Evaluation of bone availability for grafts in different donor sites, through computed tomography

Abstract Objective To quantify the bone volume that can be safely withdrawn from 3 donor sites: (1) the mandibular symphysis, (2) the oblique mandibular line and (3) the skullcap. Methodology For the symphysis, 200 tomographic exams were evaluated by the extension of the anterior loop of mental foramen, by the nerve, by the distance of the foramens, by the distance between the vestibular cortical and the lingual plates and by the distance between the apexes, or lower anterior teeth, and the mandibular base, using the "distance" tool of the I-CAT Vision, in the panoramic and parasagittal reformations. For the oblique line, 70 TCFC exams were analyzed retrospectively in panoramic and parasagittal reformations, evaluating the thickness of the vestibular cortical and the distance between the cortical and the mandibular canal. For the cranial bone, a hexagonal donor site located in parietal area was considered. Results The average dimensions of the bone blocks that can be safely removed from the region of the mandibular symphysis are: 32.27 mm in length, 4.87 mm in height and 4 mm in thickness, providing a volume of 628.61 mm3 available for grafting. In the oblique line, the available bone volume for grafting was 859.61 mm3. In the region of the cranial vault, multiplying the average bone thickness by the area of the hexagon, an average volume of 2,499 mm3 was obtained. Conclusions Comparing the donor sites, the bone availability in the cranial vault is 3 times greater than in the mandibular posterior region, and at least 2 times greater than in the mandibular symphysis.

Immediate Removal of a Dislocated Dental Fragment from the Submandibular Space during Extraction of the Lower Third Molar: Case Report and Literature Review / Remoção Imediata de fragmento Radicular Deslocado Para o Espaço Submandibular Durante a Exodontia de Terceiro Molar Inferior. Relato de Caso e Revisão de Literatura

This paper aims to report a case of radicular displacement to the submandibular space and to review the literature seeking reports of dental displacements / fragments published in the period from 2007 to 2017 in PubMed evidencing risk factors, prevention and forms of treatment. In this article a case of displacement of dental fragments to the submandibular space with immediate removal is reported. The third molar or its roots displacement into facial spaces is a rare situation. The preoperative surgical planning is fundamental to avoid this type of complication. The association of (1) good surgical planning, (2) surgical technique utilization and adequate instruments, and (3) the surgeon experience are determining factors to avoid the occurrence of this complication. (AU).

A extração de terceiros molares é o procedimento cirúrgico mais frequente nos consultórios odontológicos. Como qualquer cirurgia, existe a possibilidade de complicações trans e pós-operatórias. O deslocamento desses dentes ou fragmento dentário para espaços faciais é raro, com frequência extremamente baixa. Este trabalho tem como objetivo relatar um caso de deslocamento radicular para o espaço submandibular e revisar a literatura buscando relatos de deslocamentos dentários/fragmentos publicados no período de 2007 a 2017 no Pubmed evidenciando fatores de risco, prevenção e formas de tratamento. Nesse artigo nós relatamos um caso de deslocamento de um fragmento radicular para o espaço submandibular, sendo este removido imediatamente. O deslocamento do terceiro molar ou de fragmentos radiculares para os espaços faciais é raro. A avaliação pré-operatória é fundamental para evitar esse tipo de complicação. A associação entre (1) planejamento cirúrgico correto, (2) utilização de técnica e materiais corretos e (3) experiência do profissional, são fatores determinantes para evitar esse tipo de complicação. (AU).

Treatment of bisphosphonate-related osteonecrosis using platelet-rich plasma: microtomographic, microscopic, and immunohistochemical analyses

Abstract The present study aimed to investigate the use of platelet-rich plasma (PRP) on tooth extraction sites in rats treated with bisphosphonates. Thirty Albinus Wistar male rats were administered 0.035 mg/kg zoledronic acid intravenously for 8 weeks, divided into four administrations with a 2-week interval between each application, after which their upper right central incisors were extracted to induce the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). The samples were divided into the following two groups: Group 1 (G1) underwent marginal resection of BRONJ followed by the use of PRP, while Group 2 (G2) underwent resection of BRONJ but without the use of PRP. The treatment groups were evaluated after 14, 28, and 42 days. Clinical, microtomographic, microscopic, and immunohistochemical (IHC) evaluations were performed. Microtomography results revealed no significant difference between the groups (p <0.05) in any time period. Histomorphometric analysis showed increased bone formation over time for both groups (p < 0.001). G1 demonstrated a greater amount of new bone formation than G2 at 28 and 42 days (p < 0.001), with G1 presenting greater vascularization and a slightly higher VEGF expression. For both groups, RANKL/OPG expression levels were sufficient as a parameter for indicating the rate of bone remodeling in a previously treated area of osteonecrosis groups. Taken together, our findings indicated that the use of PRP improves the resolution process of BRONJ.

Condylar positioning in orthognathic surgery: a cone beam computed tomography-based in vitro analysis of a positioning method

Aim: Orthognathic surgery aims to correct facial skeletal deformities and the correct condylar positioning is very important for stable results. The aim of the present study was to verify the occurrence of changes in the postoperative condylar positioning in artificial skulls with a skeletal Class II maxillomandibular relationship submitted to bilateral sagittal split osteotomy when the method of cephalometric data transfer was used. Methods: Ten skeletal Angle class II polyurethane skulls were used with metallic markers in the articular surfaces of the temporomandibular joint and mandibular condyles. The skulls were submitted to preoperative and postoperative cone beam computed tomography before and after the bilateral sagittal split osteotomy. To verify the condylar positioning, measurements between the distances of the markers at the temporal bones and mandibular condyles were taken in the coronal and sagittal views by the DISTANCE tool of the iCat Vision software. All measurements were obtained by one examiner in the preoperative and postoperative CBCTs, tabulated and submitted to statistical analysis by the Wilcoxon test with a level of significance of 5% (p<0,05). After 15 days of the completion of the first data collection, all measurements were redone to determine the random and systematic error by the Intraclass Correlation Coefficient. Results: With the exception of the average of the lateral-medial distance (from the measurements between the medium left markers only), the averages of the anterior-posterior distances (only in the left posterior and lateral right markers) and the vertical average (only in the central markers) showed no statistically significant differences between the preoperative and postoperative distances of the metallic markers. Conclusion: Even when using the method of cephalometric data transfer, variation of the condylar positioning occurred between the preoperative and postoperative periods. This variation occurred only in a few points of the mandibular condyles

Tomographic late evaluation of xenogeneic bone grafts in sockets of impacted third molars

Abstract It is necessary to preserve height and thickness of the alveolar bone to facilitate rehabilitation with osteointegratable implants or simply to maintain bone integrity after extraction. Biomaterials associated with resorbable or non-resorbable membranes, when placed in the region of the socket, may contribute to avoid this unwanted reabsorption. Objective The objective of this study was to evaluate the distance of the crest of alveolar ridge to the cementoenamel junction (CEJ) of the lower second molars and the bone density of the third molar socket filled with Gen-Tech®, 5 years after an exodontia using cone beam computed tomography (CBCT) to visualize the central region of the sockets, without overlapping of the buccal and lingual cortical bones. Material and Methods A total of 12 individuals from an initial group of 39 patients submitted to extraction of the unruptured lower third molars and grafting of an association of inorganic bovine bone matrix, organic bovine bone matrix, collagen and bone morphogenetic proteins (BMP) (Gen-Tech®) on one side and the contralateral sockets filled only by clot, returned to control after 5 years, and were submitted to CBCT. The distance from the crest of alveolar bone to the CEJ and the bone density (BD) were measured using the i-CAT Vision Software. Results The results showed that the distance from the crest of alveolar bone to the CEJ in the control group was similar to that observed before the exodontia; in the experimental group, this distance was smaller. Considering the BD measurement, a significantly higher density was observed in the experimental group (p<0.05). Conclusion Part of the biomaterial was not absorbed and allowed the stability of the evaluated parameters after 5 years, being able to be used as a bone substitute in the socket.

Current considerations on bone substitutes in maxillary sinus lifting / Consideraciones actuales sobre sustitutos óseos en elevación del seno maxilar

The procedure of maxillary sinus lifting using autogenous bone was considered the reference standard choice for oral rehabilitation in cases of severe atrophic maxilla. However, it is not always a viable option, due to the limitations or morbidity caused by grafting techniques. This has led to the development of bone substitutes, which have been elaborated and improved. Choosing the best biomaterial becomes difficult due to the wide variety of bone substitutes. The aim of this article is to present some of these materials that are reported in the current scientific literature for maxillary sinus lifting.

El procedimiento de elevación del seno maxilar utilizando hueso autógeno se consideraba la opción estándar de oro para la rehabilitación oral en casos de maxilar atrófico grave. Sin embargo, no siempre es una opción viable, debido a las limitaciones o a la morbilidad causada por técnicas de injerto, lo que justifica la existencia de sustitutos óseos que han sido elaborados y mejorados. En cuanto a la amplia variedad de sustitutos óseos, se hace difícil la mejor elección de biomaterial. El objetivo de este informe es presentar una variedad de sustitutos óseos respetados en la literatura científica actual, usados en la elevación del seno maxilar.

Medication-related osteonecrosis of the jaw. Introduction of a new modified experimental model

ABSTRACT PURPOSE : To evaluate a modified experimental model for medication-related osteonecrosis of the jaw (MRONJ) through the upper right central incisor extraction followed by intravenous bisphosphonate administration. METHODS: Forty five rats underwent the upper right central incisor tooth extraction were divided in 2 groups: Group I - experimental group, 30 rats received an intravenous administration protocol of zoledronic acid 35μg/kg into the tail vein every two weeks, totalizing four administrations, during eight weeks of administration, previously the extraction, and Group II - control group, 15 rats didn't received any medication before extraction. The groups were subdivided in postoperative periods: 14/28/42 days. Clinical analysis and microtomography were performed to verify the presence of osteonecrosis. In addition, descritive histological analysis of hematoxylin-eosin stained sections was performed to evaluate the presence of osteonecrosis or necrotic foci. RESULTS: Twelve (40%) rats, from experimental group, showed clinical signs of MRONJ (p=0.005), however, all samples showed imaginologic findings like osteolysis and loss of integrity of the cellular walls (p≤0.001). Microscopic evaluation revealed osteonecrosis areas with microbial colonies and inflammatory infiltrate (p≤0.001). In the control group, all animals presented the chronology of a normal wound healing. CONCLUSIONS: The presence of medication-related osteonecrosis of the jaw after maxillary central incisor extraction in rats. This new experimental model may be considered an option for the study of MRONJ.

Evaluation of opening pattern and bone neoformation at median palatal suture area in patients submitted to surgically assisted rapid maxillary expansion (SARME) through cone beam computed tomography

AbstractSurgically assisted rapid maxillary expansion (SARME) is the treatment of choice to adult patients even with severe transversal maxillary discrepancies. However, the adequate retention period to achieve the bone remodeling, thus assuring treatment stability, is controversial.Objective To evaluate the opening pattern and bone neoformation process at the midpalatal suture in patients submitted to surgically assisted (SARME) through cone beam computed tomography (CBCT).Material and Methods Fourteen patients were submitted to SARME through subtotal Le Fort I osteotomy. Both the opening pattern and the mean bone density at midpalatal suture area to evaluate bone formation were assessed pre- and post-operatively (15, 60 and 180 days) through CBCT.Results Type I opening pattern (from anterior to posterior nasal spine) occurred in 12 subjects while type II opening pattern (from anterior nasal spine to transverse palatine suture) occurred in 2 individuals. The 180-day postoperative mean (PO 180) of bone density value was 49.9% of the preoperative mean (Pre) value.Conclusions The opening pattern of midpalatal suture is more related to patients’ age (23.9 years in type I and 33.5 years in type II) and surgical technique. It was not possible to observe complete bone formation at midpalatal suture area at the ending of the retention period studied (180 days).

Lower third molar fused with a supernumerary tooth: diagnosis and treatment planning using Cone-Beam Computed Tomography / Terceiro molar inferior fusionado com um supranumerário: diagnóstico e plano de tratamento usando Tomografia Computadorizada Volumétrica

Fusion is the union of two developing dental germs, resulting in a single large dental structure. It involve two normal dental germs or the germ of a normal tooth with a germ of a supernumerary one. Supernumerary teeth are additional teeth of the normal series which may occur in any region of the dental arch, althoug they are more common in the maxilla than in the mandible. This article presents a case of fusion between a third molar and a supernumerary tooth, in which a surgical intervention was carried out, with the objective of removing the dental elements. The panoramic radiography was complemented by the Donovan´s radiographic technique, but because of the proximity of the dental element to the mandibular ramus, it was not possible to have a final fusion diagnosis. Hence, the Cone-Beam Computed Tomography which provides precise three-dimensional information, was used to determinate the fusion diagnosis and also to help in the surgical planning.

Fusão é a união de dois germes dentários em desenvolvimento, resultando numa única estrutura dentária, podendo ocorrer entre dois germes dentários normais ou entre o germe de um dente normal com um supranumerário. Dentes supranumerários são dentes adicionais à série normal e podem ocorrer em qualquer região da arcada dentária, entretanto, são mais comumente encontrados na maxila do que na mandíbula. O presente artigo ilustra um caso de fusão entre um terceiro molar mandibular e um dente supranumerário, onde foi realizada uma intervenção cirúrgica com o objetivo de remover os elementos dentários. Para complementar o diagnóstico, além da radiografia panorâmica, utilizou-se a técnica radiográfica de Donovan, mas, devido à proximidade do elemento dental com o ramo mandibular, não foi possível determinar um diagnóstico preciso de fusão. Sendo assim foi utilizada a Tomografia Computadorizada Volumétrica que fornece informações precisas e em três dimensões, possibilitando desta forma chegar ao diagnóstico de fusão e também auxiliando no planejamento cirúrgico.

Comparación de la posición de terceros molares no erupcionados entre individuos con y sin fisura labiopalatina / Comparison of the position of non-erupted third molars in patients with and without cleft lip and palate

Objetivo: comparar la posición de terceros molares no erupcionados entre individuos con y sin fisura labiopalatina a través de radiografías panorámicas. Materiales y métodos: se realizó un estudio documental, retrospectivo, con datos primarios, a partir del análisis de 1.000 radiografías panorámicas: 500 pertenecientes a la Facultad de Odontología de Baurú, Universidad de San Pablo (FOB/USP) y otras 500 provenientes del Hospital de Rehabilitación de Anomalías Craneofaciales, Universidad de San Pablo (HRAC/USP), seleccionadas aleatoriamente entre agoswto y diciembre de 2009. De ese universo se eligió una muestra de 152 imágenes, según los criterios de inclusión: radiografías panorámicas pertenecientes a individuos entre 15 y 20 años de edad, de ambos géneros, que presentaran los cuatro terceros molares no erupcionados, cuyas imágenes fueran de buena calidad, con un grado medio de densidad y contraste. El Grupo 1 o Grupo control fue constituido a partir de 76 radiografías de pacientes no portadores de fisura labiopalatina, tratados en la FOB/USP; y el Grupo 2 o Grupo experimental constó de otras 76 radiografías pertenecientes a individuos con fisura transforamen completa, atendidos en el HRAC/USP. Todas las radiografías fueron obtenidas con el mismo dispositivo panorámico y, más tarde, digitalizadas por medio del software ImageJ(R) (McGill University, Montreal, Canada). Los terceros molares no eurpcionados fueron clasificados según su angulación respecto del segundo molar adyacente. Resultados: se constató una diferencia estadísticamente significativa entre los grupos evaluados respecto de los dientes inferiores (p<-0,05). En cuanto a la angulación, en el Grupo control hubo mayor frecuencia de dientes en la posición distoangular, mientras que en el Grupo Experimental predominó la posición mesioangular. Conclusión: la posición de los terceros molares en individuos con fisura no difiere de la de los individuos sin fisura.

Análise morfológica da osteocondução do Gen-Phos e Gen-Mix em calvária de rato / Morfologic osteoconduction evaluation of Gen-Phos and Gen-Mix in rat calvaria

Introdução: a utilização de substitutos ósseos vem aumentando na Odontologia em decorrência de resultados clínicos satisfatórios e previsíveis, menor morbidade pós-operatória e preços acessíveis. O material mais utilizado ainda é o osso bovino inorgânico com propriedades osteocondutoras. Na década de 80 iniciaram as buscas por um material sintético, osteocondutor com resultados iguais ou superiores ao osso inorgânico bovino. Objetivo: comparar histológica e histometricamente a propriedade osteocondutora do osso composto (GenMix, Baumer) com o fosfato betatricálcio (GenPhos, Baumer) implantados em defeito de tamanho crítico em calvária de rato. Resultados: observou-se 32,5% de neoformação óssea no grupo do osso composto e 45,9% no grupo do fosfato betatricálcio. Conclusões: com o tempo de observação microscópica desse trabalho, é possível afirmar que os materiais estudados não são absorvíveis e que o fosfato betatricálcio é mais osteocondutor comparado ao osso composto.

Introduction: the use of bone replacements in Dentistry has increased as a result of satisfactory and predictable clinical results, lower postoperative morbidity and affordable prices. The most common material used is still the inorganic bovine bone with osteoconductive properties. In the 1980’s began the search for a synthetic material with osteoconductive results equal or superior to inorganic bovine bone. Objective: To compare histological and histometric property of osteoconductive bone compound (GenMix, Baumer) with phosphate beta- tricalcium(GenPhos, Baumer) implanted in critical size defects in rat calvaria. Results: It was observed 32.5% of new bone formation in the group of compound bone and 45.9% in the phosphate beta-tricalcium group. Conclusions: Along the time of microscopic observation of this work, one can state that the materials studied are not absorbable and that phosphate beta-tricalcium is more osteoconductive compared to the compound bone...

Experimental dry socket: microscopic and molecular evaluation of two treatment modalities / Alveolite experimental: análise microscópica e molecular de duas modalidades de tratamento

PURPOSE: To evaluate two treatment modalities of dry socket in rats and to discuss the first findings of the molecular analysis in this experimental model. METHODS: 84 rats underwent a tooth extraction were divided in 4 groups: I-uninfected socket (control), II-infected socket without any treatment, III-infected socket treated with irrigation of 2 percent sodium iodide and 3 percent hydrogen peroxide solution, IV-infected socket submitted to curettage, irrigation with physiological saline solution and fulfilled with metronidazole paste as base. The groups were subdivided in postoperative sacrifice periods: 6/15/28 days. A quantitative and a qualitative microscopic analysis was performed. Also, a quantitative analysis was performed using a RealTimePCR to evaluate the genes expression in the wound healing: Collagen Type I/COL-I, vascular endothelial growth factor/VEGF, osteocalcin/OCN, alkaline phosphatase/ALP, runt-related transcription factor 2/RUNX2 and tumor necrosis factor alpha/TNF-α. RESULTS: The group I showed higher bone formation, followed by groups IV, III, II respectively. The group II presented higher inflammatory infiltrate and the wound healing was delayed compared with other groups. It was obtained a significant positive correlation between bone neoformation and the expression of OCN and RUNX2, inflammatory infiltrate with TNF-α and a negative correlation between bone neoformation and TNF-α. CONCLUSION: No significant difference was found between the treatments.

OBJETIVO: Avaliar duas modalidades de tratamento da alveolite em ratos e discutir os primeiros achados de uma análise molecular neste modelo experimental. MÉTODOS: 84 ratos foram submetidos a uma extração dentária e foram divididos em quatro grupos: I- alvéolo não infectado (controle), II- alvéolo infectado sem tratamento, III- alvéolo infectado tratado com irrigação de iodeto de sódio a 2 por cento e solução de peróxido de hidrogênio a 3 por cento, IV- alvéolo infectado submetido à curetagem, irrigação com solução salina fisiológica e preenchimento com pasta a base de metronidazol. Os grupos foram subdivididos em períodos de sacrifício pós-operatório: 6/15/28 dias. Uma análise quantitativa e qualitativa microscópica foi realizada. Além disso, uma análise quantitativa foi realizada utilizando RealTimePCR para avaliar a expressão de genes no reparo alveolar: o colágeno tipo I / COL-I, o fator de crescimento endotelial vascular / VEGF, osteocalcina / OCN, fosfatase alcalina / ALP, fator de transcrição runt relacionados 2 / RUNX2 e fator de necrose tumoral alfa / TNF-α. RESULTADOS: O grupo I mostrou maior formação óssea, seguido pelos grupos IV, III, II, respectivamente. O grupo II apresentou maior infiltrado inflamatório e a cicatrização foi atrasada em comparação com outros grupos. Foi obtida uma correlação positiva entre a neoformação óssea e a expressão de OCN e RUNX2, infiltrado inflamatório com TNF-α e uma correlação negativa entre a neoformação óssea e TNF-α. CONCLUSÃO: Nenhuma diferença significativa foi encontrada entre os tratamentos.

Experimental alveolitis in rats: microbiological, acute phase response and histometric characterization of delayed alveolar healing

The pathogenesis of alveolitis is not well known and therefore experimental situations that mimic some features of this disease should be developed. OBJECTIVE: In this study, the evolution of the experimentally induced infection in rat sockets is characterized, which leads to clinical signs of suppurative alveolitis with remarkable wound healing disturbs. MATERIAL AND METHODS: Non-infected (Group I) and experimentally infected sockets in Rattus novergicus (Group II) were histometrically evaluated regarding the kinetics of alveolar healing. In addition, the characterization of the present bacteria in inoculation material and the serum levels of C-reactive protein (CRP) were performed. The detected species were Capnocytophaga ochracea, Fusobacterium nucleatum ss nucleatum, Prevotella melaninogenica, Streptococcus anginosus, Treponema socranskii and Streptococcus sanguis. RESULTS: All experimentally infected rats developed suppurative alveolitis, showing higher levels of CRP in comparison to those non-infected ones. Furthermore, infected rats presented a significant delayed wound healing as measured by the histometric analysis (higher persistent polymorphonuclear infiltrate and lower density of newly formed bone). CONCLUSION: These findings indicate that rat sockets with experimentally induced infection produced higher levels of serum CRP, showing the potential of disseminated infection and a disturb in the alveolar repair process in an interesting experimental model for alveolitis studies.

Importância do reconhecimento da anatomia radiográ cadentomaxilar na prevenção de complicações cirúrgicas / Recognition of the importance of dental radiographic anatomy of the jaw in the prevention of surgicalcomplications

A prevenção das complicações cirúrgicas odontológicas na maxila depende de fatores que envolvem a habilidade do cirurgião, o conhecimento da anatomia e fisiologia dos tecidos, planejamento correto, anamnese e exame físico, técnicas radiográficas específicas, qualidade das imagens e da capacidade de interpretá-las. Radiografias intra e extrabucais são fundamentais no planejamento cirúrgico e minimizam as complicações, pois permitem melhor planejamento e, consequentemente, maior sucesso cirúrgico, pois auxiliam na avaliação das estruturas ósseas e dentárias e dos reparos anatômicos na área da intervenção cirúrgica. Nosso estudo relacionou os achados na literatura com o estudo de casos clínicos e radiográficos já documentados no Departamento de Estomatologia, disciplinas de Radiologia e Cirurgia da FOBUS P.

The prevention of dental maxillary surgical complications depends on factors that involve the surgeon’s skill, knowledge of anatomy and physiology of tissues, proper planning, history and physical examination, radiographic techniques specific quality of the images and the ability to interpret them. Intraand extraoral radiographs are essential in surgical planning and minimize the complications, because they allow better planning and, consequently, greater surgical success, because they help in the evaluation of bone and tooth structures and anatomical landmarks in the area of surgery. Our study findings in the literature related to the study of clinical and radiographic cases already documented in the Department of Stomatology, Department of Radiology and Surgery, FOB-USP.

Anatomia radiográfica do canal mandibular e suas variações em radiografias panorâmicas / Radiographic anatomy of the mandibular canal and its variations in panoramic radiographs

Neste estudo avaliamos a prevalência das diferentes variações anatômicas do canal mandibular e a visualização do forame mentual em radiografias panorâmicas, utilizando a classificação proposta por Nortjé. Em relação aos canais bífidos, utilizamos a classificação proposta por Langlais. A amostra foi composta por 915 radiografias, sendo 583 de mulheres e 332 de homens, brancos e negros. Para a descrição das proporções foi utilizado Intervalo de Confiança a 95 por cento. Para comparação das proporções entre grupos foi utilizado o teste do qui-quadrado, sendo adotado nível de significância de 5 por cento (p < 0,05). As diferenças morfológicas do canal mandibular não foram influenciadas pelo sexo e nem pela etnia, na amostra estudada; quando comparamos a amostra estudada com amostras obtidas por outros autores, houve diferença. Em relação à altura do canal mandibular, a maior ocorrência foi do Tipo 2 em mulheres e do Tipo 4 em homens; a menor ocorrência foi pra o Tipo 3 em ambos os sexos; para os canais que apresentaram bifurcação o Tipo 0 foi mais prevalente em ambos os sexos. A curva mesial do canal mandibular estava presente na maioria das radiografias interpretadas, porém essa diferença não é estatisticamente significante; o forame mentual não pode ser visualizado em 0,4 por cento das radiografias, todas de homens.

In this study, the prevalence of the different anatomical variations of the mandibular canal and the view of the mental foramen in panoramic radiographs, using the classification proposed by Nortjé was evaluated. Regarding channels bifid, we use the classification proposed by Langlais. The sample comprised 915 radiographs, 583 were women and 332 men, whites and blacks. For the description of proportions was used Confidence Interval 95 percent. For comparison of proportions between groups was used the chi-square, with the level of significance of 5 percent (p < 0.05). The morphological differences of the mandibular canal were not influenced by gender or by ethnicity, the sample studied, when comparing the sample with samples obtained by other authors, there were differences, relative to the height of the mandibular canal, the most prevalent was the Type II in women and Type IV in males and the lowest prevalence was for Type III in both sexes, for the channels that showed the bifurcation Type 0 was more prevalent in both sexes; curve mesial of the mandibular canal was present in most interpreted the radiographs, but this difference was not statistically significant, the mental foramen can not be viewed in 0.4 percent of the radiographs, all men.

Avaliação das posições dos terceiros molares impactados de acordo com as classificações de Winter e Pell & Gregory em radiografias panorâmicas / Evaluation of the positions of impacted third molars according to the Winter and Pell & Gregory classifications in panoramic radiography

Os terceiros molares apresentam as maiores taxas de não irrompimento retenção dental, seguidos dos caninos superiores e dos dentes supranumerários. Os terceiros molares podem ser classificados de acordo com as classificações propostas por Winter e Pell & Gregory. OBJETIVOS: O presente trabalho tem como objetivo avaliar a prevalência das posições de terceiros molares inclusos em relação às classificações de Winter e Pell & Gregory. MATERIAIS E MÉTODOS: Realizou-se um estudo retrospectivo, descritivo, com dados de 2629 prontuários de pacientes atendidos nas clínicas de Cirurgia da Faculdade de Odontologia de Bauru - Universidade de São Paulo (FOB-USP), Bauru/SP, Brasil no período de janeiro de 1997 a dezembro de 2002. RESULTADOS: Do total de prontuários avaliados, 2290 foram incluídos no presente estudo. Pacientes do gênero feminino foram observados com maior frequência (61,1 por cento). Foi observado um total de 7222 terceiros molares. A posição mais comum para os dentes superiores foi a vertical, seguida da distal, enquanto que, nos dentes inferiores, observou-se maior frequência de dentes verticais seguidos dos mesiais e na posição IIA, seguida da IIB. CONCLUSÃO: O conhecimento do posicionamento dos terceiros molares facilita o planejamento da cirurgia para sua extração.

The third molars present the highest rates of unerupted teeth, followed by the upper canines and supernumerary teeth. Third molars can be classified according to the classifications proposed by Winter and Pell & Gregory. AIMS: The present study set out to evaluate the prevalence of the positions of impacted third molars in relation to the Winter and Pell & Gregory classifications in panoramic radiography. MATERIALS AND METHODS: A documental, retrospective, descriptive study was carried out using the records of 2,629 patients seen in the oral surgery clinics of the Bauru Dental School, University of São Paulo, Bauru/SP, Brazil, between January 1997 and December 2002. RESULTS: The sample was composed of 2,290 records selected in accordance with the inclusion criteria. The majority of patients (61.1 percent) were female. It was found that 7,222 specimens represented impacted third molars. Regarding position, in the maxilla, the vertical position was the most frequent, followed by the distoangular, while in the mandible the vertical position was the most common, followed by the mesioangular, and in the IIA position, followed by the IIB one. CONCLUSIONS: Knowledge of the position of third molars facilitates the surgical planning of extraction.

Abordagem cirúrgica de hemangioma intra-oral / Surgical approach of intraoral hemangioma

Hemangioma é um termo clínico que designa uma neoplasia vascular benigna ou malformação vascular de origem endotelial. Não é incomum na região de cabeça e pescoço, portanto, o cirurgião-dentista deve conhecer seu aspecto clínico, manobras de diagnóstico e saber conduzir o caso. É mais comum acometerem os tecidos moles e geralmente se apresentam clinicamente como pápulas ou nódulos avermelhados assintomáticos. Existem várias formas de abordagem terapêutica descritas na literatura. Alguns fatores do próprio paciente e características da lesão devem ser considerados para o melhor tratamento. Este artigo relata um caso de um hemangioma em mucosa jugal, optando-se por uma abordagem cirúrgica da lesão.

Hemangioma is clinical term for designate a benign vascular neoplasm or vascular malformation of endothelial origin. Isn't unusual occurs into head and neck region, therefore, surgeon dentis must to know your clinical aspect, diagnosis measures and how follow-up the case. The most common locations are the soft tissues and it presents as asymptomatic papule or nodule red. There are some therapeutic alternatives in the literature. Treatment of hemangioma depends of factors of the patient and characteristic of the lesion. The aim of this paper is to report a hemangioma into cheek in which the treatment was the excision of the lesion.

Cisto dentígero: características clínicas, radiográficas e critérios para o plano de tratamento / Dentigerous cyst: clinical and radiographic characteristics and criteria for treatment planning

O cisto dentígero é o segundo cisto odontogênico mais frequente nos maxilares. São sempre radiolúcidos e mais comumente uniloculares.Geralmente são observados em exames de rotina ou quando do não irrompimento de um dente permanente. Os terceiros molares inferiores seguidos dos caninos superiores e ocasionalmente dentes supranumerários e odontomas podem estar envolvidos com a formaçãodo cisto dentígero, porém, sua etiopatogenia ainda não é totalmente conhecida. O cisto dentígero ocorre principalmente nas três primeiras décadas de vida, seu crescimento é lento e assintomático, contudo pode atingir dimensões consideráveis causando deformação facial, impactação e deslocamento de dentes e/ou estruturas adjacentes. A descompressão, marsupialização e a enucleação são as formas de tratamento mais empregadas, porém alguns critérios importantes devem ser considerados para o plano de tratamento como, tamanho do cisto, idade, proximidade com estruturas anatômicas e importância clínica do dente envolvido. Apesar das peculiaridades clínicas de cada caso e do método de tratamento escolhido, o prognóstico destas lesões é favorável.

The dentigerous cyst is the second most frequent odontogenic cyst in jaws. They are always radiolucent and commonly unilocular. They are usually found in routine exams or when a permanent tooth does not erupt. The third molars followed by maxillary canines and occasionally supernumerary teeth and odontomas may be involved with the formation of the dentigerous cyst, but its etiology is not yet completely known. The dentigerous cyst occurs mainly in the first three decades of life, and its growth is slow and asymptomatic, however, it may reach considerable dimensions causing facial deformity, impaction and displacement of teeth and/or adjacent structures. Decompression, marsupialization and enucleation are the most frequent forms of treatment used, nevertheless, some important criteria must be considered for the treatment plan such as cyst size, age, proximity to anatomical structures and clinical importance of the tooth involved. Despite the clinical peculiarities of each case and the treatment method chosen, prognosis of these lesions is favorable.

Cisto ósseo de Stafne - área radiolúcida na mandíbula versus patologias ósseas: revisão de literatura / Stafne´s defect ? radiolucent area in the mandible versus bone diseases: a literature review

O cisto ósseo de Stafne representa uma cavidade óssea localizada na mandíbula, contendo a glândula submandibular. Foi descrito pela primeira vez, por Edward Stafne, em 1942, como uma lesão radiolúcida unilateral, bem circunscrita, localizada na região posterior da mandíbula, logo abaixo do canal mandibular. Comumente é encontrado em exames radiográficos de rotina, assintomático, apresenta maior predileção pelo gênero masculino, numa proporção de 6:1. Constitui um achado raro na população, com prevalência entre 0.1% a 0.48%. O objetivo do presente estudo é o de realizar uma revisão de literatura, com o intuito de ampliar o conhecimento a despeito da etiologia, epidemiologia e diagnóstico diferencial desse cisto ósseo. Foi enfatizado, também, o uso dos recursos imaginológicos no diagnóstico como a Tomografia Computadorizada Volumétrica - Cone Beam. Pôde-se concluir que o cisto ósseo de Stafne se manifesta de diferentes formas radiograficas, tornando-se indispensável a requisição de outros exames de imagem para o correto diagnóstico, evitando procedimentos invasivos, como o cirúrgico exploratório e a sialografia.

Stafne?s bone cyst is a bony cavity of the mandible containing the submandibular gland. It was described for the first time in 1942 by Edward Stafne, who reported a well-defined, unilocular radiolucency, located in the posterior mandible, directly below the mandibular canal. It is usually asymptomatic and frequently found on routine x-ray examinations, being more common in males, in a male:female ratio of 6:1. This is a rare defect whose prevalence ranges from 0.10% to 0.48%. The purpose of this study was to make a review of the literature in order to shed light on the etiology, epidemiology, and differential diagnosis of this cyst. Also focused was the use of diagnostic imaging resources, such as Volumetric Computed Tomography - Cone Beam, one of the most important techniques used to confirm the diagnosis of Stafne?s bone cyst. In conclusion, because Stefane?s cyst manifests itself radiologically in different ways, complementary imaging studies are essential for a correct diagnosis, thereby avoiding invasive procedures, such as surgical exploration and sialography.

Análise de duas formas de tratamento da raiz distal do segundo molar inferior após exodontia do terceiro molar adjacente não-irrompido / Analysis of Two Ways of Treatment of the Second Molar Distal Root after extraction of the Adjacent Unerupted Third Mol

Estudou-se a cicatrização na distal de segundos molares inferiores após a exodontia dos terceiros molares adjacentes não-irrompidos. Foram operados 29 pacientes que possuíam terceiros molares inferiores não-irrompidos bilateralmente, que se apresentavam simétricos quanto ao posicionamento em relação ao segundo molar. Após a exodontia, a face distal das raízes dos segundos molares recebeu tratamentos distintos; no grupo-controle, realizou-se somente raspagem e irrigação com soro fisiológico, enquanto que, no grupo experimental, além da raspagem, foi aplicado um gel de ácido cítrico a 50% (pH1) por três minutos, seguido de irrigação com soro fisiológico. A análise consistiu de exames clínicos e radiográficos pré e pós-operatórios por meio da medição dos índices gengival e de placa, da profundidade de sondagem e da verificação radiográfica da altura da crista óssea alveolar à junção amelo-cementária; esses exames foram realizados no pré-operatório imediato, com 90 e 180 dias após a exodontia. Os resultados demonstraram que os critérios avaliados apresentaram melhora após a cirurgia, porém não houve diferenças estatisticamente significantes entre os grupos. Os resultados sugerem que a aplicação do ácido cítrico é uma etapa dispensável durante a exodontia de terceiros molares inferiores não-irrompidos, no que diz respeito à cicatrização na distal dos segundos molares adjacentes.

The healing of the distal root of the second lower molars following extraction of adjacent unerupted third molars was studied. Twenty-nine patients with unerupted lower third molars that were symmetrically positioned in relation to the second molar were operated on. After extraction the distal surface of the roots of the second molars received different treatments; in the control group only scraping and irrigation with saline was performed, whereas in the experimental group, in addition to scraping, a 50% citric acid gel (pH1) was applied for three minutes, followed by irrigation with saline. The analysis consisted of clinical and radiographic pre- and postoperative examinations through the measurement of plaque and gingival index, probing depth and radiographic verification of alveolar bone height; these examinations were performed preoperatively and at 90 and 180 days following surgery. The results demonstrated that the criteria evaluated showed an improvement after surgery, but there were no statistically significant differences between the groups. The results suggest that the application of citric acid is not a necessary step during extraction of unerupted lower third molars as far as the healing of the distal root of adjacent second molars is concerned.