Evaluation of calcium hydroxide mixed with propolis by ultrasonic activation as root canal dressing in delayed tooth replantation.

Background: In cases of tooth avulsion, in which the neurovascular bundle responsible for nourishing the dental pulp is break, endodontic treatment is necessary before proceeding with tooth replantation. In this process, various substances have been tested in combination with calcium hydroxide Ca(OH)2 in an attempt to improve its effectiveness. This study aimed to examine the effects of using a mixture of Ca(OH)2 and 10% propolis, with subsequent application of ultrasonic treatment, on the delayed replantation of teeth in rats. Material and Methods: Twenty-four rats underwent a surgical procedure to extract the upper right incisor, leaving it on a surface to dry for one hour. The pulp and periodontal ligament were removed and the teeth were submerged in a 2% sodium fluoride acidulated phosphate solution. The canals were dehydrated using paper cones and the teeth were divided into four groups, according to the type of intracanal dressing: Ca(OH)2 group, Ca(OH)2 group with ultrasonic agitation, Ca(OH)2 and propolis group, Ca(OH)2 and propolis group with ultrasonic agitation. The root canals were irrigated with saline solution and the teeth were reimplanted. Sixty days after reimplantation, the animals were euthanized. Results: With regard to the presence of acute and chronic inflammatory infiltrate in the periodontal ligament, there was no statistically significant difference among some of the groups. Root resorption was identified in all groups, and there was no significant difference between them. Conclusions: It is concluded that the application of intracanal dressing containing Ca(OH)2 associated with 10% propolis, followed by ultrasonic agitation, did not prove to be more effective than the use of Ca(OH)2 alone in the repair process in the delayed replantation of rat teeth. Key words:Tooth replantation, Calcium hydroxide, Propolis, Ultrasound, Intracanal dressing.

Evaluation of Bone Repair Using a New Biphasic Synthetic Bioceramic (Plenum® Osshp) in Critical Calvaria Defect in Rats.

(1) Background: Biphasic bioceramics are synthetic bone substitutes that provide greater safety and better predictability in guided bone regeneration. This study aimed to evaluate the bone repair process using a new biphasic bioceramic of synthetic origin (Plenum® Osshp-70HA: 30ß-TCP) in critical calvarial defects. (2) Methods: seventy-four defects were created in rat calvaria and divided into two groups-Plenum® Osshp (PO), right side, and Straumann® BoneCeramic™ (BC), left side. Euthanasia was performed at 7, 15, 30, and 60 days after surgery. (3) Results: Lower gene expression was observed for runt-related transcription factor 2 (RUNX2) and vascular endothelial growth factor (VEGF) and higher expression for Integrin Binding Sialoprotein (IBSP). The results correlated with moderate immunolabeling for osteocalcin (OCN) and slight immunolabeling for osteopontin (OPN) in the PO group. Histometry showed a greater amount of biomaterial remaining in the PO group at 60 days. The microtomographic analysis showed a lower density of bone connectivity and a greater thickness of the trabeculae for the remnants of the PO group. (4) Conclusions: the Plenum® Osshp showed no differences compared to BoneCeramic™ and is therefore considered an effective option as a synthetic bone substitute in bone regeneration.

What are the Consequences of Incorrect Handling in the Treatment of Blunt-Cut Lip Injuries?

This study aimed report two cases of blunt-cut lip injury which occurred in postoperatory dehiscence. Patients were referred to the emergence attendance and the clinical examination revealed extensive laceration on the upper and lower lips of both patients, highly contaminated with asphalt residue. The affected regions were properly cleaned with saline and antiseptic solution, and, under local anesthesia, suturing was performed in layers in the muscle and oral mucosa region with 4-0 resorbable thread and in the skin region with 6-0 non-absorbable thread. Patients presented different levels of dehiscence on post-operatory evaluation. Thus, it was prescribed antibiotic and healing ointments for decontamination and improvement of the healing process. Third days post-operatory one of the patients presented a great healing of external lips and vermilion lip. However, the other patient presented aesthetic sequelae in the vermilion region of the lip, with a line of fibrosis and misalignment in the region, but not function sequelae. Thus, it was concluded that blunt injuries on the lip must strictly follow the established treatment protocols and must begin aiming for favorable results in the first intervention. Moreover, the postoperative care of the patient and the surgeon are as important as the procedure itself.

The Characterisation of the Craniofacial Morphology of Infants Born With Zika Virus; Innovative Approach for Public Health Surveillance and Broad Clinical Applications.

Background: This study was carried out in response to the Zika virus epidemic, which constituted a public health emergency, and to the 2019 WHO calling for strengthened surveillance for the early detection of related microcephaly. The main aim of the study was to phenotype the craniofacial morphology of microcephaly using a novel approach and new measurements, and relate the characteristics to brain abnormalities in Zika-infected infants in Brazil to improve clinical surveillance. Methods: 3D images of the face and the cranial vault of 44 Zika-infected infants and matched healthy controls were captured using a 3D stereophotogrammetry system. The CT scans of the brain of the infected infants were analysed. Principal component analysis (PCA) was applied to characterise the craniofacial morphology. In addition to the head circumference (HC), a new measurement, head height (HH), was introduced to measure the cranial vault. The level of brain abnormality present in the CT scans was assessed; the severity of parenchymal volume loss and ventriculomegaly was quantified. Student's t-test and Spearman's Rho statistical test have been applied. Findings: The PCA identified a significant difference (p < 0.001) between the cranial vaults and the face of the Zika infants and that of the controls. Spearman's rank-order correlation coefficients show that the head height (HH) has a strong correlation (0.87 in Zika infants; 0.82 in controls) with the morphology of the cranial vaults, which are higher than the correlation with the routinely used head circumference (HC). Also, the head height (HH) has a moderate negative correlation (-0.48) with the brain abnormalities of parenchymal volume loss. Interpretation: It is discovered that the head height (HH) is the most sensitive and discriminatory measure of the severity of cranial deformity, which should be used for clinical surveillance of the Zika syndrome, evaluation of other craniofacial syndromes and assessment of various treatment modalities.

Aspiration of the dental crown in an elderly patient.

The aspiration of objects and foreign bodies requires quick and systematic care. During emergent orotracheal intubation, accidental dental crown release can cause a threat to the patient's life. This paper aimed to report a case of foreign body (dental prosthetic crown) aspiration and its management and discuss alternative approaches. An 81-year-old male patient, who was admitted to the hospital's intensive care unit (ICU) for meningitis, presented with altered consciousness, and decreased oxygen saturation. He underwent emergent orotracheal intubation. After intubation, chest radiography was performed to check for proper orotracheal tube positioning and lung expansion. The resultant images revealed the presence of a foreign body within the right lower lobe bronchus in the shape of a dental crown. The foreign body, intubation cannula and basket clamp were successfully removed, followed by reintubation of the patient. The foreign body was a prosthetic upper premolar dental crown (24). While care should be taken to avoid complications, if a foreign body is aspirated during emergent orotracheal intubation, endoscopic removal appears safe and effective. Careful creation, placement, maintenance, and preservation of prosthetic crowns are critically important in elderly patients.

Management of Complications Related to Removal of the Buccal Fat Pad.

ABSTRACT: Removal of the buccal fat pad (BFP) is an important topic of discussion in the literature. Several studies have reported improvements in facial esthetics as a result of this technique. The BFP is close to vital structures, such as the facial nerve, parotid duct, and vessels. Injuries related to these structures may occur during the surgical procedure. This manuscript aimed to report and discuss 2 clinical cases of the complications after removal of the BFP. Besides the case presentation, a comprehensive review of the literature was also provided. The reported cases were 2 patients aged 31 and 38 years who were attended by the oral and maxillofacial surgery teams after a complication in the BFP surgery. The first case involved swelling due to Stensen's duct injury, and the second involved uncontrolled bleeding from the internal maxillary artery. Removal of the BFP must have precise indications. Complications may occur during or after surgery; hence, anatomical knowledge is fundamental to appropriate patient management.

Oral health in patients with Prader-Willi syndrome: current perspectives.

Prader-Willi syndrome (PWS) is a rare complex multisystem disorder and presents several aspects related to dentistry. The purpose of this review is to present current perspectives about oral health in patients with PWS. Delay development, hyperphagia, foamy and highly viscous saliva raise the risk of caries and contribute to tooth wear. Cariogenic foods uncontrolled consumption allows to obesity and dental problems progress worsening systemic disorders. These factors can be controlled. The success in follow-ups with caries free and oral health controlled demonstrate the importance of multidisciplinary team intervention corroborated by support at home from birth to adulthood. Thereby, current perspective on the disease is that there is possibility of proper maintenance of oral health in PWS patients. Guided care interferes positively with the overall well-being and quality of life of the individual with PWS and their family. A multidisciplinary team with a focus on teaching patients and family members will help minimize eventual problems.

Sonochemical time standardization for bioactive materials used in periimplantar defects filling.

The aim of this study was determinate the best sonochemical time in order to obtain better bone characteristics when a bioactive material (Biogran) is used in the filling periimplantar defects. In this study, 32 rats were submitted to surgical proceedings to create a periimplantar defect that was filled with Biogran receiving different sonochemical times: 15 (G1), 30 (G2), 45 (G3) or 90 min (G4). The biomaterial was characterized through X-ray diffraction and scanning electron microscopy (SEM). In vivo analysis was performed through micro CT, laser confocal microscopy, immunohistochemistry and evaluation of bone cytoarchitecture through hematoxylin and eosin (HE) staining. The data were submitted to statistical testing, considering a significance level of p < 0.05. Rx diffraction of pure bioglass showed that it is predominantly amorphous; otherwise, there are small peaks at 23° and 31°. SEM shows that the longer the sonochemical time, the less edges the biomaterial will present. Within the groups, G1 and G2 showed the best quantity and quality by micro CT (p > 0.05). The best bone turnover result was found in G1 and G2, otherwise the better results were related to neoformed bone area, bone mineral apposition rate and bone implant contact to G1 (p < 0.05). G1 had the best results in terms of bone cytoarchitectural evaluation and immunohistochemistry. It is possible to conclude that Biogran that received 15 min of sonochemical treatment (G1) presented periimplantar bone repair with the best extracellular matrix properties, including the best quality and quantity of vital bone.

Tratamento de Fratura Le Fort I em paciente jovem: relato de caso / Treatment of a Le Fort I fracture in young patient: case report / Tratamiento de Fractura Le Fort I en paciente joven: relato de caso

Em seu estudo, René Le Fort caracterizou três tipos de padrões fratura: Le Fort I, II e III. Na Le Fort I, observou um traço de fratura transverso na maxila acima do ápice dos dentes. Com o aumento da força de intensidade nos traumas, os três padrões de fratura Le Fort, são cada vez mais improváveis de acontecer de forma isolada. Com isso, este trabalho tem como objetivo apresentar um caso clínico de uma fratura do tipo Le Fort I em um paciente jovem, tratada com placas de titânio nos pilares caninos e zigomáticos da maxila(AU)

In his study, René Le Fort characterized three types of fracture patterns: Le Fort I, II and III. At Le Fort I, he observed a trace of transverse fracture in the maxilla above the apex of the teeth. With increased strength of intensity in traumas, the three Le Fort fracture patterns are increasingly unlikely to occur in isolation. The aim of this study is to present a case report of a Le Fort I type fracture in a young patient, treated with titanium plates in the canine and zygomatic maxillary pillars(AU)

En su estudio, René Le Fort caracterizó tres tipos de patrones fractura: Le Fort I, II y III. En la Le Fort I, observó un trazo de fractura transverso en la mandíbula encima del ápice de los dientes. Con el aumento de la fuerza de intensidad en los traumas, los tres patrones de fractura Le Fort, son cada vez más improbables de suceder de forma aislada. Con ello, este trabajo tiene como objetivo presentar un caso clínico de una fractura del tipo Le Fort I en un paciente joven, tratada con placas de titanio en los pilares caninos y zigomáticos de la mandíbula(AU)

Implantes em pacientes com osteonecrose dos maxilares associado ao uso de bifosfonatos: relato de caso e revisão de literatura / Implants in patients with bisphosphonate-related osteonecrosis of the jaw: clinical case and literature review / Implantes en pacientes con osteonecrosis de los maxilares inducida por bifosfonatos: reporte de caso y revisión de literatura

A osteoporose é responsável por causar condições devastadoras no tecido ósseo elevando o risco de fraturas, constituindo uma problemática importante de saúde pública. É comum o uso de medicamentos, como os bifosfonatos para o controle dessa patologia. Contudo, a associação do uso desse medicamento com a osteonecrose dos maxilares vem sendo amplamente discutido na literatura, assim como a dificuldade da reabilitação desses pacientes como implantes e do protocolo de tratamento dessa condição. Assim sendo, o objetivo do presente trabalho foi realizar uma revisão de literatura para discutir as principais falhas associadas a instalação de implantes em pacientes portadores de osteonecrose dos maxilares associada ao uso de bifosfonatos (OMAB), assim como as possibilidades de tratamento, e relatar um caso clínico. As informações obtidas na revisão nos permitiu concluir que o uso de bifosfonatos orais, como o alendronato, é capaz de levar ao desenvolvimento da OMAB sendo necessária bastante precaução na reabilitação oral com implantes dentários, tanto em pacientes que fazem uso, como pacientes que apresentam risco de futura utilização de bifosfonatos para o tratamento de desordens esqueléticas(AU)

Osteoporosis is responsible for the devastating disease in the bone tissue, increasing the risk of fractures, constituting an important public health problem. It is common to use medications, such as bisphosphonates to control this pathology. The dosage application with osteonecrosis of the jaws has been discussed in the literature, as well as a rehabilitation task such as the implant and the transport protocol of this condition. Thus, the present study was carried out in a literature review on the main problems related to bisphosphonate-related osteonecrosis of the jaw (BRONJ) as well as the possibilities of treatment, and to report a clinical case. The information can be reviewed together, so that the use of oral bisphosphonates, such as alendronate, will be able to lead to the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ), the future use of bisphosphonates for the treatment of skeletal disorders(AU)

La osteoporosis es responsable de causar condiciones devastadoras en el tejido óseo, elevando el riesgo de fracturas, constituyendo una problemática importante de salud pública. Es común el uso de medicamentos, como los bifosfonatos para el control de esa patología. Sin embargo, la asociación de los usos de este medicamento con la osteonecrosis de los maxilares viene siendo ampliamente discutida en la literatura, así como la dificultad de la rehabilitación dos pacientes como implantes y del protocolo de tramo de esa condición. Por lo tanto, el objetivo del presente trabajo fue realizar una revisión de literatura para discutir las principales fallas asociadas a la instalación de implantes en pacientes portadores de osteonecrosis maxilar inducida por bifosfonatos (ONMB), así como las posibilidades de tratamiento, e informar un caso clínico. La información obtenida en la revisión nos permitió concluir que el uso de bifosfonatos orales, como el alendronato, es capaz de llevar al desarrollo de la osteonecrosis maxilar inducida por bifosfonatos (ONMB), siendo necesario bastante precaución en la rehabilitación oral con implantes dentales, tanto en pacientes que hacen uso, como pacientes que presentan riesgo de la futura utilización de bifosfonatos para el tratamiento de desórdenes esqueléticos(AU)

Clinical Outcome Of Dental Implant Therapy In Association With Le Fort I Osteotomy Preprosthetic Surgery: A Systematic Review.

PURPOSE: The purpose of this systematic review was to evaluate the outcome of dental implant treatment in fully edentulous patients who underwent Le Fort I osteotomy as a preprosthetic surgical technique. MATERIALS AND METHODS: A search was conducted of the PubMed (MEDLINE), EMBASE, Scopus, and Cochrane databases to identify records published from 1995 to 2017 dealing with Le Fort I osteotomy procedures for implant placement purposes. The primary outcomes of interest were the survival and success rates. The secondary outcomes consisted of the analysis of intra- and postsurgical complications and the surgical and prosthetic loading protocols. RESULTS: Overall, 20 articles were selected for data analysis. A total of 483 patients accounting for 3,596 implants were analyzed. The cumulative survival rate was 90.22% ± 0.8% at 10 years (mean: 59.20 ± 32.31 months). The cumulative success rate was 89.07% ± 1.3% at 10 years (mean: 62.82 ± 25 months). Higher survival rates were found for implants with a rough surface (P < .001) and for implants loaded with a delayed protocol (P < .001). The fracture of the palatine bone during the downfracture procedure was the main intrasurgical drawback, while sinus pathology and graft resorption were commonly observed during the postoperative healing. Surgical and prosthetic loading protocols were heterogenous. CONCLUSION: Based on this review, Le Fort I osteotomy might be considered a viable technique to recreate favorable conditions for implant-supported rehabilitations. Caution has to be taken when using machined implants, particularly in the case of a simultaneous approach.

Maxillary Alveolar Ridge Atrophy Reconstructed With Autogenous Bone Graft Harvested From the Proximal Ulna.

Atrophy of the alveolar ridge requires bone grafting at the implant site for rehabilitation of the masticatory function with dental implants. Despite the advances in the development of bone substitutes, autogenous bone graft remains the "criterion standard" because of its osteogenic, osteoinductive, osteoconductive potential, and non-immunogenic properties. However, harvesting of autogenous bone is not exempt from donor site morbidity. In this context, the use of autogenous bone derived from the proximal ulna might be a viable resource to obtain corticocancellous bone graft, as the harvesting from this donor site is associated with low morbidity. Thus, this article aimed to describe a case in which a maxillary sinus floor augmentation was performed by means of autogenous bone graft harvested from the proximal ulna, as the donor site. An appositional bone block graft harvested from the same region was used to augment the residual alveolar ridge. Clinically, healing proceeded uneventfully with no major complications. After 8 months, a proper amount of bone was found at the implant site, allowing a prosthetically driven implant insertion and subsequent implant-supported rehabilitation. Results were clinically and radiographically stable after a 3-year follow-up. The present case report suggested that proximal ulna as a donor site should be considered as a safe and reliable alternative for alveolar ridge augmentation. Besides the case presentation, a comprehensive review of the literature was also provided.

Rehabilitation with implants simultaneously to mandible fracture treatment. Follow up of 18 months

ABSTRACT: Objective: This study was reduction of a bilateral mandibular fracture through the installation of dental implants with immediate loading, re-establishing the stomatognathic function of the patient. Case Report: A 58-year-old male patient seek the emergency room from hospital after suffering a motorcycle accident. After physical and imaging examinations was diagnosed with bilateral mandibular fracture. The treatment of choice, once the patient was edentulous, was the reduction and stabilization of the fracture with the installation of 5 dental implants with immediate loading. After 1 year of postoperative follow-up, the facial contour along with the occlusion were reestablished. Radiographically, it was found the proper placement of plates and screws with correct baseline realignment and maintenance of implant-supported prosthesis. Conclusion: In this case report with follow-up of 18 months, the functional prosthetic rehabilitation and immediate aesthetic with immediate loading system, after reduction and fixation of mandibular fractures proved to be a good treatment option.

Oral Myiasis in a Patient With HIV Manifestations and Neurologic Toxoplasmosis Treated by Ivermectin.

Myiasis has been defined as a pathologic condition where dipterous larvae are lodged in mammalian hosts causing an infestation, which feeds on living or dead tissue for at least a certain period inside the host and develops itself as parasites. In humans, the most commonly affected sites are the nose, eyes, skin wounds, sinuses, lungs, ears, gut, gall bladder, vagina, nasal cavities, and rarely the mouth because the oral tissues are rarely exposed to the external environment. The etiology of oral myiasis is usually related to local factors such as poor oral hygiene, periodontal disease and labial incompetence, and systemic factors such as neurologic deficits.

Daily melatonin administration improves osseointegration in pinealectomized rats.

INTRODUCTION: The hypothesis of this study was that the peri-implant bone healing of the group of pinealectomized rats would differ from the control group. The samples were subjected to immunohistochemical, microtomographic (total porosity and connectivity density), and fluorochrome (mineralized surface) analyses. OBJECTIVES: The goal of this study was to investigate the cellular changes and bone remodeling dynamics along the bone/implant interface in pinealectomized rats. MATERIAL AND METHODS: The total of 18 adult male rats (Rattus norvegicus albinus, Wistar) was divided into three groups (n=6): control (CO), pinealectomized without melatonin (PNX) and pinealectomized with melatonin (PNXm). All animals were submitted to the first surgery (pinealectomy), except the CO group. Thirty days after the pinealectomy without melatonin, the second surgery was conducted, in which all animals received an implant in each tibia (36 titanium implants with surface treatment were installed - Implalife® São Paulo, SP, Brazil). By gavage, the rats of the PNX group received the vehicle solution, and the procedure. RESULTS: Immunohistochemical analysis for runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), osteopontin (OP) and osteocalcin (OC) showed that the bone repair process in the PNXm group was similar to that of the CO group, whereas the PNX group showed a delay. The microtomographic parameters of total porosity [Po(tot)] and bone surface (BS) showed no statistically significant differences, whereas for the connective density (Conn.Dn) a statistical difference was found between the CO and PNXm groups. Fluorochrome analysis of the active mineralized surface showed statistically significant difference between the CO and PNX and between the CO and PNXm groups. CONCLUSION: The absence of the pineal gland impaired the bone repair process during osseointegration, however the daily melatonin replacement was able to restore this response.

Cervicofacial Necrotizing Fasciitis and Drugs.

Necrotizing fasciitis (NF) is a devastating disease that typically affects immunocompromised patients, chronically debilitated patients or drug users, but can also affect healthy patients. Necrotizing fasciitis can rapidly produce septic shock and requires immediate surgical management of the necrotic tissue. It is a bacterial infection that progresses rapidly and has a high mortality generally caused by aerobic and anaerobic bacteria. The patient was immunocompromised and drug user. During treatment, a combination of broad-spectrum antibiotic therapy with Ciprofloxacin and Metronidazole, besides the use of activated charcoal dressing composed of carbonized fabric and impregnated with 0.15% silver nitrate enveloped by layer of fabric without activated carbon, chemical-mechanical debridement with hydrogen peroxide, 0.9% saline, and povidone iodine. According to the patient presented, for the treatment of NF there is a need for broad-spectrum antibiotic therapy associated with surgical debridement, use of activated charcoal for antiseptic compression and general intensive care.

Doxycycline and Autogenous Bone in Repair of Critical-Size Defects.

PURPOSE: The association of doxycycline (DOX) and autogenous bone on repair of critical-size defects was evaluated. MATERIALS AND METHODS: Fifty albino rats were divided into 5 groups (n = 10). A 5-mm diameter defect was treated with: control (CO)-blood clot; DOX in Natrosol (NAT)-10% gel; NAT-gel; particulate autogenous bone (PAB); and PAB + DOX - PAB associated with 10% DOX gel. The animals were euthanized at 4 and 8 weeks postoperatively. Histomorphometric analysis was performed to assess the percentage of new bone in the defect area. Statistical analysis of the results was performed using analysis of variance and the Tukey test (P < 0.05). RESULTS: The results showed that new bone formation was limited to the margins of the defect. At 4 and 8 weeks, the group PAB + DOX showed higher bone formation (38.59% and 47.86%, respectively), with statistical difference in comparison with the CO (19.52%) at 4 weeks and CO (18.80%), DOX (22.05%), and NAT (15.89%) at 8 weeks (P < 0.05). CONCLUSIONS: The association of 10% DOX with autogenous bone significantly improved bone healing in critical-size defects.

Comparative Evaluation of Cell Viability Immediately After Osteotomy for Implants With Drills and Piezosurgery: Immunohistochemistry Analysis.

OBJECTIVE: To evaluate the effect of reusing drills and piezosurgery tips during implant osteotomy on immediate bone cell viability through immunohistochemical analysis. MATERIALS AND METHODS: Six male rabbits were divided into 2 groups and then divided into 5 subgroups-correspond to drills and tips used 10, 20, 30, 40, and 50 times, respectively. All animals received 10 osteotomies in each tibia, by use of the classic drilling procedure in one group (G1) and the piezosurgery device in the other group (G2). For immunohistochemical technique were utilized the osteoprotegerin, RANKL, osteocalcin, and caspase 3. Control procedures were performed by omitting the primary antibodies (negative control). RESULTS: Bone formation and resorption responses presented in more intense way during the piezosurgery. The expression of osteocalcin had become quite intense in piezosurgery groups, but with reduced immunostaining from the 30th osteotomy. The caspase 3 showed the viability of the osteoblast from the 20th osteotomy with piezosurgery and remained constant until the 50th. CONCLUSION: Piezosurgery provides greater osteoblastic cell viability than the system of conventional drilling. CLINICAL RELEVANCE: This study will provide data so that the authors can recycle the drills and tips for implant placement, thus enabling a better cell viability for osseointegration.