Condiciones de aplicación del injerto ilíaco óseo en la sustitución de defectos mandibulares: un estudio retrospectivo de 11 años de experiencia / Conditions of iliac bone grafts application in mandibular defects replacement: a retrospective study of 11-years’ experience

Antecedentes: Este estudio tenía como objetivo aclarar la aparición y las causas de complicaciones postoperatorias en pacientes con defectos mandibulares continuos, reconstruidos con injertos óseos ilíacos libres. Pacientes y métodos: Los pacientes con defecto de continuidad mandibular con pérdida de tejido óseo, que dio lugar a una brecha de 2 cm o más, se sometieron a reconstrucción con injerto óseo de cresta ilíaca no vascularizado. La variable de resultado fue el fracaso del injerto, que se definió como su pérdida por infección postoperatoria, exposición del injerto, reabsorción completa o no unión del injerto. Los factores predictivos fueron el momento de la reconstrucción, la longitud del defecto óseo, la presencia preoperatoria de defecto mucoso y/o dehiscencia y el método de fijación. Todas las variables explicativas y predictoras se analizaron mediante regresión logística binomial univariante.Resultados: El estudio incluyó los resultados de 50 reconstrucciones mandibulares con injerto óseo de cresta ilíaca no vascularizado que se observaron retrospectivamente. El seguimiento de los pacientes incluidos osciló entre 6 meses y 11 años. 34 pacientes (68 %) tuvieron resultados quirúrgicos satisfactorios. En 16 pacientes (32 %) se perdieron los injertos óseos. Todos ellos debido al desarrollo de infección, supuración y/o exposición del injerto durante los primeros 6 meses del periodo de observación. En el análisis univariante, las principales variables predictoras de fracaso fueron el tabaquismo (OR 5,8; IC: 1,48-22,7; p = 0,002), el momento de la reconstrucción (OR 7,94; IC: 1,88-33,5; p = 0,004) y el defecto o dehiscencia de la mucosa (OR 8,49; IC: 2,21-32,6; p = 0,002). El análisis multivariante también reveló la afectación sinfisaria del defecto (OR 5,63; IC: 1,14-27,8; p = 0,034) como factor predictivo significativo de fracaso en un caso de reconstrucción inmediata. ... (AU)

Background: This study aimed to clarify the occurrence and causes of postoperative complications in patients with continuous mandibular defects, reconstructed with free iliac bone grafts.Patients and methods: Patients with mandibular continuity defect with bone tissue loss, resulting in a 2 cm gap or more underwent reconstruction with non-vascularized iliac crest bone graft. The outcome variable was graft failure which was defined as its loss due to the postoperative infection, graft exposure, full resorption or non-unition of the graft. The predictors were timing of reconstruction, length of the bone defect, preoperative presence of mucosa defect and/or dehiscence and fixation method. All explanatory and predictor variables were analyzed with univariate binomial logistic regression.Results: The study included the results of 50 mandibular reconstructions with non-vascularized iliac crest bone graft which were observed retrospectively. The follow-up of included patients ranged from 6 months to 11 years. 34 patients (68 %) had successful surgery results. In 16 patients (32 %) the bone grafts were lost. All of them due to the infection development, suppuration and/or graft exposure during the first 6-months of the observation period. In univariate analysis, the main failure predictor variables were smoking (OR 5.8, CI 1.48-22.7, p = 0.002), timing of reconstruction (OR 7.94, CI 1.88-33.5, p = 0.004) and mucosa defect or dehiscence (OR 8.49, CI 2.21-32.6, p = 0.002). The multivariate analysis also revealed symphyseal involvement of defect (OR 5.63, CI 1.14-27.8, p = 0.034) as the significant failure predictor in a case of immediate reconstruction. The length of defect and fixators type remained statistically non-significant for mandibular reconstruction with NVICG (p < 0.05).Conclusion: ... (AU)

Bone Regeneration of a 3D-Printed Alloplastic and Particulate Xenogenic Graft with rhBMP-2.

This study aimed to evaluate the bone regeneration capacity of a customized alloplastic material and xenograft with recombinant human bone morphogenetic protein-2 (rhBMP-2). We prepared hydroxyapatite (HA)/tricalcium phosphate (TCP) pure ceramic bone blocks made using a 3D printing system and added rhBMP-2 to both materials. In eight beagle dogs, a total of 32 defects were created on the lower jaws. The defective sites of the negative control group were left untreated (N group; 8 defects), and those in the positive control group were filled with particle-type Bio-Oss (P group; 12 defects). The defect sites in the experimental group were filled with 3D-printed synthetic bone blocks (3D group; 12 defects). Radiographic and histological evaluations were performed after healing periods of 6 and 12 weeks and showed no significant difference in new bone formation and total bone between the P and 3D groups. The 3D-printed custom HA/TCP graft with rhBMP-2 showed bone regeneration effects similar to that of particulate Bio-Oss with rhBMP-2. Through further study and development, the application of 3D-printed customized alloplastic grafts will be extended to various fields of bone regeneration.

Atrofia combinada maxilo-mandibular. Uso de implantes cortos y estrechos (BTI(R) CORE y BTI(R) 3.0) / Combined maxillo-mandibular atrophy. Use of short and narrow implants (BTI(R) CORE AND BTI(R) 3.0)

Cada día con más frecuencia en las clínicas odontológicas nos enfrentamos a atrofias maxilares y mandibulares más extremas y en muchos casos con el retratamiento de implantes fracasados biológica y/o mecánicamente. En el presente caso clínico mostramos una paciente con una atrofia combinada (horizontal y verticalmente) además de un tratamiento con implantes dentales fracasado

More and more frequently in dental clinics we are confronted with more extreme maxillary and mandibular atrophy and in many cases with the retreatment of biologically and/or mechanically failed implants. In the present clinical case we show a patient with a combined atrophy (horizontally and vertically) in addition to a failed dental implant treatment

Riesgos asociados al uso de Expansión Rápida del Maxilar / Risks associated with the use of Maxillary Rapid Expansion

INTRODUCCIÓN: Las anomalías dentomaxilares corresponden a un grupo de alteraciones que dificultan el desarrollo armónico de los maxilares, donde encontramos las anomalías transversales. La expansión rápida del maxilar (ERM) se utiliza como tratamiento de anomalías transversales, su objetivo es aumentar la distancia transversal por la separación de ambas hemiarcadas a nivel de la sutura palatina, utilizando un aparato expansor fijo y rígido. Los disyuntores más utilizados son los expansores Hass, Hyrax y de McNamara. OBJETIVO: El objetivo de la presente revisión es identificar los riesgos de la RME reportados en la literatura relacionados con disyuntores Hass, Hyrax y Mc Namara. METODOLOGÍA: Se realizó una búsqueda en PubMed, Scielo, Science Direct, Trip Database y Google Acadèmico utilizando los tèrminos: "Rapid Maxillary Expansion", "Risks", "Child", "Maxillary Expansion", "RME", "Palatal Expansion", "Hyrax", "Hass". Se incluyeron estudios en inglès y español, sin límites en el año de publicación o tipo de estudio. Como criterios de exclusión consideramos la expansión quirúrgica, expansión lenta u otro tratamiento simultáneo durante la fase de expansión activa. RESULTADOS: De los artículos encontrados, veinte cumplieron los criterios de inclusión. Dentro de los riesgos se encuentran: deglución accidental del dispositivo de activación del expansor, bacteremia transitoria, desviación del septum nasal, reabsorción radicular, compromiso periodontal, cambio posicional de los cóndilos, cambios faciales de tejido blando y cambios esqueletales. CONCLUSIÓN: La ERM es un procedimiento ortopèdico eficaz, sus indicaciones en el tratamiento precoz han aumentado debido a resultados positivos. De acuerdo con la bibliografía encontrada los beneficios superan considerablemente a los efectos negativos

INTRODUCTION: The dentomaxillary anomalies correspond to a group of alterations that hinder the harmonic development of the jaws, where we find the transversal anomalies. Rapid Maxillary Expansion (RME) is used as a treatment for transverse anomalies, its objective is to increase the transversal distance by separating both hemiarchies at the level of the palatal suture, using a fixed and rigid expander. The most used are the Hass, Hyrax and McNamara expanders. OBJECTIVE: The objective of this review is to identify the EMR risks reported in the literature related to Hass, Hyrax and Mc Namara expander. METHODOLOGY: A search was made in PubMed, Scielo, Science Direct, Trip Database and Google Scholar using the terms: "Rapid Maxillary Expansion", "Risks", "Child", "Maxillary Expansion", "RME", "Palatal Expansion", "Hyrax", "Hass". Studies in English and Spanish were included, without limits in the year of publication or type of study. As exclusion criteria, we consider surgical expansion, slow expansion or other simultaneous treatment during the active expansion phase. RESULTS: Of the articles found, twenty met the inclusion criteria. Among the risks are: accidental swallowing of the expander activation device, transient bacteremia, deviation of the nasal septum, root resorption, periodontal involvement, positional change of the condyles, soft tissue facial changes and skeletal changes. CONCLUSION: RME is an effective orthopedic procedure, its indications in early treatment have increased due to positive results. According to the bibliography found, the benefits considerably outweigh the negative effects

Fonoaudiologia e cirurgia ortognática: revisão de literatura / Speech therapy and orthognathic surgery: a literature review

Introdução: As deformidades dentofaciais estão associadas às alterações de oclusões dentárias, que podem causar modificações no sistema miofuncional de acordo com o tipo de desproporção. Essas deformidades, podem provocar alterações e/ou adaptações no sistema estomatognático. O objetivo desse estudo foi identificar, com base na literatura arbitrada, a relação entre a Fonoaudiologia e a Cirurgia Ortognática. Método: Foi realizado levantamento bibliográfico sem período específico, nas bases de dados PubMed, SciELO e BVS. Resultados: Foram avaliados 15 artigos de forma crítica, quanto ao tipo de estudo, seus objetivos, número e gênero dos participantes, metodologia, resultados e conclusões. Os artigos foram agrupados com base nos seus objetivos em 1) Grupo Fonoaudiologia (GF); 2) Grupo Mudanças (GM); 3) Grupo Técnicas (GT) e 4) Grupo Outros (GO). Conclusão: Pouco se encontrou sobre a intervenção fonoaudiológica direta, sendo a maioria dos estudos direcionada às mudanças estéticas e funcionais do tecido duro e mole de pacientes submetidos à cirurgia ortognática. Houve também estudos que abordaram métodos e/ou exames específicos para verificar as mudanças nos tecidos moles e duros do perfil facial dos pacientes submetidos à cirurgia ortognática e estudo que detalhou o perfil dos indivíduos que realizaram tratamento para deformidade dentofacial e síndrome da Apneia e Hipopneia do Sono.

Introduction: Dentofacial deformities are associated with changes in dental occlusion, which may cause changes in the myofunctional system according to the type of disproportion. These deformities can cause changes and/or adaptations in the stomatognathic system. The objective of this study was to identify the relationship between speech therapy and orthognathic surgery based on refereed publications. Method: A bibliographic survey was conducted without considering a specific publication period in the databases, PubMed, SciELO and BVS. Results: Fifteen articles were critically evaluated with respect to the type of study, objectives, number and sex of participants, methodology, results and conclusions. Based on their aims, the articles were grouped into 1) speech-therapy group (STG); 2) changes group (CG); 3) techniques group (GT) and 4) others group (OG). Conclusion: There is little information regarding direct speech therapy intervention, and the majority of the studies were directed to the aesthetic and functional changes in the hard and soft tissue in patients who underwent orthognathic surgery. Some studies addressed methods and/or specific examination procedures to verify the changes in the soft and hard tissues of the facial profile of patients who underwent orthognathic surgery, and a study detailed the profile of individuals who underwent treatment for dentofacial deformity and apnea-hypopnea syndrome.

Development of a new three-directional distractor system for the correction of maxillary transverse and sagittal deficiency.

PURPOSE: Class 3 malocclusions with maxillary deficiency, which are treated surgically and/or ordonotically, are common among adult patients. The aim of this study was to develop a three-directional bone-borne distractor that would allow the transverse expansion and sagittal advancement of the maxilla simultaneously. MATERIALS AND METHODS: Computed tomography images of a patient with maxillary deficiency were transmitted to a software program, and a distractor was designed with different sizes (D1, D2, D3) and manufactured from titanium alloy. Y-shape segmental osteotomies were performed on the model, and vertical bite forces were applied. The biomechanical properties were evaluated by using the finite element method. RESULTS: The highest von Mises stress value on the body of the distractor was seen in D2 (D2>D3>D1), with 234 N bite forces. D2 had maximum stress distribution on maxillary bone under 234 N and 93 N (D2>D1>D3). No difference was found among the plastic deformation rates according to biomechanical test results. CONCLUSION: A three-directional bone-borne palatal distractor was produced, and this distractor system can be used for the treatment of skeletal class 3 patients with maxillary hypoplasia for its advantages of shortening the overall treatment time and reducing the scar formation. However, further animal and clinical studies are essential to determine the biological response of soft and hard tissues.

[Effects of maxillary disjunction on canine impaction in patients presenting a maxillary transverse skeletal deficiency]. / Effets de la disjonction maxillaire rapide sur la rétention des canines chez les patients présentant un déficit squelettique transversal maxillaire.

INTRODUCTION: This study focuses on the effects of rapid maxillary disjunction on the tendency to canine impaction in patients displaying a maxillary transverse skeletal deficiency. MATERIALS AND METHODS: Using the segmentation method described by Ericson and Kurol and modified by Lindauer, et al., a series of panoramic views taken before and after disjunction was studied to compare changes in the position of the tip of the maxillary canine depending on whether it was covered or not by the homolateral lateral incisor, according to the side and patient's sex. The cohort consisted of 193 patients, all treated using a palatal expander welded to bands. RESULTS: A statistically significant improvement was observed in all categories regarding the position of the maxillary canine. Disjunction was successful in 87% of cases in our sample. No significant differences were found according to side or sex.

Sarpe. Técnica de anclaje óseo. Revisión de la literatura a propósito de un caso clínico / Sarpe. Bone anchoring technique. Case report and review

Objetivo: Conocer las principales ventajas, inconvenientes y nuevas alternativas del tratamiento de expansión rápida palatina quirúrgicamente asistida o ‘SARPE’ (Surgically Assisted Rapid Palatal Expansion), realizando para ello una revisión de la literatura científica a propósito de un caso clínico de una compresión transversal del maxilar en un paciente adulto. Caso clínico: Paciente mujer de 19 años con mordida cruzada posterior bilateral asociada a hipoplasia del maxilar a la que se decide realizar un tratamiento de expansión rápida quirúrgicamente asistida. La peculiaridad de este caso se encuentra en que antes de la cirugía se colocó un disyuntor hecho a medida anclado directamente al hueso palatino. Se realizó la cirugía, la expansión y el posterior tratamiento de ortodoncia y, tras un período de seguimiento, se pudo observar una significativa expansión maxilar, evitando los inconvenientes dentales y periodontales de la técnica tradicional. Conclusiones: Los nuevos procedimientos tienden a realizar un anclaje del disyuntor al hueso palatino mediante microtornillos, consiguiendo una expansión palatina satisfactoria, pero evitando los inconvenientes que provoca utilizar un disyuntor dentoanclado (AU)

Objective: To know the main advantages, disadvantages and new alternatives of the treatment of Surgically Assisted Rapid Palatal Expansion (SARPE), making for it a review of the scientific literature on purpose of a clinical case. Clinical case: A 19-year-old female patient with bilateral posterior crossbite associated with maxillary hypoplasia who was decided to perform a surgically assisted rapid expansion treatment. The peculiarity of this case is that before the surgery was placed a custom-made distractor anchored directly to the palatal bone. Surgery, expansion and subsequent orthodontic treatment were performed and, after a follow-up period, a significant maxillary expansion was observed, avoiding the dental and periodontal drawbacks of the traditional technique. Conclusions: New procedures tend to make a direct bone placement of the distractor by means of microimplants, achieving satisfactory palatal expansion but avoiding the inconveniences of using a dental anchorage disjunctor (AU)

Dexmedetomidine-based monitored conscious sedation combined local anesthesia for levator resection in a 10-year-old child with Marcus Gunn jaw-winking synkinesis: A case report.

RATIONALE: Levator resection has become a routine procedure for patients with severe Marcus Gunn jaw-winking synkinesis (MGJWS). To optimize the surgical outcome, adult patients need to be kept awake, or easily aroused and responsive to verbal commands during the operation. However, levator resection is commonly performed under general anesthesia in pediatric patients. In the present case, we described a successful anesthetic protocol of conscious sedation with local anesthesia for levator resection in a child. PATIENT CONCERNS: A 10-year-old boy with MGJWS was admitted to our hospital and scheduled for levator resection. The patient was born through a normal delivery and had no previous history of allergy, no comorbidity, and no history of receiving anesthesia or operation. The laboratory tests of the patient were unremarkable. DIAGNOSES: The diagnosis of MGJWS was made by two experienced ophthalmologists. INTERVENTIONS: A 10-year-old boy with MGJWS was admitted to our hospital and scheduled for levator resection. The levator resection was performed under monitored conscious sedation with dexmedetomidine and local anesthesia. OUTCOMES: Patient with spontaneous breathing responded normally to verbal commands throughout the operation, and no adverse events occurred. The patient and ophthalmologist reported high satisfaction with anesthesia management. LESSONS: Dexmedetomidine-based monitored conscious sedation with local anesthesia is a feasible alternative to general anesthesia for levator resection in collaborative patients.

Orthodontic Treatment of a Patient with Bilateral Congenitally Missing Maxillary Canines: The Effects of First Premolar Substitution on the Functional Outcome.

Permanent canines are thought to play a pivotal role in obtaining an ideal occlusion. Dentists occasionally encounter patients who lack canines and are therefore missing a key to harmonious guidance during functional mandibular excursions. This case report describes the substitution of maxillary first premolars for congenitally missing canines in the context of an orthodontic treatment plan. A boy, age 10 years and 11 months, with a chief complaint of crooked teeth was diagnosed with Class II division 2 malocclusion associated with a high mandibular plane angle and deep overbite. A stable occlusion with a satisfactory facial profile and functional excursions without interference were achieved after a comprehensive two-stage orthodontic treatment process. The resulting occlusion and satisfactory facial profile were maintained for 12 months. These results indicate that substituting the first premolars for the canines is an effective option in treating patients with missing canines while maintaining functional goals.

Tratamientos ortopédicos y ortodóncicos de pacientes con síndromes poco comunes: protocolo / Orthopedic and orthodontic treatments of patients with unusual syndromes: a protocol

Son muchos los síndromes que manifiestan alteraciones dento-esqueletales y, a su vez, manifiestan diferentes complicaciones, no permitiendo tener un protocolo definido para cada síndrome. Para establecer un adecuado protocolo de tratamiento, basado en tratamientos realizados exitosamente y tomando en cuenta los fracasos para no incurrir en el mismo error, se hizo una revisión bibliográfica desdemayo hasta septiembre de 2012, de artículos publicados en los últimos diez (10) años, de revistas internacionales de ortodoncia, ortopedia y cirugía maxilofacial que registraban estudios de investigación y casuística, en buscadores científicos como PubMed, Scielo, Medline. Posteriormente, se tomó la clasificación de Kenneth Lyons Jones, MD, en su obra literaria Patrones Reconocibles de Malformaciones Humanas (2007), tomando en cuenta para la elaboración de este trabajo, los que presentan craneosinostosis, defectos faciales mayores y defectos faciales y de las extremidades como características mayores, que ameritan tratamiento para corregir problemas dento-esqueletales. De los 39 artículos se seleccionaron 11 que tenían relevancia con su tema. Conocer y describir todos los síndromes, mencionando cada característica, es de suma importancia para los profesionales de la salud, ya que de ellos depende no sólo el correcto diagnóstico, sino el tratamiento más adecuado...

[Peculiarities of microbiological composition of oral fluid during various stages of orthodontic treatment in children and adolescents].

The article presents the results of analysis of spectrum, the rate of frequency and the amount of microorganisms in oral liquid before the beginning of orthodontic treatment of dental abnormalities and deformations and in its stages (6 and 12 months later). As the result of the study the appearance of pathologic microorganisms Staphylococcus aureus and a great number of conditionally-pathogenic fungi of Candida family and Porphyromonas spp. were determined. The obtained results show the need of elaboration of standards for the treatment of orthodontic patients.

Hemimandibular hyperplasia: a rare case of vertical facial asymmetry. A case report.

BACKGROUND: Hemimandibular hyperplasia (HH), also known as hemimandibular hypertrophy, is characterised by excessive unilateral three-dimensional growth of the mandible after birth. Vertical elongation of the mandible on one side becomes clinically evident as a rare form of vertical facial asymmetry. Aberrant growth of the facial skeleton affects the developing dentition and dental compensation is usually unable to maintain optimal occlusal relationships. The resulting malocclusion is best managed surgically to address the various facial, skeletal and dental problems that confront clinicians. AIM: To present a case of hemimandibular hyperplasia treated using a combined surgical-orthodontic approach. METHODS: Combined surgical-orthodontic treatment was accomplished in four phases: 1) presurgical orthodontic, 2) surgical, 3) post-surgical orthodontic and 4) orthodontic retention. Comprehensive records (including photographs, study models and radiographs) were taken at the pre-treatment, pre-surgery and debanding stages of treatment. RESULTS: A significant improvement in facial symmetry and a positive occlusal outcome were achieved. A more balanced gingival display has improved the patient's smile aesthetics. CONCLUSION: Hemimandibular hyperplasia is a rare condition causing vertical facial asymmetry and a resulting malocclusion. A combined surgical-orthodontic approach is able to accomplish sound facial, skeletal and dental treatment outcomes.

Comparison of the effects of rapid maxillary expansion and surgically assisted rapid maxillary expansion in the sagittal, vertical and transverse planes

Objective: The aim of this study was to evaluate and compare the effects of rapid maxillary expansion (RME) and surgically assisted RME (SARME) in the sagittal, vertical, and transverse planes. Study design: Orthodontic records of 28 patients were selected retrospectively and divided into two treatment groups. Group 1 comprised 14 patients (4 boys, 10 girls, mean age 14.2 ± 0.74 years) who had been treated with RME. Group 2 comprised 14 patients (4 boys, 10 girls, mean age 19.6 ± 2.73 years) who had been treated with SARME. Measurements were performed on lateral and posteroanterior cephalograms and dental casts obtained before (T0) and after (T1) expansion. Results: Statistically significant differences were found in soft tissue convexity angle, anterior face height, and upper nasal width in group 1, and in U1-NA length and posterior face height measurements in group 2 (P<.05). In both groups significant increases were found in interpremolar, intermolar, maxillary, and lower nasal widths and in anterior lower face height (P<.01). Statistically significant intergroup differences were found in the ANB angle(P<.05) and maxillary intercanine (P<.01) measurements. Conclusion: With both RME and SARME, successful expansion of maxillary dentoalveolar structures and nasalcavity and palatal widening were achieved. Sagittal plane effects of SARME were similar to those of RME on dental skeletal and airway measurements (AU)