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1.
BMJ Case Rep ; 14(4)2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888482

RESUMO

We report the case of a 25-year-old man with a maxillary ghost cell odontogenic carcinoma (GCOC). The patient presented to the maxillofacial and head and neck surgery clinic with a growing lump in the left maxilla. Initial workup with CT revealed a cystic lesion in the left upper jaw with associated bone erosion and an enhancing soft-tissue component. Enucleation showed a GCOC associated with a calcifying odontogenic cyst. After the diagnosis was obtained, the patient underwent widening of the first surgical resection. GCOCs are rare odontogenic neoplasms with unspecific clinical and imaging presentation, whose definitive characterisation is based on pathology. Current treatment approaches mainly involve surgical excision, but the prognosis is highly unpredictable due to intertumoral heterogeneity. As tumour recurrences occur in 73% of cases, radical surgery with negative margins is highly recommended. Therefore, it is essential to recognise this entity to offer patients adequate management.


Assuntos
Carcinoma , Neoplasias Maxilares , Cisto Odontogênico Calcificante , Tumores Odontogênicos , Adulto , Humanos , Masculino , Maxila/diagnóstico por imagem , Maxila/cirurgia , Neoplasias Maxilares/diagnóstico por imagem , Neoplasias Maxilares/cirurgia , Recidiva Local de Neoplasia , Tumores Odontogênicos/diagnóstico por imagem , Tumores Odontogênicos/cirurgia
2.
Georgian Med News ; (311): 58-62, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33814392

RESUMO

Surgically assisted rapid maxillary expansion (SARME) is a common technique developed to treat skeletally mature patients with transverse maxillary deficiency. Although SARME is supposed to be a relatively safe procedure, it is not completely free of complications. The purpose of this study was to reveal the most typical postoperative SARME complications. Retrospective evaluation of the clinical cases of 665 patients (247 males and 418 females, mean age 25,3 years) with the diagnosis of maxillary transverse deficiency, who underwent SARME in period between 2012 and 2017 at the Clinical Center of Maxillofacial, Plastic Surgery and Dentistry, Moscow. According to the results of the research, the most typical complications of SARME are paresthesia of the infraorbital nerve branches and nasopalatine nerve (198/665), distraction device dislocation (61/665), inflammation in the distraction device area (57/665), insufficient expansion of the maxilla (42/665), asymmetric expansion (27/665). The number of complications revealed indicates that SARME is an operation associated with the risks of postoperative complications. Careful treatment planning, following the operation protocol and performing the minimally invasive access can help to avoid the majority of complications.


Assuntos
Técnica de Expansão Palatina , Dente , Adulto , Feminino , Humanos , Masculino , Maxila/cirurgia , Estudos Retrospectivos
3.
Artigo em Inglês | MEDLINE | ID: mdl-33819331

RESUMO

This study aimed to assess how frequently the maxilla anatomy allows for lingualized immediate implants in the central incisor region with a screw channel that has an ideal distance of 1.5 mm from the incisal margin. The effect of abutments with angle correction on case selection will also be verified. A retrospective cross-sectional study of 181 CBCT scans was carried out. Using an implant-planning software, implant placement was simulated in the lingual aspect of the socket. The location of the prospective screw channel was registered as incisal, lingual, or facial. The angle between the actual screw channel and the position of the ideal one was calculated. The effect of angle correction on allowing an ideal screw channel configuration was computed. Out of 161 eligible cases, 144 presented favorable anatomy for an immediate implant. The screw channel had an incisal position in 40 cases (28%), a lingual position in 60 cases (42%), and a facial position in 44 cases (30%). The screw channel could be placed at the planned distance from the incisal edge in 35 cases (24%). The position was unfavorable in the remaining 109 cases. In 103 of these cases, an abutment with an angled screw channel could make the conditions feasible. Within the simulated conditions, a majority of maxillary central incisors present favorable ridge anatomy for lingualized immediate implant placement. Achieving a proper location of the screw channel requires abutments with angle correction in a majority of cases.


Assuntos
Implantes Dentários , Tomografia Computadorizada de Feixe Cônico Espiral , Parafusos Ósseos , Estudos Transversais , Estudos de Viabilidade , Humanos , Incisivo/diagnóstico por imagem , Maxila/diagnóstico por imagem , Maxila/cirurgia , Estudos Prospectivos , Estudos Retrospectivos
4.
Artigo em Inglês | MEDLINE | ID: mdl-33819332

RESUMO

The aim of the present case series was to evaluate the outcomes of the modified coronally advanced tunnel technique (MCAT) using the width of keratinized tissue (KTW) as an indicator to apply the connective tissue graft (CTG) specifically. Seven patients requiring treatment for the presence of multiple gingival RT1 recession defects in the maxilla were enrolled in the study. A total of 36 recessions were treated with MCAT, and the CTG was applied in 16 sites presenting < 2 mm of KTW at baseline. The mean root coverage from baseline to 1 year postsurgery was 90% for the sites treated with MCAT alone and 93.7% for those treated with MCAT+CTG. The increase of KTW was higher in the sites treated with CTG than in the sites treated without it. Within the limitations of the present case series, it can be concluded that the proposed surgical technique is extremely effective in gaining root coverage and reducing the amount of connective tissue harvested from the donor site.


Assuntos
Retração Gengival , Tecido Conjuntivo , Gengiva , Retração Gengival/cirurgia , Humanos , Maxila/cirurgia , Retalhos Cirúrgicos , Raiz Dentária , Resultado do Tratamento
5.
Artigo em Inglês | MEDLINE | ID: mdl-33819333

RESUMO

This study aimed to rehabilitate shortened maxillary dental arch with splinted crowns by connecting ultra-short implants with longer ones. In the posterior maxilla of 11 patients, one 10-mm (n = 11) and one or two ultra-short 4-mm (n = 17) dental implants were inserted. The insertion torque was lower than 20 Ncm in 55% of the 10-mm implants and in 94% of the 4-mm implants (P > .05). Median (range) implant stability quotients at the time of insertion and after 6 months were 61 (14 to 72) and 68 (51 to 79), respectively, for 4-mm implants, and 66 (52 to 78) and 78 (60 to 83), respectively, for 10-mm implants (P < .05). One 4-mm implant failed to integrate. All patients were restored with splinted metal-ceramic crowns connecting 4- and 10-mm implants. Median (range) clinical crown/implant ratios of 4-mm and 10-mm implants were 2.79 (1 to 3.66) and 1.06 (0.85 to 1.46), respectively (P < .05). Six months after prosthetic rehabilitation, the median (range) crestal bone loss was 0.3 mm (-0.7 to 1.7 mm) for 4-mm implants and was 0.5 mm (-0.8 to 3.5 mm) for 10-mm implants (P > .05). Splinted crowns combining 4- and 10-mm implants may contribute to a better force distribution in the treatment with ultra-short implant-supported prosthesis in the posterior maxilla.


Assuntos
Implantes Dentários , Maxila , Coroas , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Seio Maxilar/cirurgia
6.
Braz Dent J ; 32(1): 34-41, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33914000

RESUMO

The objective of this study was to compare the biomechanical behavior of peri-implant bone tissue and prosthetic components in two modalities of treatment for posterior region of the maxilla, using short implants or standard-length implants associated with bone graft in the maxillary sinus. Four 3D models of a crown supported by an implant fixed in the posterior maxilla were constructed. The type of implant: short implant (S) or standard-length implant with the presence of sinus graft (L) and type of crown retention: cemented (C) or screwed (S) were the study factors. The models were divided into SC- cemented crown on a short implant; SS- screwed crown on the short implant; LC- cemented crown on a standard-length implant after bone graft in the maxillary sinus and LS- crown screwed on a standard-length implant after bone graft in the maxillary sinus. An axial occlusal loading of 300 N was applied, divided into five points (60N each) corresponding to occlusal contact. The following analysis criteria were observed: Shear Stress, Maximum and Minimum Main Stress for bone tissue and von Mises Stress for the implant and prosthetic components. The use of standard-length implants reduced the shear stress in the cortical bone by 35.75% and the medullary bone by 51% when compared to short implants. The length of the implant did not affect the stress concentration in the crown, and the cement layer acted by reducing the stresses in the ceramic veneer and framework by 42%. Standard-implants associated with cemented crowns showed better biomechanical behavior.


Assuntos
Implantes Dentários , Maxila , Coroas , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Análise do Estresse Dentário , Análise de Elementos Finitos , Maxila/cirurgia , Estresse Mecânico
7.
Int J Oral Maxillofac Implants ; 36(2): 371-378, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33909730

RESUMO

PURPOSE: The aim of this study was to evaluate the survival and success rates of oral rehabilitations in a shortened maxillary dental arch and expanded maxillary sinus with 4-mm extrashort implants splinted to longer ones. MATERIALS AND METHODS: One 10-mm and one/two extrashort 4-mm titanium-zirconium SLActive tissue-level dental implants were inserted into 11 patients with limited vertical bone availability due to an expanded maxillary sinus antrum. Immediately and 6 months after insertion, implant stability resonance frequency analysis (RFA) values were assessed with an Osstell device. Splinted crowns combining 4- and 10-mm implants were supplied to all 11 cases. RESULTS: In 10 cases, the bone quality was type III, and in one case, type IV. Among 17 4-mm and 11 10-mm implants, the median RFA values were 61 (interquartile ranges [IQR]: 59 to 64) and 66 (IQR: 64 to 72). One 4-mm implant failed to osseointegrate and was removed. After 6 months of healing, secondary-stability measurements of 16 of the remaining 4-mm implants increased to 68 (IQR: 62 to 72) and of 10-mm implants to 78 (IQR: 77 to 80). After 1 year, all (11/11) oral rehabilitations supported by 10-mm (11/11) and 4-mm (16/16) implants were functional. The medians and IQRs of the probing depths (median: 2.8 mm, IQR: 2.3 to 3.1 mm vs median: 2.9 mm, IQR: 2.4 to 3.1 mm) and the crestal bone loss (median: 0.75 mm, IQR: 0 to 0.9 mm vs median: 0.22 mm, IQR: 0 to 0.4 mm) for the 10-mm and 4-mm implants, respectively, were similar. CONCLUSION: Rehabilitations with splinted crowns combining 4- and 10-mm implants demonstrated a favorable 1-year performance in a shortened maxillary dental arch.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/cirurgia , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Estudos Prospectivos
8.
Br J Oral Maxillofac Surg ; 59(4): 413-418, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33714624

RESUMO

The purpose of this study was to validate the applicability of using maxillary voxel-based dentoalveolar registration (VDAR) at long-term follow up in orthognathic surgical patients. A retrospective sample of 25 patients (skeletal class II or III) who underwent bimaxillary orthognathic surgery was recruited and divided into two groups. Group A included 15 patients (seven females, eight males, mean (SD) age 25.8 (14.4) years) with unrestored dentition and group B involved 10 patients (five females, five males, mean (SD) age: 26.2 (11.9) years) with dental restorative treatment. Postoperative cone-beam computed tomography (CBCT) scans were acquired at four time-points, one to six weeks (T1), six months (T2), one year (T3) and two years (T4). Voxel- based registration was applied using the cranial base and then complete dental segment with part of the alveolar bone at T1-T2, T1-T3 and T1-T4 time-intervals. The translational and rotational accuracy and reproducibility of the registered maxillary segment was evaluated at these three intervals by analysing the transformation matrix using singular value decomposition. All translational and rotational measurements showed excellent reliability in both groups without any significant difference. The combined translational and rotational difference was found to be within the clinically acceptable range of 2mm and 4°. The VDAR was found to be accurate and reliable to be utilised for a long-term skeletal follow-up in orthognathic surgical patients.


Assuntos
Cirurgia Ortognática , Procedimentos Cirúrgicos Ortognáticos , Adulto , Cefalometria , Tomografia Computadorizada de Feixe Cônico , Feminino , Seguimentos , Humanos , Masculino , Maxila/diagnóstico por imagem , Maxila/cirurgia , Projetos Piloto , Reprodutibilidade dos Testes , Estudos Retrospectivos
9.
Br J Oral Maxillofac Surg ; 59(4): 407-412, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33771377

RESUMO

Pterygomaxillary (PTM) dysjunction is a technique-sensitive step in Le Fort I osteotomy. Various studies implicate improper osteotomy techniques and anatomical variations of the midface in ophthalmic/orbital complications. The aim of this study was to assess the stress distribution and its transmission to the orbit during PTM dysjunction while using different angulations of the osteotome. The study involved the generation of two virtual models from the computed tomographic images of a non-cleft and cleft patient. Nonlinear, three-dimensional finite element analysis (3D-FEA) of the models was performed for mapping the equivalent stress (in megapascals [MPa]) and maximum principal stress (in MPa) at the PTM junction, optic canal, and superior orbital fissures. The results of our study showed that there was no significant change in the transmission of stress to the bony orbit in a normal maxilla, with variations in the angulation of the osteotome. However, the equivalent stress generated for the cleft maxilla showed an increase that could potentiate indirect globe injury. The study shows that a judicious technique for PTM dysjunction and a cautious approach in cleft maxillae could reduce incidence of ophthalmic complications in clinical practice.


Assuntos
Maxila , Órbita , Análise de Elementos Finitos , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Órbita/diagnóstico por imagem , Órbita/cirurgia , Osteotomia de Le Fort , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/cirurgia
10.
J Vis Exp ; (168)2021 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-33720129

RESUMO

The technique of maxillectomy has been revised since it was first described in the 1820s. During the past decade, the endoscopic approach has been widely practiced for resecting maxilla. Compared with the traditional approaches, the combined endoscopic and transoral approach has many advantages such as avoiding facial incisions and postoperative scars and better visualization of the surgical margin. However, this technique is complicated to master and possess several challenges. Here, we demonstrate this approach step-by-step to show how to perform a total maxillectomy. We also reported nine cases with malignant tumors originating from the maxilla, and for all of them total maxillectomy was performed with combined endoscopic and transoral approach. Our data showed that the combination of the endoscopic and transoral approach could be used to resect the total maxilla successfully, though the tumor extended to the infratemporal and pterygopalatine fossa should be treated very carefully to avoid its spread in the local area. Furthermore, besides denture, other reconstruction methods should be attempted to improve the postoperative quality of life after the total maxillectomy.


Assuntos
Endoscopia , Maxila/cirurgia , Adolescente , Adulto , Idoso , Craniotomia , Feminino , Humanos , Masculino , Maxila/diagnóstico por imagem , Pessoa de Meia-Idade , Qualidade de Vida , Adulto Jovem
11.
Dental Press J Orthod ; 26(1): e2119155, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33759962

RESUMO

INTRODUCTION: Shorter miniscrew implants (MSIs) are needed to make orthodontics more effective and efficient. OBJECTIVE: To evaluate the stability, insertion torque, removal torque and pain associated with 3 mm long MSIs placed in humans by a novice clinician. METHODS: 82 MSIs were placed in the buccal maxillae of 26 adults. Pairs of adjacent implants were immediately loaded with 100g. Subjects were recalled after 1, 3, 5, and 8 weeks to verify stability and complete questionnaires pertaining to MSI-related pain and discomfort. RESULTS: The overall failure rate was 32.9%. The anterior and posterior MSIs failed 35.7% and 30.0% of the time, respectively. Excluding the 10 MSIs (12.2%) that were traumatically dislodged, the failure rates in the anterior and posterior sites were 30.1% and 15.2%, respectively; the overall primary failure rate was 23.6%. Failures were significantly (p= 0.010) greater (46.3% vs 19.5%) among the first 41 MSIs than the last 41 MSIs that were placed. Excluding the traumatically lost MSIs, the failures occurred on or before day 42. Subjects experienced very low pain (2.2% of maximum) and discomfort (5.5% of maximum) during the first week only. CONCLUSIONS: Shorter 3 mm MSIs placed by a novice operator are highly likely to fail. However, failure rates can be substantially decreased over time with the placement of more MSIs. Pain and discomfort experienced after placing 3 mm MSIs is minimal and temporary.


Assuntos
Implantes Dentários , Procedimentos de Ancoragem Ortodôntica , Adulto , Parafusos Ósseos , Implantação Dentária Endo-Óssea , Implantes Dentários/efeitos adversos , Prótese Dentária Fixada por Implante , Estudos de Viabilidade , Humanos , Maxila/cirurgia , Torque
12.
Am J Orthod Dentofacial Orthop ; 159(4): 536-544, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33568277

RESUMO

Treatment of an impacted incisor with a dilacerated root is challenging for clinicians because of the position of the impacted incisor, the abnormality of the root, unfavorable prognosis, and, especially, the long treatment duration. We report on 2 young patients who had inversely impacted maxillary central incisors with developing labially dilacerated roots. Both patients were treated by a novel surgical approach, in situ rotation, by which the crowns of the inversely impacted incisors were carefully rotated to a relatively normal position, whereas the apical location remained relatively unchanged. About 2 weeks after surgery, spontaneous eruption of the treated incisors was observed. Three months later, the postoperative central incisors were further aligned into the maxillary arch with a fixed orthodontic appliance. Follow-up visits 2 or 3 years after surgery indicated that the positions of the dilacerated incisors maintained stability with good gingival esthetics, and the pulpal vitality was favorable. The roots grew further in a relatively normal direction of the incisor's longitudinal axis, which was different from the initial curvature angle. Moreover, with the in situ rotation surgery, treatment time was greatly reduced and resulted in a favorable prognosis compared with conventional treatment.


Assuntos
Incisivo , Dente Impactado , Estética Dentária , Humanos , Incisivo/cirurgia , Maxila/diagnóstico por imagem , Maxila/cirurgia , Rotação , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/cirurgia , Dente Impactado/diagnóstico por imagem , Dente Impactado/cirurgia
13.
J Craniomaxillofac Surg ; 49(5): 347-351, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33602598

RESUMO

This study aimed at evaluating changes in scleral show following Le Fort I osteotomy with either impaction or lengthening of the mid face. Patients who underwent Le Fort I osteotomy were included. The patients were divided according to the direction of the movement: group 1 underwent maxillary advancement and impaction, while group 2 underwent maxillary advancement and lengthening. Standardized preoperative and 6-month postoperative photos were superimposed using Microsoft PowerPoint. The inferior visible scleral area was assessed with landmarks and measured separately using ImageJ software. Marked scleral surface area was determined using pixel count. A total of 36 consecutive patients were included. The mean maxillary advancement in the patients was 4.16 ± 2.14 mm. The mean impaction in group 1 (n= 21) was 1.06 ± 1.49 mm, while the mean vertical lengthening in group 2 (n = 15) was 1.54 ± 1.65 mm. The difference in improvement in the inferior scleral show between the groups was not statistically significant. Preoperative (180 ± 118.2 mm) and postoperative (147.75 ± 92.2 mm) scleral show significantly improved (p = 0.012) in both groups. Scleral show can be overlooked for movements under 6 mm while planning for maxillary orthognathic movement, as it improves regardless of the desired movement.


Assuntos
Osteotomia de Le Fort , Dente Impactado , Cefalometria , Face , Humanos , Maxila/cirurgia , Osteotomia Maxilar , Estudos Retrospectivos
14.
Br J Oral Maxillofac Surg ; 59(3): 292-296, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33579541

RESUMO

We designed this study to determine the efficiency and stability of anterior segmental osteotomies (ASO) without orthodontics for various dentofacial deformities. Records of patients treated with maxillary or mandibular ASO, or both, without orthodontics in the past 15 years were analysed. The assessment included postoperative analysis of patients' aesthetics and functional satisfaction using a questionnaire and grading (score 0 - 4) system, and the amount of relapse calculated from 12-month postoperative cephalograms. A total of 26 ASO subjects (age range 13- 31 years) were studied (14 maxillary, two mandibular, and 10 bimaxillary). Long-term stability was acceptable in all cases with no significant relapse (p>0.05). No major complications were encountered. All patients reported good to excellent (score=3 to 4) satisfaction following surgery. Using meticulous planning and a careful surgical technique, ASO without orthodontics is a simple, quick, safe, and stable option for the correction of dentofacial deformities.


Assuntos
Ortodontia , Adolescente , Adulto , Cefalometria , Estética Dentária , Humanos , Mandíbula , Maxila/cirurgia , Ortodontia Corretiva , Osteotomia , Adulto Jovem
15.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(2): 164-169, 2021 Feb 09.
Artigo em Chinês | MEDLINE | ID: mdl-33557500

RESUMO

Objective: To study the clinical effect of early loading restoration a superhydrophilic implant after 1 year, so as to provide reference evidence for clinical practice. Methods: A total of 41 patients with dental defects, including 20 males and 21 females [age (52.3±13.1) years old], were enrolled in the Department of VIP, Hangzhou Dental Hospital (Pinghai Hospital) from July 2017 to January 2019. A total of 74 superhydrophilic implants were implanted, including 27 maxillary implants and 47 mandiolar implants. All patients without bone augmentation or soft tissue transplantation, the maxilla was taken impression 4 weeks after implant implantation, with 6 weeks of loading, the mandible was taken impression 2 weeks after implant implantation, with 4 weeks of loading. The stability of the implant was measured by resonance frequency analyzer before implant implantation, impression and loading. Periapical radiograph were taken immediately after mold removal, immediately after loading and reexamination 1 year after loading, to measure and record the changes in the bone level of the mesial and distal margins of the implant. Results: No biological complications occurred in all implants before loading restoration, and the implant survival rate was 100%(74/74). In 2 cases, the implant stability quotient (ISQ) value of the implant at the mandibular site was lower than 65 at 2 weeks after surgery, and the restoration was delayed. The ISQ values of the other 72 implants at the time of implantation (75.22±4.32) were not significantly different from those at the time of modeling (75.13±4.23) (P>0.05), but the ISQ values at the moment of weight loading (76.46±3.73) were significantly higher than those at modeling (P<0.05). All the early loading implants were reviewed 1 year after early loading, and none of them were loose or fell off, and the implant survival rate was 100%(72/72). X-ray measurement and evaluation showed that after 1 year of early loading restoration, the mean marginal bone absorption of 72 implants was (0.18±0.06) mm, among which the mandibular was (0.17±0.06) mm and the maxillary was (0.19±0.06) mm, showing no statistical difference (P>0.05). After 1 year of early loading restoration, the mean marginal bone absorption of 72 implants was (0.17±0.05) mm, including (0.17±0.06) mm for mandibular and (0.16±0.05) mm for maxillary, showing no statistical difference (P>0.05). Conclusions: In the limited scope of this clinical study, it has been proved that early loading of superhydrophilic implant is a safe and feasible treatment scheme, and the bone resorption at the implant edge after long-term early loading restoration needs further follow-up study.


Assuntos
Implantes Dentários , Carga Imediata em Implante Dentário , Adulto , Idoso , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Feminino , Seguimentos , Humanos , Masculino , Maxila/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Medicine (Baltimore) ; 100(6): e24012, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578517

RESUMO

INTRODUCTION: Distraction osteogenesis (DO) is a widely used for cleft and palate related maxillary hypoplasia. There has been little research on temporomandibular joint (TMJ) dislocation after maxillary DO. We present these 3 cases and analyze the possible causes for reference by other clinicians. PATIENT CONCERNS: In the late stages of maxillary DO, the patients gradually felt a decrease in mandibular mobility and suffered from limited mouth opening. Case 2 and 3 could open their mouth up to 1 and 2 fingers and Case 1 barely able to open her mouth at the completion of distraction. DIAGNOSIS: Case 1 and Case 3 were diagnosed as right TMJ dislocation and Case 2 had a TMJ dislocation on her left side. INTERVENTIONS: Patients with TMJ dislocation were repositioned with manipulation as soon as detected. OUTCOMES: There was no recurrence in all three cases during the postoperative follow-up period. CONCLUSIONS: Maxillary DO can sufficiently advance the maxilla in cleft lip and palate patients. Clinicians should be mindful of the TMJ dislocations that maxillary DO can exert on patients.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Luxações Articulares/etiologia , Maxila/cirurgia , Osteogênese por Distração/efeitos adversos , Adolescente , Criança , Fenda Labial/complicações , Fissura Palatina/complicações , Feminino , Seguimentos , Humanos , Fixadores Internos/normas , Luxações Articulares/cirurgia , Masculino , Maxila/anormalidades , Osteogênese por Distração/instrumentação , Transtornos da Articulação Temporomandibular/fisiopatologia , Resultado do Tratamento , Adulto Jovem
17.
Int J Oral Maxillofac Implants ; 36(1): 137-145, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33600535

RESUMO

PURPOSE: To evaluate the clinical and radiographic outcomes of endoscope-assisted maxillary sinus floor elevation with platelet-rich fibrin grafting and simultaneous implant placement (PESS) in atrophic maxillae. MATERIALS AND METHODS: Twenty-three implants were placed to rehabilitate atrophic maxillae. Patient satisfaction was measured with a visual analog scale (VASpain). CBCT was taken to assess the bone changes for the elevated sites. RESULTS: Twenty-two of 23 implants fulfilling the survival criteria represented a 1-year survival rate of 95.65%. The VASpain score decreased with time. The residual bone height was 4.45 ± 1.44 mm. The elevation height was 6.72 ± 1.84 mm. The definitive restoration was completed in the 4th month postsurgery. The peri-implant bone level value was 6.04 ± 2.30 mm, 6.32 ± 2.25 mm, and 6.71 ± 1.97 mm at the 3rd, 9th, and 15th month postsurgery. The crestal bone level value decreased by 0.22 ± 0.56 mm from the 3rd month to the 15th month postsurgery (P > .05). Bone mineral density increased with time at the neck, middle, and root site of implant. CONCLUSION: PESS in the maxilla resulted in predictable peri-implant bone formation. This strategy is a relatively safe and effective approach with less invasion, which provides new insights into the choice of implant treatment plans.


Assuntos
Implantes Dentários , Fibrina Rica em Plaquetas , Levantamento do Assoalho do Seio Maxilar , Implantação Dentária Endo-Óssea , Endoscópios , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Estudos Prospectivos , Resultado do Tratamento
18.
Clin Implant Dent Relat Res ; 23(1): 31-42, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33595906

RESUMO

BACKGROUND: The overlying maxillary sinus frequently restrains the height of the posterior maxillary bones. PURPOSE: Evaluating the effect of downsizing the antrostomy side-window on the stability of the installed implants and vertical bone gain, after employing a graftless antral membrane balloon elevation (AMBE). MATERIALS AND METHODS: The study is a randomized controlled clinical trial conducted on 20 patients with 30 deficient maxillary alveolar ridges underwent graftless (AMBE) after being allocated into a (5 mm) entry antrostomy group (the test group) and a (10 mm) entry antrostomy group (the control group) implementing a radiographic linear bone height and implant stability quotations (ISQ) comparison among both groups immediately after the placement of 38 Implants and 6 months after. RESULTS: Radiographic bone gain of the test group (5.55 ± 0.93 mm) was significantly higher than the control group (2.86 ± 0.60 mm) (p <0.001). There was no significant difference in primary stability between the test (65 ± 5.32) and control groups (62.67 ± 4.46) (p = 0.202); while the test group (73.43 ± 4.39) showed significantly higher secondary stability than the control group (64.83 ± 6.05) (p <0.001). ISQ values recorded at 6 months were significantly higher than those recorded at insertion in the test group (p <0.001), while they were insignificant in the control group (p = 0.148). CONCLUSION: Undersizing the antrostomy window deemed beneficial concerning the vertical bone gain and the simultaneously placed root form dental implants' secondary stability.


Assuntos
Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Implantação Dentária Endo-Óssea , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia
19.
Int J Oral Maxillofac Implants ; 36(1): 21-29, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33600519

RESUMO

PURPOSE: To assess the postoperative complications and outcome (implant survival) of quad zygomatic implants inserted in patients with edentulism and severely atrophic maxillae. MATERIALS AND METHODS: Two independent reviewers conducted an electronic search of the literature (PubMed, Scopus, EBSCO, Web of Science) from January 2000 to February 2019. The inclusion criteria were articles published in English reporting data of at least five patients with severely atrophic edentulous maxillae undergoing placement of four zygomatic implants without additional insertion of standard implants, with a minimum of 6 months of follow-up. Data extracted included number of patients, characteristics of the maxillary defect, number of zygomatic implants, implant details, surgical procedure, prosthetic rehabilitation, postoperative complications, survival rate, and length of follow-up after definitive prosthesis delivery. RESULTS: Eleven studies with 166 patients were included. The heterogeneity among studies was not significant. The pooled incidence rates of complications were as follows: sinusitis 12% (95% confidence interval [CI]: 4% to 23%), malposition and surgical guiding failure 11% (95% CI: 3% to 21%), local infection/injury 10% (95% CI: 3% to 18%), and prosthetic complications 5% (95% CI: 0% to 13%). The implant survival rate ranged between 95.8% and 100%, and the pooled implant survival rate in the meta-analysis was 98% (95% CI: 97% to 99%). CONCLUSION: Quad zygomatic implants inserted in patients with severely atrophic edentulous maxillae have a high implant survival rate, but the incidence of complications should not be underestimated.


Assuntos
Implantes Dentários , Arcada Edêntula , Implantação Dentária Endo-Óssea/efeitos adversos , Implantes Dentários/efeitos adversos , Prótese Dentária Fixada por Implante , Seguimentos , Humanos , Arcada Edêntula/cirurgia , Maxila/cirurgia , Resultado do Tratamento , Zigoma/cirurgia
20.
Int J Oral Maxillofac Implants ; 36(1): 154-164, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33600537

RESUMO

PURPOSE: Using panoramic radiograph and CBCT to compare the measurement errors of the residual bone height in the same site before implant placement in the posterior maxilla and endo-sinus bone gain after osteotome sinus floor elevation without grafting, and to evaluate endo-sinus bone augmentation before stage-two surgery with CBCT. Also, some related factors of new bone formation in the sinus were analyzed, such as small bone block elevated by osteotome at the implant apex intraoperatively. MATERIALS AND METHODS: Patients were enrolled in the retrospective study; dental implants were placed in the maxillary posterior region using osteotome sinus floor elevation without grafting. The panoramic radiograph and CBCT were taken preoperatively, immediate postoperatively, and before the stage-two surgery. Endo-sinus bone augmentation was evaluated. A generalized linear model was made to explore the related factors of endo-sinus bone gain. Also, some clinical indexes, such as sinus membrane perforation rate, implant success, and failure criteria were assessed. RESULTS: One hundred two dental implants were inserted in 91 patients. Preoperatively, the mean residual bone height was 8.53 ± 1.76 mm and 7.87 ± 1.45 mm measured using a panoramic radiograph and CBCT, respectively, with significant statistical differences (P < .05). Endo-sinus bone gains of 1.31 °æ 1.05 mm by panoramic radiograph and 1.80 ± 1.72 mm by CBCT were observed, with statistically significant differences (P < .05). The final endosinus bone gain was positively correlated with the implant protrusion length at baseline without any other relevant factors, such as elevated small bone block. CONCLUSION: Measurement errors could be relatively minimized when using CBCT. Using the osteotome sinus floor elevation technique without grafting, approximately 2 mm of endo-sinus bone could be acquired. The final endo-sinus bone gain was positively correlated with implant protrusion length at baseline. Small bone block elevated intraoperatively did not gain more endo-sinus bone.


Assuntos
Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Implantação Dentária Endo-Óssea , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Osteotomia , Estudos Retrospectivos , Resultado do Tratamento
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