Virtual Versus Conventional Planning in Orthognathic Surgery: A Systematic Review and Meta-analysis.

Objectives: The purpose of this study was to compare the accuracy of hard tissues movements planned to result of the maxillary and mandibular positions between conventional surgical planning (CSP) and virtual surgical planning (VSP) in patients undergoing orthognathic surgery. Methods: A systematic electronic search was carried out in six databases and gray literature with no restriction of publication date and language. Clinical observational studies that compared accuracy of maxillary position between CSP and VSP were included. Linear measurements of the mandible in the transverse plane and linear measurements of the maxilla in the vertical, horizontal and transverse planes were considered for analysis, comparing planned to postoperative outcomes of CSP and VSP. Cochrane tool was used to assess bias risk. A meta-analysis was performed to summarize similar results by using the Review Manager 5.3 software. Significance level was set at 5%. Results: Six studies (2 RCT and 4 retrospective cohorts) were included according to inclusion and eligibility criteria, involving 255 patients. The inter-rater reliability of selection and eligibility was excellent (k = 0.8315 and k = 0.9329, respectively). Two studies presented that VSP seemed to have better results than CSP regarding linear measurements of the mandible in the transverse plane. Results from CSP and VSP were similar in accuracy for hard tissue in vertical plane of maxillary position (I2 = 0%; p = 0.17), although VSP was more accurate in horizontal plane (I2 = 0%; p = 0.02). Conclusion: VSP presented better accuracy for transverse movements in mandible of asymmetric patients. VSP showed to be more accurate for movements in the horizontal plane, and qualitative analysis seemed to be more effective for transverse movements.

Radiographic Assessment of Different Autogenous Bone Grafts in the Alveolar Cleft: A Retrospective Longitudinal Study.

Objectives: To assess feasibility and maintenance of bone after alveolar cleft reconstructions using graft from iliac crest and mandibular symphysis. Methods: 51 alveolar clefts grafted with iliac crest and 51 ones grafted with mandibular symphysis bones were selected from patients aged between 7 and 12 years. At three (T1) and 12 months (T2) after surgeries, periapical radiographs were performed to measure the height of the grafted bone based on the modified Bergland scale. Chi-square and Mann-Whitney-Wilcoxon tests compared differences between T1 and T2 according to each bone graft. Results: From the clefts grafted with mandibular symphysis bone, 47 were classified as type I (92.5%) and 04 as type II (7.84%) at T1. At T2, 36 were classified as type II (25.49%) and 02 as type III (3.92%). In the analysis of the clefts grafted with iliac crest at T1, 48 were classified as type I (94.11%) and three as type II (5.88%). At T2, 37 classifieds as type I (72.54%), 12 as type II (23.52%) and two as type III (3.92%). There was no statistically significant difference between treatments. Conclusions: It was concluded that iliac crest and mandibular symphysis are adequate areas from which bone grafts can be obtained for reconstruction of alveolar cleft.

Manejo das disfunções temporomandibulares. Parte I: tratamento conservador / Management of temporomandibular joint disorders. Part I: conservative treatment

Objetivo: Apresentar as modalidades de tratamentos conservadoras e minimamente invasivas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTM). Revisão da literatura: Os objetivos do tratamento invariavelmente incluem redução da dor, diminuição das atividades parafuncionais e restauração da função. Dentre as alternativas conservadoras e minimamente invasivas, podemos citar os dispositivos interoclusais, exercícios terapêuticos, eletrofototermoterapia, agulhamento seco e infiltração de anestésicos locais em pontos gatilho, injeção de sangue autógeno para controle da luxação mandibular, terapia cognitivo comportamental, toxina botulínica, viscossuplementação, controle farmacológico da dor aguda e crônica. As DTMs afetam uma proporção significativa da população. Somente após o fracasso das opções não invasivas é que devem ser iniciados tratamentos mais invasivos e irreversíveis. No entanto, algumas condições, como a anquilose e neoplasias, por exemplo, são essencialmente tratadas cirurgicamente e tentativas de tratamentos conservadores podem trazer piora na qualidade de vida ou risco de morte. Considerações finais: Uma abordagem de equipe multidisciplinar para o manejo é essencial no cuidado fundamental de todos os pacientes com DTM, para que o tratamento possa ser especificamente adaptado às necessidades individuais do paciente.

Aim: To present the most widely used conservative and minimally invasive treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: Treatment goals invariably include pain reduction, reduction of parafunctional activities and restoration of function. Among the conservative and minimally invasive alternatives, we can mention interocclusal devices, therapeutic exercises, electrophototherapy, dry needling and infiltration of local anesthetics in trigger points, autogenous blood injection to control mandibular dislocation, cognitive behavioral therapy, botulinum toxin, viscosupplementation, pharmacological control of acute and chronic pain. TMD affects a considerable proportion of the population. Only after non-invasive options have failed should more invasive and irreversible treatments be initiated. However, some conditions, such as ankylosis and neoplasms, for example, are treated surgically and attempts at conservative treatments can lead to worsening quality of life or risk of death. Conclusions: A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients, so that treatment can be specifically tailored to the patient's individual needs.

Manejo das disfunções temporomandibulares. Parte II: tratamento cirúrgico / Management of temporomandibular joint disorders. Part II: surgical treatment

Objetivo: Apresentar as modalidades de tratamentos cirúrgicas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTMs). Revisão da literatura: As DTMs são muito frequentes e são responsáveis ​​por dor e desconforto em um número importante de pacientes. A avaliação e o diagnóstico são as chaves para determinar um plano de manejo adequado dessas doenças. Embora o tratamento conservador seja bem-sucedido na maioria dos pacientes, os tratamentos cirúrgicos podem ser a única opção para aqueles que não respondem ao tratamento conservador ou para casos com indicação cirúrgica inicial como, por exemplo, algumas neoplasias articulares. Dentre as alternativas cirúrgicas, podemos citar a artrocentese, artroscopia, reposicionamento do disco articular por cirurgia aberta, discectomia e tratamentos cirúrgicos para hipermobilidade e anquilose da articulação temporomandibular. Considerações finais: A seleção adequada dos casos é requisito obrigatório para uma intervenção cirúrgica bem-sucedida, a fim de alcançar o resultado desejado do tratamento, como alívio dos sintomas e melhora da função.

Aim: To present the most commonly used surgical treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: TMD is very common and is responsible for pain and dysfunction in a significant number of patients. Assessment and diagnosis are key to determining a management plan for these diseases. Although conservative treatment is successful in most patients, surgical treatments may be the only option for those who do not respond to conservative treatment or for some cases with an initial surgical indication, such as some joint neoplasms. Surgical alternatives include arthrocentesis, arthroscopy, repositioning of the articular disc by open surgery, discectomy and surgical treatments for temporomandibular joint hypermobility and ankylosis. Conclusions: Proper case selection is the mandatory requirement for successful surgical intervention in order to achieve the desired treatment outcome, such as symptom relief and improved function.

Clinical outcomes of the discopexy using suture anchors for repositioning disc displacement in temporomandibular joints: Systematic review and meta-analysis.

The present study evaluated the literature regarding the clinical outcomes after discopexy using suture bone anchors for repositioning disc displacement. A systematic review was conducted according to the PRISMA statement and applied for the PROSPERO platform. The database searches were performed in the PubMed, Scopus, Web of Science, EMBASE, The Cochrane Library, and LILACS for full articles published from no restrictions of the initial period time to April 2022. Selection criteria included clinical studies in humans comparing maximal inter-incisal opening (MIO), pain by visual analogue scale (VAS), and protrusive and lateral excursions before and after discopexy. The screening process was performed by two independent reviewers, and if they did not agree with each other, a third reviewer was consulted before proceeding. The meta-analysis was carried out by Comprehensive Meta-Analysis software. Eleven studies met the inclusion criteria. A total of 327 patients were diagnosed with disc displacement, and 142 patients were refractory to conservative and minimally surgical therapies. Preauricular and endaural approaches were performed to place suture bone anchors on the posterior area of the condyle. A significant difference was found in MIO, which ranged from 15.5 mm pre-opeatively to 41.6 mm post-operatively (p = 0.001). Pain scores using the VAS ranged from 7.42 to 0.28 indicating improvement post-operatively (p = 0.001). Mandibular excursions were underestimated. The available results have shown that discopexy using suture anchors seemed to decrease pain and improve mouth opening. Clinical studies are required in a larger sample and lower variability of follow-up time to predict actual benefits.

Solitary intraosseous myofibroma: a rare case diagnosed from mandibular fracture.

Intraosseous myofibroma is a rare tumor of benign nature, slow growth, and low morbidity. The aim of this article is to report a case of pathologic fracture associated with the incidental diagnosis of myofibroma in the mandible of an adolescent. A 15-year-old girl reported that she experienced a physical assault resulting in facial injuries 1 month previously and had since experienced severe pain, malocclusion, and chewing difficulty. The cone beam computed tomographic examination revealed multiple features suggestive of pathologic fracture associated with a hypodense lesion with lobulated limits, as well as expansion and thinning of the cortical bone in the left mandible. The histopathologic diagnosis of the lesion indicated myofibroma. Treatment consisted of enucleation and curettage of the lesion with reduction and internal fixation of the fracture. After 18 months, the osteosynthesis plates and an impacted mandibular third molar were removed. Curettage of the lesion in association with treatment of the mandibular fracture proved to be effective for both bone consolidation and absence of recurrence while restoring mandibular functionality.

Chin Wing Osteotomy for Improving Mandible Projection and Contour in Patients with Normal Occlusion: Case Reports.

Aim: To present a chin wing osteotomy in two patients who had undergone a virtual surgical planning workflow for surgical procedures and were followed up for 4 years. Case reports: Two retrognathic patients with normal occlusion were evaluated by means of dental and facial photographs, cone beam computed tomographs and digitization of dental arches. Virtual surgical planning was performed by using the Dolphin Imaging software to simulate the chin wing osteotomy. Next, three-dimensional models were imported into computer-aided design system (Rhino 6) for designing two hybrid (dental-bone supported) cutting and repositioning guides. Chin wing osteotomies were carried out by using the cutting guides and the osteotomized segments were placed by using L-shaped plates and screws assisted by the repositioning guides. Bone grafts were interposed in the mandibular angle region bilaterally. In both cases, the patients reported aesthetically and functionally favorable outcomes. Conclusion: Chin wing osteotomy is an appropriate treatment for retrognathic mandible in patients with normal occlusion and no additional discrepancies as the technique provided chin advancement and improvement in facial contour. The post-operative outcomes showed reliable workflow of virtual planning and surgical procedures, which could be adopted as an alternative in similar cases.

Different Modalities to Record and Transfer Natural Head Position to Virtual Planning in Orthognathic Surgery: Case Reports of Asymmetric Patients.

AIM: To describe different modalities to record and transfer natural head position (NHP) to 3D facial imaging by using the virtual surgical planning software in three facial asymmetry patients. CASE REPORTS: Three patients with facial asymmetries (A, B, and C) were evaluated by means of dental and facial analysis, photographs, cone-beam computed tomography (CBCT) and digitized dental arches. Before starting the VSP workflow with Dolphin Imaging, NHP was recorded by three modalities and transferred to three-dimensional (3D) facial images as follows: (a) facial photographs taken with digital camera and the estimated NHP was transferred to 3D images by comparing lines and planes from both images; (b) cross-line level laser was used to place radiopaque markers on the face skin for recording the estimated NHP, which was transferred to 3D images by alignment of planes and markers in the software; and (c) photographs of the face were processed to generate facial surface mesh by using the Agisoft PhotoScan software, which maintained the same position of the estimated NHP in 3D for aligning the images of the soft tissue with the facial surface mesh by using superimposition. All the three patients underwent bi-maxillary orthognathic surgery. CONCLUSION: There are different modalities using simple and available technologies in the clinical routine, but whose reproducibility, reliability and validation could not be assessed nor compared to each other. There was no trend for better predictability, feasibility and efficiency because the postoperative outcomes were adequate regarding the patients' satisfaction and facial symmetry.

Immediate three-dimensional changes in the oropharynx after different mandibular advancements in counterclockwise rotation orthognathic planning.

BACKGROUND: A retrospective cohort study was performed to evaluate the immediate effect on the oropharynx dimensions from different mandibular advancements in patients undergone counterclockwise rotation (CCW) of the maxillomandibular complex. MATERIAL AND METHODS: 138 CBCT images of patients, who had undergone orthognathic surgery, were identified from Dolphin Imaging archive according to pre- (T0) and post-operative (T1) times. Each pre-operative CBCT image was selected considering retrognathic mandible. Superimpositions of CBCT images were performed to measure mandibular advancement at B point in millimeters (mm) and divided into three groups: G1 (< 5 mm), G2 (between 5 and 10 mm) and G3 (> 10 mm). For evaluating oropharynx dimension at T0 and T1 for each group, medial sagittal area (MSA), volume, and minimum cross-sectional axial area (CSA) were measured on Dolphin Imaging. Pearson correlation verified reliability of method. Paired t-test were applied to compare values of measurements between T0 and T1 (p ≤ 0.05). RESULTS: 88 CBCT images were included. Method was reliable (r ≥ 0.93). According to MSA, volume and CSA values from G1, there was no significant difference between T0 and T1. CSA values presented significant difference comparing T0 and T1 in G2 (p ≤ 0.05). In subjects of G3, measurements increased in T1 significantly affecting oropharynx dimension. CONCLUSIONS: MSA, volume and CSA values showed a significant increase affecting upper airway in advancements higher than 10 mm. Mandibular advancement range showed different effects in the airway space and should be considered to achieve favorable post-operative results in the oropharynx dimensions. Key words:Retrognathia, orthognathic surgery, three-dimensional imaging, oropharynx, airway.

Bleeding complication after surgical removal of impacted teeth in a patient with undiagnosed clotting disorder / Complicação de sangramento após remoção cirúrgica de dentes impactados em um paciente com desordem de coagulação não diagnosticado

ABSTRACT To report one case of bleeding episodes after impacted teeth extractions had been performed in a patient with undiagnosed clotting disorder, describing a sequence of approaches for hemostasis up to the appropriated diagnosis and effective resolution. A male 16-year old patient with surgical indication to remove eight impacted teeth. After the surgery, there were bleeding episodes, being needed for hospital admission to keep on his physiological functions, blood pressure and heartbeat frequency regularly, to carry out laboratory blood tests, and to achieve hemostasis by using antifibrinolytics and blood products. After 24 hours, 11% of IX clotting factor was verified into bloodstream by specific blood test, being diagnosed with mild Hemophilia B. From the diagnosis, infusions of IX clotting factor were performed to the adequate resolution and recovery of the patient. The clinical conducts were efficient to keep on stable vital signs and achieving appropriate diagnosis. However, preventive behaviors should be applied in hemophilic patients in pre- or intra-operative, avoiding circumstances that can compromise health condition of the patient.

RESUMO Relatar um caso de episódios de sangramento após remoção de dentes inclusos em paciente com distúrbio de coagulação não diagnosticado, descrevendo uma sequência de condutas para hemostasia até o diagnóstico apropriado e resolução efetiva. Paciente do gênero masculino, 16 anos, com indicação de remoção de 8 dentes inclusos. Após a cirurgia, houve episódios de sangramento, sendo necessária sua internação para integridade das funções orgânicas básicas, realização de exames laboratoriais, controle hemodinâmico e tentativa de obtenção de hemostasia por meio de antifibrinolíticos e hemoderivados. Após 24 horas de internação, 11% do fator IX de coagulação foi verificado na corrente sanguínea por meio de exame específico, sendo o paciente diagnosticado com Hemofilia B de caráter leve. A partir do diagnóstico, infusões do fator deficiente foram realizadas para resolutividade adequada e recuperação do paciente. As condutas realizadas foram eficientes para manutenção dos sinais vitais até a hemostasia obtida após diagnóstico adequado. No entanto, as condutas preventivas devem ser aplicadas em pacientes hemofílicos no pré- ou trans-operatórios, evitando circunstâncias que podem comprometer o estado de saúde do paciente.

Feasibility of iterative closest point algorithm for accuracy between virtual surgical planning and orthognathic surgery outcomes.

PURPOSE: To evaluate the feasibility of iterative closest point (ICP) algorithm for assessing the accuracy between virtual surgical planning (VSP) and outcomes in orthognathic surgery. MATERIALS AND METHODS: VSP and results of surface mesh (SM0 and SM1) from CBCT scans of 25 patients who had been undergone bi-maxillary orthognathic surgery were converted into STL-format files and then imported to Geomagic software for semi-automatic alignment. ICP algorithm was used to calculate mean deviations (MD) and root mean square (3D error) at different calibrations of ±2 mm (T1), ±5 mm (T2) and ±10 mm (T3), with workflow being performed by two evaluators. Colour maps were generated to assess the 3D congruence qualitatively. Linear regression analysis was used to estimate whether SM0 or SM1 could condition the ICP and t-tests were used to assess whether MD and 3D error values were ≤-2 mm and ≥2 mm. Descriptive statistics was used to assess the method's feasibility by comparing T2 to T1 and T3. RESULTS: High intra- and inter-rater correlations supported the workflow reproducibility with the software. SM0 conditioned the ICP algorithm regarding both evaluators, and t-tests demonstrated that MD and 3D error were >-2 mm and <2 mm. MD and 3D error at T3 were 30% higher than those at T1. CONCLUSIONS: ICP algorithm provided a reproducible method, but its feasibility was limited due to underestimation or overestimation of the results as they affect the validity of the actual deviations.

Accuracy between virtual surgical planning and actual outcomes in orthognathic surgery by iterative closest point algorithm and color maps: A retrospective cohort study

Background: To evaluate the accuracy between actual outcomes and virtual surgical planning (VSP) in orthognathic surgery regarding the use of three-dimensional (3D) surface models for registration using iterative closest point (ICP) algorithm and generated color maps. Material and Methods: Construction of planning and postoperative 3D models in STL files format (M0 and M1, respectively) from CBCT of 25 subjects who had been submitted to bimaxillary orthognathic surgery was performed. M0 and M1 were sent to Geomagic software in semi-automatic alignment surface mesh order of M0 and M1 for registration using ICP algorithm to calculate mean deviation (MD, MD+, MD-, SD) and root mean square (RMS - 3D Error). Color maps were generated to assess qualitative congruence between M0 and M1. From deviation analysis, 3D Error was defined as accuracy measurement. To assess the reproducibility, the workflow was performed by two evaluators multiple times. t-tests were used to assess whether all means of MD, MD+, MD-, SD and 3D Error values would be ≤ - 2 mm and ≥ 2 mm. Results: High intra and inter evaluators correlation were found, supporting the reproducibility of the workflow. t-tests proved that all MDs and 3D Error values were > - 2 mm and < 2 mm. Conclusions: 3D error mean was within the standards of clinical success lower than 2 mm. ICP algorithm provided a reproducible method of alignment between 3D models and generated color maps to evaluate 3D congruence but did not answer all methodological parameters regarding the assessment of accuracy in orthognathic surgery

No disponible

Edital 45 anos / Editorial 45 years

Perspectiva históricaA HU Revista é um dos muitos projetos que abracei ao longo de minha trajetória no Hospital Universitário. Este periódico foi criado em 1974 por um grupo de professores idealistas que, àquela época, já pensavam o hospital como produtor de assistência de qualidade e instituição formadora. Nesta linha, uma publicação que disseminasse conhecimento e publicasse a produção acadêmica de seus colaboradores, foi o ponto de partida para o lançamento da HE Revista. O periódico teve grande desenvolvimento tendo sido inclusive indexado no PubMed. O tempo passou, o hospital cresceu e as dificuldades atingiram também a revista que neste meio do caminho passou a se chamar HU Revista. Não consigo citar quantos colegas se empolgaram e tentaram mantê-la com periodização e alcançar indexação em bases nacionais e internacionais. Em 2006 assumi o papel de editora-chefe, com o desafio de retorno das publicações, mas a impressão em papel, a forma de submissão e de avaliação dos manuscritos precisavam de nova abordagem. Adotamos a plataforma Open Journals System (OJS), ousando lançar o sistema de submissão on-line e recolocando no fluxo os manuscritos que estavam parados na submissão. Montamos uma equipe com voluntários dedicados e em dezembro de 2007 lançamos os números de 2006 e 2007, com critérios de revisão por pares e conseguimos fazer um pequeno rol de pareceristas. Estava assim iniciado novo caminho para a HU Revista, do qual fui juntamente com muitos colegas dedicados iniciadores.Uma nova jornadaEm fevereiro de 2018, a convite da então Gerente de Ensino e Pesquisa, Profa. Dra. Angela Maria Gollner, recebemos o desafio de reconduzir as atividades da HU Revista e constituir o Grupo de Trabalho (GT) provisório pela Gerência de Ensino e Pesquisa (GEP) do Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF/EBSERH).Dada a relevância da tarefa e de todos os desafios apresentados no início, o grupo não poupou esforços na capacitação, aprimoramento e desenvolvimento de novas estratégias voltadas para a retomada das atividades regulares da HU Revista, preservando suas raízes e abrindo as portas para novas ideias, conceitos, tendências e diretrizes, com o objetivo de tornar o periódico mais interessante não só para seus leitores, mas para autores, revisores e editores, personagens principais dessa longa e vitoriosa história. Nesses 45 anos, centenas de trabalhos foram publicados, o que se reflete em difusão constante de conhecimento. Inúmeros desafios ainda estão por vir, como a indexação a novas bases de dados, aprimoramento do fluxo editorial, versão em dois ou mais idiomas, maior robustez no corpo de revisores, bem como aumento da qualidade dos artigos a serem publicados na revista. Desta forma, com a visão em longo prazo e a certeza de que onde há trabalho honesto, transparente, profissional e, sobretudo, com apreço pelo que se faz, temos a convicção de que é questão de tempo para a HU Revista se tornar referência não somente em Juiz de Fora e região, mas no meio acadêmico nacional. E, assim que isso acontecer, esforços não serão poupados para que a internacionalização deste importante veículo de divulgação científica seja o próximo passo. Parabéns, HU Revista

Alteration of Occlusal Plane in Orthognathic Surgery: Clinical Features to Help Treatment Planning on Class III Patients.

Dentofacial deformities (DFD) presenting mainly as Class III malocclusions that require orthognathic surgery as a part of definitive treatment. Class III patients can have obvious signs such as increasing the chin projection and chin throat length, nasolabial folds, reverse overjet, and lack of upper lip support. However, Class III patients can present different facial patterns depending on the angulation of occlusal plane (OP), and only bite correction does not always lead to the improvement of the facial esthetic. We described two Class III patients with different clinical features and inclination of OP and had undergone different treatment planning based on 6 clinical features: (I) facial type; (II) upper incisor display at rest; (III) dental and gingival display on smile; (IV) soft tissue support; (V) chin projection; and (VI) lower lip projection. These patients were submitted to orthognathic surgery with different treatment plannings: a clockwise rotation and counterclockwise rotation of OP according to their facial features. The clinical features and OP inclination helped to define treatment planning by clockwise and counterclockwise rotations of the maxillomandibular complex, and two patients undergone to bimaxillary orthognathic surgery showed harmonic outcomes and stables after 2 years of follow-up.

Accuracy of computer-guided surgery for dental implant placement in fully edentulous patients: A systematic review.

Assess clinical studies regarding accuracy between virtual planning of computer-guided surgery and actual outcomes of dental implant placements in total edentulous alveolar ridges. A PubMed search was performed to identify only clinical studies published between 2011 and 2016, searching the following combinations of keywords: "Accuracy AND Computer-Assisted Surgery AND Dental Implants." Study designs were identified using the terms: Case Reports, Clinical study, Randomized Controlled Trial, Systematic Reviews, Meta-Analysis, humans. Level of agreement between the authors in the study selection process was substantial (k = 0.767), and the study eligibility was considered excellent (k = 0.863). Seven articles were included in this review. They describe the use of bone and muco-supported guides, demonstrating angular deviations cervically and apically ranging from (minimum and maximum means), respectively, 1.85-8.4 (°), 0.17-2.17 (mm), and 0.77-2.86 (mm). Angular deviations obtained most inaccuracy in maxila. For cervical and apical deviations, accuracy was preponderantly lower in maxilla. Despite the similar deviations measurement approaches described, clinical relevance of this study may be useful to warn the surgeon that safety margins in clinical situations.

Comparação de diferentes planejamentos em cirurgia ortognática para tratamento de assimetrias faciais: relato de casos / Comparison between planning in orthoganathic surgery for treating facial asymmetries: case reports

Introdução: a cirurgia ortognática envolve a correção de desarmonias funcionais e estéticas. A hiperplasia condilar (HC) unilateral resulta em crescimento mandibular acentuado, provocando assimetria facial. Para obter previsibilidade e sucesso nos resultados, é imprescindível planejamento preciso e adequado. Objetivo: descrever e comparar diferentes métodos de planejamento e seus resultados no pós-operatório no tratamento de pacientes com assimetria facial. Relato de caso: foram avaliados 03 casos orto-cirúrgicos (A, B e C) de pacientes adultos jovens, com média de idade de 22 anos, portadores de má oclusão esquelética de Classe III, com assimetria facial resultante de HC inativa. Foi realizada análise facial e empregou-se dois métodos de planejamento em cirurgia ortognática (convencional e virtual). O caso A foi planejado por meio de imagens bidimensionais (2D) e sequência cirúrgica iniciada pela maxila. O caso B foi planejado por imagens 2D associado ao recurso de simulação em protótipo. Por fim, o caso C foi planejado exclusivamente com imagens tridimensionais (3D) e simulação virtual, sendo que os casos B e C utilizaram sequência cirúrgica iniciada pela mandíbula. Foi utilizado o software Dolphin Imaging® em todos os planejamentos e os mesmos foram transferidos para os procedimentos cirúrgicos com auxílio dos guias em resina acrílica estereolitográfica. Conclusão: os planejamentos demonstraram eficácia em termos de previsibilidade e viabilidade para a correção das assimetrias faciais, sendo todos os resultados considerados satisfatórios por parte dos cirurgiões e dos pacientes. Houve tendência de melhores resultados quando da utilização de prototipagem, das imagens 3D e sequência operatória iniciada pela mandíbula, no planejamento.

Introduction: orthognathic surgery provides correction of functional and esthetic disharmony. Condylar hyperplasia induces in pronounced mandibular growth, resulting facial asymmetry. Planning is important to get predictable and successful on outcomes. Purpose: to describe and compare methods of planning and post-operative outcomes by reporting three cases associated with facial asymmetries. Case report: a total of 03 young adult patients (cases A, B and C), mean of age 22 years old, Class III skeletal malocclusion, and facial asymmetry after inactive condylar hyperplasia were evaluated. They were undergone facial analysis, two methods of planning in orthognathic surgery (conventional and virtual). Patient A was planned by bidimensional (2D) images and maxilla first sequence. Patient B was planned by 2D images associated with simulating on surface mesh prototyping. And, Patient C was solely planned by three-dimensional (3D) images and virtual surgical planning. Patients B and C used mandible first sequence. Dolphin Imaging software was used on each planning. Each planning was transferred to surgical procedures by assisting of the guides manufactured (acrylic resin and stereolithography). Patients were usually assessed during post-operative and were pleasured with outcomes. Conclusion: planning showed predictable and feasibility for facial asymmetries because outcomes were great. There was a propensity of better outcomes when surface mesh, 3D images and mandible first sequence were used at the treatment planning.

Avanços tecnológicos em odontologia: vários caminhos e uma certeza / Technological advances in dentistry: several paths and a certainty

A HU Revista, na busca de novos caminhos para divulgar conhecimento de forma séria e transparente, traz a edição temática de Odontologia, abordando os avanços tecnológicos desta importante área da Saúde. Fruto de esforço mútuo entre corpo editorial, editores de seção e pesquisadores de destaque na área, esta edição temática ou especial traz, à luz do conhecimento, temas relevantes não somente para a Odontologia, mas para todo o público leitor da HU Revista, interessado em se atualizar sobre inovação e desenvolvimento tecnológico em Saúde. Tópicos relacionados à diferentes especialidades odontológicas como implantodontia, ortodontia, odontopediatria, endodontia, radiologia, prótese e cirurgia compõem esta edição, com abordagens atuais e de importância ímpar para o conhecimento de todos, principalmente daqueles envolvidos diretamente com esta área única da Saúde, capaz de devolver não somente sorrisos àqueles que dela precisam, mas também elevar sua autoestima e qualidade de vida. Foi um trabalho árduo, onde meses foram consumidos desde sua idealização até o presente momento de divulgação dos frutos desta empreitada, que são os 15 artigos que compõe o atual número. O caminho não foi fácil, mas temos certeza de que é desta maneira, com dedicação e compromisso, que se deve fazer a divulgação científica. Estamos orgulhosos do cumprimento de mais uma etapa. Esperamos ter atendido às expectativas não somente nossas, do corpo editorial, mas de todos os leitores da HU Revista. Boa leitura a todos e que venham os próximos desafios com as futuras edições temáticas das demais áreas da Saúde.

Perfil clínico e histopatológico do cisto odontogênico calcificante: relato de caso / Clinical and histopathological features of calcifying odontogenic cyst: case report

O cisto odontogênico calcificante (COC) é considerado como condição patológica benigna de ocorrência rara em maxila e mandíbula, caracterizado por revestimento cístico de células epiteliais odontogênicas, contendo células fantasmas com propensão a regiões de calcificação. Neste artigo, descreveu-se a configuração clínica e histopatológica do COC por meio de relato de caso submetido a tratamento cirúrgico e acompanhamento pós-operatório. Paciente de 11 anos apresentou aumento de volume em região maxilar à esquerda, próxima ao sulco nasolabial e sem sintomatologia dolorosa. Os exames radiográficos indicaram lesão radiolúcida, bem circunscrita e expansiva em maxila, que foi submetida a enucleação associada a ostectomia marginal das paredes corticais ósseas. O histopatológico revelou revestimento cístico com epitélio odontogênico ameloblástico, ninhos espalhados de células fantasmas e regiões eosinofílicas de material compatível com dentinóide. Evidenciou-se, assim, perfil clínico de COC, que pode ser confundido com outras lesões císticas ou tumorais, sendo essencial o diagnóstico por meio de análise histopatológica. A abordagem cirúrgica proporcionou adequado diagnóstico e tratamento. Após acompanhamento clínico e radiográfico, não houve recorrência do COC.

Calcifying odontogenic Cyst (COC) has been considering as benign pathological ill and rare occurrence in maxilla and mandible, there been showed odontogenic epithelial cystic lining demonstrating ghost cells with a propensity to calcify. In this article, we described the clinical and histopathological features from case reported who had undergone surgical approach and postoperative follow-up. A 11 year-old-girl had presented volumetric increased in left maxilla area near nasolabial fold. The radiography images had indicated radiolucent lesion, well-circumscribed and wide on cortical maxillary bone, which was undergone enucleation associated with marginal osteotomy on the bone cortical walls. The histopathological features showed cystic lining with odontogenic epithelium containing ghost cells and some areas with eosinophilic matrix material compatible dentinoid. Thus, it was evidenced a clinical features of COC which could be confused with other cystic or tumoral lesions, there being essential on diagnosis and treatment. After clinical and radiographic follow-up during 07 years, there was no recurrence of the COC.