Comparative Effects of Different Materials on Alveolar Preservation.

OBJECTIVE: The purpose of this study was to compare different materials' effects on alveolar ridge preservation of postextraction sockets in anterior maxilla. MATERIALS AND METHOD: In this prospective, single center, randomized, controlled clinical trial, healthy patients who needed one single anterior maxillary tooth extraction (including bicuspids) were selected. After a minimally traumatic extraction without complications, 44 patients were randomly allocated into 4 groups: 1) natural socket healing (blood clot), 2) xenograft and gingival free graft, 3) dense polytetrafluoroethylene membrane, and 4) platelet rich fibrin plugs. Alveolar ridge height and width loss were evaluated in cone beam computed tomography (CBCT) and in dental casts at 3 moments: 1) preoperative (T1), 2) 7 days postoperative (T2), and 3) 120 days postoperative (T3). Height and width alveolar ridge loss detected in CBCT and in dental casts were compared among the groups (two-way analysis of variance [ANOVA]; P < .05). RESULTS: Forty patients (24 women and 16 men) ranging from 25 to 70 years old (mean of 42 years old) participated in this study. Group 2 showed the least alveolar ridge height loss results in CBCT (9.8 ± 1.9% at T3) and dental cast analysis (1.0 ± 0.2 mm). Groups 2 (12.7 ± 4.7% at T3) and 3 (15.4 ± 2.7% at T3) showed the least alveolar ridge width loss measured in CBCT compared with groups 1 and 4, but the difference between groups 2 and 3 were not statistically significant (P = .968). Group 3 (0.9 ± 0.2 mm) and group 2 (1.0 ± 0.2 mm) showed the least width loss compared with groups 1 and 4 in dental cast analysis. Again, the difference between groups 3 and 2 was not statistically significant (P = 1.000). CONCLUSION: In postextraction sockets of the anterior maxilla and bicuspid region, group 2 (xenogenous bone graft with free gingival graft) and group 3 (dense polytetrafluoroethylene) obtained the best results in alveolar preservation, with group 2 being more indicated when the vertical alveolar ridge preservation is mandatory.

Paracoccidioidomicose afetando a mucosa bucal: relato de caso / Paracoccidioidomycosis affecting the buccal mucosa: case report / Paracoccidioidomicosis con afectación de la mucosa oral: relato de caso

Introdução: A paracoccidioidomicose é uma infecção micótica sistêmica com manifestações pulmonares primária que podem apresentar lesões cutâneas e orais. É mais comum no Brasil e em alguns outros países da América Latina, representando um importante problema de saúde pública devido às suas características potencialmente fatais. Relato de caso: Trabalhador rural de 53 anos, fumante e etilista, apresentando lesão ulcerada de aspecto moriforme em mucosa bucal direita. Realizou-se biópsia incisional cujo laudo histopatológico foi de paracoccidioidomicose. O paciente foi encaminhado ao médico infectologista para tratamento por meio de itraconazol (200mg por dia) por 18 meses. Após 03 meses de tratamento já apresentava regressão da lesão. Considerações Finais: Portanto, o objetivo deste trabalho é enfatizar a importância do cirurgião-dentista no reconhecimento das lesões oral e realização da biópsia para o correto diagnóstico e manejo desta doença por meio de um relato de caso clínico... (AU)

Paracoccidioidomycosis is a systemic mycotic infection with primary pulmonary manifestations that can present cutaneous and oral lesions. It is more common in Brazil and some other Latin American countries, representing an important public health problem due to its potentially fatal characteristics. Case report: 53-year-old rural worker, smoker and drinker, presenting an ulcerated lesion with a moriform aspect in the right oral mucosa. An incisional biopsy was performed, and the histopathological report was of paracoccidioidomycosis. The patient was referred to the infectious disease physician for treatment with itraconazole (200mg per day) for 18 months. After 03 months of treatment, he already had regression of the lesion. Final Considerations: Therefore, the objective of this paper is to emphasize the importance of the dentist in recognizing oral lesions and performing a biopsy for the correct diag... (AU)

La paracoccidioidomicosis es una infección micótica sistémica con manifestaciones pulmonares primarias que pueden presentar lesiones cutáneas y bucales. Es más común en Brasil y algunos otros países de América Latina, lo que representa un importante problema de salud pública debido a sus características potencialmente fatales. Caso clínico: trabajador rural de 53 años, fumador y bebedor, con lesión ulcerada de aspecto moriforme en mucosa oral derecha. Se realizó biopsia incisional y el informe histopatológico fue de paracoccidioidomicosis. El paciente fue remitido al médico de enfermedades infecciosas para tratamiento con itraconazol (200 mg al día) durante 18 meses. Después de 03 meses de tratamiento, ya tenía regresión de la lesión. Consideraciones finales: Por lo tanto, el objetivo de este trabajo es enfatizar la importancia del odontólogo en el reconocimiento de las lesiones bucales y la realización de una biopsia para el correcto diagnóstico y manejo de esta enfermedad a través de la presentación de un caso clínico... (AU)

A Simple Method to Retract the Descending Palatine Neurovascular Bundle During Osseous Removal of Posterior Interferences in Le Fort I Osteotomy.

ABSTRACT: For accurate repositioning of the maxilla in Le Fort I osteotomy, bone removal around the descending palatine neurovascular bundle and maxillary tuberosity is frequently required. Such task can be challenging due to the high vascularity of the region, which is the most common site of hemorrhage during removal of bony interferences. Although a rare occurrence, ligation of the descending palatine artery in cases of intraoperative vascular damage can be related to the development of aseptic necrosis. This article reports a simple technique for retraction and protection of the descending palatine neurovascular bundle during bony removal related to a posterior maxillary impaction, which can be easily reproduced in orthognathic selected cases.

A Simple Method of Transoperative Maxillomandibular Fixation in Pediatric Facial Fractures.

ABSTRACT: Maxillomandibular fixation in pediatric facial fractures is quite challenging to be achieved, especially in mid-mixed dentition. Traditional well established intermaxillary devices have a lot of limitations in these patients. This article presents a case of a 9-year-old female patient with a displaced mandibular fracture in which orthodontic buttons were used for transoperative maxillomandibular fixation followed by internal fixation after adequate occlusion reestablishment and fracture reduction. The method showed high efficacy and celerity, allowing the success of treatment, with satisfactory evolution of the patient.

Alveolodental ankylosis: biological bases and diagnostic criteria / Anquilose alveolodentária: bases biológicas e critérios para o diagnóstico

ABSTRACT Alveolodental ankylosis is the fusion of cementum or root dentin with the alveolar bone in both deciduous and permanent teeth. This leads to important clinical and radiographic changes in the affected teeth. Moreover, knowledge of the biological principles involved allows adequate management of teeth affected by this phenomenon.

RESUMO A anquilose alveolodentária consiste na fusão do cemento ou dentina radicular com o osso alveolar tanto em dentes decíduos como nos dentes permanentes. Isto leva a uma série de alterações clínicas e radiográficas importantes para o diagnóstico. Além disso, o conhecimento dos princípios biológicos envolvidos irá permitir o controle adequado dos dentes acometidos por este fenômeno.

Burkitt Lymphoma in Adult With Atypical Clinical Presentation Primarily Involving the Oral Soft Tissue.

Non-Hodgkin lymphoma is the second most common neoplasm of the head and neck after squamous cell carcinoma. However, it accounts for only 3.5% of all malignancies of the oral cavity. Oral lesions are often a component of disseminated disease process that may involve regional lymph nodes or may at times represent the primary extra nodal form of the disease. Although, isolated oral lymphoma in adults is extremely rare, this paper presents a patient with Burkitt lymphoma in an adult male with atypical clinical presentation primarily involving the oral soft tissue. It is believed that the prognosis of Burkitt lymphoma depends on the extent of the disease, the patient's age, and the timing of diagnosis. Therefore, the role of the dentist in the early diagnosis and prompt referral of patients with Burkitt lymphoma cannot be overemphasized.

Unicystic Ameloblastoma with Mural Proliferation Managed by Conservative Treatment.

Unicystic ameloblastoma is a distinguishable entity of ameloblastomas, characterized by slow growth and being relatively locally aggressive. Three histological types are recognized according to the degree of ameloblastomatous epithelial extension, namely, luminal, intraluminal, and mural types. This classification has a direct bearing on their biological behavior, treatment, and prognosis. However, there is difficulty in determining the most appropriate form of treatment for unicystic ameloblastoma. We present a case of unicystic ameloblastoma that occurred in the right posterior mandible of 19-year-old girl, which was enucleated and did not recur after 12-month follow-up.

Cementoblastoma benigno: relato de caso / Benign Cementoblastoma: Case Report

O cementoblastoma benigno ou cementoma verdadeiro é uma neoplasia odontogênica benigna. Acredita-se que essa lesão é a única neoplasia verdadeira do cemento. Ela apresenta incidência entre 1 e 6,2% dentre os tumores odontogênicos, o que vem a tornála rara. Sendo assim, o objetivo do presente trabalho foi relatar o caso clínico de uma paciente com diagnóstico de cementoblastoma benigno, enfatizando as peculiaridades desse tumor, a importância do diagnóstico correto e o estabelecimento de um tratamento adequado, bem como ressaltar a importância da proservação do caso.

Benign cementoblastoma or true cementoma is a benign odontogenic tumour. It is believed that this lesion presents the unique true cementum neoplasm. It is a rare lesion comprising 1 to 6,2% of odontogenic tumours. Therefore, the objective of this study was to report the case of a patient diagnosed with benign cementoblastoma, emphasizing the peculiarities of this tumor, the importance of correct diagnosis and appropriate treatment setting, as well as underscoring the importance of proactive observation.

Descompressão cirúrgica no tratamento de lesões císticas da cavidade oral / Surgical decompression in the treatment of cystic lesions of the oral cavity

Os cistos são lesões formadas por uma cavidade revestida de tecido epitelial, as quais contêm, em seu interior, material líquido ou semisólido, podendo ser classificados em cistos odontogênicos e não odontogênicos. Apesar de existirem diversas modalidades de tratamentos descritas na literatura para tratamentos dos cistos da cavidade oral, até o presente momento, não se observa um consenso em relação à qual técnica que oferece os melhores resultados. Sendo assim, procurou-se relatar um caso clínico com a utilização da técnica de descompressão, procurando evidenciar suas indicações, vantagens, desvantagens e demais peculiaridades... (AU)

Cysts are lesions formed by a cavity lined with epithelial tissue, which contains in its interior material liquid or semisolid, and may be classified into odontogenic cysts and non-odontogenic. Although there are several treatment modalities described in the literature for treatment of cysts of the oral cavity, to date not seen a consensus as to which technique offers the best results. Therefore, we sought to a case report using the technique of decompression, seeking to highlight their indications, advantages, disadvantages and other peculiarities... (AU)

Experimental alveolitis in rats: microbiological, acute phase response and histometric characterization of delayed alveolar healing.

UNLABELLED: The pathogenesis of alveolitis is not well known and therefore experimental situations that mimic some features of this disease should be developed. OBJECTIVE: In this study, the evolution of the experimentally induced infection in rat sockets is characterized, which leads to clinical signs of suppurative alveolitis with remarkable wound healing disturbs. MATERIAL AND METHODS: Non-infected (Group I) and experimentally infected sockets in Rattus novergicus (Group II) were histometrically evaluated regarding the kinetics of alveolar healing. In addition, the characterization of the present bacteria in inoculation material and the serum levels of C-reactive protein (CRP) were performed. The detected species were Capnocytophaga ochracea, Fusobacterium nucleatum ss nucleatum, Prevotella melaninogenica, Streptococcus anginosus, Treponema socranskii and Streptococcus sanguis. RESULTS: All experimentally infected rats developed suppurative alveolitis, showing higher levels of CRP in comparison to those non-infected ones. Furthermore, infected rats presented a significant delayed wound healing as measured by the histometric analysis (higher persistent polymorphonuclear infiltrate and lower density of newly formed bone). CONCLUSION: These findings indicate that rat sockets with experimentally induced infection produced higher levels of serum CRP, showing the potential of disseminated infection and a disturb in the alveolar repair process in an interesting experimental model for alveolitis studies.

Experimental alveolitis in rats: microbiological, acute phase response and histometric characterization of delayed alveolar healing

The pathogenesis of alveolitis is not well known and therefore experimental situations that mimic some features of this disease should be developed. OBJECTIVE: In this study, the evolution of the experimentally induced infection in rat sockets is characterized, which leads to clinical signs of suppurative alveolitis with remarkable wound healing disturbs. MATERIAL AND METHODS: Non-infected (Group I) and experimentally infected sockets in Rattus novergicus (Group II) were histometrically evaluated regarding the kinetics of alveolar healing. In addition, the characterization of the present bacteria in inoculation material and the serum levels of C-reactive protein (CRP) were performed. The detected species were Capnocytophaga ochracea, Fusobacterium nucleatum ss nucleatum, Prevotella melaninogenica, Streptococcus anginosus, Treponema socranskii and Streptococcus sanguis. RESULTS: All experimentally infected rats developed suppurative alveolitis, showing higher levels of CRP in comparison to those non-infected ones. Furthermore, infected rats presented a significant delayed wound healing as measured by the histometric analysis (higher persistent polymorphonuclear infiltrate and lower density of newly formed bone). CONCLUSION: These findings indicate that rat sockets with experimentally induced infection produced higher levels of serum CRP, showing the potential of disseminated infection and a disturb in the alveolar repair process in an interesting experimental model for alveolitis studies.

Clinical concepts of dry socket.

Dry socket is one of the most studied complications in dentistry, and a great number of studies have searched for an effective and safe method for its prevention and treatment. One of the great clinical challenges since the first case was reported has been the inconsistency and differences in the various definitions of dry socket and the criteria used for diagnosis. The pathophysiology, etiology, prevention, and treatment of dry socket are very important in the practice of oral surgery. The aim of the present report was to review and discuss each aspect.

Cisto dentígero: características clínicas, radiográficas e critérios para o plano de tratamento / Dentigerous cyst: clinical and radiographic characteristics and criteria for treatment planning

O cisto dentígero é o segundo cisto odontogênico mais frequente nos maxilares. São sempre radiolúcidos e mais comumente uniloculares.Geralmente são observados em exames de rotina ou quando do não irrompimento de um dente permanente. Os terceiros molares inferiores seguidos dos caninos superiores e ocasionalmente dentes supranumerários e odontomas podem estar envolvidos com a formaçãodo cisto dentígero, porém, sua etiopatogenia ainda não é totalmente conhecida. O cisto dentígero ocorre principalmente nas três primeiras décadas de vida, seu crescimento é lento e assintomático, contudo pode atingir dimensões consideráveis causando deformação facial, impactação e deslocamento de dentes e/ou estruturas adjacentes. A descompressão, marsupialização e a enucleação são as formas de tratamento mais empregadas, porém alguns critérios importantes devem ser considerados para o plano de tratamento como, tamanho do cisto, idade, proximidade com estruturas anatômicas e importância clínica do dente envolvido. Apesar das peculiaridades clínicas de cada caso e do método de tratamento escolhido, o prognóstico destas lesões é favorável.

The dentigerous cyst is the second most frequent odontogenic cyst in jaws. They are always radiolucent and commonly unilocular. They are usually found in routine exams or when a permanent tooth does not erupt. The third molars followed by maxillary canines and occasionally supernumerary teeth and odontomas may be involved with the formation of the dentigerous cyst, but its etiology is not yet completely known. The dentigerous cyst occurs mainly in the first three decades of life, and its growth is slow and asymptomatic, however, it may reach considerable dimensions causing facial deformity, impaction and displacement of teeth and/or adjacent structures. Decompression, marsupialization and enucleation are the most frequent forms of treatment used, nevertheless, some important criteria must be considered for the treatment plan such as cyst size, age, proximity to anatomical structures and clinical importance of the tooth involved. Despite the clinical peculiarities of each case and the treatment method chosen, prognosis of these lesions is favorable.

Unilateral patent nasopalatine duct: a case report and review of the literature.

A 15-year-old white female sought our institution complaining of a chirping noise during speech and swallowing. The noise was spontaneous, perceptible, and enhanced when hard suction on the anterior palate was performed. The patient reported no trauma, infection, or other clinical feature related to the noise. Clinical examination showed 2 small grooves on both sides of the midline, lateral to the incisive papilla. The left groove was visually deeper. Careful probing with a gutta-percha cone revealed the existence of a communication on this side extending from the mouth to the nasal cavity, which was confirmed clinically and radiographically. Probing was not possible on the right side. The diagnosis was unilateral patent nasopalatine duct, which was surgically treated. We report here a new case of patent nasopalatine duct and also present a review of the pertinent literature.

Cirurgia ortognática de modelos: protocolo para mandíbula / Orthognathic model surgery: mandibular protocol

INTRODUÇÃO: o ensaio em modelos de gesso tem grande importância para o planejamento em cirurgia ortognática. OBJETIVO: neste artigo, será apresentado, passo-a-passo, uma técnica de cirurgia de modelos iniciando pela mandíbula, destacando aspectos importantes e as vantagens deste procedimento.

INTRODUCTION: The cast surgery has great importance in orthognatic surgery treatment planning. AIM: In this article, a step by step lower model surgery will be presented, emphasizing important details and advantages of this procedure.

Análise microscópica e histométrica comparativa da aplicação de uma pasta à base de metronidazol e da irrigação com iodeto de sódio e peróxido de hidrogênio para o tratamento de alvéolos dentários infectados de ratos / Microscopic and histometric comparative analysis of a metronidazole ointment application and sodium iodide plus hydrogen peroxide irrigation in the treatment of infected tooth sockets of rats

O processo de reparo em alvéolo infectado de ratos foi avaliado após a utilização de três tipos de tratamento: (1) curetagem e irrigação com soro fisiológico seguida do preenchimento com uma pasta à base de metronidazol a 10%, lidocaína a 2%, menta e carboximetilcelulose, (2) irrigação única com solução de iodeto de sódio a 2% e peróxido de hidrogênio a 3% na proporção 1:1 e (3) irrigação diária, por 3 dias, com solução de iodeto sódio a 2% e peróxido de hidrogênio a 3% na proporção 1:1. Foram utilizados 75 ratos que constituíram os seguintes grupos: Grupo I: alvéolo não infectado (grupo controle positivo); Grupo II: alvéolo infectado sem nenhum tratamento; Grupo III: alvéolo infectado tratado com irrigação única de solução de iodeto de sódio a 2 % e peróxido de hidrogênio a 3% na proporção 1:1; Grupo IV: alvéolo infectado tratado com irrigação diária, por 3 dias, de solução de iodeto de sódio a 2 % e peróxido de hidrogênio a 3% na proporção 1:1; Grupo V: alvéolo infectado submetido à curetagem, irrigação com soro fisiológico e preenchimento com pasta à base de metronidazol a 10% e lidocaína a 2%, carboximetilcelulose e menta. Os animais, em número de 5 em cada grupo foram sacrificados aos 6, 15 e 28 dias após a exodontia do incisivo superior e as peças obtidas analisadas em microscopia óptica. Os resultados foram submetidos à análise qualitativa e quantitativa e evidenciaram melhor reparo nos grupos tratados em relação ao grupo sem tratamento. Com base nos resultados foi possível concluir que: os grupos III, IV e V apresentaram melhores condições de reparo frente ao grupo II, porém diferentes significantemente ao grupo I; o grupo V apresentou os melhores resultados quanto à neoformação óssea nos períodos de 15 e 28 dias, sendo uma opção interessante a ser considerada para o tratamento da alveolite.

Planejamento digital em cirurgia ortognática: precisão, previsibilidade e praticidade / Digital surgical treatment planning: accuracy, predictability and practicity

A cirurgia ortognática deixou de ser um procedimento com finalidade exclusivamente funcional e a estética facial consagrou-se como um dos objetivos mais importantes da Cirurgia e da Ortodontia. A evolução dos conceitos envolvidos no diagnóstico e plano de tratamento em Cirurgia Ortognática tem sido imensurável. As metas para o tratamento dos pacientes tornaram-se mais amplas, levando ao desenvolvimento de novos instrumentos de diagnóstico. Dentre eles, destaca-se o planejamento cirúrgico digital, o qual proporciona maior previsibilidade e padronização de toda sequência clínica, além de ser um método extremamente preciso. Considerando a análise clínica soberana e imprescindível ao planejamento de sucesso, a proposição neste artigo foi evidenciar pontos importantes na análise clínica e na predicção digital, e apresentar um caso clínico, cujo tratamento foi executado seguindo as linhas mais modernas em termos de análise facial e planejamento cirúrgico digital

Síndrome de apnéia obstrutiva do sono (SAOS) - O papel da cirurgia ortognática no aumento das vias aéreas superiores / Obstructive sleep apnea (OSAS) - The role of orthognatic surgery in airway enlargement

0s tratamentos conservadores para a Síndrome da Apnéia Obstrutiva do Sono (SAOS), em especial o aparelho nasal "continuous positive airway pressure" (CPAP), constituem uma rotina no tratamento de pacientes com apnéia. Mas de acordo com os objetivos e parâmetros que guiam a cirurgia para o tratamento da SAOS, o avanço maxilomandibular (AMM) não deve ser restrito aos casos mais severos, utilizado somente como último recurso após falha de procedimentos prévios. Deve ser também indicado como primeira escolha nos casos de estreitamento da orofaringe e/ou hipofaringe. O manejo de pacientes com SAOS requer uma equipe multidisciplinar, incluindo o cirurgião-dentista e o médico do sono, para que seja conduzido um minucioso diagnóstico e como conseqüência correto tratamento da doença. A SAOS é uma doença sistêmica potencialmente fatal com freqüência associada com hipertensão, hipertensão pulmonar, arritmias cardíacas noturnas, infarto do miocárdio, que em grande parte dos pacientes não e diagnosticada. Este trabalho tem por objetivos fornecer ferramentas de diagnóstico aos cirurgiões- dentistas, apresentar a opinião de vários autores sobre as modalidades de tratamento de pacientes com SAOS, siias indicações, contra-indicações, vantagens e desvantagens. E também apresentar um caso clínico que além do avanço mandibular, utilizou-se uma técnica de avanço do tubérculo Geni para aumento dos espaços das vias aéreas superiores.

The conservative treatment for obstructive sleep apnea syndrome (OSAS), specially the nasal continuous positive airway pressure (CPAP), are a routine in treatment of patients with apnea. According to the goals and guidelines of the sugery for treatment of OSAS patients, the maxillomandibular advancement (MMA) should not he restricted to the more severe case, used only after failure of previous procedures. Should be used as a primary procedure in the cases of narrowing of oro and/or hypopharynx. The management of OSAS patients requires a multidisciplinary team, including the dentist and sleep specialist in order to achieve a correct diagnostic and treatment of illness. The OSAS is a systemic illness life-threatening frequently associated with hypertension, pulmonary hypertension, nocturnal cardiac dysrhythmias, myocardial infarts which in greatnumber of patients is not diagnosed. This paper have the goal of furnish diagnostic tools to dentists, as well to present the opinion of several autors about treatment modalities of patients with OSAS, their indications, contraindications, vantages and disadvantages and to present a case report in which was performed a surgery to enlarge the pharyngeal airway space (PAS).