Distribution of traumatic injuries after the installation of complete dentures in adult patients

Aim Describe the location of traumatic lesions of the oral mucosa that develop after the installation of complete dentures, as well as to quantify the number of post-operative controls that are required. A descriptive study was conducted by examining 84 patients who attended the dental center of Universidad de Los Andes, San Bernardo, during the period from July 2012 to July 2013. A sample of 120 edentulous patients was obtained. After the fabrication and installation of the complete dentures, at least 3 post-operative controls were performed and the location of oral lesions was recorded. Documentation of the association between the patient's clinical variables and the appearance of oral lesions during the first 3 controls was performed using a logistic regression. Results For maxillary dentures, 5 post-operative visits were made and 6 controls for mandible dentures. In the upper jaw the anatomical areas of higher incidence of traumatic injuries were: canine fossa (23.9%), average bridle (23.1%), and distobuccal sulcus (20.1%). In the lower jaw, the highest number of lesions were recorded on the anterior lingual flank (16.5%), anterior and posterior lingual flank (13.4%), and distobuccal sulcus (12.8%). A significant association was observed between subjects who reported consumption of cholesterol-lowering medications and the development of traumatic lesions of the oral mucosa (OR: 0.25 and 95% CI: 0.055-0.939). The installation of complete dentures does not determine that the treatment has ended. Post-operative controls are needed to assess areas of erythema and ulceration.

Objetivo Describir la ubicación y frecuencia de las lesiones traumáticas de la mucosa oral que se generan después de la instalación de las prótesis dentales completas, y cuantificar el número de controles postoperatorios necesarios. Se realizó un estudio descriptivo, examinando a 84 pacientes que asistieron al centro dental de la Universidad de Los Andes, durante el período comprendido entre de julio de 2012 y julio del de 2013. Se obtuvo una muestra de 120 pacientes edéntulos. Después de la fabricación e instalación de las dentaduras completas se realizaron por lo menos 3 controles postoperatorios y la localización de las lesiones orales fue registrada. La documentación de la asociación entre las variables clínicas de los pacientes y la aparición de lesiones orales durante los 3 primeros controles fue realizado por medio de una regresión logística. Resultados Para prótesis maxilar 5 visitas de controles postoperatorios fueron realizados y 6 para mandibulares. En el maxilar superior las zonas de mayor incidencia de lesiones traumáticas fueron: fosa canina (23,9%), flanco medio (23,1%) y distovestibular del surco (20,1%). En la mandíbula se registraron mayor frecuencia de las lesiones en el flanco lingual anterior (16,5%), anterior y posterior (13,4%) y distovestibular del surco (12,8%). Una asociación significativa se observó entre los sujetos que reportaron consumo de medicamentos reductores del colesterol y el desarrollo de las lesiones traumáticas de la mucosa oral (o: 0,25 e IC: 0,055-0,939). La instalación de las prótesis dentales completas no determina que el tratamiento haya terminado. Los controles postoperatorios son necesarios para evaluar las áreas de eritema y ulceración.

Risk factors associated with facial fractures

The aim of the present study was to identify risk factors for facial fractures in patients treated in the emergency department of a hospital. The medical charts of 1121 patients treated in an emergency ward over a three-year period were analyzed. The independent variables were gender, age, place of residence (urban or rural area) and type of accident. The dependent variables were fractured mandible, zygoma, maxilla, nasal bone and more than one fractured facial bone. Statistical analysis was performed using the chi-square test (a < 0.05), univariate and multivariate Poisson distributions and the logistic regression analysis (p < 0.20). Maxillofacial trauma was recorded in 790 charts (70.5%), with 393 (35.1%) charts reporting facial fractures. Motorcycle accidents were found to be the main risk factor for mandibular fractures (PR = 1.576, CI = 1.402-1.772) and simultaneous fractures of more than one facial bone (OR = 4.625, CI = 1.888-11.329) as well as the only risk factor for maxillary bone fractures (OR = 11.032, CI = 5.294-22.989). Fractures of the zygomatic and nasal bones were mainly associated with accidents involving animals (PR = 1.206, CI = 1.104-1.317) and sports (OR = 8.710, CI = 4.006-18.936), respectively. The determinant for the majority of facial fractures was motorcycle accidents, followed by accidents involving animals and sports.

Tratamento da fratura mandibular bilateral com o uso de fixação interna rígida na pediatria / Treatment of the bilateral mandibular fracture with the use af rigid internal fixatian in the pediatrics

O tratamento cirúrgico da fratura mandibular bilateral com o uso da fixação interna rígida na criança é muito variável, e depende mais da filosofia do cirurgião do que do tipo de injúria sofrida pelo paciente. O manejo e tratamento das fraturas mandibulares em pacientes pediátricos sofreram alterações ao longo do tempo, com o advento de novas técnicas e produtos disponíveis no restabele- cimento da função normal do paciente traumatizado. O uso de fixação interna rígida mostrou- se uma alternativa bastante útil em algumas situações, pois apresenta vantagens sobre outras técnicas, tais como a redução imediata correta e eficaz da fratura, o rápido restabelecimento da função mastigatória e a rapidez no processo de reparo ósseo. Atualmente, alguns autores preconizam o uso desta técnica sempre que possível e quando bem indicada. O caso ilustra fratura de mandíbula na região de parassínfese e corpo de mandíbula, tratado com placa, parafuso e a técnica do parafuso posicional.

The cirurgical treatment of bilateral mandibular fracture with the usage of rigid internal fixation in children is very variable, and it depends more on the surqeon's philosophy than the type of injury which the patient has suffered. The handling and treatment of mandibular fractures of pediatric patients has changed over the time, with the advent of the new techniques and products available in order to reestablish the regular function of the traumatized patient. The use of rigid internal fixation has shown to be a very useful alternative in many situations, which demonstrate advantages when compared to other techniques, such as: the immediate reduction, correct and effective of the fracture, the recovery of masticatory function and fast healing processo Nowadays, some authors advocate the use of this technique whenever possible and when well indicated. The case shows mandibular fracture in the parassinfises region and in the body of the jaw, treated with a plate, a screw and the positional screw technique.

Fraturas mandibulares na cidade de Pelotas, Rio Grande do Sul / Mandibular fracture cases in Pelotas, Rio Grande do Sul, Brazil

Objetivos: Analisar os dados existentes na literatura, que mostra uma alta incidência de fraturas mandibulares e elucidar o contexto de sua ocorrência no universo dos pacientes atendidos pelo Pronto Socorro Municipal de Pelotas, Rio Grande do Sul, Brasil. Métodos: A partir dos registros referentes ao período de junho de 2001 a agosto de 2007, obtivemos 1 345 pacientes com fraturas faciais. Foram selecionados para este estudo 116 pacientes com fraturas mandibulares, nos quais os itens analisados foram: faixa etária, sexo, sítio mandibular fraturado, etiologia e período do ano. Resultados: Assim, encontramos 86,2% de indivíduos do sexo masculino. A faixa etária mais atingida foi a dos 20 aos 29 anos, com 36,2%, e os sítios mandibulares mais afetados foram o corpo com 29 casos (25%) e o côndilo com 26 casos (22,4%). As causas mais comuns destas fraturas foram as agressões físicas, com 37,1%. O verão foi o período do ano com a maior incidência de fraturas mandibulares, com 38 casos (32,8%). Conclusão: Observou-se, então, que os pacientes com fratura mandibular, atendidos no Pronto Socorro Municipal de Pelotas, Rio Grande do Sul, geralmente são homens, na faixa etária dos 20 aos 29 anos, com fratura do corpo mandibular e que foram vítimas de agressão física.

Objectives: To analyze the data in the literature, which show a high incidence of mandibular fractures. The aim of this research was to elucidate the context in which these fractures occur among patients attended at the first aid center of "Pronto Socorro Municipal de Pelotas", Rio Grande do Sul, Brazil. Methods: From the records referring to the period of June, 2001 to August, 2007, there were 1 345 patients with facial fractures. Of this total, 116 patients with mandibular fracture were selected for this study and the items analysed were: age, gender, mandibular fracture site, etiology and period of the year. Results: It was found that 86.2% of the sample were men. The most prevalent age was 20 to 29 years old representing 36.2%, and the most affected mandibular sites were the body, with 29 cases (25%), and the condyle, with 26 cases (22.4%). The most common cause of fractures was the physical aggression representing 37.1%. The period of the year with the highest incidence of mandibular fractures was the summer, with 38 cases (32.8%). Conclusion: It was therefore observed that the patients with mandibular fracture assisted at Pronto-Socorro Municipal de Pelotas, Rio Grande do Sul, Brazil, were generally men, 20 to 29 years old with mandibular body fracture and they were victims of physical aggression.

Bone damage induced by different cutting instruments: an in vitro study

The aim of this study was to compare the peripheral bone damage induced by different cutting systems. Four devices were tested: Er:YAG laser (2.94 mm), Piezosurgery, high-speed drill and low-speed drill. Forty-five bone sections, divided into 9 groups according to different parameters, were taken from pig mandibles within 1 h post mortem. Specimens were fixed in 10 percent buffered formalin, decalcified and cut in thin sections. Four different parameters were analyzed: cut precision, depth of incision, peripheral carbonization and presence of bone fragments. For statistical analysis, the Kruskal-Wallis test was applied to assess equality of sample medians among groups. All sections obtained with the Er:YAG laser showed poor peripheral carbonization. The edges of the incisions were always well-shaped and regular, no melting was observed. Piezosurgery specimens revealed superficial incisions without thermal damage but with irregular edges. The sections obtained by traditional drilling showed poor peripheral carbonization, especially if obtained at lower speed. There was statistically significant differences (p<0.01) among the cutting systems for all analyzed parameters. Er:YAG laser, gave poor peripheral carbonization, and may be considered an effective method in oral bone biopsies and permits to obtain clear and readable tissue specimens.

O objetivo deste estudo foi comparar o dano ósseo periférico produzido por diversos sistemas de corte. Foram avaliados 4 dispositivos: laser Er:YAG (2,94 mm), Piezo-cirurgia, broca em alta rotação e broca em baixa rotação. Para isto, foram utilizadas 45 seções ósseas retiradas de mandíbulas de suínos, até 1 h post-mortem, divididas em 9 grupos de acordo com diversos parâmetros. As amostras foram fixadas em formalina a 10 por cento tamponada, descalcificadas e cortadas em lâminas finas. Foram analisados 4 parâmetros diferentes: a precisão do corte, a profundidade da incisão, a carbonização periférica e presença de fragmentos ósseos. A análise estatística empregou o teste de Kruskal-Wallis para avaliar a similaridade das medianas entre os grupos. Todas as seções feitas com o laser Er:YAG exibiram pouca carbonização. As margens das incisões foram todas bem acabadas e regulares, sem apresentar pontos de fusão. As amostras obtidas por piezo-cirurgia apresentaram incisões superficiais sem danos térmicos, mas com margens irregulares. As seções obtidas pelas brocas convencionais apresentaram pouca carbonização marginal, particularmente as feitas em baixa rotação. Foram observadas diferenças estatisticamente significantes (p<0,01) entre todos os sistemas de corte para cada um dos parâmetros analisados. O laser Er:YAG apresentou pouca carbonização e pode ser considerado como um método eficaz para biópsias de ossos bucais, produzindo amostras de tecido limpas e fáceis de analisar.

Evaluation of different rotary devices on bone repair in rabbits

In oral surgery, the quality of bone repair may be influenced by several factors that can increase the morbidity of the procedure. The type of equipment used for ostectomy can directly affect bone healing. The aim of this study was to evaluate bone repair of mandible bone defects prepared in rabbits using three different rotary devices. Fifteen New Zealand rabbits were randomly assigned to 3 groups (n=5) according to type of rotary device used to create bone defects: I - pneumatic low-speed rotation engine, II - pneumatic high-speed rotation engine, and III - electric low-speed rotation engine. The anatomic pieces were surgically obtained after 2, 7 and 30 days and submitted to histological and morphometric analysis. The morphometric results were expressed as the total area of bone remodeling matrix using an image analysis system. Increases in the bone remodeling matrix were noticed with time along the course of the experiment. No statistically significant differences (p>0.05) were observed among the groups at the three sacrificing time points considering the total area of bone mineralized matrix, although the histological analysis showed a slightly advanced bone repair in group III compared to the other two groups. The findings of the present study suggest that the type of rotary device used in oral and maxillofacial surgery does not interfere with the bone repair process.

A ostectomia é uma manobra cirúrgica fundamental que pode afetar a reparação tecidual de modo a aumentar a morbidade do procedimento. O tipo de equipamento e/ou instrumental utilizado para a ostectomia pode influenciar diretamente no reparo ósseo. O objetivo deste trabalho foi analisar o processo de reparação óssea em defeitos realizados em mandíbula de coelho com três diferentes equipamentos. Quinze coelhos foram aleatoriamente divididos em 3 grupos (n=5) de acordo com o equipamento usado para preparacão de 3 cavidades ósseas com brocas padronizadas: I) motor de baixa rotação pneumático, II) motor de alta rotação pneumático e III) motor de baixa rotação elétrico, todos com refrigeração constante. Após os períodos experimentais de 2, 7e 30 dias, as peças anatômicas foram removidas e submetidas a análises microscópica e histomorfométrica. Não houve diferença estatisticamente significante (p>0,05) entre os grupos nos 3 períodos experimentais, considerando-se a área total de matriz óssea mineralizada, embora a análise microscópica tenha revelado uma tendência a um processo de reparação óssea um pouco mais adiantado no grupo III, quando comparado aos demais grupos. Os resultados deste estudo sugerem que o tipo de equipamento rotatório utilizado em cirurgia bucomaxilofacial não interfere no reparo ósseo.

Histology of the jaw deformation in salmon of southern Chile (salmo salar)

In adult salmon of the sea centres in southern Chile, a jaw deformation (JD) has been identified. It affects the dental and hyomandibular bones, which bend ventrally up to 90° of their normal position. The deformation affects also the dental articular bone. This pathology is related to weight loss and increased mortality of the salmons. It was empirically postulated that a probable cause for this anomaly was food from vegetal origin in the diet of the fishes (which are carnivores) Therefore, the present work aims at comparing the biostructure of jaw bone of salmons fed either with vegetal (soja and gluten) formulation or animal formulation, mostly fish powder. Fifty specimens were analyzed from Puerto Montt, 35 having JD and 15 normal control. Samples were obtained in June, July and September 1999. (group 1) and March, Sept and October, 2000 (group 2). Group 1 was fed mostly with vegetal flour and group 2 with fish flour. Each group was subdivided in two subgroups, one of healthy animals and the other of fishes with JD. Jaw and articular bones were fixed in 10 per cent formaldehyde and 1 per cent glutaraldehyde and processed for histology (hematoxylin.eosin, Alcian blue, Masson trichrome) histochemistry (Syrius red and von Kossa) and scanning electron microscopy (SEM). The mandibular bone of group 1 with JD presented large amounts of osteoid tissue compared with its control. Collagen I disminishes and its architecture and composition changes, collagen III increases. No significant difference was found in calcium content between normal and JD fishes. SEM shows that the dental bone close to the joint in the fishes with JD displayed a disorganized structure and no trabecular formation, compared to controls, In group 2, these pathological findings were less evident, both macro- and microscopically. Results suggest that JD is of multifactorial origin; the primary cause can be a genetic or congenital alteration of the Jaw cartilage. There should be susceptibility for presentation of the defect in this group of fishes, but its expression is triggered by deficit of phosphorous of animal origin in food, so that this pathology is not seen in fishes with adequate nutrition.

Cisto ósseo traumático: relato de caso / Traumatic bone cyst: case report

Os autores relataram um caso de cisto ósseo traumático localizado na regiäo de corpo mandibular direito em um paciente de 16 anos de idade. O tratamento instituído consistiu numa abordagem cirúrgica para exposiçäo da cavidade óssea e estabelecimento de sangramento em seu interior. Após 1 ano de "follow-up" houve completa neoformaçäo óssea na área.

Distracción osteogénica mandibular intraoral / Intraoral mandibular osteogenic distraction

Se describe una técnica de expansión mandibular intraoral que utiliza un dispositivo tipo Hyrax, para promover el crecimiento óseo en sentido transversal, antero-posterior o vertical de la mandíbula. Se estudiaron 20 pacientes a los cuales les fueron diagnósticados diferentes tipos de deficiencias mandibulares y se sometieron a la técnica de distracción osteogénica intraoral mandibular para corregir problemas de crecimiento en las tres dimensiones del espacio. En los veinte pacientes se obtuvo un significado crecimiento mandibular y un apropiado alineamiento dentario sin la necesidad de extracciones, obteniendo excelentes uniones óseas, una respuesta periodontal saludable, ausencia de disfunción de la articulación témporo-mandibular, sin daño neurológico o a los gérmenes dentarios y una excepcional aceptación del paciente. La máxima expansión obtenida fue de 10 mm, con un promedio de 6.3 mm. La técnica de distracción osteogénica mandibular provee un crecimiento confiable, con una intervención quirúrgica sencilla, pudiendo se combinada con otras osteotomías maxilomandibulares, a fin de corregir deficiencias en el crecimiento, de menera tridemensional