Tratamiento de la anquilosis temporomandibular en niños con materiales aloplásticos / Treatment of temporomandibular ankilosis in children with alloplastic materials

La anquilosis de la articulación temporomandibular en niños continúa siendo una patología presente a pesar de los avances médicos y sociales. El tratamiento de esta patología en niños tiene como objetivos restablecer la apertura bucal y mejorar la estética facial cuando se presentan hipoplasias o micrognatias asociadas. El uso de materiales aloplásticos para el tratamiento de la anquilosis temporomandibular en niños es evitar la reanquilosis y disminuir riesgos, molestias y costos que ocasionan la toma y aplicación de injertos, siendo utilizados con buenos resultados en niños en otras especialidades como la Traumatología y Ortopedia. Estos procedimientos pueden llevarse a cabo de manera segura y predecible. En este artículo se reportan dos casos de anquilosis temporomandibular en niños, tratados con materiales aloplásticos, llevados a cabo en la Unidad Médica de Alta Especialidad No. 71 del Instituto Mexicano del Seguro Social, Torreón, Coahuila, México, con un seguimiento de 11 y 16 años de postoperatorio, demostrando que se trata de una buena opción de tratamiento sin presentar alteraciones al crecimiento y desarrollo de los pacientes (AU)

Temporomandibular ankilosis in children is pathology still present despite the medical and social advances. The treatment of this pathology in children aims to restore mouth opening and improve facial aesthetics when hypoplasia or micrognatia are present. The use of alloplastic materials to treat temporomandibular ankilosis in children is to prevent the re ankilosis and reduce discomfort, risks, and cost causing by the take and application of graft, alloplastic materials being used with good results in children in other specialties such as Traumatology and Orthopedics. These procedures can be made safely and predictably. This article describes two cases of temporomandibular ankilosis in children, treated with alloplastic materials, carried out in the Medical Unit of High Specialty, number 71, of the Mexican Institute Social Security, Torreon, Coahuila, Mexico, with follow up of cases 11 and 16 years of postoperative, prove that is a good option of treatment, without presenting any alterations in growth and development of patients (AU)

Tratamiento de anquilosis temporomandibular con materiales aloplásticos en niños: reporte de 3 casos / Treatment of temporomandibular joint ankylosis with alloplastic materials in children: report of 3 cases

La anquilosis de la articulación temporomandibular en niños continúa siendo una patología presente a pesar de los avances médicos y sociales. El tratamiento de esta patología en niños tiene como objetivos restablecer la apertura bucal y mejorar la estética facial, cuando se presentan hipoplasias o micrognatias asociadas. El objetivo del uso de materiales aloplásticos para el tratamiento de esta patología en niños es evitar la morbilidad y los gastos que ocasiona la toma y aplicación de injertos, para esto, durante 15 años, en la Unidad Médica de Alta Especialidad del Instituto Mexicano del Seguro Social, Torreón, Coahuila, México, Departamento de Cirugía Maxilofacial, se ha establecido el protocolo de tratar esta patología en niños con el uso de prótesis metálicas de cavidad glenoidea, en lugar de injertos costales o de otro tipo, además de tratar las hipoplasias o micrognatias en un mismo tiempo quirúrgico con el uso de aparatos distractores óseos, teniendo excelentes resultados a mediano plazo, sin daño a estructuras anatómicas ni a los procesos de crecimiento y desarrollo de los pacientes. Se utilizan prótesis prediseñadas de cromo, cobalto, molibdeno, que se adaptan adecuadamente a las estructuras óseas, siendo un material utilizado ya en otras áreas de la ortopedia en niños, concluyendo que se trata de una buena opción de tratamiento que disminuye el riesgo, frecuencia y costos de cirugías de mayor complejidad y que puede llevarse a cabo de manera segura y predecible. En este artículo se reportan tres casos de niños con anquilosis temporomandibular tratados con este método con buenos resultados (AU)

Temporomandibular joint ankylosis in children is actually a pathology still present despite the medical and social advances. The treatment of this pathology in children has restored the buccal opening and improve the facial aesthetics when hypoplasia and micrognathia are present. The purpose of using alloplastic material for treatment of this disease in children is to prevent morbidity and expenses related to making and implementing grafts, for this, for 15 years in the Medical Unit of High Specialty the Mexican Institute of Social Security, Torreon, Coahuila, Mexico, Department of Maxillofacial Surgery, has been established protocol to treatment this pathology in children with the use of metal glenoid prosthesis instead of rib grafts or otherwise in addition to treating hypoplasias or micrognatias in the same surgical time with the use of distracting devices bone, having excellent results in the medium term without damage to anatomical structures or processes of growth and development of patients. The prosthesis used predesigned chromium, cobalt, molybdenum, which are suitably adapted to the bone structures, with a material already used in other areas of orthopedics in children, concluding that this is a good treatment option that reduces the risk, and surgeries often cost more complex and can be performed safely and predictably. In this paper, three cases of children with temporomandibular ankylosis treated with this method with good results are reported (AU)

Substitutos ósseos sintéticos na Implantodontia / Synthetic bone substitutes for Implant Dentistry ­ a literature review

Objetivo: analisar sistematicamente, na literatura científica, o uso de substitutos ósseos sintéticos na regeneração óssea para Implantodontia. Material e métodos: uma busca foi realizadas nas bases de dados PubMed, Cochrane, LILACS e SciELO, nos últimos quinze anos, combinando as palavras-chave "regeneração óssea", "materiais biocompatíveis", "implantes dentários", e "materiais aloplásticos". Resultados: Dos 199 artigos inicialmente recuperados, apenas 27 foram selecionados, incluindo revisões sistemáticas/ metanálises (n=2), revisões da literatura (n=1), estudos clínicos (n=9) e pré-clínicos (n=12), relato de caso (n=1) e tese (n=1). Nos modelos animais, o vidro bioativo é capaz de provocar formação óssea à distância, inibir a migração apical do epitélio juncional, e gerar maior deposição de cemento na superfície radicular. Partículas esféricas geram melhor dissolução e integração com o novo osso circundante, e bons resultados são vistos nas técnicas de ROG e RTG. Em um estudo clínico randomizado, o vidro bioativo misturado ao osso autógeno para regeneração de defeitos intraósseos reduziu significativamente a profundidade de sondagem, com ganho de nível clínico de inserção, e resolução dos defeitos já aos seis meses. Nos modelos animais, a tríade hidroxiapatita (HA), beta-fosfato tricálcio (ß-TCP), e fosfato de cálcio bifásico (HA+ ß-TCP) tem se mostrado biocompatível, biorreabsorvível e osteocondutora. Um estudo clínico controlado com HA+ ß-TCP/ membrana revelou melhor preservação óssea vertical e horizontal comparado ao coágulo/membrana, nas TCFCs de seis meses. Regenerações ósseas verticais significativas com estes materiais sintéticos são potencializadas pelo uso dos fatores de crescimento. Conclusão: substitutos ósseos sintéticos demonstram uso promissor para regeneração. Entretanto, a evidência clínica deve ser substancialmente aumentada.

Objective: to systematically analyze in the scientifi c literature the use of synthetic bone substitutes for bone regeneration in implant dentistry. Material and methods: a search was conducted at the PubMed, Cochrane, LILACS and SciELO databases considering the last fi fteen years, and combining the keywords "bone regeneration", "biocompatible materials", "dental implants", and "alloplastic materials". Results: of the 199 articles initially retrieved, only 27 were selected, including systematic reviews/meta-analysis (n=2), literature reviews (n=1), clinical (n=9) and pre-clinical (n=12) studies, case report (n=1) and thesis (n=1). In animal models, the bioactive glass can cause bone formation at distance, inhibit apical migration of the junctional epithelium, and generate greater deposition of cementum over the root surface. Spherical particles generate better dissolution and integration with the new surrounding bone, and good results are seen in the ROG and RTG techniques. In a randomized study, the bioactive glass mixed with autogenous bone to regenerate intra-osseous defects signifi cantly reduced probing depths, with clinical attachment level gains, and defect resolution as early as 6 months. In animal models, the triad hydroxyapatite (HA), beta-tricalcium phosphate (ß-TCP), and biphasic calcium phosphate (HA + ß-TCP) has been shown to be biocompatible, bioresorbable, and osteoconductive. A controlled clinical study with (HA + ß-TCP/membrane) showed better vertical and horizontal bone preservation compared to clot / membrane at the 6 month CBCT images. Also, signifi cant vertical bone regeneration with these synthetic materials is enhanced by the use of growth factors. Conclusion: the synthetic bone substitutes are good candidates for regeneration. However, the level of clinical evidence must be substantially increased.

Histometrical evaluation of biphasic calcium phosphate in surgically created 1-wall periodontal intrabony defects in dogs / 대한치주과학회지

PURPOSE: The aim of this study was to evaluated biphasic calcium phosphate applied in surgically created 1-wall periodontal intrabony defects in dogs by histometrical analysis. MATERIAL AND METHOD: Critical sized(4 mm x 4 mm), one wall periodontal intrabony defects were surgically produced at the proximal aspect of mandibular premolars in either right and left jaw quadrants in four canines. The control group was treated with debridement alone, and experimental group was treated with debridement and biphasic calcium phosphate application. The healing processes were histologically and histometrically observed after 8 weeks. RESULTS: In biphasic calcium phosphate group, more new bone and cementum formation, less epithelium and connective tissue attachment were observed compared to other groups. But there was no statistical significance. CONCLUSION: Though the statistically significant difference could not be found, it seemed that there was more new bone and cementum formation with applying biphasic calcium phosphate in 1 wall intrabony defects in dogs by preventing junctional epithelium migration.

Case Report of Cranioplasty by Composite Use of Alloplastic Materials

In patients who have defects on cranial bone, it is well known that reconstruction with autogenous bony material is the method of choice. However, it has limitations.; manipulation difficulty, donor site morbidity. Recently, many available synthetic materials has been developed, and their use became more common. The original cranial bone has three layers. ; outer table, medulla, inner table. Based on this finding, we performed cranioplasty in bony defect patients by composite use of Bone wax(R), Bone chip(R), Medpor(R). With this method, we could reproduce more reliable bony contour which mimic original cranial bony three layers.

A Correction of Hypoplastic Mandible Using Mandibular Shape Porous High Density Polyethylene (PHDPE)

The mandible with the lower maxilla comprises the lower third of the face. A correction of the mandible in facial asymmetry would be helpful in improving aesthetic appearance. In general, surgical techniques for improving the contour of lower jaw deformities include correcting the deficient mandible by osteotomies, distraction osteogenesis and the augmentation of the mandible with alloplastic or autogenous materials. In a patient with satisfactory occlusal relationships and mild hypoplasia, alloplastic material for augmentation of the mandible on the affected side is more practical than autogenous augmentation. The porous high density polyethylene (PHDPE) implant is a widely available alloplast which is an attractive alternative to other alloplasts and autogenous tissues. Thirteen patients (8 men, 5 women), ages ranging from 17 to 47 years old, have types IA (n = 6) and IB (n = 5) hemifacial microsomia(Munro and Lauritzen, 1985), Klippel-Feil syndrome (n = 1), Romberg's disease (n = 1) were corrected with prefabricated porous high density polyethylene over a 4 year period (1996- 1999). The average follow-up period was 12 months, however the range has been between 6 and 36 months. Preoperative planning was done based on an aesthetic assessment of thickness of the soft tissue, the use of life size photographs, cephalometric and panorex x-rays and three dimensional computed tomography. The surgical technique consists of an intraoral approach incision, the an implant was placed subperiostealy, appropriately sculptured and fixed to posterior and inferior border of the mandible at the gonial angle. In four patients the implant had to be removed due to complications which included three cases of infection and one case of extrusion by iatrogenic trauma. One of the above four patients' implant was replaced with a smaller one, approximately 3 months after its removal. With the others nine patients there was no infection or permanent morbidity. Postoperative appearance was considered very satisfactory, the mandible was well outlined, and the facial proportions were improved. Porous high density polyethylene implant is recommended for hypoplastic mandible augmentation when proper indication are strictly observed and surgical steps are accurately followed.