Condylar Positional Changes in Skeletal Class II and Class III Malocclusions after Bimaxillary Orthognathic Surgery.

Orthognathic surgery is indicated to modify the position of the maxillomandibular structure; changes in the mandibular position after osteotomy can be related to changes in the position of the mandibular condyle in the articular fossa. The aim of this study was to determine changes produced in the mandibular condyle 6 months after orthognathic surgery. A cross-sectional study was conducted that included subjects who had undergone bimaxillary orthognathic surgery to treat dentofacial deformity of Angle class II (group CII) or Angle class III (group CIII). Standardized images were taken using cone-beam computed tomography 21 days before surgery and 6 months after surgery; measurement scales were used to identify the condylar position and its relations with the anterior, superior, and posterior joint spaces. The results were analyzed using the Shapiro-Wilk and Student's t-tests, while considering a value of p < 0.05 as indicating a significant difference. Fifty-two joints from 26 patients, with an average age of 27.9 years (±10.81), were analyzed. All subjects in both group CII and group CIII showed a significant change in the anterior, superior, and posterior joint spaces. However, postoperative changes in the position of the condyle in the articular fossa were not significant in the anteroposterior analysis. We conclude that orthognathic surgery causes changes in the sagittal position of the mandibular condyle in subjects with mandibular retrognathism and prognathism.

Retrospective Analysis of the Airway Space Changes in Dentofacial Deformity after Two-Jaw Orthognathic Surgery Using Cone Beam Computed Tomography.

Orthognathic surgery is used to modify anomalies in maxillomandibular position; this process can significantly affect the anatomy of the airway and cause functional changes. This study aims to define the impact of mandibular maxillary movement on the airway of subjects with dentofacial deformity. A retrospective study was conducted on subjects with Angle class II (CII group) and Angle class III (CIII group) dentofacial deformities. The subjects were treated via bimaxillary surgery; for all of them, planning was performed with software and 3D printing. Cone beam computed tomography (CBCT) was obtained 21 days before surgery and 6 months after surgery and was used for planning and follow-up with the same conditions and equipment. Was used the superimposition technique to obtain the maximum and minimum airway areas and total airway volume. The data were analyzed with the Shapiro-Wilk test and Student's t-test, while Spearman's test was used to correlate the variables, considering a value of p < 0.05. Thus, 76 subjects aged 18 to 55 years (32.38 ± 10.91) were included: 46 subjects were in CII group, treated with a maxillo-mandibular advancement, and 30 subjects were in the CIII group, treated with a maxillary advancement and a mandibular setback. In the CII group, a maxillary advancement of +2.45 mm (±0.88) and a mandibular advancement of +4.25 mm (±1.25) were observed, with a significant increase in all the airway records. In the CIII group, a maxillary advancement of +3.42 mm (±1.25) and a mandibular setback of -3.62 mm (±1.18) were noted, with no significant changes in the variables measured for the airway (p > 0.05). It may be concluded that maxillo-mandibular advancement is an effective procedure to augment the airway area and volume in the CII group. On the other hand, in subjects with mandibular prognathism and Angle class III operated with the maxillary advancement and mandibular setback lower than 4 mm, it is possible to not reduce the areas and volume in the airway.

Comparison of the pattern of activation of the masticatory muscles among individuals with and without TMD: A systematic review.

OBJECTIVE: To verify the characteristics of the electromyographic signal of masticatory muscles in individuals with TMD and asymptomatic individuals. METHODS: A systematic review was carried out, selecting cross-sectional studies with at least one electromyographic parameter (FM; iEMG; RMS) of the masticatory muscles (anterior temporal, bilateral masseter, and suprahyoid muscles) of individuals with TMD compared to asymptomatic individuals. RESULTS: This review identified 1656 titles, of which 30 articles were included in the final analysis. It was observed that the data referring to the pattern of activation of masticatory muscles in the rest, isometry, and isotonic conditions of individuals with TMD are heterogeneous. This fact may be related to variability in the methods and analyses applied in the studies. CONCLUSION: Data referring to the pattern of activation of masticatory muscles in the rest and isometry conditions and in the mastication cycle of individuals with TMD and asymptomatic individuals are diverse.

In vitro mechanical test of grid plates for mandibular angle fractures.

This study evaluated, by mechanical testing, the strength of four-hole grid plates used for mandibular angle fracture fixation. Much has been discussed about the treatment of mandibular fractures with straight or curved plates. However, there are few studies about the use of grid plates. The geometry of such plates provides three-dimensional stability, resistance against torque associated with a low profile. Ninety polyurethane hemimandibles were used as substratum. The hemimandibles were divided into nine groups and fixation of the fractures was performed varying the type and position of plate and type of screw. An intact hemimandible group was used as control. It was possible to observe that plates positioned at the tension zone present the highest load values, both for dislocations of 3 and 5 mm. There was no statistical difference when plates with or without an intermediate bar were tested. The locking screws were more efficient than the non-locking screws when the plates were positioned at the neutral zone. Results allowed us to conclude that grid plates installed at the tension zone presented greater mechanical efficiency. If grid plates are positioned at the neutral zone, they should have an intermediate bar and be fixed with locking screws.

Central Giant Cell Granuloma in the Mandibular Condyle in a Teenager. A Case Report with Literature Review.

Central giant cell granulomas (CGCG) are not common in the mandibular condyle. In teenagers, the problem is more complex because of difficulties in diagnosis and treatment involving the potential growth of the mandibular process and development of the face. In this short communication a case is presented of an eleven-year-old female under diagnosis of central giant cell granuloma affecting the mandibular condyle treated surgically in two steps using a condylectomy and vertical ramus osteotomy at the first time and later orthognathic surgery, showing the clinical evolution after 13 years of follow-up. In addition, we performed a review of the scientific reports related to CGCG in the mandibular condyle to compare this treatment with others, in terms of follow-up and results. We concluded that the CGCG affecting the mandibular head can be properly treated with low condilectomy, vertical mandibular ramus sliding osteotomy, and discopexy.

TMJ Position in Symmetric Dentofacial Deformity.

The aim of this research was to analyze the facial class, presence of malocclusion, and the mandibular plane and to relate this to the mandibular condyle position. A cross-sectional study in subjects under analysis for orthognathic surgery was done. The mandibular plane, the gonial angle, and the molar class were included to compare the coronal and sagittal position of the condyle and the joint space observed in the CBCT. The measurements were obtained by the same observer at an interval of two weeks. In addition, the Spearman test was performed to determine the correlation using a p value < 0.05 to observe any significant differences. Eighty-nine male and female subjects (18 to 58 years old, 24.6 ± 10.5) were included. In the coronal section, subjects with CIII had a greater mediolateral distance (MLD, p = 0.0001) and greater vertical distance (SID, p = 0.0001) than subjects with CII. In terms of the skeletal class and the mandibular plane, it was observed that subjects in the CII group had a greater mandibular angle (open angle) (p = 0.04) than the CII group and was related to the anterior position of the condyle. The most anterior condylar position was observed in the CII group (p = 0.03), whereas a posterior condylar position was significant in CIII subjects (p = 0.03). We can conclude that the sagittal position of the TMJ was related to the mandibular plane and the skeletal class showing a higher mandibular angle and most anterior position of the condyle in CII subjects and a lower mandibular angle and most posterior position of the condyle in CIII subjects. The implications for surgical treatment have to be considered.

Speaking Space, Chewing Rotational Denture Movement, OHRQoL, and Patient Expectations for Single-Implant Mandibular Overdentures.

PURPOSE: To compare the speaking space, perceived rotational movement during chewing, and oral health-related quality of life (OHRQoL) of elderly people rehabilitated with new conventional complete dentures (CDs) and single-implant mandibular overdentures (SIMOs) using a paired design. Patient expectations for SIMO use were also evaluated. MATERIALS AND METHODS: The participants were 22 elderly users of unsatisfactory CDs. They received new sets of conventional CDs, and assessment was performed after 2 months of use. Speaking space was recorded with a kinesiograph while participants read a list of words. Participants were asked two questions about perceived posterior rotational denture movement during chewing. The Dental Impact on Daily Living (DIDL) questionnaire was used to examine OHRQoL, and a visual analog scale was used to quantify participants' SIMO expectations. Subsequently, the mandibular CDs were converted to SIMOs, and the assessment was repeated after 2 months of use. Speaking space and OHRQoL data were submitted to ANOVA and Student t test, and perceived mandibular movement and expectation data were examined using likelihood-ratio chi-square test. RESULTS: The speaking space and perceived rotational movement did not differ between CD and SIMO use. General performance and eating restriction DIDL scores increased after SIMO insertion. Participants' SIMO expectations regarding speaking, cleaning, esthetics, and general aspects were met. CONCLUSION: Relative to CD use, SIMO use did not change the speaking space or perceived rotational movement when chewing among elderly patients. It improved OHRQoL via enhancement of two DIDL dimensions and met most elderly patients' expectations.

Speech and the swallowing threshold in single implant overdenture wearers: A paired control study.

BACKGROUND: Single implant mandibular overdentures (SIMOs) can improve mastication in edentulous elderly people. However, little attention has been paid to their effects on articulation disorders and the swallowing threshold relative to those of conventional complete dentures (CDs). OBJECTIVE: To compare the effects of new conventional CD set and SIMOs on articulation disorders, mandibular movements during speech and swallowing threshold using a paired study design. METHODS: Twenty-two edentulous Brazilian Portuguese-speaking elderly people (mean age 66.7 ± 4.6 years) were first evaluated whilst wearing their old conventional CDs. Articulation disorders were analysed by audio and video recordings, mandibular movements during speech were measured by kinesiography, and the swallowing threshold was assessed by masticatory cycle counting and medium particle size (X50 ) calculation. Participants then received new conventional CDs, and evaluations were repeated 2 months later. Subsequently, single implants were installed in the midlines of subjects' mandibles, and the conventional CDs were converted to SIMOs. After 2 months of SIMOs use, the evaluations were repeated. Data were submitted to the Cochran-Mantel-Haenszel and ANOVA. RESULTS: No difference in articulation disorders was found between new conventional CD and SIMO use. The frequency of anterior lisp during /s/ and /z/ phoneme pronunciation was reduced with new conventional CD use relative to old conventional CD use (p < .05). The X50 decreased progressively with new conventional CD and SIMO use (both p < .05). CONCLUSION: SIMOs do not alter speech relative to new well-fitted conventional CDs, but improved the swallowing threshold, in edentulous elderly people.

The Airway Volume Related to the Maxillo-Mandibular Position Using 3D Analysis.

OBJECTIVE: The aim of this research was to compare three cephalometric analyses and their correlation with the airway volume in subjects with different skeletal classes using 2D and 3D images. Study Design. Cross-sectional descriptive study. Material and Method. Steiner, McNamara, and Ricketts analyses and the airway volume were compared in 115 subjects who were candidates for orthognathic surgery under diagnosis using cone beam computed tomography (CBCT); 46 males (40%) and 69 females (60%) were included. The sagittal positions of the maxilla and mandible, the angulation of the mandibular plane, the sagittal positions of the upper and lower incisors, measurements of the largest or shortest airway area, and the volume were compared using Spearman's test considering a p value < 0.05. RESULTS: Differences were observed between the Steiner and McNamara techniques for the sagittal position of the maxilla (p = 0.01). For mandibular angulation, there was a greater difference between values for Steiner and Ricketts techniques (p = 0.001). In the upper incisor, the results for McNamara and Ricketts techniques were significantly different (p = 0.004). Analysing the airway, subjects with a class II skeletal pattern had a smaller volume than those with a class III pattern (p = 0.034). CONCLUSION: It may be concluded that skeletal class II patients have a significantly smaller airway volume than class III patients. The skeletal parameter does not always relate to the airway volume; however, the high mandibular angle could be related to the airway conditions.

Single implant overdenture reinforced with a metallic framework: A 2-year clinical follow-up.

INTRODUCTION: To prevent single-implant overdenture (SIO) fracture, the inclusion of a framework in the overdenture has been suggested. However, no investigations verified their benefits. OBJECTIVE: To evaluate prosthetic maintenance events, patient satisfaction, and mastication of SIO reinforced by metallic framework users. MATERIAL AND METHODS: Fifteen volunteers had a new set of complete dentures converted into an SIO containing a framework. Maintenance events were recorded, while patient satisfaction was assessed using a visual analog scale. Masticatory performance (MP) was evaluated using the sieving method, maximum bite force (MBF) by pressure sensors, and masseter thickness by ultrasound. Measurements were performed 2, 12, and 24 months after SIO use. Repeated-measures ANOVA and paired Student's t-tests (p < 0.05) were applied. RESULTS: Matrix exchange was the most prevalent maintenance event (83.6%), and no SIO was fractured during the entire follow-up. Satisfaction with the SIO stability decreased (p < 0.01) after 12 months. MP did not change between evaluations (p > 0.05). Conversely, MBF and masseter thickness improved after 12 and 24 months of SIO use (p < 0.05). CONCLUSIONS: Reinforced SIO did not fracture during 2 years but requires maintenance. It improves bite force and muscle thickness, maintaining MP values. Satisfaction with SIO stability decreased in the first year of use.

Anatomical control of the lower nasal width in Le Fort I osteotomy / Control anatómico del ancho nasal inferior en osteotomía Le Fort I

SUMMARY: The aim of this research is to show a simple technique to obtain control in the alar base width in Le Fort I osteotomy. The technique was used in eighteen patients submitted to maxillary impaction and/or advancements (≥ 3 mm). Inter-alar width, alar base width and right/left nostril were studied before surgery and 6 months of follow-up. Data were reported as means and standard deviations; statistical analysis was realized by t test considering a p-value <0.05. Left nostril was modified 0.33 ± 1.03 mm, right nostril was modified 0.39 ± 0.98 mm after 6 months and inter-alar width show a decrease of 0.17 ± 1.15 mm. No statistical differences were observed between the preoperative and the postoperative measurements. Our results show this technique as effective in to obtain a stable position in nasal width.

RESUMEN: el objetivo de esta investigación es presentar una técnica simple para obtener el control en el ancho de la base alar en la ejecución de una osteotomía de Le Fort I. La técnica fue usada en 18 sujetos sometidos a cirugía maxilar de ascenso y/o avance maxilar mayor (≥ 3 mm). El ancho inter-alar, el ancho de la base alar y el orificio nasal derecho e izquierdo fueron estudiados antes de la cirugía y seis meses después de la misma. Los datos fueron presentados en promedios y desviación estándar; el análisis estadístico fue realizado utilizando el t test considerando un valor de p <0,05. El orificio izquierdo fue modificado en 0,33 ± 1,03 mm, el orificio izquierdo fue modificado en 0,39 ± 0,98 mm des- pués de 6 meses y el ancho inter alar mostro una reducción de 0,17 ± 1,15 mm. No se observaron diferencias estadísticas entre las mediciones obtenidas previo a la cirugía y después de la cirugía. Nuestros resultados muestran que la técnica es efectiva para obtener una posición estable del ancho nasal.

Nasal septum deviation and inferior nasal concha bone hypertrophy in class III facial deformity / Desviación del septum nasal e hipertrofia de la concha nasal inferior en deformidad facial clase III

SUMMARY: The aim of this research was to analyze the morphology of the nasal septum and inferior nasal concha bone in class III facial deformities prior to orthodontic treatment in orthognathic surgery candidates. 40 subjects were included in this research. The inclusion criteria were an Angle class III, negative overjet and SNA angle less than 80º. Patients with facial asymmetry, facial trauma or who had undergone maxillofacial or ENT procedures were excluded. CBCT images were obtained for all the patients and the nasal septum deviation, morphology of inferior nasal concha bone and ostium of the maxillary sinus were analyzed and related to the complexity of the facial deformity expressed by the ANB angle and dental relations. The measurement was standardized by ICC and the data was analyzed using a chi square test and Spearman's coefficient with a p value < 0.005 for statistical significance. Nasal septal deviation was observed in 77.5 %. The deviation angle was 13.28º (±4.68º) and the distance from the midline to the most deviated septum was 5.56 mm (±1.8 mm) with no statistical relation to the complexity of the facial deformity. The deviated nasal septum showed inferior nasal concha bone hypertrophy on the concave side of the nasal septum deviation (p=0.049). The open or closed condition of the maxillary sinus ostium was not related to any conditions in the septum or complexity of the facial deformity. Inferior nasal concha bone hypertrophy could be related to nasal septal deviation. The nasal condition in a class III facial deformity could not differ from the general population; careful in orthognathic surgery as to be assume in the Le Fort I Osteotomy and nasal approach related to nasal septum deviation and inferior nasal concha bone.

RESUMEN: El objetivo de esta investigación fue analizar la morfología del septum y la concha nasal inferior en sujetos con deformidad facial clase III previo al tratamiento de ortodoncia preparatorio para cirugía ortognática. Fueron incluidos 40 sujetos en esta investigación. Los criterios de inclusión fueron la de presentar una clase III de Angle, overjet negativo y ángulo SNA menor que 80º. Sujetos con asimetría facial, trauma facial o quienes presentaron algún tipo de procedimiento maxilofacial o de otorrinolaringología fueron excluidos. Tomografía computadorizada cone beam (CBCT) fueron obtenidas para todos los sujetos donde le morfología del septum nasal, morfología de la concha nasal inferior y el ostium del seno maxilar fueron analizados y relacionados con la complejidad de la deformidad facial expresada como ángulo ANB y relaciones dentales. Las medidas fueron estandarizadas por el ICC y los datos fueron analizados utilizando la prueba chi cuadrado y coeficiente de Spearman con un valor de p<0,05 para obtener relaciones significativas. La desviación del septum nasal se observó en el 77,5 %; el ángulo de desvío fue de 13,28º (±4,68º) y la distancia de desvío del septum desde la línea media fue de 5,56 mm (±1,8 mm) sin diferencias estadísticas en relación a la complejidad de la deformidad. El desvío de septum nasal demostró hipertrofia de la concha nsal inferior en el lado cóncavo del septum desviado (p=0,049). La condición de ostium abierto o cerrado no fue relacionado con ninguna condición del septum nasal o complejidad de la deformidad facial. La hipertrofia de la concha nasal inferior se relacionó con el desvío de septum nasal. La condición nasal en deformidad facial de clase III no es diferente de la observada en la población general; cuidados deben ser realizados en cirugía ortognática para el desarrollo de la osteotomía de Le Fort I y aproximación nasal en relación al desvío de septum y probable alteración de la concha nasal inferior.

Relación Transversal, Vertical y Sagital en Sujetos con Deformidad Facial Candidatos a Cirugía Ortognática / Transverse, Vertical and Sagittal Relationship in Subjects with Facial Deformity Candidates for Orthognathic Surgery

RESUMEN: El objetivo de este estudio fue evaluar la relación entre la clase esqueletal sagital y las condiciones transversales o verticales en sujetos con deformidad facial sin presencia de asimetría facial; Se realizó un análisis cefalomét rico de la clase esqueletal sagital, transversal y vertical en 115 sujetos con indicaciones de cirugía ortognática. Se consideró algunos datos del análisis cefalométrico de Steiner y el análisis cefalométrico de Ricketts en sentido sagital para determinar la clase esqueletal facial. A nivel transversal se determinó la dimensión transversal facial, dimensión transversal maxilar y dimensión transversal mandibular. A nivel vertical se determinó la dimensión vertical oclusal y dimensión vertical total. Al comparar las mediciones transversales y verticales entre sujetos de sexo femenino y masculino, se observó que los hom- bres presentaban mayores dimensiones que las mujeres (p=0,0001) en todos los análisis realizados. Los sujetos clase III presentaron mayor dimensión transversal facial (p=0,0002) y transversal mandibular (p=0,001) que los sujetos clase II. Además, se observó que los sujetos clase III presentaban mayor dimensión vertical total (p=0,002) que los sujetos clase II; Es posible concluir que existe características faciales transversales y verticales que se pueden relacionar con la posición sagital de las estructuras maxilo-mandibulares.

ABSTRACT: The aim of this study is to evaluate the relationship between sagittal skeletal class and transverse or vertical conditions in subjects with facial deformity without presence of facial asymmetry; A comparative study was conducted between the results of the cephalometric analysis of the sagittal, transverse and vertical skeletal class in 115 subjects with indications for orthognathic surgery. The Steiner cephalometric analysis in the sagittal direction was used to determine the facial skeletal class and the Ricketts cephalometric analysis in the sagittal analysis. At the transverse level it was determined the facial transverse dimension, maxillary transverse dimension and mandibular transverse dimension. At a vertical level it is determined the occlusal vertical dimension and total vertical dimension. When comparing cross-sectional and vertical measurements between female and male subjects, it was observed that male subjects presented greater dimensions than female subjects (p=0.0001). Class III subjects present greater facial transverse dimension (p=0.0002) and mandibular transverse dimension (p=0.001) than class II subjects. Also, it was observed that class III subjects had a greater total vertical dimension (p=0.002) than class II subjects; It is possible to conclude that there are facial characteristics transverse and vertical that can be related with the sagittal position of the maxillo-mandibular structures.

About chin (genioplasty) surgery / Sobre cirugía del mentón (genioplastía)

Facial harmony is the consequence of a proper balance between all facial structures. The identification and classification of morphologic characteristics that detract from facial harmony is most effectively accomplished by clinical examination. The maintenance of the ratios between the facial thirds, correct spatial bone position and soft tissues accommodation are all factors that directly contribute in a balanced facial profile. The chin, likewise, contributes significantly in facial balance, mainly in the profile view. Expressive changes on chin position are associated with the perception of strong or delicate characters. Thus, over the years, a series of studies has been constructed focusing on mandibular osteotomies techniques that enable changes in chin position: advances, setback, extrusion, intrusion, widening, narrowing and asymmetry. This study aims to address historical and technical aspects of genioplasty; associating patient's condition with the surgical techniques that can be applied for correction of chin deformities.

La armonía facial es la consecuencia del balance entre las estructuras facial. La identificación y clasificación de las características morfológicas que están acompañando la armonía facial son mas efectivas al realizar un estudio de análisis facial. La obtención de promedios entre los tercios, corrección especial de la posición del hueso y la acomodación de los tejidos blandos son factores directamente involucrados en el balance del perfil. El mentón, contribuye significativamente en este balance. Cambios expresivos en la posición del mentón son asociados con la percepción de características fuertes o delicadas. Durante los años, una serie de estudios han sido desarrollados enfocándose en las osteotomías mandibulares y técnicas capaces de alcanzar los cambios en la posición del mentón: avances, retrocesos, extrusiones, ensanchamientos, estrechamientos y asimetrías. Este estudio pretende orientar las condiciones históricas y técnicas respecto de la genioplastia; la asociación de las características del paciente con la técnica quirúrgica pueden ser aplicadas para la corrección de las deformidades.

Comparison of two anorganic bovine bone in maxillary sinus lift: a split-mouth study with clinical, radiographical, and histomorphometrical analysis.

BACKGROUND: Anorganic bovine bone (Bio-Oss®) has been extensively used for reconstruction of posterior area of maxilla in sinus lift procedure; however, a new graft material (Lumina-Bone Porous®), that has a different manufacturing process, has not been yet compared in clinical and histological terms. The manufacturing process of bovine bone graft is related to size and porosity of the particles, and this can change osteoconductive property of the material and bone formation. The use of Lumina-Porus® could improve bone formation, reduce the remaining particles of the biomaterial using a low-cost material. The aim of this research was to compare the clinical, radiological, and histomorphometrical results from maxillary sinus lift with two different anorganic bovine bone substitutes Bio-Oss® (control) and Lumina-Bone Porous® (test). RESULTS: A split-mouth study was performed with 13 volunteers. The mean bone ridge height in the deepest portion of maxillary sinuses floor was 3.11 ± 0.83 mm in the Bio-Oss® and 2.38 ± 0.75 mm in the Lumina-Bone Porous®. After sinus lift, the Bio-Oss® group shows bone ridge height of 11.56 ± 2.03 mm and Lumina-Bone® of 10.62 ± 1.93 mm. The increase in alveolar bone height scores was significant between pre-augmentation and 6 months after SL in both groups (p < 0.001). No statistical significant difference in newly formed bone in the Bio-Oss® group (20.4 ± 5.4%), and Lumina-Bone Porous® (22.8 ± 8.5%) was histomorphological observed (p > 0.05). On the other hand, the residual graft particles showed significant difference between the Bio-Oss® group (19.9 ± 8.6%) and Lumina-Bone Porous® (14.6 ± 5.6%) (p < 0.05). The survival rate of dental implants for augmented area with Lumina Bone Porous® was 88.88%, while for Bio-Oss® group was 100%. CONCLUSION: Both materials Bio-Oss® and Lumina-Bone Porous® can be used in the maxillary sinus floor augmentation with good predictability in clinical, radiographical, and histological point of view.

Stability as a key factor for bone repair in nonunion of mandibular osteotomy / Estabilidad como factor clave en la reparación de la nonunión de la osteotomía mandibular

Stability is necessary to ensuring proper bone repair after osteotomies and fractures. The aim of this research was to analyze how the repair of pseudoarthrosis sites was affected by different conditions in related to soft tissue. An experimental study was designed with 18 New Zealand rabbits. Six study groups were formed. An osteotomy was performed on the mandibular body of each animal and muscle was installed at the osteotomy site to model pseudoarthrosis. Fixation by surgery was then carried out, using plates and screws. The animals were submitted to euthanasia after 21, 42 and 63 days to make a descriptive comparison of the histological results. No animal was lost during the experiment. In all the samples, bone formation was observed with different degrees of progress. Defects treated with or without removal of the tissue involved in pseudoarthrosis presented comparable bone repair, showing that stability of the bone segments allows the repair of adjacent tissue. In some samples cartilaginous tissue was associated with greater bone formation. Stabilization of the fracture is the key in bone repair; repair occurs whether or not the pseudoarthrosis tissue is removed.

La estabilidad de las osteotomías y de las fracturas son fundamentales para asegurar la adecuada reparación ósea; el objetivo de esta investigación fue analizar la reparación presente en sitios de pseudoartrosis realizando la limpieza de la zona previo a la fijación o manteniendo el tejido de la nounión en el mismo lugar durante la osteosíntesis. Se diseñó un estudio experimental incluyendo 18 conejos de raza Neozelandesa. Se formaron 6 grupos de estudios a quienes se relizó una osteotomía en el cuerpo mandibular y posterior instalación de músculo en el lugar de la osteotomía para fabricar un modelo de pseudoartrosis. En cirugía posterior se fijó con placa y tornillos. Se realizaron eutanasias a los 42 y 63 días para comparar los resultados de forma descriptiva mediante estudio histológico. No fue perdido ningún animal durante el experimento. En todas las muestras evaluadas se observó formación ósea en diferentes niveles de avance; defectos tratados con o sin el retiro del tejido involucrado en la pseudoartrosis presentaron una condición de reparación ósea comparables, determinando que la estabilidad de los segmentos óseos permite la reparación del tejido adyacente. El tejido cartilaginoso se presentó en algunas muestras asociadas a sectores con mayor presencia de formación ósea. La estabilización de la fractura es clave en la reparación ósea; la reparación se produce manteniendo o retirando el tejido presente en la pseudoartrosis.

Effectiveness of Acupuncture in Dental Surgery: A Randomized, Crossover, Controlled Trial.

OBJECTIVES: The objective of this crossover clinical study was to evaluate the effectiveness of Energy Regulation with Acupuncture in clinical occurrences in impacted lower third molar surgeries. METHODS: The sample consisted of 22 patients with two impacted third molars, in symmetrical position; divided into two groups: Test Group (TG) with Real Energy Regulation Group and Sham Group (SG) with Acupuncture without Energy Regulation function. The extraction was performed 30 days apart. Energy flow (Ryodoraku Method) and energy regulation performed before extraction were measured. Heart Rate (HR) and Blood Pressure (BP) were evaluated before and after energy regulation and after surgery, residual edema was measured by facial measurements (angle of the mandible to tragus (A-T); angle of the mandible to labial commissure (A-LC); angle of the mandible to the wing of the nose (A-WN); angle of the mandible to the corner of the eye (A-CE); angle of the mandible to the chin (A-C); and mouth opening by the interincisal distance, before and after seven days of surgery. To quantify intraoperative bleeding (ml), blood was aspirated along with the saline solution using a portable vacuum pump adaptor. The amount of saline solution used was subtracted from the final amount of aspirated fluid. RESULTS: Mean of bleeding was lower in TG (p = 0.0392). There were significant differences between groups in facial distances: A-LC (p = 0.010), A-WN (p = 0.030) and A-C (p = 0.008). CONCLUSION: Energy regulation with real acupuncture was effective in reducing postoperative residual edema and intraoperative bleeding.

Analysis of the Survival of Dental Implants Installed in Reconstructed Maxilla With Autogenous Iliac Crest Graft: 7- to 9-Year Follow-Up.

The aim of this study was to analyze the survival of dental implants installed in maxillae reconstructed with autogenous iliac crest grafts and to assess patient satisfaction with the treatment by means of a questionnaire. The study conducted medical record reviews and clinical/radiographic assessments of 10 patients with severe maxillary atrophy who had undergone reconstruction with autogenous iliac crest grafts and rehabilitation with dental implants between 2008 and 2011. Patients were assessed for the survival of the implants, considering implant diameter and length, smoking status, diagnosis of diabetes, type of loss, and region of implant loss. In addition, a questionnaire with specific questions on the patients' satisfaction with the treatment was administered. Seventy-six implants were installed in the sampled patients, and only 1 loss was observed (late loss in the anterior maxilla region) after an average follow-up of 7.9 years, which corresponds to a 98.60% survival rate. The installed implants were of the most frequently used dimension (3.75 × 10 mm). One sampled patient was diabetic, and a second patient was both diabetic and a smoker. No loss of implants was observed in these 2 patients. All patients reported being completely satisfied with the treatment and would undergo the procedure again or refer it to a friend/relative. Six patients reported regular maintenance of the prosthesis, and only 3 had changed the prosthesis prior to the time of questionnaire administration. The results of this limited study with a restricted sample population suggest that the reconstruction of the maxilla with an autogenous iliac crest graft provides both adequate implant survival and patient satisfaction.

Cutaneous Fistula Associated with Salivary Calculi in the Parotid Gland: Report of a Rare Case / Fístula cutánea asociada a cálculos salivales en la glándula parótida: reporte de un caso raro / Fístula Cutânea Associada a Cálculos Salivares na Glândula Parótida: Relato de Caso Raro

Abstract The formation of calcific concretions in the salivary duct or glands is a common disorder, but parotid calculi represent only a small proportion of all salivary calculi. This case describes a rare coexistence of a cutaneous fistula with salivary stones located in the superficial lobe of the parotid gland that was removed under local anesthesia. This patient provides illustration of the difficulty there may be in establishing the diagnosis of parotid calculus. We believe that the report of this rare case will help health professionals, reinforcing the importance of proper diagnosis based on clinical and imaging evaluations.

Resumen La formación de concreciones calcificadas en el conducto salival o glándulas es un trastorno común, pero los cálculos de la parótida representan una pequeña parte de los cálculos salivares. Nosotros describimos este raro caso de la presencia de una fístula de piel asociada a un cálculo salivar del lóbulo superficial de la glándula parótida que foi removido sobre anestesia local. Este reporte muestra la dificultad que puede existir para establecer el diagnóstico del cálculo de la parótida. Creemos que el informe de este caso raro ayudará a los profesionales de la salud, reforzando la importancia de un diagnóstico adecuado basado en evaluaciones clínicas y de imágenes.

Resumo A formação de concreções calcificadas no ducto ou nas glândulas salivares é um distúrbio comum, mas os cálculos na parótida representam só uma pequena parte dos cálculos salivares. Nós descrevemos este raro caso de uma fístula cutânea associada a um cálculo salivar do lobo superficial da glândula parótida que foi removido sob anestesia local. Este reporte mostra a dificuldade que podemos ter na hora de diagnosticar o cálculo da parótida. Acreditamos que o relato desse caso raro ajudará os profissionais da saúde, reforçando a importância do diagnóstico adequado baseado em avaliações clínicas e por imagem.