COVID-19 y la odontología: una revisión de las recomendaciones y perspectivas para Latinoamérica / COVID-19 and dentistry: a review of recommendations and perspectives for Latin America

COVID-19 es una enfermedad altamente contagiosa y potencialmente mortal que nos acompañara por largo tiempo. Las profesiones de la salud y la vida en general ha sido afectada de forma significativa en todo lugar del mundo. La odontología ha pasado de una etapa de gran desarrollo clínico a una etapa donde el manejo de barrera de protección, el control de tratamientos y el tiempo asignado a los pacientes cambiará la forma de realizar la profesión. El presente trabajo pretende resumir las indicaciones y recomendaciones basadas en la evidencia disponible y realizar un análisis de la condiciones de salud oral para Latinoamérica en esta época de pandemia.

COVID-19 is a profound, highly contagious and life-threatening viral disease that will be with us for a long time. Health Care-related professions and life in its entirety are significantly, and perhaps irreversibly affected, all around the World. COVID-19 is and will continue to transform Dentistry and its practise. Based on the available evidence accrued to date, this work attempts to address such changes, current and anticipated, as well as present recommendations for clinical practise implementation, tailored for Latin/South America, in light of such lifealtering momentous pandemic.

Treatment of atrophic maxilla with zygomatic implants in 29 consecutives patients.

Atrophic maxilla is a common condition in older population; some treatments are proposed with bone reconstruction or zygomatic implant. Long-term follow up show the efficiencies of zygomatic implant but limited data are associated to consecutive patient. The aim of this study was to evaluate retrospectively the zygomatic implants performed consecutively in 29 patients. Data from clinical records of 29 patients treated with zygomatic implants were analyzed; were include patient with at least 10 month of prosthetic function. Four surgeons realized all surgeries using local anesthesia with a slot technique on local anesthesia; the variables analyzed were implant survival, complications, prosthetic load and satisfaction of patient; data collection was analyzed by descriptive statistic and chi-square test with p<0.05 for significance statistical. 67 zygomatic implants and 84 conventional implants were installed in patients between 35 and 69 year old being 18 (62%) female and 11 (38%) male.The main indication was the case of severe alveolar resorption in 21 cases (72.41%), followed by failures in maxillary reconstruction with bone graft in 4 (13.79%). The implant success was 79.1% and the immediate or delayed load was not associated to statistical difference (p=0.104). The main complication was the loss of osseointegration and mucositis. Analogue Visual Scale (AVS) for satisfaction show acceptable esthetic and function. Finally we conclude that zygomatic implant present adequate survivor and a good response of patient; important complication can be present in a learn curve for this surgery.

Considerações atuais sobre a remoção de enxerto do mento / Current considerations on the chin bone harvesting

A utilização de enxerto ósseo do mento com o objetivo de readequar regiões alveolares atróficas é reportada na literatura como um procedimento viável e previsível, com elevados índices de sucesso. No entanto, trabalhos relacionados a essa modalidade de enxerto, abordando os cuidados necessários e principalmente as alterações que essa remoção causa na região doadora, são escassos. O objetivo deste trabalho foi relatar um caso clínico, procurando abordar e discutir as alterações que a remoção de enxerto do mento pode causar no contorno do tecido mole da região, na sensibilidade do tecido mole e pulpar, além de abordar o potencial de neoformação óssea e a percepção dos pacientes frente a essas alterações... (AU)

The use of the chin bone graft in order to readjust atrophic alveolar regions is reported in the literature as a viable and predictable procedure with high success rates. However, works related to this type of graft covering the necessary care and especially the changes that the removal because the donor region are scarce. Therefore, the objective was case report seeking to address and discuss the changes that the removal of the graft in treatment can cause soft tissue contour of the region, the sensitivity of the soft tissue and pulp, and to discuss the potential for new bone formation and perception of patients treated with these changes... (AU)

Seleccion de osteosintesis en la reconstruccion maxilar con injerto oseo de cresta Iliaca / Selection of osteosynthesis in maxillary reconstruction with iliac crest bone graft

La reconstrucci¢n ¢sea maxilar con injertos libres junto a la osteotom¡a Le Fort I ha sido desarrollada para dar respuesta a las necesidades cl¡nicas funcionales y est‚ticas de los pacientes, debido principalmente a la discrepancia antero-posterior de las maxilas atr¢ficas. Dentro de la t‚cnica, existe necesidad de osteos¡ntesis mediante fijaci¢n interna r¡gida (FIR) que puede ser desarrollada tanto con dispositivos met licos como con dispositivos reabsorbibles. El presente estudio eval£a el uso de ambos materiales de fijaci¢n, relatando las caracter¡sticas, comparaciones y situaciones cl¡nicas que podr¡an estar asociados a su elecci¢n.

The maxillary bone reconstruction with free flaps with LeFort I osteotomy has been developed to give answer to the functional and aesthetic clinical needs of patients, mainly due to the anteroposterior discrepancy of atrophic maxillae. Within the technique, there is need for osteosynthesis though rigid internal fixation (RIS) that can be developed as both metal devices and absorbable devices. This study evaluates the use of both fixing materials, relating the features, comparisons and clinical situations that might be associated with its choice.

Mandible condylar hyperplasia: a review of diagnosis and treatment protocol.

Condylar hyperplasia (CH) is a bone disease characterized by the increased development of one mandibular condyle. It regularly presents as an active growth with facial asymmetry generally without pain. Statistically it affects more women in adolescence, although it does not discriminate by age or gender. Its best-known consequence is asymmetric facial deformity (AFD), which combined with alteration of the dental occlusion with unilateral crossbite or open bite. It is not known when CH begins and how long it lasts; diagnostic examinations are described and are efficient in some research about diagnosis. Protocol treatment is not well studie and depends on the criteria described in this paper. The aim of this research is to provide up-to-date information about the diagnosis of this disease and to analyze the treatment protocol, visualizing the CH and AFD presented.

Implantes extrabucales para la rehabilitación craneofacial / Extraoral fixation for craniofacial rehabilitation

Las prótesis maxilofaciales retenidas en implantes extrabucales o fijaciones cr neofaciales son herramientas claves en la rehabilitaci¢n de pacientes con alteraciones faciales debido a resecciones asociada con enfermedades, traumas graves, malformaciones y otros. El uso de implantes craneofaciales se caracteriza, principalmente, por ser procedimientos quir£rgicos r pidos, efectuados con anestesia general o local, con poca morbilidad y gran versatilidad para tratar diferentes  reas cr neofaciales como la regi¢n orbitaria, auricular y nasal, entre otras. Sin embargo, a£n existen dudas respecto a los protocolos e indicaciones de tratamientos asi como en otros t¢picos de relevancia. La siguiente revisi¢n bibliogr fica tiene como objetivo recolectar la informaci¢n cient¡fica disponible respecto de las fijaciones cr neofaciales abordando diferentes elementos de la evoluci¢n y procedimientos quir£rgicos para la instalaci¢n de estos dispositivos.

Maxillofacial prosthesis retained in extraoral implants or craneofacial attachments are key tools in the rehabilitation of patients withfacial abnormalities due to associated diseases, severe trauma, malformations and others. The use of craniofacial implants is mainlycharacterized by rapid surgical procedures performed under general or local anesthesia, with little morbidity and versatility to treatdifferent facial skull and the orbital region, auricular, nasal, among other areas. However, there are still doubts about protocols andtreatment indications as well as other relevant topics. The aim of this literature review was to collect the scientific information availablerelated to craniofacial fixations addressing different elements of evolution and surgical procedures for the installation of these devices.

Biocompatibilidad del cianoacrilato de butilo en suturas en piel en comparación con las suturas convencionales / Biocompatibility of n-butyl-cyanoacrylate compared to conventional skin sutures in skin wounds

Introducción: El cianoacrilato de butilo es un material de síntesis de tejidos, presenta innumerables ventajas como un tiempo de aplicación corto, fácil ejecución, carácter hemostático, bacteriostático, biodegradable y una adecuada fuerza tensil. Objetivo: Evaluar histológicamente la biocompatibilidad del cianoacrilato de butilo en el lomo de rata en comparación con la seda negra trenzada y la poliglactina 910. Materiales y métodos: Se emplearon 36 ratas albinas de raza Wixtar. Se dividieron aleatoriamente en 4 grupos (A, B, C y D) correlacionados con los periodos de sacrificio (3°, 7°, 14° y 21° día) respectivamente. Se realizaron 3 incisiones de 2 cm de longitud en el lomo de rata. Los parámetros histológicos fueron: infiltrado inflamatorio de células polimorfonucleares, fibroblastos jóvenes y engrosamiento de la epidermis. Resultados: El cianoacrilato de butilo ocasionó menor infiltrado polimorfonuclear en comparación con los otros materiales utilizados. Los picos de proliferación fibroblástica en los grupos tratados con cianoacrilato de butilo fueron superiores al resto. El engrosamiento de la epidermis mostró la alta capacidad mitótica de los queratinocitos para remodelar el epitelio. Al 14° y 21° día, la mayoría de los tejidos tratados con cianoacrilato de butilo ya se encontraban totalmente remodelados en comparación con el resto. Conclusiones: El cianoacrilato de butilo es un material biocompatible con los tejidos, permitiendo disminuir el tiempo de cicatrización de los mismos.

Introduction: N-Butyl-cyanoacrylate is a tissue-synthesis material. It offers countless advantages: short application time, easy execution, as well as possessing hemostatic character. This material is bacteriostatic, biodegradable, and exhibits suitable tensile strength. Objective: The objective of the present paper was the histological evaluation of n-butyl-cyanoacrylate biocompatibility on rats dorsum (spine), compared to braided black silk and Polyglactin 910. Materials and Methods: Thirty six Wixtar albino rats were used for the procedure. They were randomly divided into four groups (A, B, C, D) related to the time of sacrifice (3rd, 7th, 14th and 21st day) respectively. On the rats' spine, three 2 cm long incisions were performed. Histological parameters were as follows: polymorphonuclear cell inflammatory infiltrate, young fibroblasts and epidermis thickening. Results: N-butyl-cyanoacrylate caused lesser polymorphonuclear infiltrate when compared to other used materials. Fibroblast proliferation peaked in groups treated with n-butyl-cyanoacrylate when compared to the rest. Epidermis thickening showed high mitotic ability of keratocytes to remodel epithelium. At the 14th and 21st days most tissues treated with N-Butyl-cyanoacrylate were found to be completely remodeled when compared to the rest. Conclusion: N-butyl-cyanoacrylate was shown to be the most biocompatible material, since it elicited shortest healing time.

Complicações em fixações zigomáticas: revisão da literatura e análise retrospectiva de 16 casos / Complications in zygomatic fixtures: literature review and retrospective analysis of 16 cases

A reabilitação de maxilas atróficas permanece como grande desafio ao cirurgião, mesmo nos dias atuais. Nos últimos anos, as fixações zigomáticas têm sido apresentadas na literatura como uma opção viável para o tratamento daqueles pacientes que apresentam severa atrofia do rebordo alveolar maxilar com extensa pneumatização dos seios maxilares e que não desejam se submeter a procedimentos reconstrutivos. Sendo assim, o objetivo do presente estudo é realizar uma breve revisão da literatura e avaliar retrospectivamente as complicações encontradas em 16 casos de implantes zigomáticos, em um período mínimo de 24 meses de acompanhamento. Os resultados mostram que o percentual de complicações foi de 50% e que o índice de sucesso no tratamento foi de 76%. A dor foi o tipo de complicação mais comum (30%), seguida pela não osseointegração (25%) e pela infecção (20%). Em conclusão, podemos afirmar que complicações podem ocorrer em qualquer fase do tratamento e podem ocasionar a perda dos implantes zigomáticos instalados, devendo o cirurgião estar apto a intervir no momento necessário.

The rehabilitation of atrophied maxillary arches stands is a great challenge to surgeons. In the last years, the zygomatic fixations have been presented in literature as a practicable option to the treatment of patients with severe atrophy, large pneumatization of maxillary sinuses, and avoiding reconstructive procedures. In this case, the aim of this study is to perform a brief literature review and retrospectively evaluate the complications found in 16 cases of zygomatic implants, with a minimum period of 25- month follow-up. The results show that the percentage of complications was 50%, and the treatment success rate was 76%. Pain was the most common complication (30%), followed by the lack of integration (25%), and infection (20%). In this way, we can affirm that complications may occur in any treatment phase with loss of the zygomatic implant installed, obligating surgeons to interfere in certain occasions

Relación entre el exito y fracaso en los procedimientos implantológicos: análisis retrospectivo de 06 años / Relationship between success and failure in implant procedures: a retrospective analysis of 06 years

Los implantes dentales oseintegrados son actualmente una opción de tratamiento segura e previsible para la rehabilitación de pacientes desdentados. De esta manera el objetivo del presente estudio fue evaluar retrospectivamente el índice de éxito y fracaso de los implantes oseointegrados instalados por el Área de Cirugía y Traumatología Bucomaxilofacial de la Facultad de Odontología de Piracicaba de la Universidad Estatal de Campinas (FOP-UNICAMP) en el período de Junio del 2001 hasta Julio del 2007. Durante este período fueron encontrados 1,800 historias clínicas de pacientes tratados con implantes, siendo que de estos fueron seleccionados 492 que cumplían los criterios de inclusión-exclusión establecidos. Los resultados muestran que el índice de fracaso fue de 10,6% siendo que en 6,3 % de los casos hubo pérdida primaria y en 4,3% hubo pérdida tardía; mientras que el índice de éxito fue del 89,4%. En conclusión, se observa que los resultados encontrados se encuentran próximos de los padrones normales relatados en la literatura

The osseointegraveis dental implantations are currently an option of safe and previsible treatment for the whitewashing of edentate patients. Being thus, the objective of the present study is retrospectively to evaluate the index of success and failure of the osseointegraveis implantations installed by the area of Buco-Maxilo-Face Surgery of the Fop/Unicamp in the period of June of 2001 the July of 2007. During this period they had been found a total of 1.800 handbooks of patients dealt with implantations, being that of these 492 had been selected that they fulfilled to the criteria of established inclusion/exclusion. The results show that the failure index was of 10,6%, being that in 6,3% of the cases it had primary loss and in 4,3% had delayed loss; whereas the success index was of 89,4%. In conclusion, it is observed that the joined results are next to the normal standards told by literature

Inflammatory fibrous hyperplasia treated with a modified vestibuloplasty: a case report.

AIM: The purpose of this report is to present a case of surgical and prosthetic treatment of a woman with inflammatory fibrous hyperplasia (IFH) and her evaluation during a six month period. BACKGROUND: IFH is a benign pathology, prevalent in female patients, and principally associated with ill-fitting prosthetic devices in need of adjustment. It is common for patients to require surgical removal of the hyperplastic tissue and fabrication of a new prosthesis. CASE REPORT: A 55-year-old female with a history of smoking presented with a chief complaint of missing the scheduled adjustment of her maxillary complete denture and the presence of moveable tissue under the denture. Surgical excision of the hyperplastic tissue followed with fixation of the prosthesis for six months to guide the healing of the soft tissue and to reshape the contours of the maxillary supporting tissues. SUMMARY: Surgical removal of hyperplasic soft tissue is a routine procedure, and the fixation of the prosthesis for the support of tissue during healing improves intraoral conditions for the fabrication of a new prosthesis in the future.

Hiperplasia fibrosa traumática asociada a implante ortodóncico: reporte de caso / Traumatic fibroseous hiperplasy asociated to orthodontic implant: case report

Los implantes de titanio como anclaje para el movimiento dentario en la práctica ortodontica es una terapia en constante crecimiento en consecuencia del poco tiempo de uso. De esta forma, sus complicaciones no han sido completamente evaluadas. El presente caso representa una complicación asociada a una técnica incorrecta, acentuada por algunas características locales. La resolución final del caso es simple y responde a la indicación quirúrgica (biopsia excisional) para este tipo de situaciones.

Titanium implant used for anchorage to dental movement in orthodontics practice is a growing therapy because its shorter treatment time. Because of this, its complications have not been totally evaluated. The present case reports a complication due an incorrect technique, increased by characteristic of the area. The final resolution of this problem is simple and responses for the surgical indications (excisional biopsy) in this situation.