Bone grafting for alveolar ridge reconstruction. Review of 166 cases. / Enxerto ósseo para reconstrução óssea alveolar. Revisão de 166 casos

ABSTRACT Objective: to investigate the predictive factors of failure in bone grafts for alveolar ridge augmentation and implant surgery. Methods: we reviewed the charts of 166 patients operated between 1995 and 2014. A total of 248 grafting procedures were performed. We submitted the data to the binomial test at 5% significance. Results: grafts to gain width of the alveolar ridge (65.32%) were more frequent than sinus lifting (p<0.0001) and the number of grafts to the posterior maxilla (48.8%) was greater than in other regions (p<0.01); 6.04% of the grafts were lost. The losses in anterior (p<0.0309) and posterior (p<0.0132) maxilla were higher than in the mandible. There were 269 ​​implants installed in the grafted areas, of which only 4.83% were lost. The number of implants lost (4.51%) in areas of onlay grafts was not statistically higher than those placed after sinus lifting (2.63%, p<0.2424). Losses were greater in the anterior (53.85%) and posterior (38.46%) maxilla than in the mandible (p<0.031). Regarding patients' age, 76.92% of the lost grafts (p<0.006) and 80% of the lost implants (p<0.001) were installed in patients over 40 years. Conclusion: failure rate was higher both for grafts and dental implants in the maxilla and in patients over 40 years of age.

RESUMO Objetivo: investigar os fatores preditivos de falhas em enxertos ósseos para aumento do rebordo alveolar e cirurgia de implantes. Métodos: os prontuários de 166 pacientes, operados entre 1995 e 2014, foram revistos. Um total de 248 enxertos foi realizado. Os dados foram submetidos ao teste binomial a 5% de significância. Resultados: os enxertos para ganho em espessura do rebordo alveolar (65,32%) foram mais frequentes do que levantamentos de seio maxilar (p<0,0001) e o número de enxertos para a região posterior da maxila (48,8%) foi maior do que em outras regiões (p<0,01). Foram perdidos 6,04% dos enxertos. As perdas em maxila anterior (p<0,0132) e posterior (p<0,0309) foram maiores do que na mandíbula. Foram instalados 269 implantes nas áreas enxertadas e apenas 4,83% perdidos. O número de implantes perdidos (4,51%) em áreas de enxertos em bloco não foi estatisticamente maior do que na área de seios maxilares enxertados (2,63%) (p<0,2424). As perdas foram maiores na região anterior (53,85%) e posterior (38,46%) da maxila em relação a mandíbula (p<0,031) e, 76,92% dos enxertos (p<0,006) e 80% dos implantes perdidos (p<0,001), foram instalados em pacientes com mais de 40 anos de idade. Conclusão: maior taxa de falhas foi observada para enxertos e implantes dentários realizados em maxila e em pacientes com mais de 40 anos de idade.

Third molar extractions: a retrospective study of 1178 cases / Exodontias de terceiros molares: estudo retrospectivo de 1178 casos

ABSTRACT Objective: This study aims to investigate the demographics, patient health status, position of the teeth, pericoronitis incidence, surgical complications, use of antibiotics to third molar removal and correlate those findings. Methods: Based on panoramic radiographs, the teeth were classified as proposed by Pell and Gregory and Winter. The binomial test for proportions with a significance level of 5% was applied. Results: Records of 337 patients submitted 1178 third molar extractions in the period from 1993 to 2011 were reviewed. Most upper teeth were vertically positioned, (84.2%) (p<0.0001), class I (49.55%) (p<0.0001), position C (58.88%) (p<0.0001) and most inferiors were mesioangulated (42.03%) (p<0.0122), class II (60.22%) (p<0.0001), position A (48.15%) (p<0.0001). Complications occurred in 2.88% of the procedures (p<0.0006), mainly in women (69.7%) (p<0.0014) and more frequently in patients who did not receive antibiotics (71.43%) (p<0.0027). Complications were more frequent after extraction of inferior third molars (75.75%) (p<0.0001). The most common complication was alveolitis (52.51%) (p<0.0006). Conclusion: In this study, the complication rates were low. They were more frequent in women who did not receive antibiotics. The most common complication was alveolitis.

RESUMO Objetivo: Este estudo objetivou descrever os dados demográficos dos pacientes, posicionamento dos terceiros molares, complicações cirúrgicas, condição sistêmica, histórico de pericoronarite e antibioticoterapia e correlacionar esses achados. Métodos: Com base em radiografias panorâmicas os dentes foram classificados conforme proposto por Pell e Gregory e Winter. Foi utilizado o teste Binomial para proporções a 5% de significância. Resultados: Foram revisados os prontuários de 337 pacientes submetidos a 1178 exodontias durante o perído de 1993 a 2011. Os dentes superiores apresentaram-se predominantemente verticais (84,2%) (p<0,0001), classe I (49,55%) (p<0,0001), posição C (58,88%) (p<0,0001) e os inferiores mesioangulados (42,03%) (p<0,0122), classe II (60,22%) (p<0,0001), posição A (48,15%) (p<0,0001). As complicações ocorreram em apenas 2,88% das cirurgias, foram mais comuns em mulheres (69,7%) (p<0,0014) e em pacientes que não fizeram uso de antibióticos (71,43%) (p<0,0027). A maioria das complicações ocorreu após extrações de dentes inferiores (75,75%) (p<0,0001). A complicação mais comum foi a alveolite (52.51%) (p<0.0006). Conclusão: Neste estudo, as complicações não foram frequentes e acometeram mais mulheres e pacientes que não fizeram uso de antibióticos, sendo a alveolite a mais comumente observada.

Partial glossectomy as an auxiliary method to orthodontic treatment of dentofacial deformity

Introduction: macroglossia is a condition which influences the size and shape of the teeth employed due to the forces on teeth. Objective: To establish bases for the indication of partial glossectomy associated with orthodontic treatment and surgical dento-facial deformity in patients without tumors and Down syndrome as a cause of macroglossia. Case reports: Three patients underwent orthognathic surgery associated with partial glossectomy under general anesthesia. All patients had macroglossia relative and underwent clinical assessment taking into account the respiratory function, swallowing and speech deficits and radiological evaluation. The technique used consist of segmental resection along the median raphe of the tongue and suture by planes. We used rigid skeletal fixation with titanium plates and screws so that patients could stay without intermaxillary block in the immediate postoperative period. Were followed over five years. The symptoms regressed completely and all skeletal segments remained stable. Discussion: The decision to refer the patient to partial glossectomy should be based on the volume of the language, mobility, position, function, symptoms, speech intelligibility, skeletal anterior open bite, interference in orthodontic treatment, drooling, swallowing and tongue trauma applicant...