Are There Differences in Fracture Patterns in Mandibular Ramus Sagittal Osteotomies Between Hunsuck/Epker, Wolford, and Posnick Modifications?

PURPOSE: Despite decades of study, the best technique for mandibular ramus sagittal osteotomy has not been definitively determined. The purpose of the present study was to compare fracture patterns, inferior alveolar nerve (IAN) visualization, and torque required for mandibular sagittal splitting using the Hunsuck/Epker, Wolford, and Posnick techniques. METHODS: This was a laboratory (ex vivo), randomized, a single-blind study performed to evaluate sagittal split osteotomies in porcine mandibles using a specifically designed test system. The study's predictor variable was the osteotomy technique, which was divided into 3 groups: Group Hunsuck/Epker (GHE), group Wolford (GW), and group Posnick (GP). The outcome variables were lingual fracture pattern, torque in newtons (N) required to separate the mandible, and IAN visualization. The covariates were mandibular radiodensity and time between dejection and the experiment. The Kolmogorov-Smirnov normality statistics and analysis of variance with Tukey post test statistics were performed. P value <.05 was considered statistically significant. RESULTS: The sample was composed of 120 equally divided porcine hemimandibles in each group. The torque forces were significantly lower (P < .001) when using the Posnick technique (2.07 ± 0.22 N) than when using the Hunsuck/Epker technique (4.45 ± 0.32 N) and Wolford (3.00 ± 0.21 N). GW (93.3%) and GHE (56.7%) showed a higher prevalence of lingual fracture in the posterior region of the mandibular canal (P < .001), while the GP (90%) had a higher frequency of lingual fracture pattern on the mylohyoid sulcus (P < .001). In more than 90% (P < .001) of the mandibles in GW and GHE, the IAN visualization was higher than 50%. In the GP, 90% (P < .001) of patients had IAN visualization of less than 50%. CONCLUSIONS: The Posnick technique required less torque to perform the sagittal osteotomy in a pig mandible and had good predictability (90%) for the less preferred lingual fracture pattern and minimal visualization of the nerve. The Wolford technique provided the best predictability (93%) for the preferred lingual fracture pattern and the best nerve visualization. Caution must be exercised when extrapolating the results from animal models to human applications.

Mini-Anchors to Surgically Treat the Chronic Mandibular Dislocation.

PURPOSE: Evaluate the feasibility of using mini-anchors for the treatment of chronic mandibular dislocation and to identify the variables that affect the success of this approach. PATIENTS AND METHODS: A retrospective cohort study evaluated 9 patients with bilateral recurrent dislocation of the mandible (18 operated joints), treated by a mandibular translation control system using the mini-anchor technique. Data was collected using a Visual Analog Scale (VAS) for subjective parameters and measurements for objective parameters prior to surgery (T1) and at the longest available follow-up (T2) with a minimum of a 12 months interval. Patients subjectively rated their facial pain/headache, jaw function, disability, temporomandibular joint (TMJ) pain and diet. Objective functional changes were determined by measuring the interincisal opening and lateral excursions at T1 and T2. RESULTS: Significant subjective improvements in pain and dysfunction (89 to 94%) were observed (P < .01) from T1 to T2 in all parameters. The comfortable and guarded interincisal opening without mandibular dislocation increased by 41%, the maximum interincisal opening reduced 12 mm, and lateral excursions improved by 43%. CONCLUSIONS: Patients with recurrent mandibular dislocations with or without disc dislocation can be treated effectively by the mini-anchor translation control system.

Does the Preemptive Use of Oral Nonsteroidal Anti-inflammatory Drugs Reduce Postoperative Pain in Surgical Removal of Third Molars? A Meta-analysis of Randomized Clinical Trials.

The purpose of this study was to investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in third-molar surgery. A PubMed literature search was conducted for articles restricted to the English language using the following terms (DeCS/MeSH) or combinations: analgesia, third molar, and preemptive. From a total of 704 articles, 6 (n=420 subjects) were selected. All studies presented a low risk of bias (Cochrane criteria) but exhibited high heterogeneity of methods. Two studies were excluded from the meta-analysis because they did not have adequate numeric values (dichotomous data) for the calculations. Preemptive analgesia showed no significant benefit (n=298, P=.2227, odds ratio: 2.30, 0.60-8.73) in reducing postoperative pain after removal of lower impacted third molars. However, there was a probable direct relationship between the effectiveness of NSAIDs in preemptive analgesia for removal of third molars and its selectivity for the cyclooxygenase-2 (COX-2). Preemptive analgesia did not have a significant effect in reducing postoperative pain after removal of lower impacted third molars. More homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs' selectivity for COX-2 and treatment effectiveness.

Forensic study of the mechanical properties of prosthetic materials: Submersion in mangrove environment - A pilot study.

INTRODUCTION: It is crucial for dental surgeons to use the mechanical properties of dental prosthetic materials to correlate the submersion time in a mangrove environment. OBJECTIVE: This study aimed to submerge dental prosthetic materials, such as acrylic resin and zirconia, contained within acrylic resin disks in a mangrove environment, and analyze the alterations in mechanical parameters, such as surface roughness and microhardness, to estimate submergence time in similar forensic situations. MATERIALS AND METHODS: A total of 6 specimens was embedded in acrylic resin disks numbered from 1 to 6. The materials were polished for initial parameter readings a day before submersion, and new readings were obtained 1after submersion. All specimens were subjected to surface roughness analysis, in addition to Knoop microhardness analysis for acrylic resin and Vickers microhardness analysis for zirconia. After the experiment, the data were computed for statistical comparation of the materials properties different parameters. RESULTS: There was a significant increase in surface roughness and Knoop microhardness was reduced in the Acrylic Resin samples (p< 0.05); however, no statistically significant differences were observed in the roughness or Vickers microhardness values of the zirconia samples. CONCLUSION: Zirconia prosthetics were more resistant to degradation when submerged in a mangrove environment compared to acrylic resin ones; however, owing to the obstacles inherent in this study, we suggest further research on the properties of prosthetic materials submerged in mangroves or other environments, which could bolster the work of dental professionals in forensic medical institutes.

Rare hybrid odontogenic tumor in a 2-year-old child.

Hybrid odontogenic tumors are rare conditions that can affect the oral maxillofacial region and usually occur in adults as an asymptomatic swelling. Hybrid odontogenic tumors exclusively involving adenomatoid odontogenic tumor (AOT) and calcifying cystic odontogenic tumor (CCOT) are rare, with only 4 reported cases. In addition, there are only few studies describing the presence of abortive enamel in AOT and, to our knowledge, CCOT was not present in any of them. We described a rare case of AOT associated with CCOT and abortive enamel formation in a 2-year-old child, a condition not well described in the international literature. Secretory cell activity was assessed by periodic acid-Schiff and Congo red stains.

Treatment of the Temporomandibular Joint Ankylosis with a Customized Prosthesis in a Single Stage: The Use of 3D Cutting Guides and Virtual Surgical Planning.

BACKGROUND: Ankylosis of the temporomandibular joint (TMJ) is a debilitating condition and disabling as a result of craniomandibular fusion, which can result in trismus, pain and a poor quality of life. Current management includes interposition arthroplasty, gap arthroplasty, and reconstruction. Traditionally, the joints are reconstructed with pre-made prostheses (in stock), or the procedure is performed in two steps; with a computerized tomography scan, its design is observed between the respective and reconstructive procedures. STUDY DESIGN: A technical note about the customization management of ankylosis of the temporomandibular joint. OBJECTIVE AND METHODS: Describe a modification of technique using 3D surgical cutting and positioning guides digitally created to help determine the position and dimensions of the osteotomies as an auxiliary tool in the management of TMJ ankylosis, enabling the installation of personalized prostheses in a single stage. CONCLUSION: This technique has the advantage of allowing the installation of customized TMJ prostheses in a single stage, allowing greater predictability, less surgical time and less morbidity, in addition to being relatively simple and can be easily picked up by young surgeons.

Development and validation of a new formula for sex estimation based on multislice computed tomographic measurements of maxillary and frontal sinuses among Brazilian adults.

OBJECTIVES: To evaluate the accuracy of the measurements of the maxillary sinus (MS) and frontal sinus (FS) in sex estimation among Brazilian adults using multislice computed tomography (MCT) and to develop and cross-validate a new formula for sex estimation. METHODS: The present cross-sectional research was conducted in two phases: (1) development of a formula on the basis of the measurements of both the sinuses (50 males and 50 females); and (2) validation study (20 males and 20 females). The linear measurements (height, width and diameter) were assessed using the RadiAnt DICOM software. A new formula for sex estimation was developed (multivariate statistical approach) and validated. Receiver operating characteristic curves, area under the curve, sensitivity, specificity, positive and negative predictive values, accuracy and likelihood ratio were estimated. RESULTS: Males displayed higher mean values (width, height and diameter) of the FS and MS (p < 0.05). The MS was a better predictor in sex estimation (males vs females), compared to the FS (accuracy between 61-74% and 58-69%, respectively). The distance between the right and left MS displayed the highest accuracy (74%). The sensitivity, specificity and accuracy of the new formula were 80%, 95.5% and 87.5%, respectively. 63.1% reduction was observed in the number of predictive values for sex estimation (individuals older than 30 years). CONCLUSIONS: The present MCT measurements showed a higher accuracy in the estimation of sex in males. The highest accuracy was associated with the distance between the right and left MS. The new formula displayed high precision for sex estimation.

Forensic study of mechanical properties of dental restoration after burial in mangrove environment.

Conducting research in the field of forensic sciences with methodologies that simulate situations found in the day-to-day practice of a given field of expertise is relevant insofar as this approach can produce results that are as close as possible to reality. In this context, the present study provided situations based on burial in a mangrove environment to estimate the changes in the mechanical properties (Knoop microhardness, roughness and color) of dental restorations utilizing silver amalgam, composite resin and glass ionomer cement over the time of burial. The silver amalgam showed a significant increase in surface roughness and a reduction in Knoop microhardness. Composite resin showed a statistically significant increase in color variation, and the glass ionomer cement showed significant increases in color variation and Knoop microhardness. These results allowed us to conclude that teeth restored with silver amalgam, composite resin and glass ionomer cement submitted to burial in mangrove environments produce different changes in surface roughness, Knoop microhardness and color properties depending on the time of burial to which the victims were submitted. These proprieties could help the forensic sciences to estimate time intervals for burial in mangrove environments.

Performance and comparison of the London Atlas technique and Cameriere's third molar maturity index (I3M) for allocating individuals below or above the threshold of 18 years.

Age estimation is an important procedure in the forensic practice, especially when it comes to the criminal imputability of juvenile offenders. This study aimed to compare two radiographic methods for dental age estimation in a population of subadults from Northeast Brazil considering their performance on allocating individuals below or above the age threshold of 18 years. A cross-sectional observational study was designed. The sample consisted of 1200 panoramic radiographs of Northeastern Brazilian females (n = 600) and males (n = 600) aged between 16 and 21 years. Dental age estimation was performed using the London Atas technique and Cameriere's third molar maturity index (I3M). Statistical tests were performed to assess the sensitivity, specificity and accuracy of the two methods on distinguishing individuals below or above the legal age threshold of 18 years. Considering the total sample, the London Atlas technique reached sensitivity of 92.3%, specificity of 56% and accuracy of 79.9%. I3M revealed sensitivity of 94.1%, specificity of 55.4% and accuracy of 79.8%. Specificity rates systematically decreased when the sample was progressively stratified based on age groups that narrowed close to 18 years. The methods performed very similar (0.878). The combination of methods did not improve the performance on dental age estimation. The London Atlas and the I3M methods similarly distinguished Brazilian individuals as minors or not. Their performance, however, was suboptimal because of the low rates of specificity that could negatively influence on Court decisions. In other words, the methods could wrongly classify minors into the age of legal majority (culminating in false positives). In practice, the misleading classification could restrict individual rights (in the civil scenario) or even support more severe penalties (in the criminal scenario).

Maxillofacial and dental-related injuries from a Brazilian forensic science institute: Victims and perpetrators characteristics and associated risk factors.

BACKGROUND: Trauma due to external causes represents one of the greatest challenges for public health services in different regions around the world. This study aimed to determine the prevalence of facial trauma, associated risk factors, and classification of body injuries in individuals who underwent forensic examination in a Brazilian center. MATERIAL AND METHODS: Data were collected at the Ceará State Forensic Medicine unit in a 12-year period. Sociodemographic data related to the etiological agent and lesions resulting from the bodily injury were recorded. RESULTS: Among 1,031 physical injury exams, physical aggression (p<0.001), male victims aged between 21 and 30 years (p<0.001), salaried workers (p<0.001), and soft tissue and dentoalveolar injuries were significant findings. Regarding aggression, domestic violence was prevalent (p<0.001), perpetrated by the victim's partner (p<0.001), using a blunt instrument during the aggression (p<0.001), and directly associated with soft tissue injury (p<0.001). In traffic accidents, the most common type was motorcycle accident (p<0.001), on weekdays (p=0.036), at nighttime (p=0.134), showing a significant association with bone fractures (p=0.001). CONCLUSIONS: Oral and maxillofacial injuries obtained from a Brazilian forensic science center were significantly associated with sociodemographic and etiological factors. Key words:Forensic dentistry, facial trauma, violence, public health.

Forensic study of mechanical properties of dental fillings after immersion in marine environment.

Human identification and postmortem intervals can be difficult to estimate when corpses are found in drowning situations, and forensic odontologists can bring valuable input to forensic science investigations of this type. Studies that simulate real scenarios are crucial for providing parameters that can be used in real cases. The present study created the necessary circumstances, i.e. immersion in a marine environment, to estimate the changes in the mechanical properties (Knoop microhardness, roughness, and color) of various dental fillings (silver amalgam, composite resin, and glass ionomer cement) over different immersion periods of time (one and three months). The silver amalgam fillings showed a significant increase in surface roughness. The composite resin fillings showed statistically significant increases in surface roughness and Knoop microhardness, and the glass ionomer cement showed a significant increase in surface roughness. These results lead to the conclusion that teeth restored with silver amalgam, composite resin, and glass ionomer cement, when subjected to immersion in marine environments, produce different changes in surface roughness, Knoop microhardness, and color properties depending on the length of immersion time. These findings could help in the field of forensic science to accurately estimate immersion time of dead bodies found in marine environments.

Photobiomodulation Therapy Reduces the Inflammatory Process without Inhibiting Bone Deposition in Rats in an Extraction Model.

Objective: We evaluated the influence of photobiomodulation therapy (PBMT) application during bone healing postexodontia in rats. Methods: We divided 84 male Wistar rats into a control group (CG), which received placebo treatment without PBMT, and a test group (TG), which was treated with PBMT. After exodontia, the animals were subjected to PBMT (TG) with an AsGaAI diode laser at 810 nm, 100 mW, 2 J, and 70 J/cm2 or placebo treatment (CG) every 72 h. After 1, 3, 7, 14, 21, and 28 days, the animals were weighed and euthanized to remove the left hemimandibles for radiographic (alveolar filling) and histomorphometric (inflammatory polymorphonuclear cell (PMN), mononuclear cell (MN), osteoclast (OC), and blood vessels counting) analysis. Statistic approach used two-way variance analysis followed by Bonferroni post hoc (p < 0.05, GraphPad Prism 5.0). Results: There was no significant difference in body mass variation (p = 0.828) and bone neoformation (p = 0.365) between the two groups, but the TG presented lower PMN (p < 0.001), MN (p < 0.001), and OC counts (p < 0.001) and higher blood vessels count (p < 0.001) throughout the repair process. Conclusions: PBMT attenuated the inflammatory process after exodontia without interfering with bone neoformation.

Intraoral device for sociodigital inclusion of patient with quadriplegia / Dispositivo intraoral para inclusão sócio-digital de paciente com tetraplegia

Introduction: The use of computers, tablets, and cell phones with the Internet by people with quadriplegia from spinal cord injuries is much lower when compared to the general population. The quality of life of these people can be substantially improved through access to these technologies, which would allow a quadriplegic to take advantage of the rapid evolution of information and communication. Many of these individuals have the function of preserved neck and mouth muscles, and it is possible to manipulate intraoral devices as an adaptation tool. Case Report: We report an intraoral device installation in a patient with quadriplegia, a victim of a firearm accident, who had a great desire to reuse the tablet for internet access. A device made of acrylic resin, similar to a myorelaxant plate, was designed to allow the use of a computer that was comfortable and at the same time, the patient could talk and not harm the dental structures. The person responsible agreed to participate in the research and signed the consent form. In addition, the work was submitted to an ethics committee. Considerations: The ideal intra-oral device for patient rehabilitation should be inexpensive, easy to adapt and promote muscle relaxation besides allowing the patient to expand their abilities and digitally increase their autonomy for society.

Introdução: O uso de computadores, tablets e celulares com internet por pessoas com tetraplegia por lesão medular é muito menor quando comparado à população geral. A qualidade de vida dessas pessoas pode ser, substancialmente, melhorada por meio do acesso a essas tecnologias, o que permitiria aos tetraplégicos aproveitar a rápida evolução da informação e da comunicação. Muitos desses indivíduos têm a função de músculos cervicais e bucais preservados, sendo possível a manipulação de dispositivos intraorais como ferramenta de adaptação. Relato de Caso: Relatamos a instalação de um dispositivo intraoral em um paciente com tetraplegia, vítima de acidente com arma de fogo, que tinha grande desejo de reutilizar o tablet para acesso à internet. Um dispositivo feito de resina acrílica, semelhante a uma placa miorrelaxante, foi projetado para permitir o uso de um computador que fosse confortável e, ao mesmo tempo, o paciente pudesse falar e não prejudicar as estruturas dentárias. O responsável concordou em participar da pesquisa e assinou o termo de consentimento. Além disso, o trabalho foi submetido a um comitê de ética. Considerações: O dispositivo intraoral ideal para a reabilitação do paciente deve ser barato, de fácil adaptação e promover o relaxamento muscular, além de permitir que o paciente amplie suas habilidades e aumente sua autonomia pessoal, digitalmente para a sociedade.

Orthodontic Records Helping to Identify A Victim of Execution / Registros Ortodonticos que Ayudan a Identificar una Víctima de Ejecución

Human identification is the process that identifies an individual as a unique being, differentiating him/ her from all others. The participation of Odontology in the processes of identification is fundamental in situations of human remains. This paper aims to report a case of positive identification, through dentistry, in human remains. The forensic odontologist performed a post-morten (PM) examination, which consisted of the collection of post-mortem dental findings in human bones, collection of ante-mortem (AM) dental findings in the patient's orthodontic records, and the comparison between AM and PM information. Dental elements are widely used in the processes of human identification, since they are resistant to time and to physical, chemical and mechanical impacts. Positive identification is guided by the presence of individualizing characteristics, easily detected in dental records. It is concluded that human identification through dentistry is a safe and reliable method, since dental elements have individualizing characteristics that make the process possible.

La identificación humana es el proceso que identifica a un individuo como un ser único, diferenciándolo de todos los demás. La participación de la Odontología en los procesos de identificación es fundamental en situaciones de restos humanos. Este trabajo tiene como objetivo reportar un caso de identificación positiva, a través de la odontología, en restos humanos. El odontólogo forense realizó un examen post-morten (PM), que consistió en la recolección de hallazgos dentales post-mortem en huesos humanos, recolección de hallazgos dentales ante-mortem (AM) en los registros de ortodoncia del paciente y la comparación entre AM y Información de PM. Los elementos dentales son ampliamente utilizados en los procesos de identificación humana, ya que son resistentes al tiempo y a los impactos físicos, químicos y mecánicos. La identificación positiva está guiada por la presencia de características individualizantes, que se detectan fácilmente en los registros dentales. Se concluye que la identificación humana a través de la odontología es un método seguro y confiable, ya que los elementos dentales tienen características individualizantes que hacen posible el proceso.

Postoperative hemostatic efficacy of gauze soaked in tranexamic acid, fibrin sponge, and dry gauze compression following dental extractions in anticoagulated patients with cardiovascular disease: a prospective, randomized study.

INTRODUCTION: Oral anticoagulants are widely prescribed drugs. Interruption of anticoagulant therapy prior to oral surgery has been an issue of great controversy. The purpose of this study was to evaluate the incidence of bleeding complications after dental extractions in patients on anticoagulant therapy (warfarin) in whom different local hemostatic methods were used. MATERIAL AND METHODS: Patients using warfarin and requiring extractions of at least two teeth were screened to participate in this prospective, randomized study. Extraction sites were considered as sampling units (statistically representative sample size) and were allocated to one of the three study groups (G1-4.8% tranexamic acid; G2-fibrin sponge; and G3-no local hemostatic agents). RESULTS: Eighty-four extraction sites were obtained from patients with mitral valve prolapse (47.4%), prosthetic cardiac valve (23.7%), venous thromboembolism (21.1%), and pulmonary embolism (5.2%). International normalized ratio (INR) values ranged between 2.1 and 3.1 (mean 2.51 ± 0.1). Postoperative bleeding was observed in four surgical sites (p < 0.001) and was mainly in older patients (p = 0.005). DISCUSSION: The three local hemostatic protocols were similarly effective in controlling postoperative bleeding in patients undergoing anticoagulant therapy with warfarin. The majority of teeth could be extracted with minimal problems in patients with cardiovascular diseases receiving treatment with anticoagulant therapy.

Pneumonia and the role of dentistry on ICU Staff: 8-year analysis of health indicators

Ventilator-associated pneumonia (VAP) is one of the most prevalent healthcare-associated infections (HAI) and causes of death in intensive care units (ICUs), and studies have shown its relation to oral health. Aim: To report the impact of the incorporation of dental professionals into multidisciplinary ICU staff on the incidence of VAP. Methods: A retrospective observational study was carried out to collect and analyze health indicators of patients in the ICUs from 2011 to 2018 and to differentiate these indicators between the periods before and after the participation of dental staff in the ICU. This study was approved by the Research Ethics Committee. Results:The average number of monthly ICU admissions was 105.89 ± 169.72, and the discharge was 105.21 ± 168.96, with a monthly average number of deaths within 24 h of 38.61 ± 62.27. The average number of monthly HAI-related deaths decreased from 2011 to 2018, followed by a reduction in cases of HAI per month. The average monthly number of HAIs related to mechanical ventilation (MV) decreased, and the same was observed for the infection density of HAIs related to MV (p < 0.001). In multivariate analysis, there was a significant decrease in the number of HAIs related to MV (p = 0.005). Conclusion: Although a reduction in the number of admissions or complexity of cases was not observed in the study period, multidisciplinary staff practices were essential for controlling HAIs and the presence of dental professionals can assist in the control of HAIs related to MV