek Active® e Optium Xceed®). Todos os aparelhos estavam devidamente calibrados e certificados pelo INMETRO. Foram aplicados o teste t de "Student" e a análise do coeficiente de correlação. Resultados: As médias da pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD) para o método auscultatório foram respectivamente, 124,5 mmHg e 80,67 mmHg; e para o oscilométrico, 132,80 mmHg e 82,20 mmHg. Em relação à glicemia capilar, as médias foram de 115,05 mg/dl para o Optium Xceed® e 107,28 mg/dl para Accu-Check Active®. Diferença estatisticamente significante (p menor que 0,001) foi encontrada entre os métodos avaliados. Quanto à análise do coeficiente de correlação, obteve-se correlação normal entre PAS (r=0,6486) e PAD (r=0,6618), e excelente entre os glicosímetros (r=0,9621). Conclusão: A utilização dos dois métodos, auscultatório e oscilométrico, permitiu verificar uma correlação normal entre as aferições obtidas para PAS e para PAD. Houve excelente correlação entre os valores de glicemia capilar, encontrados por meio dos glicosímetros, Accu-Check Active® (Roche) e Optium Xceed® (Abbott).

Objective: The aim of the present study was to compare and test the reliability and efficiency of two blood pressure measurements devices, aneroid (BD®) and digital (G-Tech®), and two glucose measurements devices (Accu-Chek Active® and Optium Xceed®), in the a preoperative dentistry situation. Methods: A sample with 60 patients was evaluated by one calibrated examiner. Blood pressure measurement was performed with both devices (aneroid and digital) with the patient at rest and the arm at the level of the heart, and then, the measurements of capillary blood glucose were performed by two glucometers (Accu-Chek Active® and Optium Xceed®). All equipment was properly calibrated and certified by INMETRO. We applied Student's t test and analysis of the correlation coefficient. Results: The medias of systolic blood pressure (SBP) and diastolic blood pressure (DBP) to the auscultatory method were respectively, 124,50 mmHg and 80,67 mmHg; and to the oscillometric method were 132,80 mmHg and 82,20 mmHg. In relation to capillary glucose, the media were 115,05 mg/dl to Optium Xceed® and 107,28 mg/dl to the Accu-Check Active®. There was a statistically significant difference (p less than 0,001) between the methods evaluated. As for correlation, we obtained normal correlation between SBP (r=0,6486) and DBP (r=0,6618) and between the two glucometers (r=0,9621). Conclusions: The use of two methods, auscultatory and oscillometric, has show a normal correlation between measurements obtained for SBP and DBP. There was excellent correlation between capillary glucose values, found by the glucometer, Accu-Check Active® (Roche) and Optium Xceed® (Abbott).

Tratamento da fístula bucosinusal pela técnica do retalho pediculado do corpo adiposo bucal: relato de caso / Treatment of oroantral fistula using the buccal fat pad pedicullate flap technique: case report

A fístula bucosinusal é descrita na literatura como um acesso direto, revestido por tecido epitelial, entre o seio maxilar e a cavidade bucal, que frequentemente é realizada acidentalmente durante a extração dentária quando o ápice do dente apresenta uma íntima relação com a cavidade sinusal. O seu diagnóstico envolve procedimentos clínicos e radiográficos, sendo a manobra de Valsalva um passo importante do exame físico. A técnica cirúrgica de escolha para o fechamento das fístulas é motivo de discussão na literatura sendo que o uso do corpo adiposo bucal, como enxerto pediculado para o fechamento de defeitos intrabucais, tem conquistado seu espaço por se tratar de um procedimento cirúrgico rápido, relativamente fácil e com alto índice de sucesso. O presente artigo descreve um caso de fístula bucosinusal, onde se optou pelo tratamento cirúrgico pela técnica do retalho pediculado do corpo adiposo bucal. Após 30 dias de proservação, o paciente apresentava-se satisfeito, com remição completa dos sinais e sintomas, total vedamento da fístula bucosinusal e ausência do tecido adiposo, com presença do epitélio bucal.

Prevalência, padrões e tratamento das fraturas bucomaxilofaciais em idosos atendidos no Serviço de Cirurgia e Traumatologia Bucomaxilofacial da Universidade Estadual de Maringá - Paraná - Brasil / Prevalence, patterns and treatment of oral and maxillofacial fractures in elderly attended in the oral and maxillofacial surgery service of Maringá State University - Paraná - Brazil

Nos países em desenvolvimento, uma pessoa é considerada idosa a partir dos 60 anos de idade. Essa faixa da população representa cerca de 9% da população brasileira. Este estudo objetivou caracterizar o perfil epidemiológico dos idosos assistidos pelo Serviço de Residência em Cirurgia e Traumatologia Bucomaxilofacial da Universidade Estadual de Maringá entre os anos de 2002 e 2009. Foram analisados 1630 prontuários, dos quais 150 pertenciam a idosos. Destes, 106 apresentavam traumatismo bucomaxilofacial. Na grande maioria dos casos, o atendimento deu-se pelo Sistema Único de Saúde (SUS), sendo a queda de própria altura o principal motivo de consulta. No que se refere ao tratamento dos traumatismos ocorridos, em 44 casos não houve necessidade de intervenção cirúrgica. Este trabalho visou dar destaque ao tema, salientando a importância de estudos na área da Gerontologia associada à Cirurgia e Traumatologia Bucomaxilofacial.

In developing countries, one is considered elderly when he or she reaches 60 years of age. The elderly represent about 9% of the total Brazilian population. The aim of this work was to present a literature review about the treatment provided by oral and maxillofacial surgeons to the elderly, and to define the epidemiologic profile of the aged treated by the oral and maxillofacial surgery residency service of Maringá State University, Brazil, in the period from 2002 to 2009. 1630 patient forms were reviewed, and a total of 150 were from elderly patients. 106 patients presented with some type of oral and maxillofacial injury. In most of the cases, care was provided via the Brazilian Public Health System, and falls were the main cause of consultation. In 44 cases surgical intervention was not necessary. This work aimed to emphasize the issue, showing the importance of studies on Gerontology associated to oral and maxillofacial surgery.

Rânula mergulhante: relato de caso clínico / Plunging ranula: case report

Rânulas são lesões resultantes do extravasamento de saliva da glândula sublingual, sendo usualmente unilaterais e relativamente incomuns. As rânulas bilaterais são raras. Duas variedades de rânula já foram descritas: a rânula oral ou superficial e a rânula mergulhante ou cervical. A patogêneses exata dessas lesões ainda é incerta. O objetivo deste trabalho é o de relatar um caso de rânula oral e mergulhante, presente, simultânea e ipsilateralmente, em uma criança. A possível patogênese e o tratamento cirúrgico do caso nele também são descritos.

Ranulas arise as a result of extravasaton of saliva from the sublingual gland. They are usually unilateral and relatively uncommon. Bilateral ranulas are quite rare. Two varieties of ranula have been reported: a superficial or oral ranula and a cervical or plunging ranula. The exact pathogenesis of ranula is still unknown. We report a case of an oral and a plunging ranula presenting synchronously and ipsilaterally in a child. The possible pathogenesis and surgical management of the patient are described.