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1.
Am J Orthod Dentofacial Orthop ; 157(2): 245-258, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32005477

RESUMO

INTRODUCTION: An adolescent girl, aged 12 years 11 months, was evaluated for orthodontic treatment. Her chief complaints included a difficulty with keeping her lips passively closed and excessive gingival exposure upon smiling. Her treatment plan included (1) restriction of maxillary growth with cervical headgear, (2) extraction of the maxillary first premolars to reduce the maxillary protrusion and the mandibular second premolars to facilitate Class II dental correction, and (3) management of maxillary incisor intrusion via anchoring with mini-implants. When indicated, even in the absence of large space discrepancies, extractions can be beneficial to the patient. The final results showed an attractive smile, passive lip seal, and a more esthetic and balanced facial profile. Retention records confirmed the stability of the treatment. The 5-year follow-up visit revealed that the treatment results were quite stable.


Assuntos
Implantes Dentários , Má Oclusão de Angle Classe II , Procedimentos de Ancoragem Ortodôntica , Adolescente , Dente Pré-Molar , Cefalometria , Criança , Estética Dentária , Feminino , Humanos , Incisivo , Má Oclusão de Angle Classe II/terapia , Maxila , Técnicas de Movimentação Dentária
2.
Am J Orthod Dentofacial Orthop ; 157(2): 259-268, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32005478

RESUMO

This case report presents the unique treatment of a patient with varying asymmetries at different levels within the face. The patient was a 17-year-old male with a diagnosis of right unilateral coronal synostosis. He had frontal and superior orbital retrusion on the fused side, and bossing of the contralateral side. The middle and lower portions of his face were rotated toward the nonfused side. This unique diagnosis presented particular challenges to surgical and orthodontic correction. The treatment approach, which included a combination of Le Fort I and II osteotomies, bilateral sagittal split osteotomy, and orthodontic treatment with 4 premolar extractions, enabled simultaneous correction of nasal, midfacial, lower facial, and dental asymmetries. The orthodontist and surgeon integrated their efforts to correct dentofacial asymmetry in all 3 planes of space. Facial esthetics and dental function were significantly improved with no appreciable relapse occurring over a 2-year retention period.


Assuntos
Craniossinostoses , Estética Dentária , Assimetria Facial , Osteotomia de Le Fort , Adolescente , Craniossinostoses/complicações , Craniossinostoses/cirurgia , Assimetria Facial/cirurgia , Ossos Faciais , Humanos , Masculino
3.
Artigo em Inglês | MEDLINE | ID: mdl-32032410

RESUMO

The objective of this study was to verify differences in eye-tracking metrics and subjective smile esthetic ratings between general practitioners, orthodontists, and laypersons in cases of maxillary lateral incisor gingival margin deviations. Unilateral apical and incisal gingival margin deviations of 1, 2, and 3 mm were digitally produced in pictures of a man and a woman smiling. Specific areas of interest (AOIs) were created in each picture. Eye-tracking metric data included the time to first fixation (TFF) and number of fixations (NF). A specific sensor and software were used to acquire information on the eye movements. Data on the smile esthetic ratings were obtained using a visual analog scale (VAS). Analysis of variance and Pearson correlation were applied. The TFF on the AOIs in the mouth was shorter for general practitioners and orthodontists, signifying that general practitioners and orthodontists rapidly perceived the features in these areas, while for laypersons, the TFF was shorter for the AOIs of the eyes (P < .05). The NF was greater on the AOIs in the mouth for general practitioners and orthodontists, whereas to the laypersons, the NF tended to be greater on the AOIs in the eyes. Mean VAS scores differed between observer groups (P < .05). For the male picture, the 1-mm and 2-mm apical gingival margin deviations received the highest scores from the laypersons, while for both female and male pictures, the 1-mm apical deviation received the highest scores from the general practitioners and orthodontists. Higher VAS scores resulted in longer times that general practitioners and orthodontists spent looking at the gingival margin changes. General practitioners and orthodontists differ from laypersons in their perceptions of smile esthetics. Eye-tracking metrics revealed that the AOIs in the mouth aroused greater interest from the general practitioners and orthodontists, and this interest became greater as the gingival margin deviations increased to 3 mm. Laypersons fixated more on the AOIs of the eyes. The VAS scores indicated that general practitioners and orthodontists were more critical than laypersons, accepting smaller deviations in the gingival margins of the maxillary lateral incisors.


Assuntos
Estética Dentária , Incisivo , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Ortodontistas , Sorriso
4.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(1): 37-41, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32037764

RESUMO

OBJECTIVE: To propose and evaluate the clinical effect of midpiece facial nerve dissection through transparotid approach in regional parotidectomy. METHODS: A total of 136 patients with benign parotid tumors were categorized into three groups according to the way of facial nerve dissection: anterograde dissection from main trunk (anterograde, n=70), retrograde dissection from distal branches (retrograde, n=34), and midpiece dissection through transparotid approach (middle dissection, n=32). Surgery duration, facial nerve injury, salivary fistula, earlobe sensation, Frey's syndrome, and aesthetic evaluation were compared. RESULTS: The surgery duration in the middle dissection group was significantly shorter than that in the other two groups. The proportion of salivary fistula was higher in the anterograde group (9 cases, 12.9%; P<0.05) compared with that in the other groups. Postoperative facial nerve injury was similar between the middle dissection (1 case, 3.1%) and anterograde groups (3 cases, 4.3%) with lower injury rate compared with the retrograde group (7 cases, 20.6%). The anterograde group had more cases of hypoesthesia of the earlobe (12 cases, 17.1%; P<0.05) than the other two groups. Aesthetic score was higher in the anterograde and middle dissection groups compared with that in the retrograde group (P<0.05). CONCLUSIONS: Midpiece facial nerve dissection is technically feasible and clinically viable in regional parotidectomy.


Assuntos
Neoplasias Parotídeas , Sudorese Gustativa , Estética Dentária , Nervo Facial , Humanos , Glândula Parótida , Complicações Pós-Operatórias , Estudos Retrospectivos
5.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(1): 95-100, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32037774

RESUMO

Dental implants have become the main choice for patients to fill in their missing teeth. A precise placement is the basis for a functional and aesthetic restoration. A digital surgical guide is a carrier that transfers the preoperative plan of dental implants to the actual surgery. This paper provides some references that can help clinicians improve the accuracy of implant surgery by stating the development, classification, advantages and disadvantages, and factors that affect the accuracy of digital guides.


Assuntos
Implantes Dentários , Cirurgia Assistida por Computador , Projeto Auxiliado por Computador , Implantação Dentária Endo-Óssea , Estética Dentária , Humanos , Imagem Tridimensional , Planejamento de Assistência ao Paciente
6.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(1): 101-103, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32037775

RESUMO

This article reports a case of an orthodontic adolescent patient without a right inferior incisor. The right lower canine was used as the abutment. The single-retainer all-ceramic resin-bonded fixed partial denture was used to restore the complete dentition. Thus, the missing space was filled, and the function and aesthetics were restored.


Assuntos
Prótese Adesiva , Adolescente , Cerâmica , Planejamento de Dentadura , Prótese Parcial Fixa , Estética Dentária , Humanos , Incisivo
7.
Artigo em Inglês | MEDLINE | ID: mdl-32032399

RESUMO

Growth factors have been used in numerous oral applications to aid in bone formation after tooth extraction. Bone morphogenetic proteins (BMPs) are members of the transforming growth factor-b superfamily and are involved in the differentiation of pluripotent mesenchymal cells, leading to new bone formation through osteoblastic induction. This study examined histologic wound healing following extraction and ridge preservation using recombinant human BMP-2 (rhBMP-2) and a collagen sponge. Formation of new vital bone was seen, suggesting that this material is a viable option for ridge preservation in preparation for implant placement.


Assuntos
Aumento do Rebordo Alveolar , Implantes Dentários , Processo Alveolar , Proteína Morfogenética Óssea 2 , Proteínas Morfogenéticas Ósseas , Estética Dentária , Humanos , Osteogênese , Proteínas Recombinantes , Fator de Crescimento Transformador beta
8.
Compend Contin Educ Dent ; 41(1): 42-49, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31895580

RESUMO

Radiation therapy for patients with head and neck cancer can have damaging effects on oral health, including reduced salivary flow. In this case report, a 58-year-old patient had previously undergone radiation therapy for stage II squamous cell carcinoma of the larynx. Symptoms of xerostomia persisted, and her dentition suffered as a result. Problems included moderate to severe loss of tooth structure; erosive pitting lesions on the cusp tips of posterior teeth; and attrition throughout her dentition, particularly in the anterior. To achieve the esthetic, functional, and biomechanical goals of the case, treatment involved the use of both full-coverage, cohesively retained restorations and feldspathic veneers, depending on the amount of adequate enamel available for adhesion, along with limited orthodontic therapy. Additionally, the patient was instructed on how to stimulate salivary flow post-treatment.


Assuntos
Dentição , Neoplasias de Cabeça e Pescoço , Esmalte Dentário , Estética Dentária , Feminino , Humanos , Pessoa de Meia-Idade , Sobreviventes
9.
Compend Contin Educ Dent ; 41(1): 34-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895581

RESUMO

Dental implants are often a preferred option when replacing missing teeth. In the esthetic zone, however, a proper soft-tissue framework is essential to accommodate the final restorations. A wax-up and subsequent esthetic provisional prototype are key components for planning prior to implant placement and performing any grafting procedures that may be needed. This case report describes a combination treatment approach that incorporates orthodontics, implant placement, and restorative dentistry to achieve the maximum esthetic potential the patient desired. The article outlines proper diagnosis, treatment planning, and sequencing.


Assuntos
Implantes Dentários para Um Único Dente , Implantes Dentários , Implantação Dentária Endo-Óssea , Prótese Dentária Fixada por Implante , Estética Dentária , Humanos , Sorriso
10.
J Craniomaxillofac Surg ; 48(1): 117-121, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31889611

RESUMO

PURPOSE: The aim of the study was to compare local and distant flaps for facial reconstruction after resection of cutaneous squamous cell carcinoma. PATIENTS AND METHOD: Fifty patients with facial CSCC and subsequent facial reconstruction were retrospectively analysed. All complications such as wound infection, wound dehiscence, flap necrosis, partial or total flap loss were recorded. The aesthetic outcome was evaluated using colour prints of patients' photographs of different flaps in terms of skin colour, texture and scars by three judges. To compare the aesthetic outcome of distant and local flaps a Wilcoxon-Mann-Whitney-U-Test was applied. RESULTS: The overall complication rate was low. Colour and texture of local flaps presented statistically significantly better results compared to distant flaps. There were no statistically significant differences between scars of local flaps and distant flaps (p = 0.528). A slight tendency was found showing scars of local flaps to be less visible than scars of distant flaps in defects extending in more than one facial aesthetic unit. CONCLUSION: Local flaps show statistically significant ly better aesthetic results compared to distant flaps in terms of colour and texture. Scars of local flaps seem to be slightly less visible compared to distant flaps in cases where defects were bridging more than one facial aesthetic unit. We conclude that local flaps should be preferred over free flaps whenever possible as far as the aesthetic outcome is concerned.


Assuntos
Carcinoma de Células Escamosas , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Cutâneas , Estética Dentária , Humanos , Estudos Retrospectivos
11.
Am J Orthod Dentofacial Orthop ; 157(1): 98-104, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31901288

RESUMO

INTRODUCTION: Esthetic improvement is a key motivator in undergoing orthodontic treatment. This study aims to quantify the contribution of the smile and other facial components to the overall esthetics of attractiveness. METHODS: The attractiveness of 60 subjects (30 men, 30 women), aged 18-35 years, before orthodontic treatment, was retrospectively evaluated by 8 laypersons using the Visual Analog Scale. Pearson and stepwise correlations were calculated between the attractiveness of the smiling face and the attractiveness of facial components; namely the smile, nose, eyes, hair, chin, eyebrows, and skin. RESULTS: A strong correlation between the face and smile attractiveness was found (r = 0.71) for the whole sample. No significant correlations were found between attractiveness and the other facial components. When divided by gender, the smile (r = 0.70) and the eyes (r = 0.51) correlated with the attractiveness of the smiling face for men. For women, the face registered a significant correlation with the smile (r = 0.83) and the skin (r = 0.37). CONCLUSIONS: In general, smile attractiveness was strongly correlated with the attractiveness of the smiling face, which is the only significant component. For men, the smile was responsible for 49% of the variation in the attractiveness of the smiling face, the eyes for 22%, and the hair for 6%. For women, 69% of the variation in facial attractiveness could be attributed to smile.


Assuntos
Correlação de Dados , Sorriso , Adolescente , Adulto , Estudos Transversais , Estética Dentária , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
12.
Int J Oral Maxillofac Implants ; 35(1): 150-159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923298

RESUMO

PURPOSE: To clinically evaluate a recently developed, standardized, three-implant-supported full-arch treatment concept for fully edentulous mandibles. MATERIALS AND METHODS: This ongoing multinational prospective cohort study is evaluating the performance of the treatment concept over 5 years in patients who were fully edentulous or had failing dentition of the mandible. The primary outcome was the cumulative survival rate of implants (CSRI). Secondary outcomes included the cumulative survival rate of the prostheses (CSRP), marginal bone level change, soft tissue outcomes, impact on quality of life, and patient and clinician satisfaction. The 1-year report is presented here. RESULTS: In total, 110 patients (330 implants) were included. Prostheses underwent immediate loading in 76.4% of cases and early loading in 23.6% of cases. The mean surgical time was 1.60 ± 0.78 hours, and the mean laboratory time was 3.99 ± 1.74 hours. At 1 year, eight implants and three prostheses failed, yielding an implant-level CSRI of 97.5% and a CSRP of 97.3%. All prosthetic failures were due to loss of two implants in the patient. The mean marginal bone level change at 1 year was -0.62 ± 1.39 mm. Among soft tissue outcomes, the Bleeding Index improved significantly between the 6-month and 1-year follow-up, and 242 implants (75%) were surrounded by keratinized mucosa by the 6-month follow-up. Patients reported a significant improvement in quality of life between prosthesis placement and the 6-month follow-up based on the Oral Health Impact Profile for Edentulous 21 questionnaire. Both patient and clinician satisfaction with function and esthetics were high throughout treatment. CONCLUSION: This novel treatment concept using a passively fitting standardized framework with simplified surgical and prosthetic workflow demonstrated high survival and excellent outcomes at 1 year while reducing chair and fabrication time. This concept may offer patients a safe and efficient option for full-arch mandibular prostheses.


Assuntos
Implantes Dentários , Arcada Edêntula , Mandíbula , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Estética Dentária , Seguimentos , Humanos , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
13.
Int J Oral Maxillofac Implants ; 35(1): 167-177, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923299

RESUMO

PURPOSE: To identify whether or not immediate loading yields different clinical outcomes from conventional loading of single-tooth implants in the esthetic zone. MATERIALS AND METHODS: Various databases (MEDLINE/PubMed, Cochrane [CENTRAL], and Embase) were searched electronically to find articles published in the English language from January 2000 to April 2018. Only randomized controlled clinical trials (RCTs) that compared conventional and immediate implant loading with a minimum follow-up period of 1 year or more were considered. Available data were pooled for meta-analysis using the Review Manager software. RESULTS: Seven RCTs were included. There was no significant difference between immediate and conventional loading protocols on implant survival at the 1-year follow-up (risk ratio [RR] = 0.99; 95% confidence interval [CI]: 0.95 to 1.02). The differences regarding marginal bone loss between the two protocols were statistically insignificant (mean difference [MD] = 0.03 mm; 95% CI: -0.09 to 0.15 mm at the 1-year follow-up, and MD = -0.01 mm; 95% CI: -0.16 to 0.15 mm at the 2-year follow-up). Soft tissue changes following different loading protocols revealed no significant differences in the mesial papillae (MD = 0.30 mm; 95% CI: -0.25 to 0.85 mm), the distal papillae (MD = -0.00 mm; 95% CI: -0.42 to 0.42 mm), and the midfacial mucosa (MD = -0.33 mm; 95% CI: -1.17 to 0.50 mm) at the 1-year follow-up. The esthetic outcomes and patient satisfaction were reported in two and three RCTs, respectively. CONCLUSION: A short-term follow-up of single-tooth implants in the esthetic zone showed that the loading protocols (conventional or immediate loading) are not likely to influence the clinical outcomes, including implant survival and peri-implant stability of soft and hard tissues.


Assuntos
Implantes Dentários para Um Único Dente , Carga Imediata em Implante Dentário , Implantação Dentária Endo-Óssea , Estética Dentária , Humanos , Satisfação do Paciente
14.
Int J Oral Maxillofac Implants ; 35(1): e15-e20, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31923302

RESUMO

This case report describes a digital workflow for a computer-aided design/computer-assisted manufacturing (CAD/CAM) healing abutment used in immediate implant placement in the esthetic zone. The design of the healing abutment was based on the existing tooth anatomy in order to provide anatomical support to the gingival tissues and to preserve the gingival contours of the natural tooth. This approach enhances the esthetic outcome of the definitive implant restoration. The surgical procedure including the guided bone regeneration is simplified, postoperative morbidity is reduced, and excessive occlusal loading during healing is limited.


Assuntos
Projeto Auxiliado por Computador , Implantes Dentários , Estética Dentária , Planejamento de Prótese Dentária
15.
Int J Esthet Dent ; 15(1): 16-42, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994534

RESUMO

Noncarious cervical lesions (NCCLs) involve the loss of hard tissue from the cervical areas of teeth through processes unrelated to caries. NCCLs are nowadays a common pathology caused by changes in lifestyle and diet. The prevalence and severity of cervical wear increase with age. It is generally accepted that the lesions are not generated by a single factor but result from a combination of factors. Among the factors proposed to be related to the formation and progression of NCCLs are biocorrosion (erosion), friction (abrasion), and possibly occlusal stress (abfraction). The clinical appearance of NCCLs can vary depending on the type and severity of the etiologic factors involved. Practitioners should follow a checklist to achieve an accurate diagnosis of the etiology of multifactorial NCCLs. The successful prevention and management of NCCLs require an understanding of the etiology and risk factors, including how these change over time in individual patients. The decision to monitor NCCLs rather than intervene should be based on the progression of the lesions and how they compromise tooth vitality, function, and esthetics. Treatment options include techniques to alleviate dentin hypersensitivity and the placement of an adhesive restoration, eventually in combination with a root coverage surgical procedure. An adhesive restoration is considered the last treatment option for NCCLs. Based on their excellent esthetic properties and good clinical performance, there is a general indication to place composite restorations for NCCLs. The clinical performance of these restorations is highly product-dependent, particularly regarding the adhesive system used. The type of composite material seems to have no significant influence on the clinical performance of NCCL restorations in clinical trials. It is much more important that the operator carries out the clinical procedure correctly. Marginal degradation is frequently seen during aging. Yearly maintenance with the eventual repolishing of the restoration margins will lengthen the lifespan of the restorations.


Assuntos
Cárie Dentária , Sensibilidade da Dentina , Cimentos Dentários , Restauração Dentária Permanente , Estética Dentária , Humanos , Colo do Dente
16.
Int J Esthet Dent ; 15(1): 56-67, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994536

RESUMO

Harvesting good-quality connective tissue grafts (CTGs) is important in periodontal surgery. Compared with CTGs, free gingival grafts (FGGs) have a slower healing process and higher donor site morbidity. As far as graft quality and anatomic limitations are concerned, deepithelialized free gingival grafts (DE-FGGs) are superior to CTGs. In the current study, a modified combined approach is proposed that aims to address the disadvantages of conventional FGG harvesting methods. This approach entails harvesting a thin and narrow DE-FGG, repositioning the epithelial layer, and applying a plastic stent. The outcomes of this improved method indicate fast healing at the donor sites, fewer postoperative complications, and better esthetic results at the recipient sites.


Assuntos
Retração Gengival , Tecido Conjuntivo , Estética Dentária , Gengiva , Humanos , Cicatrização
17.
Int J Esthet Dent ; 15(1): 68-91, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994537

RESUMO

Periimplantitis in a malpositioned maxillary anterior implant is one of the most challenging situations in implant dentistry. Since the regenerative treatment can often be unpredictable and have esthetic consequences such as soft tissue recession due to flap raising, extraction is sometimes recommended. In order to place a new implant after extraction, a bone regeneration procedure must be carried out. This implies raising a flap and therefore the risk of further interproximal gingival recession. In the case presented in this article, a hopeless implant at position 11 presented severe periimplantitis and soft tissue recession, which also affected the mesial part of tooth 12. Tooth 21 had a root canal treatment and a crown. After the implant extraction, a minimally invasive simultaneous bone regeneration and soft tissue graft procedure was performed to reconstruct the remaining ridge using xenograft, a collagen membrane, and a connective tissue graft (CTG). Ten months later, in order to improve the ridge profile, an augmentation procedure was carried out using a CTG. Three months later, an implant was placed and immediately loaded. Three months after loading, the right lateral incisor that still presented a mesial gingival recession was slowly extruded by orthodontic treatment until the papilla was symmetrical to the contralateral one. At the end of the orthodontic extrusion, an implant-supported crown was placed at position 11 and a tooth-supported crown delivered in place of tooth 21. A composite restoration was performed on tooth 12. One year later, the soft tissue level was almost symmetrical at incisor level and the periimplant bone level at implant 11 was stable.


Assuntos
Aumento do Rebordo Alveolar , Implantes Dentários para Um Único Dente , Retração Gengival , Implantação Dentária Endo-Óssea , Estética Dentária , Humanos , Incisivo , Maxila , Extração Dentária
18.
Int J Esthet Dent ; 15(1): 92-106, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994538

RESUMO

OBJECTIVE: The aim of this study was to create mathematical modeling to generate statistical models that reliably and quickly identify facial type while smiling. This analysis enables the creation of a digital design for the prosthetic restoration of the anterior teeth. MATERIALS AND METHODS: The study involved the computer analysis of 91 facial images. Through mathematical modeling, digital facial maps were generated consisting of 27 landmark points and 12 basic lines determining the facial type. Four main facial types were defined for the purposes of this study: strong, dynamic, delicate, and calm. Selected data were recorded in a database and analyzed using IBM SPSS Modeler software. RESULTS: A varying number of combinations characterize the face; 61.5% of people have the features of two facial types, and 38.5% of three facial types. The overall analysis of the data for both genders shows the most accurate model for predicting facial type by digital facial map is the created algorithm C5.1 (classification tree), with a general prediction accuracy of 84.3%. CONCLUSION: Dental Anatomical Combinations with Rebel Simplicity systems is a constructive way to ensure harmonious unity between the teeth and the facial type. Digital facial maps provide reliable and fast identification of the facial type while smiling. This analysis enables the creation of a digital design for the prosthetic restoration of the anterior teeth.


Assuntos
Sorriso , Dente , Estética Dentária , Face , Feminino , Masculino
19.
Oral Maxillofac Surg ; 24(1): 93-101, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31907677

RESUMO

AIM AND OBJECTIVE: A prospective study done to evaluate the efficacy of tongue flaps in secondary palatal defects, in terms of functionality, esthetics, and donor site morbidity, and to clarify the technique of elevating and insetting of tongue flap. MATERIALS AND METHOD: Twenty patients having recurrent secondary palatal fistula, post cleft treatment were treated with anteriorly and posteriorly based dorsal tongue flaps. Patients were evaluated for outcome in terms of flap uptake and effectiveness, correction of oronasal regurgitation, speech and articulation, donor site morbidity, and esthetics. RESULTS: Twenty patients in age range of 11-24 years, with secondary palatal fistulae, were treated with anteriorly/posteriorly based tongue flap. There were two recurrences as the flap got detached in one patient and necrosis of flap in another. In other patients, healing was uneventful. The flap showed good success rate in terms of uptake and correction of oronasal regurgitation, with imperceptible donor site morbidity. With speech therapy assistance and periodic evaluation by a therapist, significant improvement in speech and articulation was noted over time in all successfully healed patients. CONCLUSION: Use of tongue flap for repair of palatal fistulae is a successful technique as it provides appreciable quality and quantity of well-vascularized tissue for fistula closure with negligible functional and esthetic morbidity associated with donor site. As per our study, it is a reliable technique for palatal fistula closure. It even provides good speech improvement over time.


Assuntos
Fissura Palatina , Fístula , Adolescente , Adulto , Criança , Estética Dentária , Humanos , Estudos Prospectivos , Retalhos Cirúrgicos , Língua , Adulto Jovem
20.
J Oral Rehabil ; 47(2): 212-220, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31742736

RESUMO

OBJECTIVES: To explore impairments due to tooth loss and expectations of prosthetic replacements in an urban group and a rural group of patients in Sweden. MATERIAL AND METHODS: Semi-structured interviews were performed on 35 partially edentulous patients from prosthodontic specialist clinics located in an urban area and a rural area in Sweden. The interviews focused on impairments due to tooth loss and expectations of prosthetic restorations. Analysis was made using the grounded theory approach, allowing in-depth investigation of the phenomenon. RESULTS: Functional, aesthetic and social impairments were mentioned, and coping strategies (eg chewing differently and laughing less) and modifications (eg age, time and social setting) of the impairments were described. The rural patient group accepted impairments somewhat better than the urban one. Otherwise, there was only minor difference between the groups. Removable prosthodontic restorations were more acceptable among rural patients. Urban patients insisted more often on implant-based restorations and had higher expectations of longevity. Patients with minor impairments still wanted treatment, based on concerns about the future of their dentition. The interviews themselves generated new thoughts in the patients and were thus considered valuable by the patients. CONCLUSIONS: Impairments due to tooth loss and expectations of prosthetic replacements were expressed in the same way in the rural and urban patient groups. However, in the rural population, there was a higher acceptance of impairments and also of removable prosthetic restorations, whereas the urban population expressed a higher demand for implant-based restorations.


Assuntos
Perda de Dente , Estética Dentária , Humanos , Motivação , Suécia , População Urbana
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