Association of the estrogen receptor gene with oral health-related quality of life in patients with dentofacial deformities

Abstract This study aimed to evaluate the associations between oral health-related quality of life (OHRQoL) and patient-associated factors and polymorphisms in the estrogen receptor 1 (ESR1) and 2 (ESR2) genes in patients with dentofacial deformities (DFD). This cross-sectional study included 234 adult individuals. Data such as age, sex, and the type of facial profile (I, II, or III), were collected, and the short-form oral health impact profile 14 (OHIP-14) questionnaire was used to assess their OHRQoL. DNA was collected from oral mucosa cells, and the polymorphisms in ESR1 (rs2234693 and rs9340799) and ESR2 (rs1256049 and rs4986938) were evaluated using real-time polymerase chain reaction. The data were subjected to statistical analysis at a significance level of 5%. Individuals over 28 years of age exhibited worse OHRQoL (p = 0.003) than individuals aged less than or equal to 28 years. Women had worse OHRQoL than men (p < 0.001). Profile II individuals had worse OHRQoL in the social disability domain than profile III individuals (p = 0.030). Genetic analysis showed that rs9340799 was associated with OHRQoL in the functional limitation domain, and GG individuals exhibited worse OHRQoL than individuals carrying the AA/AG genotypes (p < 0.030). In the social handicap domain, individuals with GG genotype in rs9340799 exhibited worse OHRQoL than AG individuals (p < 0.043). Collectively, our results reveal that factors including age, sex, and type of facial profile, are associated with OHRQoL in patients with DFD. In addition, individuals with the GG genotype in rs9340799 (ESR1) may experience a negative impact on OHRQoL in the functional limitation and social handicap domains.

Effect of different factors on patient perception of surgical discomfort in third molar surgery

Abstract: The aim of this study was to evaluate patient perception of surgical discomfort in third molar surgery and the association with clinical variables and polymorphisms associated with the FKBP5, SLC6A4, and COMT genes. This cross-sectional observational study was carried out on 196 participants aged between 18 and 64 years at the Federal University of Paraná in 11 months. The intensity of surgical discomfort was assessed using the QCirDental questionnaire. Data on surgical and individual procedures were also cataloged. The oral health related quality of life was assessed by the Oral Health Impact Profile questionnaire (OHIP-14). The DNA sample was obtained from cells of the oral mucosa. Five markers of the FKBP5, SLC6A4, and COMT genes were genotyped. The data were submitted to statistical analysis with a significance level of 5%. Women reported greater intensity of discomfort associated with third molar surgery compared to men (p = 0.001). In the recessive model, the AA genotype of the rs3800373 marker was associated with greater surgical discomfort (p = 0.026). Therefore, women and individuals of the AA genotype for the rs3800373 marker in the FKBP5 gene reported greater surgical discomfort associated with third molar surgery.

Individuals requiring orthognathic surgery have more depression and pain than controls

Abstract The objective of this study was to evaluate if individuals with dentofacial deformities (DFD) who require orthognathic surgery are affected more by depression and pain. A case-control study was performed with 195 individuals. In the DFD group, 145 individuals with Class II and III malocclusion requiring orthognathic surgery were selected. The control group was composed of 50 individuals with no DFD. All patients were diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Data were analyzed with a significance level of 0.05. The DFD group more often presented severe depression (p = 0.020) and chronic pain (p = 0.017). They also presented higher prevalence of Nonspecific Physical Symptoms Including Pain (P = 0.002) and Nonspecific Physical Symptoms Excluding Pain (p = 0.002). Concerning TMD symptoms, the DFD group had more myofascial (p = 0.002) and articular pain (p = 0.041). Therefore, the results of this study suggest that depression and pain are more common in individuals with DFD requiring orthognathic surgery compared with individuals without DFD.

Eminectomia para tratamento de luxação recidivante da ATM / Eminectomy for treatment of recurrent TMJ dislocation

Introdução: A luxação da articulação temporomandibular ocorre quando a cabeça da mandíbula se movimenta para fora da fossa articular, fazendo com que a superfície posterior da cabeça da mandíbula fique à frente da eminência articular. Quando ocorrem episódios frequentes, essa condição é referida como luxação recidivante. Embora existam diferentes tratamentos, a eminectomia apresenta-se como uma opção cirúrgica com resultados satisfatórios e prognóstico favorável. Relato de caso: Este trabalho relata o caso de uma paciente com quadro severo de luxações recidivantes associadas à distonia muscular, tratada cirurgicamente por eminectomia. A paciente apresenta acompanhamento de 36 meses, estável, sem sintomatologia ou novos episódios de luxação. A abordagem multidisciplinar apresenta um alto índice de sucesso, e procedimentos cirúrgicos devem ser considerados quando procedimentos clínicos falham. Considerações finais: A eminectomia mostra bons resultados no tratamento da luxação recidivante de ATM, com chances mínimas de recidiva ou danos articulares. Após a cirurgia, os pacientes mostram uma boa função articular... (AU)

Introduction: Dislocation of the temporomandibular joint occurs when the jaw head moves out of the joint fossa causing the posterior surface of the jaw head to be ahead of the joint eminence. When they occur in frequent episodes, this condition is referred like relapsing dislocation. Although there are different treatments, eminectomy presents as a surgical option with satisfactory results and favorable prognosis. Case report: This paper reports the case of a patient with severe recurrent dislocations associated with muscular dystonia, treated through surgical treatment of eminectomy associated with a clinical treatment protocol. The patient has a 36-month followup, stable, without symptoms or new episodes of dislocation. The multidisciplinary approach has a high success rate and surgical procedures should be considered when clinical procedures fail. Final considerations: Eminectomy shows good results in the treatment of recurrent TMJ dislocation, with minimal chances of recurrence or joint damage. After surgery, patients show good joint function... (AU)

Enucleação associada à solução de Carnoy no tratamento de tumor odontogênico ceratocístico / Enucleation associated to Carnoy's solution on treatment of keratocistic odontogenic tumor

Tumor Odontogênico Ceratocístico (TOC) é classificado como uma lesão intraóssea benigna, de origem odontogênica. Apresenta comportamento biológico agressivo e alta taxa de recidiva. Por sua heterogeneidade clínica e histológica, gera controvérsias em relação ao tipo de tratamento. Técnicas, como marsupialização, descompressão, enucleação, ou mesmo, ressecção cirúrgica, são algumas opções de tratamento, podendo associar com outras formas de terapias. O presente trabalho tem por objetivo relatar o caso de um paciente do gênero masculino que apresentava lesão osteolítica na região posterior direita da mandíbula, diagnosticada como tumor odontogênico ceratocístico. O tratamento proposto foi enucleação associada à aplicação de solução de Carnoy. Após 4 anos de pós-operatório, a técnica cirúrgica associada à terapia química mostrou-se eficaz, apresentando resultados satisfatórios. O paciente segue em acompanhamento, sem referir queixas álgicas e funcionais, além de não apresentar alterações estéticas... (AU)

Keratocystic odontogenic tumor is classified as a benign intraosseous and odontogenic lesion. It presents an aggressive biological behavior and great tendency to relapse. Also, it is a pathology that is noteworthy due to its clinical and histological heterogeneity. This diversity reflects on controversies in defining the adequate treatment for these lesions, opting for surgical techniques such as marsupialization, enucleation or resection, even associate with other conservative treatment. By upgrading the knowledge of cell biology, development of diagnostic tests and the improvement of surgical techniques, the treatment of oral diseases suffered major changes in recent decades, making it safer and leading to more predictable results. This study aims to report the case of a male patient, suffering from osteolytic lesion in the posterior mandible, diagnosed as keratocystic odontogenic tumor, which was treated by enucleation associated to application of Carnoy's solution, which is an alternative treatment already described. After 4 years follow-up, proposed treatment has been shown efficient presenting satisfactory results. Patient remains accompanied with no pain and functional complaints as well as no aesthetics alterations... (AU)

Le Fort III osteotomy for severe dentofacial deformity correction associated with hypoplasia of the midface / Osteotomia Le Fort III para correção de deformidade dentofacial severa associada a hipoplasia de terço médio da face

ABSTRACT The combination of orthodontic therapy and orthognathic surgery is a well-established treatment modality for the correction of dentofacial deformities. When these deformities are more severe, involving hypoplastic midface, surgical techniques not used routinely in the treatment of facial changes are required, such as the Le Fort III osteotomy or variations of this technique. Few studies have reported the use of this technique or its modifications in non-syndromic patients. This paper demonstrates the orthodontic-surgical resolution of a patient with dentofacial deformity with severe malocclusion Class III, involving midface hypoplasia, with a modification technique of a Le Fort III osteotomy associated with Le Fort I and sagittal of the rami osteotomies. After three years of postoperative follow-up, the patient demonstrates significant improvement in chewing ability, no functional complaints, and high satisfaction with the aesthetics and improved quality of life.

RESUMO A combinação da terapia ortodôntica com a cirurgia ortognática é uma modalidade de tratamento bem estabelecida para a correção de deformidades dentofaciais. Quando estas deformidades apresentam maior severidade, envolvendo a hipoplasia do terço médio da face, exigem técnicas cirúrgicas não utilizadas como rotina no tratamento das alterações faciais, como a osteotomias Le Fort III ou as variações destas técnicas. Poucos estudos relatam o uso desta técnica ou de suas modificações em pacientes não sindrômicos. Este trabalho tem como objetivo demonstrar uma resolução ortodôntica-cirúrgica de um paciente apresentando deformidade de face com má-oclusão Classe III severa, envolvendo hipoplasia do terço médio facial, com a realização de uma técnica modificada da osteotomia Le Fort III, associada as osteotomias Le Fort I e osteotomia sagital dos ramos mandibulares. O paciente encontra-se com três anos de acompanhamento pós-operatório, com melhora significativa na sua habilidade mastigatória, sem queixas funcionais, relatando alta satisfação com a estética e melhora na qualidade de vida.

Resistance and Stress Finite Element Analysis of Different Types of Fixation for Mandibular Orthognathic Surgery

Abstract The aim of this study was to evaluate the stress and dislodgement resistance by finite element analysis of different types of fixation in mandibular orthognathic surgery. A 3D solid finite element model of a hemi-mandible was obtained. A bilateral sagittal split osteotomy was simulated and the distal segment was advanced 5 mm forward. After the adjustment and superimposing of segments, 9 different types of osteosynthesis with 2.0 miniplates and screws were simulated: A, one 4-hole conventional straight miniplate; B, one 4-hole locking straight miniplate; C, one 4-hole conventional miniplate and one bicortical screw; D, one 4-hole locking miniplate and 1 bicortical screws; E, one 6-hole conventional straight miniplate; F, one 6-hole locking miniplate; G, two 4-hole conventional straight miniplates; H, two 4-hole locking straight miniplates; and I, 3 bicortical screws in an inverted-L pattern. In each model, forces simulating the masticatory muscles were applied. The values of stress in the plates and screws were checked. The dislodgement resistance was checked at the proximal segment since the distal segment was stable because of the screen at the occlusal tooth. The regions with the lowest and highest displacement were measured. The offset between the osteotomized segments was verified by millimeter intervals. Inverted-L with bicortical screws was the model that had the lowest dislodgment and the model with the lowest tension was the one with two conventional plates. The results suggest that the tension was better distributed in the locking miniplates, but the locking screws presented higher concentration of tension.

Resumo O objetivo deste estudo foi verificar o estresse e a resistência ao deslocamento, pela análise de elementos finitos, de diferentes tipos de fixação em cirurgia ortognática mandibular. Um modelo 3D de elementos finitos sólidos de uma hemi-mandíbula foi obtido. Uma osteotomia sagital bilateral foi simulada e o segmento distal foi avançado 5 mm. Após o ajuste e sobreposição dos segmentos, foram simulados 9 diferentes tipos de osteossíntese com miniplacas e parafusos 2.0: A, uma miniplaca reta convencional de 4 furos; B, uma miniplaca reta lock de 4 furos; C, uma miniplaca convencional de 4 furos e um parafuso bicortical; D, uma placa lock de 4 furos e 1 parafuso bicortical; E, uma miniplaca reta convencional de 6 furos; F, uma miniplaca lock de 6 furos; G, duas miniplacas retas convencionais de 4 furos; H, duas miniplacas lock de 4 furos; e I, três parafusos bicorticais em um padrão L invertido. Em cada modelo foram aplicadas forças simulando os músculos mastigatórios. Foram verificados os valores da tensão nas placas e parafusos. A resistência ao deslocamento foi verificada no segmento proximal, uma vez que o segmento distal era estável. Foi medida a região com o maior deslocamento inferior e superior. O deslocamento entre os segmentos osteotomizados foi verificado por intervalos milimétricos. Parafusos bicorticais em L invertido foram o modelo que teve o menor descolamento inferior, e o modelo com a tensão mais baixa foi o de duas placas convencionais. Os resultados sugerem que a tensão foi melhor distribuída nas miniplacas do tipo lock, mas os parafusos de fixação apresentaram maior concentração de tensão.

Surgical treatment of mandibular condyle fracture with bicortical screws: case report

Introduction: Mandibular condyle fractures are, of all facial fractures, those with the greatest controversies in relation to its conduct. Patient systemic condition, location and displacement degree of the fracture, mouth opening amplitude, and occlusion alteration are some factors that influence on the decision on conservative or surgical treatment. Pain, mandibular movement limitation, altered dental occlusion, and facial asymmetry are signs and symptoms that indicate condylar fracture. The surgical treatment consists of surgical fracture reduction and subsequent fixing through titanium miniplates and/or screws. Objective: The aim of this study was to report the case of a patient who had parasymphyseal fracture associated with left mandibular condyle fracture, presenting limited excursive movements of the jaw, pain in function, altered dental occlusion, and bruising on chin region. Case report: Due to the type of fracture and patient systemic condition, we decided to open reduction of fractures and stable internal fixation. Conclusion: At 12-month follow-up, the patient showed significant improvement in both clinical and functional condition, demonstrating the effectiveness of the treatment method and technique.

Análise por Elementos Finitos das Forças Mastigatórias em uma Placa de Reconstrução Mandibular / Assessment of masticatory forces in a mandibular reconstruction titanium plate through finite element analysis

Ressecção cirúrgica é um tratamento radical de algumas patologias que acometem a mandíbula e suas estruturas associadas. A técnica baseia-se na remoção total da lesão com uma margem de segurança em toda a sua dimensão, podendo ser ela marginal ou parcial. A escolha dá-se pela proximidade da extensão da lesão com a margem inferior da mandíbula. Em situações de ressecção mandibular parcial, remove-se parcialmente a margem inferior da mandíbula o que, posteriormente, dificulta a reobtenção da estética e funcionalidade do aparelho estomatognático, sendo a área reconstruída com uma placa de reconstrução óssea. A análise de elementos finitos (AEF) é uma forma de análise matemática, que se fundamenta na divisão de uma estrutura em um número finito de pequenas áreas, denominado de elementos finitos. A essa divisão dá se o nome de "malha". Em geral, a AEF possui a capacidade de modelar matematicamente estruturas, tornando-se possível a aplicação de forças em qualquer ponto e/ou direção. Dessa forma, conseguem-se dados sobre a deformação e o grau de tensão inicial, sendo possível, assim, representar situações in vivo, expressando condições compatíveis com o real. O trabalho visa analisar e simular as tensões geradas pelas forças mastigatórias, com o uso de elementos finitos, em simulação de uma mandíbula reconstruída com placa e parafusos de titânio, após sua ressecção parcial... (AU)

Surgical ressection is a radical treatment of some pathologies that affect the mandible and its structures. The technique is based on total removal of the lesion with a safe margin in all extension of the bone. Partial mandible resection results in a difficult to obtain the aesthetic and functionality of the stomatognathic system. In such cases, is recommended a titanium plate commonly used to mandibular reconstruction. Finite Element Analysis (FEA) is a form of math analysis which is based on division of a structure in a finite number of small areas. In general, FEA has the ability to mathematically model structures making possible applying forces in any point and/ or direction. Thereby, it can bring forth datas of displacement and tension being possible representing in vivo situation. This study aims to analyze and simulate the tensions generated by the masticatory forces, using FEA in a mandibular reconstruction with titanium plate after partial resection... (AU)

Evaluation of the impact of orthognathic surgery on quality of life

Dental treatment and surgery is a well-established method of correcting dentofacial deformities, and such treatment has an impact on the quality of life of individuals. The objective of this study was to evaluate the effect of orthognathic surgery on the quality of life of patients receiving treatment at the Universidade Federal do Paraná – UFPR. Clinical data were evaluated for the control group, and a quality-of-life evaluation questionnaire was completed [Oral Health Impact Profile (OHIP-14)]. For the case group, the same data were gathered along with information regarding their dentofacial deformity. The OHIP-14 questionnaire was also completed at three distinct stages of the experiment. The median age in the control group was 23.5 years. In the case group, the predominant gender was female, and the mean age of patients was 29.4 years. There was a statistically significant association between gender and OHIP-14 (p< 0.001). No such association was observed between age and OHIP-14 scores (p= 0.616). In the control group the OHIP-14 median score was 11.5. In the case group, the average OHIP-14 score at was 18 at T0, 21 at T1, and 8 at T2. The results demonstrated a statistically significant association between the three time stages at which OHIP-14 was analyzed (p< 0.001). There was a smaller reduction in the negative impact for transversal deformities of the jaw when compared with other deformities. Orthognathic surgery led to a reduction in the negative effects on the quality of life of patients.

Clinical and radiographic evaluation of maxillary central incisors exposure in patients undergoing maxillary advancement

Abstract Introduction: Patients with dentofacial deformities may undergo orthodontic or orthodontic-surgical treatment. Both modalities can affect esthetics. Objective: This study aims to evaluate clinical and radiographic changes in exposure of maxillary central incisors occurring after orthognathic surgery for maxillary advancement. Methods: A total of 17 patients who underwent orthognathic surgery for maxillary advancement between September, 2010 and July, 2011 were selected. Exposure of maxillary central incisors was evaluated clinically and by lateral cephalograms. Measurements were taken one week before and three months after surgery. Data were paired in terms of sex, age, nasolabial angle, height and thickness of the upper lip, the amount of maxillary advancement, clinical exposure and inclination of maxillary central incisor by statistical tests (CI 95%). Results: After maxillary advancement, incisor clinical exposure had increased even with relaxed lips and under forced smile. Moreover, there was a mean increase of 23.33% revealed by lateral cephalograms. There was an inverse correlation between upper lip thickness and incisors postsurgical exposure revealed by radiographic images (p = 0.002). Conclusions: Significant changes in the exposure of maxillary central incisors occur after maxillary advancement, under the influence of some factors, especially lip thickness.

Resumo Introdução: pacientes portadores de deformidades dentofaciais podem submeter-se a tratamento ortodôntico ou ortodôntico-cirúrgico. Ambos podem modificar a estética do paciente. Objetivo: esse estudo tem por objetivo avaliar, clinicamente e radiograficamente, as mudanças na exposição dos incisivos centrais superiores em pacientes submetidos à cirurgia ortognática de avanço de maxila. Métodos: foram selecionados 17 pacientes submetidos à cirurgia ortognática de avanço maxilar no período de setembro de 2010 a julho de 2011. A exposição dos incisivos centrais superiores foi avaliada clinicamente e por meio de radiografias cefalométricas em norma lateral. Essas medidas foram tomadas uma semana antes e três meses depois da cirurgia. Os dados foram, por meio de testes estatísticos (CI 95%), correlacionados por sexo, idade, ângulo nasolabial, altura e espessura do lábio superior, quantidade de avanço maxilar, exposição clínica e inclinação dos incisivos centrais superiores. Resultados: após o avanço maxilar, houve um aumento da exposição clínica dos incisivos tanto com o lábio superior relaxado quanto sob sorriso forçado. Além disso, obteve-se um aumento médio de 23,33% na exposição dos incisivos nas radiografias cefalométricas em norma lateral. Houve correlação inversa entre a espessura do lábio superior e a exposição pós-cirúrgica dos incisivos nas imagens radiográficas (p = 0,002). Conclusão: mudanças significativas na exposição dos incisivos centrais superiores ocorrem após o avanço maxilar, sob influências de certos fatores, especialmente a espessura do lábio superior.

Pharyngeal airspace in patients undergoing orthognathic surgery for mandibular advancement

Aim: To evaluate the increase of pharyngeal airway space (PAS) in patients undergoing mandibular advancement. Methods:A retrospective cross-sectional study was performed in thirteen patients who underwent mandibular advancement and were evaluated by cephalometric tracing in pre and postoperative lateral radiographs. In cephalometric tracing, the PAS was assessed by measuring the distance from the lower portion of the soft palate to the posterior pharyngeal wall (UP-PHW) and from the tongue base to the posterior pharyngeal wall (TB-PHW). Results:Patients' age ranged from 22 to 42 years with an average of 28.54 ± 2.23 years. A preoperative mean of 9.20 ± 4.56 mm in the UP-PHW measure and 10.53 ± 5.84 mm in the TB-PHW measure were obtained. The mean values found for those measurements in the postoperative period were 11.61 mm and 13.95 mm, respectively. There was an average increase of 2.4 mm in the UP-PHW and of 2.95 mm in the TB-PHW. The mean mandibular advancement in evaluated patients was 5 mm. There was no statistical correlation between PAS increase and the amount of mandibular advancement for UP-PHW (p=0.058) and TB-PHW (p=0.53), as there was no such correlation either between PAS increase and the age of patients for UP-PHW (p=0.16) and TB-PHW (p=0.26). A greater effect of the retrolingual dimension in mandibular advancement was observed, with an average increase of 24.52% while in the retropalatal dimension an average increase of 20.75% was obtained. Conclusions:Surgical advancement of the mandible increases the size of the pharyngeal airway space.

Prevalência de cistos dentígeros na Universidade Federal do Paraná / Dentigerous cysts prevalence at Federal University of Paraná

O cisto dentígero destaca-se como o mais comum entre os cistos odontogênicos de desenvolvimento dos ossos maxilares. Frequentemente são encontrados em exames radiográficos de rotina devido a alterações na cronologia de erupção dentária. O tratamento dessas lesões varia de acordo com a presença de sintomatologia dolorosa, tamanho e proximidade com estruturas anatômicas nobres. O objetivo deste trabalho foi avaliar a prevalência de cisto dentígero no Serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial da Universidade Federal do Paraná, entre 2008 e 2010. Durante esse período, foram avaliados 24 prontuários de pacientes com cisto dentígero. Dados, como gênero, idade, localização e forma de tratamento da lesão, foram coletados. Os resultados mostraram predileção pelo gênero masculino (63%), com maior incidência na segunda década de vida (42%), estando geralmente localizado na região posterior da mandíbula (62%). A principal forma de tratamento foi a enucleação associada ou não à extração do elemento dentário envolvido (75%). Todos os tratamentos mostraram-se eficazes com regressão da lesão após acompanhamento clínico e radiográfico... (AU)

The dentigerous cyst stands out as the most common among odontogenic cysts development of the jaws. They are often found in routine radiographic examination due to changes in timing of tooth eruption. The treatment of these lesions varies according to the presence of painful symptoms, size and proximity to significant anatomical structures. The objective of this study was to evaluate the prevalence of dentigerous cystin Surgery and Traumatology Oral and Maxillofacial at Federal University of Paraná between 2008 and 2010. During this period were evaluated 24 medical records of patients with dentigerous cyst. Data such as gender, age, location and method of treatment of the injury were collected. The results showed a predominance of male patients (63%), with the highest incidence in the second decade of life (42%) and is usually located in the posterior mandible (62%). The main form of treatment was enucleation with or without the extraction of the involved tooth (75%). All treatments were effective with regression of the lesion after clinical and radiographic follow-up... (AU)

Correlation Between Radiographic Area and Immunolocation of MMP-2 and MMP-9 in Unilocular Radiographic Lesions

Unilocular bone cysts are the most common entities affecting the maxillofacial region. The mechanism of proliferation and expansion remains unclear. Metalloproteinases (MMPs) are associated to diverse pathological conditions. The aim of the present study was to correlate the radiographic aspect (area) and the presence of MMP-2 and MMP-9 in dentigerous cysts, radicular cysts and keratocystic odontogenic tumors. The radiographic area of each lesion was calculated using the mathematical formula of the ellipse area. All specimens were subjected to immunohistochemical analysis for these enzymes. The average radiographic area was 284.17 mm2, 235.81 mm2 and 381.81 mm2, respectively. Statistical analyses revealed no association between the immunoreactivity of MMPs and radiographic area of the lesions in all pathologies studied, except for MMP-2 and radicular cysts, for which smaller lesions had increased immunostaining for this enzyme. The results demonstrate that quantities of MMP-2 and MMP-9 are especially involved with dentigerous and radicular cysts in expansion, whereas these enzymes seem to be related to the biological behavior of keratocystic odontogenic tumors, indicating invasion and cell proliferation. Moreover, there is an inverse association between MMP-2 and MMP-9 in keratocystic odontogenic tumors (p=0.03; rs=-0.660), indicating activity in different regions.

Cistos ósseos uniloculares são as entidades mais comuns que afetam a região maxilofacial. O mecanismo de proliferação e expansão permanece obscuro. As metaloproteinases (MMPs) estão associadas a diversas condições patológicas. O objetivo do presente estudo foi correlacionar o aspecto radiográfico (área) e a presença de MMP-2 e MMP-9 em cistos dentígeros, cistos radiculares e tumores odontogênicos queratocísticos. A área radiográfica de cada lesão foi calculada usando a fórmula matemática da área de elipse. Todas as amostras foram submetidas à análise imunoistoquímica para estas enzimas. A área radiográfica média foi de 284,17 mm2, 235,81 mm2 e 381,81 mm2, respectivamente. As análises estatísticas não mostraram associação entre a imunorreatividade de MMPs e área radiográfica das lesões em todas as patologias estudadas, exceto para MMP-2 e cistos radiculares, nas quais as lesões menores tinham maior imunomarcação para esta enzima. Os resultados demonstraram que a quantidade de imunomarcação da MMP-2 e MMP-9 estão envolvidos com cistos dentígeros e radiculares na expansão óssea, ao passo que estas enzimas parecem estar relacionados com o comportamento biológico dos tumores odontogénicos queratocísticos, indicando invasão e proliferação celular. Além disso, há uma relação inversa entre a MMP-2 e MMP-9 em tumores odontogénicos queratocísticos (p=0,03; rs= -0,660), indicando atividade em diferentes regiões.

Intraoperative accidents associated with surgical removal of third molars

Aim: To evaluate the prevalence of intraoperative accidents associated with extraction of third molars and identify possible risk factors. Methods: Prospective study with patients undergoing third molar surgery by residents of the Oral and Maxillofacial Surgery Service at the Federal University of Parana. Epidemiological data were collected from preoperative evaluation forms. During the surgical procedure were evaluated the radiographic position classifications of all third molars removed, using methods such as osteotomy and/or tooth section, time for the procedure and occurrence of any complication. Results: The students extracted a total of 323 teeth. The mean surgical time was 45 min. Conclusions: The prevalence of intraoperative accidents during extraction of third molars was 6.19%. The most prevalent accident was maxillary tuberosity fracture, followed by hemorrhage. Age, positioning of the teeth and use of the techniques of osteotomy and tooth section are possible risk factors.

Osteotomia sagital e terceiros molares inferiores: mudança de paradigma / Sagittal Split Osteotomy and Lower Third Molars: a Paradigm Shift

Objetivo: O objetivo deste artigo é uma associação de revisão da literatura sobre a realização de osteotomias sagitais na presença de terceiros molares inclusos, com o relato de um caso de cirurgia ortognática em que as osteotomias sagitais dos ramos mandibulares foram realizadas na presença desses elementos dentários. Relato dos Casos: O caso a seguir demonstra a sequência cirúrgica de um paciente portador de deformidade dento-facial submetido à cirurgia ortognática. A cirurgia realizada envolveu ambos os maxilares, com realização de osteotomia Le Fort I para a maxila e ostetomias sagitais dos ramos mandibulares. A peculiaridade do caso foi a realização das osteotomias mandibulares na presença de terceiros molares inclusos, as quais não causaram qualquer dificuldade ou complicação para a realização dos cortes ósseos e separação dos fragmentos. Conclusão: A osteotomia sagital do ramo mandibular pode ser realizada na presença dos terceiros molares inferiores de forma segura, sem aumento dos riscos cirúrgicos e otimizando o tempo de tratamento orto-cirúrgico... (AU)

Purpose: The aim of this article was to compare the effects of the presence or absence of third molars from a literature review about currents of different authors, with an association of two cases related which the sagittal split osteotomy was performed in the presence of mandibular third molars. Cases report: The following cases describe two patients, of both genders, with dentofacial deformities, these which there was the need for orthognathic surgery by the use of sagittal mandibular osteotomy. Both patients had third molars in your mouth at the time of osteotomy. There were no major complications trans and postoperative. Conclusion: The sagittal split osteotomy of the ascending ramus can be performed in the presence of third molars, and it could lead to the time optimization in the ortho-surgical treatment... (AU)

Osteoctomia sagital e terceiros molares inferiores: mudança de paradigma / Sagittal Split Osteotomy And Lower Third Molars: A Paradigm Shift

Objetivo: O objetivo deste artigo é uma associação de revisão a literatura sobre a realização de osteotomias sagitais na presença de terceiros molares inclusos, com o relato de um caso de cirurgia ortognática em que as osteotomias sagitais dos ramos mandibulares foram realizadas na presença destes elementos dentários. Relato dos casos: O caso a seguir demonstra a sequência cirúrgica de um paciente portador de deformidade dento-facial submetido a cirurgia ortognática. A cirurgia realizada envolveu ambos os maxilares, com realização de osteotomia Le Fort I para a maxila e ostetomias sagitais dos ramos mandibulares. A peculiaridade do caso foi a realização das osteotomias mandibulares na presença de terceiros molares inclusos, as quais não causaram qualquer dificuldade ou complicação para a realização dos cortes ósseos e separação dos fragmentos. Conclusão: A osteotomia sagital do ramo mandibular pode ser realizada na presença dos terceiros molares inferiores de forma segura, sem aumento dos riscos cirúrgicos e otimizando o tempo de tratamento orto-cirúrgico... (AU)

The aim of this article was to compare the effects of the presence or absence of third molars from a literature review about currents of different authors, with an association of two cases related which the sagittal split osteotomy was performed in the presence of mandibular third molars. Case description: The following cases describe two patients, of both genders, with dentofacial deformities, these which there was the need for orthognathic surgery by the use of sagittal mandibular osteotomy. Both patients had third molars in your mouth at the time of osteotomy. There were no major complications trans and postoperative. Conclusion: The sagittal split osteotomy of the ascending ramus can be performed in the presence of third molars, and it could lead to the time optimization in the ortho-surgical treatment... (AU)

Fratura do corpo da mandíbula após exodontia de 2º molar inferior em paciente HIV positiva: relato de caso clínico / Mandibular body fracture after the extraction of the second lower molar in a HIV Positive patient: Case Report

Objetivo: relatar um caso clínico no qual uma fratura de corpo da mandíbula após exodontia do dente 37 em paciente soro positiva foi diagnosticada e tratada com sucesso por meio de redução cruenta com fixação interna estável. Relato de caso: a paciente foi submetida a procedimento cirúrgico sob anestesia geral, acesso cirúrgico submandibular tipo Risdon para exposição do traço de fratura. Para redução dos cotos ósseos foi instituído bloqueio maxilomandibular por meio de parafusos de bloqueio intermaxilar. A fixação interna estável da fratura foi realizada com placas e parafusos de titânio do sistema 2,0 mm (banda de tensão) e 2,3 mm (banda de compressão). Após, o bloqueio maxilo-mandibular foi removido e a oclusão checada. Considerações finais: as complicações ou acidentes em exodontias são sempre um fator que se deve ponderar ao planejar uma cirurgia. As fraturas mandibulares, apesar de raras, normalmente estão relacionadas ao emprego de forças excessivas durante o ato operatório, mas também podem ocorrer no pós-operatório, principalmente em decorrência do enfraquecimento ósseo na região da exodontia, não tendo a mandíbula força para suportar as cargas mastigatórias naquela região, levando à fratura.

Complicações associadas à osteotomia sagital dos ramos mandibulares / Complications associated with sagittal split osteotomy of the mandibular rami

Introdução: A osteotomia sagital dos ramos mandibulares é um dos procedimentos mais utilizados em cirurgia ortognática para a correção de deformidades mandibulares. Objetivo: Analisar a prevalência das complicações trans e pós-operatórias nos pacientes submetidos à osteotomia sagital dos ramos mandibulares. Materiais e Métodos: Foi realizada uma análise retrospectiva de prontuários de pacientes submetidos à cirurgia ortognática para avanço, recuo ou correção de laterognatismo mandibular no Serviço de Cirurgia e Traumatologia Buco-Maxilo-Faciais II da Universidade Federal do Paraná, durante seis anos. Os dados (gênero, idade e deformidade dentofacial apresentada) foram coletados e correlacionados com as complicações apresentadas, por meio de análise estatística (Teste de Fischer, de Mann Whitney e de Kruskal Wallis). Resultados: O gênero feminino foi predominante (69,6%). A mediana de idade foi de 23 anos (14-65). Não houve associação estatística entre o gênero e as complicações (p=0,269) e entre a idade e as complicações (p=0,071). De um total de 46 pacientes, 11 (23,9%) tiveram, ao menos, uma complicação associada. As complicações transoperatórias com maior prevalência foram os danos visíveis ao nervo alveolar inferior (n=6/13%) e as fraturas inadequadas dos segmentos ósseos (n=6/13%). A parestesia do nervo alveolar inferior foi a complicação pós-operatória mais frequente (n=6/13%). Não houve associação estatística entre as complicações e a deformidade dentofacial apresentada pelos pacientes (p=0,389). Conclusão: Um total de 23,9 % dos pacientes sofreu algum tipo de complicação. Não houve associação estatística entre as complicações e as variáveis analisadas.

Introduction: Bilateral sagittal split osteotomy of the mandibular ramus is one of the most common procedures used in orthognathic surgery for the correction of mandibular deformities. Objective: To assess the prevalence of intraoperative and postoperative complications in patients undergoing a sagittal split osteotomy of the mandibular rami. Material and Methods: A retrospective analysis was made of the medical records of patients undergoing orthognathic surgery for the advancement, retreat or correction of mandibularlaterognatism in the Oral and Maxillofacial Surgery Unit of the Federal University of Parana over a period of six years. Data (gender, age and dentofacial deformity presented) were collected and correlated with the complications by means of statistical analysis (Fischer, Mann Whitney and Kruskal Wallis tests). Results: Females were predominant (69.6%). The median age was 23 years (14-65). There were no statistical associations between gender and complications (p=0.269) or between age and complications (p=0.071). Of a total of 46 patients, 11 (23.9%) had at least one complication. The most prevalent intraoperative complications were visible damage to the inferior alveolar nerve (n= 6/13%) and inadequate fractures of the bone segments (n=6/13%). Inferior alveolar nerve paresthesia was the most frequent postoperative complication (n=6/13%). There were no statistical associations between complications and the dentofacial deformity presented by the patients (p=0.389). Conclusion: 23.9% of the patients suffered some type of complication. There were no statistical associations between complications and the variables analyzed.

Osteonecroses maxilo-mandibulares relacionadas à utilização de biofosfonados / Osteonecrosis of the jaw related to use of bisphosphonates

Os bisfosfonados (BFs) são fármacos sintéticos, utilizados no tratamento do mieloma múltiplo, patologias ósseas associadas a neoplasias malignas, doença de Paget e à osteoporose. a droga reduz a reabsorção óssea e inibe o recrutamento de osteoclastos. essas drogas apresentam alguns efeitos colaterais. Recentemente foi identificada uma nova complicação denominada osteonecrose associada aos bisfosfonados (OaB). Objetivo: Realizar uma revisão de literatura sobre o assunto, considerando os fatores etiológicos, os mecanismos de ação desses medicamentos, seus efeitos adversos e tratamentos. Metodologia: Foram utilizados todos os prontuários dos pacientes que foram diagnosticados com osteonecroses maxilo-mandibulares dentro da uFPR e do Hospital XV, a partir do ano de 2006. Resultados: Demonstraram uma prevalência pelo gênero feminino (58%). a idade variou de 55 a 81 anos. a doença-base com maior incidência foi a osteoporose (35,7%). Pacientes que faziam uso de BFs administrados por via endovenosa também foram prevalentes. O ácido zoledrônico foi a medicação mais utilizada. a mandíbula foi o osso mais acometido, e como tratamento utilizaram-se mais antibióticos e bochechos com clorexidina 0,12%. Conclusão: O uso crônico de BFs pode levar à OaB. Tendo em vista a dificuldade do tratamento, o cirurgião-dentista assume um papel fundamental na sua prevenção.

The bisphosphonates (BFs) are synthetic drugs used to treat multiple myeloma, bone pathologies associated with malignancy, Paget's disease and osteoporosis. The drug reduces bone resorption and inhibits the recruitment of osteoclasts. These drugs have a number of side effects, and a new complication known as biphosphonate-associated osteonecrosis (BaO) was recently identified. Objective: To review the literature on the subject, taking into account the etiological factors, mechanisms of action of these medications, their side effects and treatments. Methodology: We used all the records of patients diagnosed with osteonecrosis of the jaw at uFPR and Hospital XV from 2006. Results: The records showed a prevalence in females (58%). ages ranged from 55 to 81 years. The base disease with the greatest incidence was osteoporosis (35.7%). There was also a prevalence of patients using intravenously administered BFs. zoledronic acid was the most commonly used medication. The mandible was the most affected bone and the most widely used treatment was antibiotics and mouthwash with 0.12% chlorhexidine. Conclusion: The chronic use of BFs can lead to BAO. Given the difficulty of treatment, the dental surgeon plays a key role in prevention.