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1.
Int J Oral Maxillofac Implants ; 35(1): 79­90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31532823

RESUMO

PURPOSE: The aim of this study was to compare tissue-engineered bone using mesenchymal stem cells (MSCs) and conventional bone grafts in terms of histomorphometric outcome, bone gained, and implant failure in the atrophic maxilla. MATERIALS AND METHODS: A systematic review and meta-analysis of randomized clinical trials (RCTs) was conducted. An electronic search of several databases was performed. RCTs comparing tissue-engineered bone using MSCs to bone graft alone in rehabilitation of the atrophic maxilla were included. Outcome variables were a mean percentage of new bone formation, residual graft particles, and connective tissue. Bone gained and implant failure rate were also assessed. Risk ratio (RR) or standardized mean differences (SMD) were statistically analyzed. RESULTS: A total of 190 augmented sites enrolled in 12 RCTs were included in this study. Nine of the 12 RCTs included 153 maxillary sinuses that underwent sinus elevation, and three RCTs included 28 patients with bone grafting only. There was no significant increase in new bone formation between the two groups at 3 to 4 months (SMD = -0.232, CI, -0.659 to 0.195, low-quality evidence). However, at 6 months postgrafting, a statistically significant increase in new bone formation was found in favor of the tissue-engineered bone using the MSC group (SMD = 0.869%, CI, -1.98 to 9.310, moderate-quality evidence). No substantial difference was found between the two groups with respect to residual graft particles, connective tissue, bone gained, and implant failure rate (RR = 2.8, CI: 0.517 to 16.6, P = .226, very low-quality evidence). CONCLUSION: There is moderate- to very low-quality evidence supporting the use of tissue-engineered bone using MSC therapy in maxillary alveolar bone regeneration compared with conventional bone grafting without MSCs.


Assuntos
Aumento do Rebordo Alveolar , Transplante Ósseo , Implantação Dentária Endo-Óssea , Células-Tronco Mesenquimais , Humanos , Maxila/cirurgia , Seio Maxilar
3.
J Craniomaxillofac Surg ; 47(12): 1868-1874, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31812310

RESUMO

BACKGROUND: Maxillary advancement may affect speech in cleft patients. AIMS: To evaluate whether the amount of maxillary advancement in Le Fort I osteotomy affects velopharyngeal function (VPF) in cleft patients. METHODS: Ninety-three non-syndromic cleft patients (51 females, 42 males) were evaluated retrospectively. All patients had undergone a Le Fort I or bimaxillary (n = 24) osteotomy at Helsinki Cleft Palate and Craniofacial Center. Preoperative and postoperative lateral cephalometric radiographs were digitized to measure the amount of maxillary advancement. Pre- and postoperative speech was assessed perceptually and instrumentally by experienced speech therapists. Student's t-test and Mann-Whitney's U-test were used in the statistical analyses. Kappa statistics were calculated to assess reliability. RESULTS: The mean advancement of A point was 4.0 mm horizontally (range: -2.8-11.3) and 3.9 mm vertically (range -14.2-3.9). Although there was a negative change in VPF, the amount of maxillary horizontal or vertical movement did not significantly influence the VPF. There was no difference between the patients with maxillary and bimaxillary osteotomy. CONCLUSIONS: The amount of maxillary advancement does not affect the velopharyngeal function in cleft patients.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Osteotomia Maxilar/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteotomia de Le Fort/métodos , Fala/fisiologia , Insuficiência Velofaríngea/fisiopatologia , Adolescente , Adulto , Cefalometria/métodos , Fenda Labial/fisiopatologia , Fissura Palatina/fisiopatologia , Feminino , Finlândia , Humanos , Masculino , Avanço Mandibular/métodos , Maxila/anormalidades , Maxila/cirurgia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Distúrbios da Fala/fisiopatologia , Distúrbios da Fala/cirurgia , Resultado do Tratamento , Insuficiência Velofaríngea/cirurgia , Adulto Jovem
4.
J Craniomaxillofac Surg ; 47(12): 1881-1886, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31812313

RESUMO

In synchronous primary premaxillary setback and cleft lip repair for bilateral cases with severely protruding premaxilla, stabilization of the premaxilla is mostly achieved by gingivoperiosteoplasty. This kind of repair carries risk of impairment of blood supply to the premaxilla and/or prolabium, and at the same time it cannot ensure adequate stabilization of the premaxilla postoperatively. To overcome these problems, we have developed a unique technique of fixation of the premaxilla. In this paper, we discussing this technique, its advantages, and potential complications associated with it. From 2016, 10 patients aged 4-10 months, with bilateral cleft lip and palate with premaxillary protrusion (≥10 mm) underwent premaxillary setback and cheilorhinoplasty in the same stage. Instead of gingivoperiosteoplasty, a 'lag screw' fixation technique was used to stabilize the premaxilla. The follow-up period ranged between 5 and 32 months. In all the cases, we achieved adequate stabilization of the premaxilla. None of the patients had any issue related to the vascularity of the premaxilla or prolabium. There was no impairment in the eruption process of deciduous teeth in the premaxillary segment. Overall aesthetic outcomes of the lip and nose were acceptable. This technique of premaxillary fixation with lag screw gives us the liberty to perform primary cheilorhinoplasty along with premaxillary setback in the same stage, without risking the vascularity of premaxilla and prolabium. It ensures adequate stabilization of the premaxilla, but evaluation of regular growth of the midface and, if needed, corrective orthodontic and surgical treatment in the follow-up periods are advisable.


Assuntos
Parafusos Ósseos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Maxila/anormalidades , Maxila/cirurgia , Osteotomia Maxilar/métodos , Vômer/cirurgia , Estética Dentária , Feminino , Humanos , Lactente , Masculino , Procedimentos Ortopédicos/métodos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(48): e17756, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31770194

RESUMO

BACKGROUND: Surgically assisted rapid maxillary expansion (SARME) generates an uncomfortable postoperative period accompanied by pain, edema, and paresthesia. There are few studies on the effect of photobiomodulation (PBM) after SARME and it was not possible to find studies on the efficacy of light emitted by diode (LED) after this type of intervention. The main objective of the study will be to evaluate the efficacy of PBM with LED in the control of pain, facial edema, paresthesia, and bone repair after SARME. METHODS: A randomized, double-blind, placebo-controlled clinical trial involving 72 participants aged from 18 to 45 years, who search the Department of Buccomaxillofacial Surgery and Traumatology of Mandaqui Hospital Complex, will be conducted. Immediately after surgeries, the participant will be inserted into the placebo or LED group. In the LED group, the participants will receive PBM with an extraoral device (660 and 850 nm with 6 J per point) and an intraoral device (660 nm with 2 J per point) and in the control group the person in charge of the application will simulate the irradiation with the devices kept off. The applications will be in the immediate postoperative period, 1, 2, 7, 14, 30, 60, 90, and 120 days after the end of the surgeries, when the evaluations will also be performed. Facial measurements, extra and intraoral sensitivity, pain and bone repair will be evaluated. Secondarily, data regarding the occurrence of headache; otalgia; nausea; bruising; nasolacrimation; epistaxis; dysphagia; systemic and superficial temperature in the operated region; use of analgesics and anti-inflammatories; anxiety and impact of oral health on the participants' quality of life will be computed. DISCUSSION: Since PBM has shown positive effects on postoperative complications of other types of oral surgery and also has a positive effect on bone repair after maxillary disjunction, surgically assisted or not, it seems clear the need to evaluate its performance regarding pain, edema, and paresthesia after these surgeries. TRIAL REGISTRATION: This protocol was registered in Clinical Trials platform (https://clinicaltrials.gov/) with the number NCT03814525, first published and last updated on January 24, 2019.


Assuntos
Edema/terapia , Terapia com Luz de Baixa Intensidade/métodos , Doenças Maxilares/terapia , Dor Pós-Operatória/terapia , Técnica de Expansão Palatina/efeitos adversos , Parestesia/terapia , Complicações Pós-Operatórias/terapia , Adolescente , Adulto , Regeneração Óssea , Método Duplo-Cego , Edema/etiologia , Feminino , Humanos , Masculino , Maxila/cirurgia , Doenças Maxilares/etiologia , Pessoa de Meia-Idade , Parestesia/etiologia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
6.
J Craniofac Surg ; 30(6): 1873-1874, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31756876

RESUMO

Bone graft augmentation in the anterior maxilla has a high successful rate. However, suture dehiscence and consequent bone graft exposure can compromise and fail this procedure. Therefore, this article presents a new strategy of closure technique to guarantee the bone graft augmentation. The sutures occur in muscular and mucous planes to avoid suture tension, thus decreasing complications of bone graft augmentation in the anterior maxilla.


Assuntos
Transplante Ósseo/métodos , Maxila/cirurgia , Implantação Dentária Endo-Óssea , Implantes Dentários , Humanos
7.
J Craniomaxillofac Surg ; 47(12): 1839-1847, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31699397

RESUMO

This study aimed to compare the effectiveness and feasibility of inverted-L osteotomy (ILO) and sagittal split ramus osteotomy (SSRO) on obstructive sleep apnea (OSA) treatment. According to different surgery procedures, 28 OSA patients who underwent maxillomandibular advancement (MMA) were divided into 2 groups (group A: ILO, n = 9; group B: SSRO, n = 19). Polysomnography (PSG) and Epworth sleepiness scale (ESS) on T0, T1and T2 were used to evaluate the effectiveness of OSA treatments. Patients' airway structures and facial appearances were also evaluated. From T0 to T1, the mean apnea-hypopnea index (AHI,/per hour) dropped from 69.2 ± 8.4 to11.2 ± 2.4 (P < 0.01) in group A and from 54.6 ± 14.6 to 9.4 ± 5.4 (P < 0.01) in group B; LSpO2 (lowest pulse oxygen saturation, %) increased from 66.5 ± 7.7% to 88.2 ± 4.6 (P < 0.01) and from 76.6 ± 10.7%to 89.4 ± 2.4% (P < 0.01) while the mean ESS score decreased by 51% in group A and 44% in group B. Most patients (group A: 88.9%; group B: 84.3%) were satisfied with their postoperative appearance. Mild relapse was observed in both groups on T2. This study concluded that MMA containing ILO and MMA containing SSRO are both feasible and effective for selected OSA patients.


Assuntos
Avanço Mandibular/métodos , Osteotomia Sagital do Ramo Mandibular , Apneia Obstrutiva do Sono/cirurgia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Maxila/cirurgia , Osteotomia/métodos , Polissonografia , Estudos Retrospectivos , Resultado do Tratamento
8.
J Craniomaxillofac Surg ; 47(11): 1690-1698, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31677987

RESUMO

The aim of this study was to review the effects of early and late hard palate repair on maxillary growth. PubMed, Scopus, Web of Science, LILACS, Cochrane Library CENTRAL databases, OpenGrey, Google Scholar, and Clinical Trials were searched using a PICO strategy, with terms related to unilateral cleft lip and palate (UCLP) and timing of repair. Methodological quality evaluation was carried out using the Fowkes and Fulton guidelines, and quality (or certainty) of evidence and strength of recommendations were evaluated using GRADE (grading of recommendations, assessment, development and evaluation). Five retrospective and non-randomized studies were included in the study. Folkes and Fulton assessment showed a high risk of bias in all articles and very low levels of certainty (GRADE). The results showed conflicting findings for comparisons of the effects of timing of repair of hard palate in UCLP. Two studies presented better maxillary growth in a group operated on later (18 months after birth), two presented no differences between the results, and another presented better results in the group operated on earlier than 18 months of age. At this point, it cannot be proven or refuted that postponing hard palate surgery brings benefits for maxillary growth. Studies included in this review did not show similar conclusions. Randomized clinical trials present some ethical issues that make them difficult to perform.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Maxila/anormalidades , Maxila/cirurgia , Humanos , Lábio , Estudos Retrospectivos
9.
J Craniofac Surg ; 30(8): 2479-2482, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31689730

RESUMO

OBJECTIVES: To retrospectively assess malocclusions, skeletal relationships and the functional needs of orthognathic patients treated in a University teaching hospital. SUBJECTS AND METHODS: This study used clinical records of 100 consecutive patients [51 female, 49 males, mean (SD) age =21.5 (2.71) years] who had orthognathic surgery in a Shahid Beheshti University of Medical Sciences affiliated hospital (9/2014-7/2017). Malocclusion type (incisor classification), sagittal skeletal pattern (ANB angle), index of orthognathic functional treatment need (IOFTN) score, and osteotomy type were recorded. RESULTS: Overall, 66%, 31%, and 3% had Class III, II, and Class I malocclusions, respectively. Similarly, 68% and 32% had Class III and II sagittal skeletal relationships, respectively. Overall, 95% of patients scored IOFTN 4 or 5. The most prevalent IOFTN score were 4.3 (37%), 5.3 (16%), 5.4 (16%), and 4.2 (10%). There were no gender differences (P >0.05) for the distribution of malocclusions, sagittal skeletal relationships, different IOFTN scores, or when IOFTN scores were re-grouped (5, 4, and ≤3). When IOFTN scores were re-grouped (5, 4, and ≤3), they were equally distributed among patients with Class II or III skeletal relationships (P >0.05), but when the authors looked at different malocclusions, there were significant differences in IOFTN score distribution (P = 0.006). The use of genioplasty (4%) or distraction osteogenesis (2%) was limited. Single jaw surgery of either maxilla or mandible was used in 15% and 22% of patients, respectively. About 63% had undergone double-jaw surgery. CONCLUSION: Retrospective assessment using IOFTN identified 95% of patients as having great and very great functional needs, but prospective studies using IOFTN is needed to assess the need for orthognathic surgery. Class III malocclusions and Class III sagittal skeletal relationships were more common in this sample.


Assuntos
Má Oclusão/cirurgia , Adulto , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Procedimentos Ortopédicos , Estudos Retrospectivos , Adulto Jovem
10.
J Craniofac Surg ; 30(8): 2560-2564, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31689731

RESUMO

BACKGROUND: This study aimed to analyze 3-dimensional nasolabial soft tissue changes following double jaw surgery with Le Fort I maxillary advancement and relate them to underlying surgical movements. METHODS: Pre- and post-surgical cone-beam computed tomography images of 37 maxillomandibular surgery patients with ≥2 mm of advancement at A-point were analyzed. Lateral cephalograms were constructed to determine horizontal and vertical surgical movements and 3-dimensional facial images were created from the CBCTs to calculate linear and angular changes. RESULTS: Alar base width increased 1.9 mm, nasal tip protrusion decreased 0.74 mm, the upper lip flattened 7.71 degree and increased 0.9 mm in length, nasal tip was displaced 2.47 mm superiorly causing an increased concavity of 5.52 degree for the overall dorsal surface and 3.99 degree at the supratip break angle (SBA), nasal tip angle decreased 2.16 degree and nasolabial angle decreased 7.37 degree. Correlations were found between underlying surgical movements and nasal tip protrusion, SBA, nasolabial angle (NLA), and nasal tip elevation (NTE). Multiple linear regression equations were calculated to predict changes in SBA from horizontal change at A-point, NLA from horizontal change at B-point, and NTE from the change at A-point horizontally and U1-tip vertically. CONCLUSION: Double jaw surgery with maxillary advancement has significant effects on nasolabial anatomy.


Assuntos
Procedimentos Cirúrgicos Ortognáticos , Adolescente , Adulto , Tomografia Computadorizada de Feixe Cônico , Face/anatomia & histologia , Feminino , Humanos , Imageamento Tridimensional/métodos , Masculino , Maxila/diagnóstico por imagem , Maxila/cirurgia , Pessoa de Meia-Idade , Adulto Jovem
11.
J Craniofac Surg ; 30(8): 2530-2532, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31609960

RESUMO

Osteogenesis imperfecta (OI) is characterized by brittle bones, premature hearing loss, blue sclera, dental abnormalities, and short stature. Maxillofacial pathology is marked in many OI patients and includes a high incidence of class III malocclusion secondary to a retrusive maxilla relative to both the mandible and cranial base.Review of literature shows that most of the orthognathic surgeries performed in the setting of OI are double jaw surgeries, in the form of maxillary advancement and mandibular setback. However, severe maxillary hypoplasia is usually not correctable with single-stage maxillary advancement. Distraction osteogenesis (DO) is a technique that relies on the normal healing process that occurs between controlled, surgically osteotomized bone segments and it is a relatively widely used technique in modern management of craniofacial conditions.Distraction osteogenesis has been reported in only several patients with OI. There is only 1 previously documented case of maxillary distraction in the craniofacial literature. The authors present here the successful management of a patient with OI and severe class III malocclusion using LeFort I osteotomy and DO with an external rigid distractor.At 12 months follow-up, the patient had no complications and maintained stable maxillary position with normal occlusion, improvement of facial appearance, obstructive airway symptoms, speech, and chewing.This case serves to reinforce the safety and efficacy of DO in patients with OI. The authors did not significantly change our distraction protocol and did not have any complications, therefore the authors believe that DO should be the preferable treatment technique for severe malocclusion in OI patient population.


Assuntos
Osteogênese Imperfeita/cirurgia , Osteogênese por Distração , Adolescente , Humanos , Masculino , Mandíbula/patologia , Maxila/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteogênese por Distração/métodos
12.
Clin Ter ; 170(5): e345-e351, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31612191

RESUMO

BACKGROUND: Aim of this retrospective study was to evaluate the most appropriate timing for the implant placement in oral cancer patients treated with radiation therapy. MATERIALS AND METHODS: We collected data for 17 subjects (10 females, 7 males; mean age: 51 ± 19) with malignant oral tumors who had been treated with ablative surgery and radiation therapy of head and neck. The radiotherapy was set in accordance with the NCCN guidelines. Every patient received dental implant rehabilitation between 2014 and 2016. A total of 84 titanium implants were placed, at a minimum interval of 12 months, in irradiated residual bone. Every patient underwent a minimum follow-up of 12 months. RESULT: Implant loss was dependent on the position and location of the implants (P = 0.05-0.1). Moreover, implant survival was dependent on the total dose of radiation and, mostly, on the timing of implant insertion after the end of the radiation therapy. This result was highly statistically significant (P < 0.01). Whether the implant was loaded is another highly significant (P < 0.01) factor determining survival. We observed significantly better outcomes when the implant was placed at least after 14 months and not loaded until at least 6 months after placement. CONCLUSION: Although the retrospective design of this study could be affected by selection and information biases, we conclude that a delayed implant placement after the end of the radiation therapy and a delayed loading protocol will give the best chance of implant osseointegration, stability and, ultimately, effective dental rehabilitation.


Assuntos
Implantação Dentária Endo-Óssea/métodos , Neoplasias de Cabeça e Pescoço/radioterapia , Mandíbula/cirurgia , Maxila/cirurgia , Adulto , Implantes Dentários , Falha de Restauração Dentária , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
J Craniofac Surg ; 30(7): e655-e658, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31574788

RESUMO

A surgical approach to zygomaticomaxillary complex (ZMC) fracture has not been standardized. The authors reviewed 15 cases of ZMC fractures treated with the swinging eyelid approach and evaluated the effectiveness of the technique by an observational study of Japanese patients. Results were assessed from authentic and functional perspectives: the presence of entropion/ectropion, external canthal malposition and chemosis of the conjunctiva. After a minimum follow-up of 10 months, no patients had lower eyelid ectropion, entropion or retraction. Wounds appeared inconspicuous, and a lateral canthal shape was preserved. No post-operative chemosis of the conjunctiva was observed. Each case was evaluated based on patient satisfaction about their aesthetic outcomes. Patient self-assessment is classified into 4 groups (excellent, good, fair, and unsatisfactory). Thirteen patients were assessed to have an "excellent" outcome, and 2 patients were assessed to have a "good" outcome. No patients had "fair" or "unsatisfactory" outcomes. Avoidance of scarring is a goal of every craniofacial surgeon. The swinging eyelid approach to ZMC fractures offers a simple alternative to the conventional technique. It is versatile and provides sufficient exposure to surgical fields with less visible scar because skin incision is made along the natural crease line, "the crow's feet."


Assuntos
Pálpebras/cirurgia , Fraturas Ósseas/cirurgia , Adulto , Idoso , Cicatriz/patologia , Túnica Conjuntiva/cirurgia , Ectrópio/cirurgia , Entrópio/cirurgia , Feminino , Humanos , Masculino , Maxila/cirurgia , Pessoa de Meia-Idade , Satisfação do Paciente
14.
J Craniofac Surg ; 30(8): 2509-2511, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31567766

RESUMO

Distraction osteogenesis technique has gained popularity and has been established as a successful procedure in the management of cranio-maxillofacial deformities for more than 2 decades. Varieties of distractor designs were evolved for the procedures in the maxilla and mandible. Various distraction parameters are clinically important as planned in each case. Inspite of distraction osteogenesis as a well-accepted procedure, currently there is no single classification available for the distraction procedure in maxilla and mandible taking into consideration all the relevant parameters. A simple and user-friendly classification was designed with coding all the relevant parameters. A retrospective data collection from distracted case records were used to validate the classification. A survey from maxillofacial surgeons in a regional meeting was also carried out. The validation and the survey showed that the new classification is comprehensive, simple, easy to use and beneficial for communication, data storage, research, coding, and billing purposes.


Assuntos
Mandíbula/cirurgia , Maxila/cirurgia , Osteogênese por Distração , Humanos , Cirurgiões Bucomaxilofaciais , Osteogênese por Distração/métodos , Estudos Retrospectivos , Inquéritos e Questionários
15.
Niger J Clin Pract ; 22(9): 1252-1258, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489862

RESUMO

Aims: The purpose of this study is to compare the stresses occurring in the peri-implant bones, implants, crowns, abutments, and screws after loading through finite element analysis by using the poly-ether-ether-ketone (PEEK) materials, which are alternative to titanium abutment and metal supported restorations and to try to reduce the level of neck resorption. Materials and Methods: In our study, three-dimensional modeling of 2 PEEK and titanium abutments, metal-ceramic, and monolithic PEEK upper central dental restorations were made on four titanium implants (Biohorizons® Implant Systems Ins., Birmingham, AL, USA) with diameters of 3.8 mm and 10.5 mm and four groups were obtained. Then, a stress analysis of the finite element was performed by applying a 178 N oblique force of 45° to the long axis of the tooth 2 mm below the incisal edge of the model's palatal surface. Results: It has been observed that the PEEK material reduces the stresses caused by the force applied on itself during all tests. In all groups, PEEK abutments and PEEK crowns have reduced stress on the abutment. The most significant difference is observed in the stresses on the crowns and screws. When the stresses on the crown are examined, the use of PEEK crown reduces the stresses on itself and the use of PEEK abutment increases the stresses on the crown. Conclusions: The stress on the implant system can be changed through the usage of different prosthetic materials.


Assuntos
Prótese Dentária Fixada por Implante , Análise do Estresse Dentário , Análise de Elementos Finitos , Imageamento Tridimensional/métodos , Cetonas , Maxila/cirurgia , Polietilenoglicóis , Coroas , Dente Suporte , Humanos , Maxila/fisiologia , Ligas Metalo-Cerâmicas/química , Estresse Mecânico , Titânio
16.
J Craniofac Surg ; 30(7): e633-e637, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31490437

RESUMO

AIM: The purpose of the present study was to evaluate the impact of orthognathic surgery on quality of life (QoL) in elderly patients. METHODS: Twenty patients who underwent orthognathic surgery to correct Angle Class I, II e, III relations were evaluated. Condition-specific QoL through a 22-item Orthognathic Quality of Life Questionnaire (OQLQ) and generic oral health-related QoL through a 14-item short-form Oral Health Impact Profile (OHIP-14) were assessed. RESULTS: A statistically significant reduction (P < 0.001) in the average overall score was detected between the presurgical and postsurgical assessments. Male group showed significant improvement in physical pain (P = 0.047) and psychological discomfort (P = 0.039). No difference was found between the OHIP-14 (P = 0.582) and OQLQ (P = 0.525) total scores for the type of surgery (mono-maxillary or bimaxillary). CONCLUSIONS: Orthognathic surgical treatment had a positive impact on oral health-related QoL in the patients evaluated. The results of this study emphasize the concept that dental esthetics influence patients' oral health-related QoL.


Assuntos
Cirurgia Ortognática , Idoso , Humanos , Maxila/cirurgia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Ortognáticos/psicologia , Qualidade de Vida , Inquéritos e Questionários
17.
Am J Orthod Dentofacial Orthop ; 156(3): 345-354, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474264

RESUMO

INTRODUCTION: Orthodontic mini-implants are frequently used to provide additional anchorage for orthodontic appliances. The anterior palate is frequently used owing to sufficient bone quality and low risk of iatrogenic trauma to adjacent anatomical structures. Even though the success rates in this site are high, failure of an implant will result in anchorage loss. Therefore, implants should be placed in areas with sufficient bone quality. The aim of the present study was to identify an optimal insertion angle and position for orthodontic mini-implants in the anterior palate. METHODS: Maxillary cone-beam computed tomographic (CBCT) scans from 30 patients (8 male, 22 female, age 18.6 ± 12.0 years) were analyzed. To assess the maximum possible length of an implant, a 25-reference-point grid was defined: 5 sagittal slices were extracted along the median plane and bilaterally at 3 mm and 6 mm distances, respectively. Within each slice, 5 dental reference points were projected to the palatal curvature at the contact point between the cuspid (C) and first bicuspid (PM1), midpoint of PM1, between PM1 and PM2, midpoint of PM2, and between PM2 and the first molar (M1). Measurements were conducted at -30°, -20°, -10°, 0°, 10°, 20°, and 30° to a vector placed perpendicular to the local palatal curvature. Statistical analysis was conducted with the use of R using a random-effects mixed linear model and a Tukey post hoc test with Holm correction. RESULTS: High interindividual variability was detected. Maximum effective bone heights were detected within a T-shaped area at the midpoint of PM1 and contact point PM1-PM2 (P < 0.01). Within the anterior region a posterior tipping was advantageous, whereas in the posterior regions an anterior tipping was beneficial (P < 0.01). In the middle of the median plane, tipping did not reveal a significant influence. No gender- or age-related differences were observed. CONCLUSIONS: Within the limitations of this study, optimal insertion positions were found within a T-shaped area at the height of PM1-PM2 in the anterior palate. In general, a posterior tipping was beneficial at anterior positions, and an anterior tipping appeared beneficial at posterior positions. High interindividual variation was found and should be carefully considered by the clinician.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Implantes Dentários , Maxila/anatomia & histologia , Maxila/diagnóstico por imagem , Procedimentos de Ancoragem Ortodôntica/métodos , Palato/anatomia & histologia , Palato/diagnóstico por imagem , Adolescente , Adulto , Análise de Variância , Dente Pré-Molar , Parafusos Ósseos , Criança , Estudos Transversais , Dente Canino , Feminino , Humanos , Incisivo/anatomia & histologia , Incisivo/diagnóstico por imagem , Masculino , Maxila/cirurgia , Dente Molar , Osso Nasal/anatomia & histologia , Osso Nasal/diagnóstico por imagem , Procedimentos de Ancoragem Ortodôntica/instrumentação , Desenho de Aparelho Ortodôntico , Palato/cirurgia , Adulto Jovem
18.
Am J Orthod Dentofacial Orthop ; 156(3): 391-400, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474269

RESUMO

INTRODUCTION: Orthodontic traction of a maxillary impacted canine (MIC) increases the orthodontic treatment time. Therefore, the objective of this study was to evaluate the influence of MIC characteristics and factors associated with orthodontic treatment on the duration of active orthodontic traction. METHODS: This follow-up and retrospective study included 45 MICs orthodontically tractioned into the occlusal plane with the use of a standardized protocol. MIC characteristics, including type, sector, side, location, height, and complexity of impaction, as well as α and ß angles and canine root length and area were measured. Likewise, factors associated with orthodontic treatment, including sex, age, malocclusion, premolar extractions, previous incisor root resorption, ANB, APDI, and SNA angles, and PNS-ANS distance were also evaluated. The statistical analysis included multiple linear regressions to estimate the influence of all variables on the duration of traction (α = 0.05). RESULTS: Sex had significant influence (P = 0.027) on the time of traction; in female patients, the time was 2.05 months more than in male patients. Bilateral impaction treatment increased the time by 2.74 months compared with unilateral cases (P = 0.001). Traction of bicortically centered impacted canines increased the duration of traction by 2.85 months (P = 0.001). Finally, the traction time increased in 2.35 months (P = 0.046) when the impaction sectors were 4 or 5 (close to the midline). CONCLUSIONS: The duration of active orthodontic traction of MIC is mainly influenced by sex, bilateral type, bicortically centered location, or when MIC is located in sector 4 or 5 close to midline, increasing the traction time by some months.


Assuntos
Dente Canino/cirurgia , Maxila/cirurgia , Ortodontia Corretiva/métodos , Dente Impactado/complicações , Dente Impactado/terapia , Adolescente , Dente Canino/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Incisivo , Masculino , Má Oclusão/classificação , Má Oclusão/terapia , Maxila/diagnóstico por imagem , Procedimentos Cirúrgicos Bucais , Procedimentos de Ancoragem Ortodôntica/instrumentação , Procedimentos de Ancoragem Ortodôntica/métodos , Aparelhos Ortodônticos Fixos , Ortodontia Corretiva/instrumentação , Planejamento de Assistência ao Paciente , Radiografia Dentária , Estudos Retrospectivos , Reabsorção da Raiz/complicações , Fatores Sexuais , Fatores de Tempo , Erupção Dentária , Raiz Dentária/anatomia & histologia , Raiz Dentária/diagnóstico por imagem , Dente Impactado/diagnóstico por imagem , Dente Impactado/cirurgia , Tração , Resultado do Tratamento
19.
Am J Orthod Dentofacial Orthop ; 156(3): 401-411, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474270

RESUMO

A 24-year-old man presented with a severe skeletal class III malocclusion, associated with an anterior and posterior crossbite in the left side, upper and lower lip eversion, skeletal asymmetry, midline discrepancy, diastemas in the maxillary and mandibular dental arches, and agenesis of maxillary lateral incisors and canines with retained deciduous teeth. Treatment was performed with the use of the Win Lingual System. When the 0.016 × 0.022-inch NiTi archiwire was applied, the deciduous teeth were extracted and replaced with temporary crowns connected to the appliance. After the aligning, leveling, and diastema closure phases, a modified Le Fort II osteotomy, a mandibular setback with a bilateral sagittal split osteotomy and a genioplasty were performed. Implants were placed in the canine site through a flapless guided surgery, and cantilevered temporary bridges were delivered. Final prosthetic rehabilitation included veneers for the central incisors and zirconia-ceramic cantilevered bridges for the canine and lateral incisors. After 36 months of active treatment, the patient showed an Angle Class I molar and canine relationship and an ideal overbite and overjet. His profile had improved, lips were competent, and gingival levels were acceptable. The lateral radiograph and cephalometric analysis showed a good balance of the skeletal pattern, a good profile of the soft tissue, and proper inclinations of the maxillary and mandibular incisors in relation to maxilla and mandible. After 2 years of follow-up, the patient had a pleasant smile and no relapse, or joint or muscular pain.


Assuntos
Anodontia/complicações , Má Oclusão de Angle Classe III/terapia , Desenho de Aparelho Ortodôntico/instrumentação , Desenho de Aparelho Ortodôntico/métodos , Aparelhos Ortodônticos , Adulto , Cefalometria , Dente Canino , Implantação Dentária Endo-Óssea , Implantes Dentários , Modelos Dentários , Diastema/cirurgia , Diastema/terapia , Estética Dentária , Humanos , Incisivo , Lábio , Masculino , Má Oclusão de Angle Classe I/complicações , Má Oclusão de Angle Classe III/diagnóstico por imagem , Má Oclusão de Angle Classe III/reabilitação , Má Oclusão de Angle Classe III/cirurgia , Mandíbula/cirurgia , Maxila/cirurgia , Dente Molar , Procedimentos de Ancoragem Ortodôntica/instrumentação , Procedimentos de Ancoragem Ortodôntica/métodos , Braquetes Ortodônticos , Fios Ortodônticos , Osteotomia , Sobremordida/terapia , Radiografia Panorâmica , Técnicas de Movimentação Dentária/instrumentação , Técnicas de Movimentação Dentária/métodos , Adulto Jovem
20.
Stomatologiia (Mosk) ; 98(4): 71-79, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31513154

RESUMO

The aim of this study was to evaluate the effectiveness of combined orthodontic and surgical treatment of patients with maxillary transverse deficiency. Forty cone-beam computed tomograms (CBCT) were examined in 20 patients (mean age 23.5 years) who underwent surgically assisted rapid palatal expansion using a tooth-borne appliance (n=10) and a bone-borne appliance (n=10). Evaluation of the effectiveness of skeletal expansion was carried out with the help of cephalometric analysis of the width of the upper jaw in the coronary projection on the CBCT by 22 parameters. Analysis of the degree of skeletal expansion of the upper jaw before treatment and after removal of the expander allowed to assess the degree of expansion of the upper jaw at different bone levels. Surgically assisted rapid palatal expansion allows to achieve stable skeletal expansion of the upper jaw in the transverse direction with minimal risk of long-term relapse.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Técnica de Expansão Palatina , Adulto , Cefalometria , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Adulto Jovem
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