Use of platelet- and leukocyte-rich fibrin (L-PRF) as a healing agent in the postoperative period of third molar removal surgeries: a systematic review.

OBJECTIVE: The aim of this study was to analyze the effectiveness of L-PRF as a healing agent in the postoperative period of third molar extraction surgeries, as well as to investigate secondary effects, such as the reduction of pain, edema and other discomforts after the surgical intervention. MATERIALS AND METHODS: The methodology adopted consisted of carrying out a systematic review of the literature, following the model outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The inclusion criteria were previously established according to a systematic review protocol approved by the Prospective Register of Systematic Reviews (PROSPERO) under number CRD42023484679. In order to carry out a comprehensive search, a search in five databases was carried out, PubMed, Web of Science, Scopus, Cochrane Library and Embase. RESULTS: The search resulted in the selection of randomized controlled trials that conformed to the established criteria. Two authors independently screened the records and extracted the data. The assessment of bias was conducted according to the guidelines recommended by the Cochrane Collaboration, using version 2 of the Cochrane tool for assessing the risk of bias in randomized trials (RoB 2). CONCLUSION: This study demonstrated that L-PRF stands out by providing direct benefits to healing, vascularization and tissue regeneration. CLINICAL RELEVANCE: L-PRF plays an important role in reducing postoperative pain, edema, the incidence of alveolar osteitis and infections after third molar removal surgery, compared to patients who did not undergo the use of L-PRF.

Three-dimensional pharyngeal airway space changes after bimaxillary advancement.

INTRODUCTION: The probability of improvement in the upper airway space (UAS) with orthognathic surgery should be considered during the surgical-orthodontic treatment decision, providing not only an esthetic, but also a functional benefit for the patient. OBJECTIVE: The purpose of this study was to evaluate the 3D changes in the upper airway space after maxillomandibular advancement surgery (MMA). METHODS: A retrospective analysis of 56 patients, 21 male and 35 female, with a mean age of 35.8 ± 10.7 years, who underwent MMA was performed. Pre- and postoperative cone-beam computed tomography scans (CBCT) were obtained for each patient, and the changes in the UAS were compared using Dolphin Imaging 11.7 software. Two parameters of the pharyngeal airway space (PAS) were measured: airway volume (AV) and minimum axial area (MAA). Paired t-test was used to compare the data between T0 and T1, at 5% significance level. RESULTS: There was a statistically significant increase in the UAS. Bimaxillary advancement surgery increased the AV and the MAA, on average, by 73.6 ± 74.75% and 113.5 ± 123.87%, respectively. CONCLUSION: MMA surgery tends to cause significant increase in the UAS; however, this increase is largely variable.

Three-dimensional pharyngeal airway space changes after bimaxillary advancement

ABSTRACT Introduction: The probability of improvement in the upper airway space (UAS) with orthognathic surgery should be considered during the surgical-orthodontic treatment decision, providing not only an esthetic, but also a functional benefit for the patient. Objective: The purpose of this study was to evaluate the 3D changes in the upper airway space after maxillomandibular advancement surgery (MMA). Methods: A retrospective analysis of 56 patients, 21 male and 35 female, with a mean age of 35.8 ± 10.7 years, who underwent MMA was performed. Pre- and postoperative cone-beam computed tomography scans (CBCT) were obtained for each patient, and the changes in the UAS were compared using Dolphin Imaging 11.7 software. Two parameters of the pharyngeal airway space (PAS) were measured: airway volume (AV) and minimum axial area (MAA). Paired t-test was used to compare the data between T0 and T1, at 5% significance level. Results: There was a statistically significant increase in the UAS. Bimaxillary advancement surgery increased the AV and the MAA, on average, by 73.6 ± 74.75% and 113.5 ± 123.87%, respectively. Conclusion: MMA surgery tends to cause significant increase in the UAS; however, this increase is largely variable.

RESUMO Introdução: A probabilidade de melhoria do espaço aéreo superior (EAS) com cirurgia ortognática deve ser considerada durante a decisão do tratamento ortodôntico-cirúrgico, proporcionando não somente um benefício estético, mas também funcional, para o paciente. Objetivo: O objetivo do presente estudo foi avaliar as alterações 3D no espaço das vias aéreas superiores após a cirurgia de avanço maxilomandibular (AMM). Métodos: Foi realizada uma análise retrospectiva de 56 pacientes, 21 homens e 35 mulheres, com média de idade de 35,8 ± 10,7 anos, submetidos a AMM. Foram obtidas tomografias computadorizadas de feixe cônico (TCFC) pré- e pós-operatórias para cada paciente, e as alterações no EAS foram comparadas usando o software Dolphin Imaging v. 11.7. Foram medidos dois parâmetros do espaço aéreo faríngeo (EAF): volume das vias aéreas (VVA) e área axial mínima (AAM). Foi utilizado o teste t pareado para comparar os dados entre T0 e T1, com nível de significância de 5%. Resultados: Houve um aumento estatisticamente significativo no EAS. A cirurgia de avanço bimaxilar aumentou o volume das vias aéreas (VVA) e a área axial mínima (AAM) em média 73,6 ± 74,75% e 113,5 ± 123,87%, respectivamente. Conclusão: A cirurgia de AMM tende a causar o aumento significativo do EAS; no entanto, esse aumento é altamente variável.

A patient with Camurati-Engelmann disease presenting bilateral TMJ ankylosis: A case report.

Camurati-Engelmann Disease (CED), also known as progressive diaphyseal dysplasia, is a rare congenital disorder inherited in an autosomal-dominant pattern, most commonly affecting the skull and diaphysis of long tubular bones. Clinical symptoms start in early age and include ostealgia, muscle atrophy and weakness in the lower limbs, generalized fatigue in addition to gait disturbances (Garcia Armario and Lebron, 2011, Andreu-Arasa et al., 2019; Fyrgiola et al., 2017; Damiá and García Gómez, 2017; Mwasamwaja et al., 2018). CED is believed to be caused by mutation in the gene coding for Transforming Growth Factor ß-1 (TGFß-1) (Fyrgiola et al. 2017). This article presents a rare clinical case of CED, with bilaterally hypertrophic articular apparatus and subsequent ankylosis. A 33-year-old male is reported with temporomandibular joint (TMJ) ankylosis, bone pain, generalized muscle weakness, abnormal gait and bulging eyes. Diagnosis of CED was based on genetic mapping performed by genetist. Upon clinical and radiological examination, a massive bony mass in the condyloid and coronoid was discovered and treatment of choice was surgical resection and installation of bilateral stock articular prostheses.

The Prediction Capacity 3-D Software, on a 2-D Analysis, in Planning the Positioning of the Upper Lip After Maxillary Advancement.

PURPOSE: The maxillary advancement using Le Fort I osteotomy directly affects in the positioning of the upper lip (UL) and the nasolabial angle (NLA), which plays an important role in facial expression and aesthetics, because of this, the aim of this study was to evaluate the ability of Dolphin Imaging 11.8 software in predicting changes to the UL position and NLA in patients undergoing maxillary advancement. MATERIALS AND METHODS: It was a retrospective cohort study. Predictive and final tracings using pre- and postoperative Cone beam computed tomography (CBCT) of 24 patients undergoing maxillary advancement, regardless of mandibular movement, were compared. Whether the amount of advancement changes this predictability was also analyzed. The predictive and the 12-month postoperative data were evaluated using Dolphin Imaging 11.8 software and compared. Student t test was used to get the results. RESULTS: The vertical analysis of the incisal tip and cementoenamel junction of the upper central incisor (UCI) and of the UL were statistically significant (P = .001 for all). The horizontal measurements of the same variables (P = .238, P = .516, P = .930, respectively) and the NLA (P = .060) showed no statistical significance. The amount of advancement did not interfere with the variables analyzed, except for the exposure (P = .009) and inclination of the UCI (P = .010). CONCLUSION: It was concluded that the amount of maxillary advancement does not interfere with the UL prediction; the prediction capacity of the software was good for the horizontal measurements, but had a significant error index for vertical measurements.

Low-level laser therapy for neurosensory recovery after sagittal ramus osteotomy.

BACKGROUND: Dento-skeletal deformities are treated combining orthodontic treatment with orthognathic surgery. One of the techniques most used in this type of surgery is the sagittal osteotomy of the mandible. This technique offers many advantages, but within its disadvantages is the inferior alveolar nerve paresthesia. There are various treatments that aim to recovery of the nerve bundle, and one of them is low intensity laser treatment. The aim of this study was to evaluate the effectiveness of low intensity laser therapy in the recovery of neurosensorial tissues after mandibular sagittal osteotomy during orthognathic surgery. METHODS: Twelve patients submitted to surgery, using mandibular sagittal osteotomy, were treated unilaterally with low intensity infrared (808 nm, GaAIAs active medium) laser, following the inferior alveolar nerve path. The other part of the mandible was treated by placebo. The parameters used were 100 mW of power, irradiancy of 3.6 W/cm2, 2.8J energy per point, an energy density of 100 J/cm2, 28 seconds at each point with a distance of 1.0 cm between points, two sessions per week with a minimum of 10 sessions, starting 48 hours after surgery. Mechanical evaluation was performed in first, fourth, seventh and tenth session. RESULTS: Significant improvement on the treated side was observed. Comparing the behavior among the variables between the treatment (T) group and the control (C) group in the General Recovery was showed a tendency to better results in the T group when compared to the C group, with statistical difference (P≤0.05) after the 10th laser therapy session. CONCLUSIONS: The treatment of neurosensorial disorders with infrared low intensity laser could be effective in accelerating recovery, providing greater comfort to the patient, and it presents advantages over other existing methods.

Morphometric evaluation of bone regeneration in segmental mandibular bone defects filled with bovine bone xenografts in a split-mouth rabbit model.

BACKGROUND: Bovine bone grafts have been widely used in dentistry for guided tissue regeneration and can support new bone formation in direct contact with the graft. The aim of this study was to compare the morphometric and bone density changes after using two different bovine bone graft blocks in segmental osseous defects in the mandible of rabbits following different postoperative periods. MATERIAL AND METHODS: Critical size segmental defects were surgically created bilaterally in the jaw of 18 rabbits. The defects were filled with either deproteinized bovine bone mineral with 10% collagen (DBBM-C; BioOss Collagen®), lyophilized bovine medullary bone (LBMB; Orthogen®), or left untreated according to a split-mouth design. Animals were sacrificed after 3 or 6 months of healing. The hemimandibles were scanned ex vivo using a high-resolution (19 µm) microcomputed tomography. Morphometric and bone density parameters were calculated in the region of the defect using CT-Analyser (Bruker). Initial graft blocks were used as baseline. RESULTS: DBBM-C presented a denser microarchitecture, in comparison to LBMB at baseline. DBBM-C and LBMB grafted regions showed a similar progressive remodeling, with a significant decrease in structure complexity and maintenance of bone volume fraction during the postoperative follow-up periods. Both graft materials showed an enhanced bone replacement and more complex structure compared to untreated defects. The apparent fusion between the graft and host bone was observed only in the defects filled with LBMB. CONCLUSION: LBMB grafts showed a similar behavior as DBBM-C regarding structural remodeling. In LBMB samples, apparent integration between the host bone and the graft was present.

Computed tomography visualizing alterations in the upper airway after orthognathic surgery.

Three-dimensional (3D) software has revolutionized planning in orthognathic surgery. This technology allows the simulation of surgical movements and evaluation of the volume and area of the pharyngeal airway space (PAS), which are not possible with two-dimensional (2D) software. Many patients undergo orthognathic surgery to improve occlusion and facial profile. The PAS may increase or decrease depending on the surgical movements. This study aimed to evaluate the changes in the area and volume of the PAS in patients having bimaxillary movement in orthognathic surgery. The minimum axial area and volume of the PAS (preoperative (T0) and postoperative (T1) air volumes) of 68 patients (26 male and 42 female, mean age 36.6 ± 12.1 years) were analyzed. Evaluations were conducted using cone-beam computed tomography in the Nemoceph 3D-OS program. A paired t-test was used to compare pre- and postoperative volume data, and the Wilcoxon test was used to compare pre- and postoperative data of the minimal axial area. All the tests were performed with Statistica software (StatSoft Inc., Tulsa, OK, USA), and a significance level of 5% was adopted. In the study of the method error, no casual or systematic error was found between the first and second measurements of the variables (p > 0.05 in all measurements). Bimaxillary surgery presented a mean of 70.46% in volume and a median increase of 61.27% in the minimum axial area, which varied from -22.50% to 659.06%. The results demonstrated that bimaxillary advancement significantly increased the volume and minimum axial area of the upper airway; however, the increase was not homogeneous in all the patients.

Surgical Treatment of Posttraumatic Laterognathia: A Case Report and a Literature Review, Focused on the Effects of a Condylar Fracture on the Face.

Facial asymmetry, following early childhood condylar trauma, is a common complaint among patients who seek surgical treatment. G.D.M., a 27-year-old male patient, sought professional help to correct his cosmetic flaw, caused by a condylar fracture when he was 8-years-old. After the proper orthodontic treatment, he underwent a double jaw orthognathic surgery and, 9 months later, a second one to correct the remaining asymmetry. Two years after this second procedure, the patient is still under surveillance and has no complaints.

Association between imaging and clinical findings in mandibular third molar surgeries

Objective: it is important to evaluate the position andestablish the third molar relationship with the mandibularcanal to minimize the risk of nerve injury and assistin planning the extraction of this tooth. The panoramicradiograph is the standard diagnostic tool for this purpose.However, if it indicates a close relationship betweenthe third molar and the mandibular canal, furtherinvestigation using cone beam computed tomography(CBCT) may be recommended to check the three-dimensionalrelationship between the tooth and the mandibularcanal. Thus, this study aimed to correlate the clinicalfindings (observed in third molar surgeries) to imagingfindings (observed in panoramic radiographs andCBCT). Subjects and method: after the extraction of 20mandibular third molars, the panoramic radiograph andthe cone beam computed tomography were analyzed.Then, the surgical findings were correlated to the imagefindings. Results: It was observed that the radiographicfinding type 2 (darkening of roots) observed in the panoramicradiograph presented a greater relation to theabsence of cortical bone between the mandibular canaland the third molar (CBCT finding), with statistical significance(p<0.05). Conclusions: Based on the findingsobtained in this study, it may be concluded that CBCTwould be best used in the surgical planning, when thepanoramic radiograph clearly suggests a risk. Moreover,the panoramic radiograph may continue to be used forthe planning of third molar extractions.

Exodoncia de terceros molares inferiores con dispositivos piezoeléctricos: revisión de la literatura / Third molar removal with the use of piezosurgery: literature review

El objetivo de este estudio fue realizar una revisión sistemática de la literatura con relación al uso de piezocirugia comparado con instrumentos rotatorios convencionales en las exodoncias de los terceros molares inferiores. Material y método. Se realizó una búsqueda electrónica en las bases de datos: PubMed, ISI Web of Knowledge, Science Direct en los últimos 8 años, utilizando las palabras claves; tercer molar, osteotomía, instrumentos quirúrgicos, cirugía maxilofacial. Resultados. se seleccionaron veintiseis artículos después de aplicar los criterios de inclusión y exclusión. Se seleccionaron artículos que evaluaron el tiempo transoperatório, edema facial, dolor posoperatorio y cantidad de analgésico ingerida, una variable común en los estudios fue el mayor tiempo de trabajo durante los procedimientos realizados con dispositivos piezoeléctricos. Conclusión. de acuerdo con las evidencias encontradas, la mayoría de los estudios relacionaron el uso de piezocirugia para exodoncias de terceros molares inferiores con menor edema facial posoperatorio, sin embargo los procedimientos realizados con piezocirugia representan mayor tiempo transoperatório, lo que puede aumentar el dolor posoperatorio y la presencia de trismus

The aim of this study was to conduct a systematic review of the literature regarding the use of Piezosurgery instead of conventional rotary instruments in the extractions of lower third molars. Material and method. An electronic databases search was performed in PubMed, ISI Web of Knowledge, Science Direct in the last eight years, using the keywords; third molar, osteotomy, surgical instruments, maxillofacial surgery. Results. Twenty six articles were selected after applying inclusion and exclusion criteria. Articles that evaluated the perioperative time, facial edema, postoperative pain and amount of analgesics used, were selected, and a common variable in the studies was the longest working time during the procedures performed with piezoelectric devices. Conclusion. According to the evidence found, most studies have associated the use of Piezosurgery for extractions of third molars with less facial post-operative oedema. However piezosurgery has a longer greater intra-operative time, which can increase post-operative pain and presence of trismus

Avaliação das posições de terceiros molares retidos em radiografias panorâmicas: revisão da literatura / Evaluation of the positions of impacted third molars on panoramic x-rays: a literature review

A exodontia de terceiros molares inclusos é a prática mais comum dos cirurgiões bucomaxilofaciais. Portanto, para facilitar a comunicação entre profissionais e a elaboração de um planejamento satisfatório; foram criadas classificações distintas desses elementos dentários, como a de Winter e a de Pell e Gregory. O presente estudo propõe-se avaliar as posições de terceiros molares retidos em ortopantomografias por meio de uma revisão de literatura. Para isso realizou-se uma revisão de literatura incluindo o tema nas seguintes bases de dados: PubMed, CAPES, SCIELO, BBO, BIREME e LILACS. A posição vertical, conforme classificação de Winter, foi a de maior prevalência entre os terceiros molares superiores e inferiores; em relação à classificação de Pell e Gregory, as posições de maior prevalência foram a posição A e Classe I.

Exodontia of third molars included is a common practice of oral maxillofacial surgeons. Therefore, to facilitate communication between professionals and a drafting of a satisfactory planning were created for these dental elements, such as that of Winter and one of Pell and Gregory. The present study proposes to evaluate how the positions of third molars refer to orthopantomographies through a literature review. For this, a literature review was carried out including the theme in databases: PubMed, CAPES, SCIELO, BBO, BIREME and LILACS. The vertical position, as classified by Winter, had a higher prevalence among the upper and lower third molars; relative to the classification of Pell and Gregory, the positions of higher prevalence were A position and Class I.

Lingual Short Split: A Bilateral Sagittal Split Osteotomy Technique Modification.

The technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with significant improvements regarding stability, better bone contact between the segments, and possibilities of osteosynthesis. However, paresthesia is common in the postoperatory, sometimes permanent, and undesirable fractures in the subcondylar region can occur leading to longer operative time and extraoral scars. The short lingual split technique is an easy technique that simplifies the horizontal osteotomy of the ramus and decreases the risk of undesirable fractures with a neurosensitive recovery of patients in a much shorter time because of minor trauma and nerve manipulation during the execution.

Outcomes in Surgical Treatment of Mucocele in Frontal Sinus.

The aim of the study was to correlate several studies dating from 1997 to 2015 to identify the most effective treatments for mucocele in the frontal sinus (with/without other paranasal sinuses), considering successful outcomes and recurrence. We aimed to conduct a literature review for articles published between 1997 and 2015. For this, we accessed articles in the SciELO database, as well as LILACS, PubMed, and Google Scholar databases. Were identified 32 work-related injuries in the paranasal sinuses; 2 of these were not related to mucoceles or mucopyocele, 4 had no relation to the frontal sinus, 9 were related to the frontal sinus and other paranasal sinuses, 4 were related to mucocele associated with other sinuses, and 13 involved only the frontal sinus. Endoscopic techniques decrease intra- and postoperative morbidity, reducing the operative time, allow a larger view of the lesion and surrounding anatomical structures, and decrease chances of recurrence. Thus, the successful outcomes have been beneficial to both the surgeon and the patient.

Determinantes do tratamento ortodôntico-cirúrgico / Determinants of orthodontic-surgical treatment

Em algumas situações o ortodontista se depara com o dilema entre indicar apenas o tratamento ortodôntico ou o ortodôntico cirúrgico e muitos critérios devem ser considerados antes de uma decisão final ser tomada. O objetivo deste artigo é apresentar o tratamento ortodôntico-cirúrgico de um paciente com má oclusão de Classe I e discutir quais fatores são relevantes durante a escolha do melhor tipo de tratamento para cada caso.(AU)

In some situations, the orthodontist faces the dilemma of indicating only an orthodontic treatment or a surgical-orthodontic treatment and many criteria must be considered before a final decision is taken. The objective of this article is to present the orthodontic-surgical treatment of a Class I malocclusion patient and discuss which factors are relevant when deciding the best treatment approach for each case (AU)

Surgical Reconstruction of Lower Face Degloving.

One of the most impressive soft tissue injuries is the facial degloving, normally associated with industrial machines and traffic accidents. This injury is characterized by the separation of the skin and cartilage from the bones, compromising the soft tissues correlated in the trauma area, nerves, and blood vessels. A 28-year-old patient, male, was referred to Araçatuba's Santa Casa Hospital, after a motorcycle accident, hitting his face on the sidewalk. The patient was conscious, oriented, denying fainting and unconsciousness during the accident, and complaining of pain in the nasal region of the face. The suture of wounds was performed using 5-0 absorbable sutures for muscle planes, and reconstruction of the septum and nasal cartilages. The skin was sutured with interrupted stitches using 6-0 nylon. After reducing the edema, a slight increase in alar base was observed. Subsequently, the alar base cinch suture was performed aiming to bring the alar bases to a measure of 34.0 mm in diameter. As a conclusion, the knowledge of the anatomy of the region involved, the healing of tissues, and suture techniques for the facial region process were critical to the successful treatment. The evaluation of the alar base in degloving cases can involve aesthetic features.

Orthognathic Surgery in Patients With Large Condylar Destructions.

Condylar resorption is understood as changes in shape and volume of the condylar bone, due to local, systemic, and iatrogenic factors. The occurrence of condylar resorption after orthognathic surgery can occur when the condylar repositioning in mandibular fossa is performed improperly. In addition, systemic diseases such as osteoarthritis and rheumatoid arthritis seem to influence this process. The aim of this study was to report 3 cases of patients with severe condylar alterations, submitted to orthognathic surgery for treatment of dentofacial deformities. Considerations regarding the diagnosis, surgical planning (counterclockwise rotation), surgical techniques (bilateral sagittal split osteotomy, bimaxillary osteotomies, rigid fixation, maxillomandibular fixation period), and results (short terms) are discussed.

Orthognathic surgery in patients with cleidocranial dysplasia.

The aim of this study was to report the orthodontic-surgical approach of a 21-year-old female patient diagnosed with cleidocranial dysplasia. An orthognathic surgery was performed in the maxilla and mandible during the same procedure to correct an existing dentofacial deformity (class III malocclusion). In addition, malar prostheses were used to correct midface deficiency. After surgical intervention, orthodontic treatment continued in order to promote stability, function, and aesthetics. Cases of cleidocranial dysplasia treated with the defined criteria can bring aesthetic and functional benefits to the patient.

Computerized cephalometric study of the pharyngeal airway space in patients submitted to orthognathic surgery.

INTRODUCTION: Pharynx is a muscular organ with is sustained by craniofacial bones. It is divided into nasal, oral and hipopharynx, and can be considered as a tube that serves both respiratory and digestive systems. Its anatomical morphology permits that factors facilitate its obstruction, leading to the sleep apnea syndrome. One of the treatment consists of surgical mandibular advancement, increasing pharyngeal dimensions. The aim of this study was evaluate the cephalometric changes in the pharyngeal airway space after orthognathic surgery procedures for correction of mandibular prognathism. MATERIALS AND METHODS: Pre and post-operative cephalometric analysis was performed on 19 patients submitted to mandibular setback by mandibular bilateral sagittal split osteotomy associated with maxillary advancement by Le Fort I osteotomy, using the Dolphin Imaging 10.0 software. RESULTS: Results did not reveal statistically significant changes in the upper (nasopharyngeal), middle (oropharyngeal) and lower (hypopharyngeal) airway spaces, but showed increase in the nasal pharynx due the maxillary advancement and a lower position of the hyoid bone due the mandibular setback. DISCUSSION: Maxillomandibular orthognathic surgery for correction of mandibular prognathism does not seem to statistically significantly change the pharyngeal airway space, but it increases the maxillary airway. CONCLUSION: It seems to be important to consider the double jaw surgery in cases of mandibular prognathism, aiming prevention of a possible reduction of whole upper airway.