Regeneração óssea guiada para aumento horizontal de rebordo utilizando fibrina rica em plaquetas associada a enxertos ósseos: revisão de literatura / Guided bone regenerationfor horizontal bone augmentation using platelet- rich fibrin associated with bone grafts: literature review

Objetivo: revisar a literatura sobre os diferentes tipos de derivados de plaquetas autólogas e o desempenho clínico do uso do sticky bone para aumento ósseo horizontal de rebordo. Materiais e métodos: Para realização dessa revisão foram realizadas buscas nas bases de dados PubMed, Google Scholar e Web of Science, utilizando os seguintes descritores: "platelet-rich fibrin" AND "sticky bone" OR "alveolar bone grafting" AND "sticky bone" OR "guided bone regeneration" AND "sticky bone" AND "alveolar ridge augmentation" OR "Alveolar ridge augmentation" AND "sticky bone". Foram incluídos artigos publicados em inglês, que abordavam conceitos relacionados aos agregados plaquetários e a regeneração óssea guiada para aumento ósseo horizontal de rebordo utilizando fibrina rica em plaquetas associada à enxertos ósseos (sticky bone). Resultados: Após avaliação dos estudos encontrados foram selecionados 11 artigos sobre o uso do sticky bone para aumento horizontal de rebordo. Para compor este trabalho foram selecionados também 14 estudos de revisão e artigos associados ao tema. Por ser de fácil aplicação e obtenção, muitos autores têm estudado as aplicações cirúrgicas do sticky bone e os resultados demonstram que o aumento horizontal do rebordo utilizando essa técnica pode ser realizado de forma previsível. Conclusão: apesar de haver estudos promissores sobre o uso do sticky bone, falta evidência na literatura sobre seu sucesso clínico. Assim, para compreender o potencial regenerativo desta técnica são necessários um maior número de estudos randomizados, com diferentes materiais de enxerto e protocolos padronizados de obtenção do sticky bone.(AU)

Objective: to review the literature on the different types of autologous platelet derivatives and the clinical performance of using sticky bone for horizontal bone ridge augmentation. Materials and methods: In order to conduct this review, it was conducted searches in the PubMed, Google Scholar, and Web of Science databases using the following descriptors: "platelet-rich fibrin" AND "sticky bone" OR "alveolar bone grafting" AND "sticky bone" OR "guided bone regeneration" AND "sticky bone" AND "alveolar ridge augmentation" OR "Alveolar ridge augmentation" AND "sticky bone". It included articles published in English that addressed concepts related to platelet aggregates and guided bone regeneration for horizontal bone augmentation using platelet-rich fibrin associated with bone grafts (sticky bone). Results: After evaluating the studies found, were selected 11 articles on the use of sticky bone for horizontal ridge augmentation. To compose this work, 14 review studies and articles associated with the topic were also selected. Due to its ease of application and availability, many authors have explored the surgical applications of sticky bone, and the results indicate that horizontal ridge augmentation using this technique can be predictably performed. Conclusion: while there are promising studies on the use of sticky bone, the literature lacks evidence regarding its clinical success. Therefore, to fully understand the regenerative potential of this technique, further randomized studies are needed, involving different graft materials and standardized protocols for obtaining sticky bone.(AU)

Effectiveness of iliac cancellous bone grafting in alveolar cleft repair and analysis of factors affecting it / 华西口腔医学杂志

OBJECTIVES@#To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it.@*METHODS@#A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated.@*RESULTS@#Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036).@*CONCLUSIONS@#The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.

Two-stage alveolar bone grafting for nasal floor reconstruction in adult cleft patients / 华西口腔医学杂志

Alveolar cleft is one of the key links of cleft lip and palate reconstruction due to its close relationship with tooth and jaw coordination and nasolabial deformity. The alveolar bone graft repairs the hole in the gum ridge and stabilizes the bone arch, providing better support for the base of the nose and new bone for the roots of the developing teeth to grow into. Unfortunately, bone graft failure in the traditional way, even among minor clefts, bony hypoplasia, or absence that affects the nasal base and piriform rim, is common. Two-stage alveolar bone grafting, which has advantages in addressing the underlying skeleton and deficiency, could be an optional surgical procedure for nasal floor reconstruction in adult patients with a broad alveolar cleft.

Comparison of the effectiveness and safety between autologous bone grafts and xenografts for the treatment of alveolar bone defects: overview of systematic reviews using frisbee methodology / Comparación sobre la efectividad y seguridad entre los injertos óseos autólogos y xenoinjertos para el tratamiento de defectos óseos alveolares: overview de revisiones sistemáticas con metodología frisbee

Introduction: Due to the extensive number of studies developed on periodontal pathologies and the clinical need generated to correct bonvze defects, we have carried out an Overview of systematic reviews using the FRISBEE methodology. Material and Methods: Through this study we expect to bridge the knowledge gap generated regarding the clinical question on the effectiveness of autologous bone substitutes and xenografts in maxillary and mandibular bone defects. Results: For this study, we carried out a systematic search in Epistemonikos and PubMed, we included 3 systematic reviews and 5 primary studies included in these reviews to extract their data. We analyzed data using RevMan 5.4. and GRADEpro. Assessed outcomes included: bone gain [MD 0.06 mm lower (0.26 lower to 0.14 higher)] and bone resorption [MD 0.03 mm higher (0.12 lower to 0.18 higher)], where no significant differences were found between the study groups. The certainty of the evidence was moderate for both outcomes. Bone length and bone density outcomes were not measured or reported in the included studies. Conclusion: We concluded that there are no significant clinical differences between the application of autologous bone grafts and xenografts for bone defects correction for the assessed outcomes, therefore, these biomaterials should be applied at the discretion of the clinician and according to the needs and preferences of patients.

Introducción: Debido al extenso número de estudios desarrollados sobre patologías periodontales y a la necesidad clínica generada para corregir defectos óseos, hemos realizado un Overview de revisiones sistemáticas tipo FRISBEE para acortar la brecha de conocimiento generada respecto a la pregunta clínica sobre la efectividad de sustitutos óseos tipo autólogo y xenoinjertos en defectos óseos a nivel maxilar y mandibular. Material y Métodos: Para este estudio realizamos una búsqueda sistemática en Epistemonikos y PubMed, de los cuales incluimos 3 revisiones sistemáticas y 5 estudios primarios incluidos en estas revisiones para extraer sus datos. Los datos fueron analizados a través de RevMan 5.4. Y GRADEpro. Resultados: Los estudios analizaron los desenlaces propuestos: ganancia ósea posterior a la aplicación del injerto óseo [MD 0.06 mm menos (0.26 menos a 0.14 más)] y reabsorción ósea posterior a la aplicación del injerto óseo [MD 0.03 mm más (0.12 menos a 0.18 más)], donde no se encontraron diferencias significativas entre los grupos de estudio. La certeza de la evidencia fue moderada para ambos desenlaces. Los desenlaces longitud ósea y densidad ósea no fueron medidos o reportados en los estudios incluidos. Conclusión: Se concluyó que no hay diferencias que sean clínicamente significativas entre la aplicación de injertos óseos autólogos y xenoinjertos para la corrección de defectos óseos para los desenlaces analizados, por lo que, la aplicación de estos biomateriales queda a criterio del clínico, y de acuerdo a las necesidades y preferencias de los pacientes.

Expression of CD44 in previously grafted alveolar bone / Expresión del marcador óseo CD44 en hueso alveolar previamente injertado

Objetive: To determine the expressions of the bone surface marker CD44 in samples of alveolar bone previously regenerated with allograft, xenograft, and mixed, using the technique of guided bone regeneration. Material and Methods: This exploratory study was approved by the institutional research and ethics committee. By means of intentional sampling and after obtaining informed consent for tissue donation, 20 samples of alveolar bone previously regenerated with guided bone regeneration therapy with particulate bone graft and membrane were taken during implant placement. The samples were stained with hematoxylin-eosin for histological analysis, and by immunohistochemistry for the detection of CD44. Results: Sections with hematoxylin-eosin showed bone tissue with the presence of osteoid matrix and mature bone matrix of usual appearance. Of the CD44+ samples, 80% were allograft and 20% xenograft. The samples with allograft-xenograft were negative. There were no differences in the intensity of CD44 expression between the positive samples. The marker was expressed in osteocytes, stromal cells, mononuclear infiltrate, and some histiocytes. Eighty percent of the CD44+ samples and 100% of the samples in which 60 or more cells were labelled corresponded to allografts (p=0.000). A total of 67% of the samples from the anterior sector, and 40% from the posterior sector were CD44+ (p=0.689). Conclusion: This study shows for the first time that guided bone regeneration using allografts is more efficient for the generation of mature bone determined by the expression of CD44, compared to the use of xenografts and mixed allograft-xenograft, regardless of the regenerated anatomical area.

Objetivo: Determinar la expresión del marcador de membrana óseo CD44 en muestras de hueso alveolar previamente regenerado con aloinjerto, xenoinjerto y mezcla mediante la técnica de regeneración ósea guiada. Material y Métodos: Con aval del Comité de Investigación y Ética, se realizó un estudio exploratorio. Por muestreo intencional y firma de consentimiento informado de donación, se tomaron durante la colocación del implante, 20 muestras de hueso alveolar previamente regenerado con terapia de regeneración ósea guiada con injerto óseo particulado y membrana. Las muestras fueron teñidas con hematoxilina-eosina para el análisis histológico y por inmunohistoquímica para la detección del CD44. Resultados: : Los cortes con hematoxilina-eosina mostraron tejido óseo con presencia de matriz osteoide y matriz ósea madura de aspecto usual. De las muestras CD44+, 80% fueron de aloinjerto y 20% de xenoinjerto. Las muestras con aloinjerto-xeoninjerto fueron negativas. No hubo diferencias en la intensidad de la expresión del CD44 entre las muestras positivas. El marcador se expresó en osteocitos, células estromales, infiltrado mononuclear y algunos histiocitos. El 80% de las muestras CD44+ y el 100% de las muestras con marcación de 60 o más células correspondían a aloinjertos (p=0,000). El 67% de las muestras del sector anterior y el 40% del sector posterior fueron CD44+ (p=0,689). Conclusión: Este estudio muestra por primera vez que la regeneración ósea guiada usando aloinjertos, es más eficiente para la generación de hueso maduro determinado por la expresión de CD44, comparado con el uso de xenoinjertos y mezcla de aloinjerto-xenoinjerto, independientemente del sector anatómico regenerado.

Patients and informal caregivers' questions about alveolar bone graft post-operative care / Dudas de pacientes y cuidadores informales referentes a los cuidados posoperatorios de injerto oseo alveolar / Dúvidas de pacientes e cuidadores informais relativas aos cuidados pós-operatórios de enxerto ósseo alveolar

ABSTRACT Objectives: to identify patients' and informal caregivers' questions related to alveolar bone graft post-operative care. Methods: analytical and cross-sectional study, developed in a public and tertiary hospital between October 2017 and February 2018. The sample consisted of 46 participants. Data collection occurred during the preoperative nursing consultation through interview. The doubts were described in a form prepared by the researchers and later grouped by similarity of the subject. Results: doubts referred to diet (type of food, consistency, temperature and time period), surgical wound care (oral hygiene, graft rejection, removal of surgical points), post-operative complications (bleeding and edema), convalescence period (sun exposure, physical effort, time away from activities, length of stay) and medications. Conclusions: identifying the doubts allowed planning and implementing nursing care focused on the real needs of the clientele, favoring the rehabilitation process.

RESUMEN Objetivos: identificar las dudas de pacientes y cuidadores informales referentes a los cuidados posoperatorios de injerto óseo alveolar. Métodos: estudio analítico y transversal, desarrollado en un hospital público y terciario entre octubre de 2017 y febrero de 2018. La muestra ha constado de 46 participantes. La recogida de datos ha ocurrido durante la consulta de enfermería preoperatoria por medio de entrevista. Las dudas han sido descriptas en impreso elaborado por los investigadores y, posteriormente, agrupadas por similitud de asunto. Resultados: las dudas se refirieron a la alimentación (tipo de alimento, consistencia, temperatura y período de tiempo), cuidados con la herida operatoria (higiene oral, rechazo del injerto, retirada de los puntos quirúrgicos), complicaciones posoperatorias (hemorragia y edema), período de convalecencia (exposición al sol, esfuerzo físico, tiempo de alejarse de las actividades, tiempo de internación) y medicaciones. Conclusiones: Identificar las dudas permitió planear e implementar la asistencia de enfermería vuelta a las reales necesidades de la clientela, favoreciendo la rehabilitación.

RESUMO Objetivos: identificar as dúvidas de pacientes e cuidadores informais relativas aos cuidados pós-operatórios de enxerto ósseo alveolar. Métodos: estudo analítico e transversal, desenvolvido em um hospital público e terciário entre outubro de 2017 e fevereiro de 2018. A amostra constou de 46 participantes. A coleta de dados ocorreu durante a consulta de enfermagem pré-operatória por meio de entrevista. As dúvidas foram descritas em impresso elaborado pelos pesquisadores e, posteriormente, agrupadas por similaridade de assunto. Resultados: as dúvidas referiram-se a alimentação (tipo de alimento, consistência, temperatura e período de tempo), cuidados com a ferida operatória (higiene oral, rejeição do enxerto, retirada dos pontos cirúrgicos), complicações pós-operatórias (sangramento e edema), período de convalescência (exposição ao sol, esforço físico, tempo de afastamento das atividades, tempo de internação) e medicações. Conclusões: identificar as dúvidas permitiu planejar e implementar a assistência de enfermagem voltada às reais necessidades da clientela, favorecendo o processo reabilitador.

Utilización de injertos óseos autólogos y biomateriales en pacientes con atrofia alveolar. Matanzas / Use of autologous bone grafts and biomaterials in patients with alveolar atrophy.Matanzas

RESUMEN Introducción: los injertos óseos constituyen una de las técnicas más utilizadas en la cirugía reconstructiva implantológicas, son muy utilizadas para el reemplazo del hueso perdido por traumatismos, procesos patológicos congénitos o adquiridos y atrofia, son los injertos óseos autógenos o autólogos. Objetivo: caracterizar los pacientes con rebordes atróficos que necesitaron ser rehabilitados en implantología oral como alternativa de tratamiento en la consulta de Cirugía Máxilo Facial del Hospital Universitario "Faustino Pérez" y la Clínica "III Congreso del PCC", municipio Matanzas de septiembre del 2014 a julio de 2016. Material y Método: estudio prospectivo longitudinal. El universo fue de 20 pacientes mayores de 18 años de ambos sexos, que presentaron el diagnóstico de edentulismo parcial y atrofia alveolar. Se determinó por el interrogatorio, el examen clínico y los medios diagnósticos los síntomas y signos que caracterizaron esta entidad. Resultados: los traumatismos alveolares fue la causa que predominó en la pérdida dentaria, en el sexo masculino y en las edades de 18 a 37 años. La zona de mayor afectación fue la región anterior del maxilar superior y predominó la perdida de hueso en altura y en anchura y un gran número de injertos conservaron la cresta alveolar. Conclusiones: el uso de biomateriales en el tratamiento de pacientes con atrofia alveolar junto al injerto óseo fue satisfactorio en pacientes que necesitaron una base de sostén sobre la cual se colocaron los implantes dentales osteointegrados (AU).

SUMMARY Introduction: autogenous and autologous bone grafts are the elective material for replacing bones lost by trauma, congenital or acquired pathologic processes and atrophy. Objective: to characterize patients with atrophic rims needing rehabilitation in oral grafting as an alternative treatment in the Maxilla-Facial Surgery consultation of the University Hospital "Faustino Perez" and the Clinic "III Congreso del PCC", municipality of Matanzas, from September 2014 to July 2016. Materials and Methods: longitudinal prospective study. The universe was 20 patients aged 18 years and older, males and females, who presented the diagnosis of partial lack of teeth and alveolar atrophy. The symptoms and signs characterizing this entity were stated by questioning, physical examination and diagnostic means. Results: alveolar traumas were the predominant cause of dental lost in male patients aged 18-37 years. The most affected zone was the anterior region of the upper maxilla; bone lost in height and width predominated, and a great number of grafts conserved the alveolar crest. Conclusions: the use of biomaterials in the treatment of patients with alveolar atrophy together with bone graft was satisfactory in patients who needed a base support on which to put dental grafts (AU).

Relação entre reabsorções dentárias e enxerto alveolar em dentes adjacentes à área da fissura / Relationship between root resorption and alveolar graft in teeth adjacent to the cleft lip and palate area

Objetivo: avaliar, radiograficamente, a prevalência, extensão e severidade da reabsorção dentária em dentes adjacentes à área de fissura após enxerto ósseo alveolar. Métodos: radiografias de 200 indivíduos com fissura unilateral e bilateral, alveolar e palatina, foram analisadas para se investigar a presença de reabsorção dentária relacionada com o enxerto ósseo. No total, 1.315 radiografias foram analisadas (periapical, oclusal e radiografias panorâmicas), obtidas a partir de 200 indivíduos com fissura labiopalatina unilateral e bilateral completa ubmetidos a cirurgia de enxerto, disponíveis a partir dos arquivos da Seção de Radiologia do HRAC-USP. Resultados: entre os 200 indivíduos, 33 tinham reabsorções dentárias externas. Dessas, 15 estavam presentes nas radiografias pré-operatórias e 18 só depois do enxerto ósseo. No geral, 30 reabsorções localizaram- se no terço apical da raiz e 3 no terço cervical; o incisivo central esquerdo foi o mais afetado. Não foram observadas reabsorções dentárias no terço médio da raiz e nenhuma reabsorção afetou mais de um terço. Não existiu diferença estatisticamente significativa entre a idade do paciente durante a cirurgia de enxerto ósseo e a presença de reabsorção dentária externa. Conclusões: a prevalência da reabsorção dentária em dentes adjacentes à área da fissura em indivíduos submetidos a enxerto ósseo foi baixa (16,5%). O terço apical da raiz foi o local mais frequente de reabsorção radicular externa, e não houve reabsorções afetando mais de um terço da raiz. (AU)

Evaluación del espesor de la cresta infracigomática para la colocación de minitornillos mediante tomografía computarizada de haz cónico / Thickness of the infrazygomatic crest, evaluated by cone beam computed tomography

Introducción: Para colocar miniim-plantes de anclaje ortodóncico es nece-sario evaluar el hueso en el sitio de implantación. El objetivo de este estudio fue determinar la existencia de hueso infracigomático midiendo la altura y el espesor a nivel de la raíz mesiovesti-bular del segundo molar superior, a 2, 4 y 6 mm de la cresta alveolar, utilizando la tomografía computarizada de haz cónico (TCHC). Método: Se revisaron 127 TCHC de sujetos entre 17 a 75 años. Se deter-minó la existencia de hueso basados en el criterio de altura y presencia de contacto entre raíz y cortical. Cuando la altura de la cresta infracigomática era > 10 mm se tomaban medidas de espesor a 2, 4, y 6 mm de la cresta alveolar, y se compararon por género. Resultados: De 127 TCHC se midió la altura de la cresta solo en 70 TCHC. El intervalo del 95% de confianza para esta medida fue de 8,64 a 9,76 mm, pero solamente en 28 (40%) era > 10mm. Las medidas de espesor se tomaron solamente en esos 28 casos, obteniendo un promedio de 9,2 mm, 8,3 mm y 6,6 mm cuando se midió a 2, 4 y 6 mm, respectivamente. No se encontraron diferencias significativas entre géneros. Conclusiones: Tanto la apreciación cualitativa del hueso como las mediciones de altura y espesor de la cresta infracigomática indican que la región a nivel del segundo molar supe-rior no es un sitio seguro para la coloca-ción de minitornillos. (AU)

Introduction: In order to place orthodontic temporary anchorage devices it is neces-sary to evaluate bone quality and size in the intended site. The objective of this study was to measure bone thickness and height at the level of the mesiobuccal root of the upper second molar, 2 mm, 4 mm and 6 mm away from the alveolar crest, using Cone Beam Computed Tomo-graphy (CBCT). Methods: The design of the present research is descriptive, retrospective. 127 CBCT images from 17-75 year old patients, were reviewed. The presence of bone was determined based on qualitative criteria of height and contact between root and cortical. When the height of the infrazygomatic crest was > 10mm, thickness measurements were taken at 2, 4, and 6 mm from the alveolar crest. Results: Only in 70 of the 127 CBCT images the height of the ridge was measured. The 95% confidence interval for bone height was: 8.64 to 9.76 mm, but only in 28 (40%) it was > 10 mm. Thick-ness measurements, in those 28 cases, average 9.2 mm, 8.3 mm and 6.6 mm was at 2, 4 and 6 mm, respectively. No significant differences between genders was found (p > 0.05). Conclusions: Both the qualitative assessment of bone and the height and thickness measurements of the infrazygomatic crest indicate that this region at the level of upper second molar is not a safe site to place tempo-rary anchoring devices. (AU)

Clinical Investigation of Congenital Factor Affecting Craniofacial Morphology of Unilateral Cleft Lip and Palate in Japanese Patients

Objective: To evaluate the craniofacial morphology of Japanese patients with unilateral cleft lip and palate and to evaluate the multiple congenital factors that affects craniofacial morphology in unilateral cleft lip and palate patients. Material and Methods: Lateral cephalograms of 140 subjects with unilateral cleft lip and palate were taken before any orthodontic treatment and alveolar bone graft. Subjects mean age was 6.85 ±1.56 years. Primary surgeries performed by surgeons from Hokkaido University Hospital. The craniofacial morphology of the 140 subjects was assessed by angular and linear cephalometric measurements. Gender, side of cleft, complete/incomplete type of cleft, presence/absence of lateral incisor in the affected side, family history of cleft and family history of skeletal Class III was chosen as congenital factors. To compare the assessments using congenital factors affecting craniofacial morphology in the unilateral cleft lip and palate subjects, angular and linear cephalometric measured values from each individual subject (control group) were converted into Z scores in relation to the means and standard deviation of the two parameters. Results: Twelve out of 13 craniofacial morphology outcomes were insignificant in 5 out of 6 dependent variables. Only 1 dependent variable showed 3/13 significant differences. Conclusion: Current study revealed the evidence that there were almost no significant differences in the craniofacial morphology outcome among various congenital factors. This will provide base line information and help determine the effectiveness of such factors.

Comparison of minimally invasive versus conventional open harvesting technique for iliac bone graft in secondary alveolar bone grafting in cleft palate patients: a systematic review

This study evaluated and compared the donor site morbidity following minimally invasive and conventional open harvesting of iliac bone for secondary alveolar bone grafting in cleft palate patients. A thorough electronic search of PubMed, Google Scholar, EMBASE, and an institutional library and manual search of various journals was done; Inclusion criteria: 1) full-text articles using a minimally invasive or conventional open harvesting technique for iliac bone for secondary alveolar grafting in cleft palate patients and 2) articles published between January 1, 2001 and June 30, 2017 and Exclusion criteria: 1) articles published in languages other than English, 2) case reports, case series, animal studies, in vitro studies, and letters to the editor, and 3) full-text article unavailable even after writing to the authors. Preliminary screening of 274 studies excluded 223 studies for not meeting the eligibility criteria. Of the remaining 51 studies, 19 were removed for being duplicates. Of the remaining 32 studies, 15 were excluded after reading the abstract. Of the 17 studies that were left, 2 were excluded because they were in a language other than English, and 2 were excluded because the study group did not mention cleft palate patients. Thus, 13 studies providing results for a total of 654 patients were included in this qualitative synthesis. Minimally invasive bone graft harvest techniques are better than the conventional open iliac bone harvest method because they offer shorter operative time, decreased requirement for pain medications, less pain on discharge, and a shorter hospital stay.

Incidentally detected odontoma within a dentigerous cyst

Odontoma is an asymptomatic slow-growing odontogenic tumor. It is usually found by chance in the maxilla or mandible on radiography, or when it deforms the adjacent teeth. It is commonly found in patients who are 30 years of age or younger. We report our encounter with an odontoma within a dentigerous cyst found incidentally in a 56-year-old man. He presented with abnormal fullness in the right infraorbital area of the cheek. During the evaluation of the mass, we incidentally detected the odontogenic tumor within a dentigerous cyst in the patient's maxilla. Under general anesthesia, complete surgical drainage of the infraorbital cystic mass was performed. Enucleation of the odontogenic tumor and a bone grafting from the iliac bone were also performed. The final diagnosis was odontoma. After 2 years of follow-up, there was no sign of recurrence of the tumor. In case of odontogenic tumors, even in old patients, it is important to suspect an odontoma. When odontoma accompanies a dentigerous cyst, surgical excisional biopsy should be performed to rule out malignancy. In case of a large bony defect after enucleation, autogenous bone grafting is essential for reconstruction.

Oroantral fistula after a zygomaticomaxillary complex fracture

Zygomaticomaxillary complex (ZMC) fractures account for a substantial proportion of trauma cases. The most frequent complications of maxillofacial fracture treatment are infections and soft tissue flap dehiscence. Postoperative infections nearly always resolve in response to oral antibiotics and local wound care. However, a significant infection can cause a permanent fistula. A 52-year-old man visited our clinic to treat an oroantral fistula (OAF), which was a late complication of a ZMC fracture. Postoperatively, the oral suture site dehisced, exposing the absorbable plate. However, he did not seek treatment. After 5 years, an OAF formed with a 2.0× 2.0 cm bony defect on the left maxilla. We completely excised the OAF, harvested a piece of corticocancellous bone from the iliac crest, inserted the harvested bone into the defect, and covered the soft tissue defect with a buccal mucosal transposition flap. Although it is necessary to excise OAFs, the failure rate is higher for large OAFs (> 5 mm in diameter) because of the extensive defect in the underlying bone that supports the overlying flap. Inappropriate management of postoperative wounds after a ZMC fracture can lead to disastrous outcomes, as in this case. Therefore, proper postoperative treatment and follow-up are essential.

Estudio Histomorfométrico de la regeneración ósea utilizando sulfato de calcio bifásico combinado con alendronato en conejos / Estudo Histomorfométrico da regeneração óssea utilizando sulfato de cálcio bifásico combinado com alendronato em coelhos / Histomorfometric Study of the bone regeneration using bifasic calcium sulfate combined with alendronate in rabbits

El alendronato es un bifosfonato con un amplio espectro de indicaciones cuya principal capacidad es la inhibición de la función osteoclástica. El sulfato de calcio bifásico es un injerto aloplástico que posee las ventajas del sulfato del calcio simple como biocompatibilidad, propiedades osteoconductivas y de bioreabsorción. Objetivo: Determinar la eficacia de la regeneración ósea a través de un estudio histomorfométrico utilizando sulfato de calcio bifásico sólo y combinado con Alendronato. Materiales y métodos: Se utilizaron 24 fémures de conejos machos andinos entre 1,5 a 2,5 Kg, divididos en 3 grupos: G1 Regeneración ósea fisiológica, G2 Sulfato de calcio bifásico y G3 Sulfato de calcio bifásico combinado con alendronato. Se realizó una incisión de 2,5cm para crear defectos de 5mm de diámetro con una profundidad de 1.5 mm. Todos los animales fueron sacrificados a la sexta semana y se obtuvieron cortes histomorfométricos. Fueron utilizados los test estadísticos de ANOVA y Tukey con un nivel de significancia del 5%. Resultados: La regeneración ósea fue del 10.63%, 40% y 71.88% para G1, G2 y G3 respectivamente. Se encontró diferencia estadísticamente significativa entre los grupos (p<0,001). Se observó diferencia entre G1 y G3 (p<0,001), así como entre el G2 y G3 (p=0,05), siendo los mejores resultados encontrados para el G3. Conclusión: El sulfato de calcio bifásico combinado con alendronato mostró mejor regeneración ósea al compararlo con los grupos de regeneración fisiológica y sulfato de calcio en conejos.

Alendronate is a bisphosphonate with a broad spectrum of indications whose main capacity is the inhibition of osteoclastic function. Biphasic calcium sulfate is an alloplastic graft that possesses the advantages of simple calcium sulfate as biocompatibility, osteoconductive and bioreabsorption properties. Objective: To determine the efficacy of bone regeneration through a histomorphometric study using biphasic calcium sulfate alone and combined with Alendronate. Materials and methods: 24 femurs of Andean male rabbits were used between 1.5 and 2.5 Kg, divided into 3 groups: G1 Physiological bone regeneration, G2 Biphasic calcium sulphate and G3 Biphasic calcium sulphate combined with alendronate. An incision of 2.5 cm was made to create defects of 5 mm in diameter with a depth of 1.5 mm. All the animals were sacrificed at the sixth week and histomorphometriccuts were obtained. The statistical tests of ANOVA and Tukey with a level of significance of 5% were used. Results: Bone regeneration was observed in 10.63%, 40% and 71.88% for G1, G2 and G3 respectively. A statistically significant difference was found between the groups (p <0.001). A difference was observed between G1 and G3 (p <0.001), as well as between G2 and G3 (p = 0.05), being the best results found for the G3. Conclusion: Biphasic calcium sulphate combined with Alendronate showed better bone regeneration when compared to physiological regeneration and calcium sulfate groups in rabbits.

O alendronato é um bisfosfonato com amplo espectro de indicações cuja principal capacidade é a inibição da função osteoclástica. O sulfato de cálcio bifásico é um enxerto aloplástico que possui as vantagens do sulfato de cálcio simples como biocompatibilidade, osteocondutor e biorreabsorção. Objetivo: Determinar a eficácia da regeneração óssea através de estudo histomorfométrico utilizando sulfato de cálcio bifásico isolado e associado ao alendronato. Materiais e métodos: Foram utilizados 24 fémures de coelhos machos andinos entre 1,5 e 2,5 kg, divididos em três grupos: G1 Regeneração óssea fisiológica, G2 Sulfato de cálciobifásico e G3 Sulfato de cálcio bifásico combinado com alendronato. Uma incisão de 2,5 cm foi feita para criar defeitos de 5 mm de diâmetro com uma profundidade de 1,5 mm. Todos os animais foram sacrificados na sexta semana e foram obtidos cortes histomorfométricos. Os testes estatísticos de ANOVA e Tukey com nível de significância de 5% foram utilizados. Resultados: Regeneração óssea foi observada em 10,63%, 40% e 71,88% para G1, G2 e G3 respectivamente. Foi encontrada diferença estatisticamente significante entre os grupos (p <0,001). Observou-se diferença entre G1 e G3 (p <0,001), assim como entre G2 e G3 (p = 0,05), sendo os melhores resultados encontrados para o G3. Conclusão: O sulfato de cálcio bifásico associado ao alendronato apresentou melhor regeneração óssea quando comparado aos grupos regeneração fisiológica e sulfato de cálcio em coelhos.

Horizontal Bone Reconstruction on sites with different amounts of native bone: a retrospective study

Abstract: The lack of guidelines for bone augmentation procedures might compromise decision making in implantology. The objective of this study was to perform a retrospective study to verify the outcomes of horizontal bone reconstruction in implant dentistry with different types of materials and amounts of native bone in the recipient bed to allow for a new guideline for horizontal bone reconstruction. One hundred preoperative CT scans were retrospectively evaluated and categorized in accordance to horizontal bone defects as presence (Group P) or absence (Group A) of cancellous bone in the recipient bed. Different approaches were used to treat the edentulous ridge and the outcomes were defined either as satisfactory or unsatisfactory regarding the possibility of implant placement. The percentage distribution of the patients according to the presence or absence of cancellous bone was 92% for Group P and 8% for Group A. In Group P, 98% of the patients had satisfactory outcomes, and the use of autografts had 100% of satisfactory outcomes in this group. In Group A, 37.5% of the patients had satisfactory outcomes, and the use of autografts also yielded 100% of satisfactory outcomes. The use of allografts and xenografts in Group A had 0% and 33.3% of satisfactory outcomes, respectively. Therefore, it seems reasonable to speculate that the presence of cancellous bone might be predictive and predictable when the decision includes bone substitutes. In cases of absence of cancellous bone in the recipient bed, the use of a vitalized graft seems to be mandatory.

Comparing osteogenic effects between concentrated growth factors and the acellular dermal matrix

Abstract Concentrated growth factor (CGF) is an autogenuous product that contains highly concentrated number of platelets and can be derived from venous blood by selective centrifugation. It has been speculated that local growth factors in human platelets (insulinlike growth factor, IGF; transforming growth factor, TGF-b; platelet derived growth factor, PDGF) would enhance healing of grafts and also counteract resorption. The osteogensis effect of CGF and acellular dermal matrix (ADM) for alveolar cleft defects was evaluated in this study. Twenty alveolar cleft patients were divided randomly into two groups. One group underwent guided bone regeneration (GBR) using acellular dermal matrix film combined with alveolar bone grafting using iliac crest bone grafts (GBR group), while the other group underwent alveolar bone grafting combined with CGF (CGF group). Cone beam computed tomography (CBCT) images were obtained at 1 week and 6 months following the procedure. Using Mimics 17.0 software, the bone resorption rate and bone density improvement rate were calculated and compared between the two groups. Although not significant between ADM and CGF in bone resorption rate, the bone density improvement in cases with CGF(61.62 ± 4.728%) was much better than in cases with ADM (27.05 ± 5.607%) (p = 0.0002). Thus, CGF could be recommended to patients with alveolar cleft as a better choice.

The maxillary lateral incisor in the rehabilitation of cleft lip and palate

Abstract Objective This study analyzed the maintenance of lateral incisors in the dental rehabilitation of individuals with cleft lip and palate. Material and Methods The study was conducted on a tertiary craniofacial center and comprised retrospective analysis of panoramic and periapical radiographs of Caucasoid individuals with non-syndromic complete unilateral cleft lip and palate, analyzing all radiographs available on the records of each individual, from the first to the last up to 12 years of age. Overall, 2,826 records were reviewed to achieve a sample of 1,000 individuals. Among these, 487 individuals presented the permanent lateral incisors on both cleft and non-cleft sides, which were included in this study. Results The results were evaluated in percentages and by descriptive statistics. The association between maintenance of the lateral incisor and timing of alveolar bone graft were analyzed by the t test. Among the 487 individuals, 265 had not completed treatment, 62 presented insufficient information, and 44 concluded the treatment elsewhere. Among the remaining 116 individuals, the lateral incisor was extracted from 88 (75.86%) of them on the cleft side (CS) and from 23 (19.83%) people on the non-cleft side (NCS). The age at accomplishment of alveolar bone graft was significantly associated with maintenance of the lateral incisor on the cleft side (p<0.01). Most extractions were indicated because of the inadequate positioning on the CS and for midline correction on the NCS. Rehabilitation was primarily completed by orthodontic movement (53 individuals on the CS and 13 individuals on the NCS). Conclusion In conclusion, the lateral incisor on the cleft side was not maintained in most individuals. Positive relationship was observed between extraction of the lateral incisor and age at accomplishment of the alveolar bone graft, suggesting the need to anticipate the initial radiographic evaluation to enhance its maintenance and reduce the procedures required for rehabilitation.

A radiographic evaluation of graft height changes after maxillary sinus augmentation

PURPOSE: The aims of the present study were to quantitatively assess graft height changes after sinus lift procedures and to analyze the factors that influenced graft height changes, including the residual bone height before surgery, surgical approach, and tooth type. METHODS: A total of 39 maxillary posterior implants placed during a simultaneous sinus lift procedure were evaluated. Panoramic radiographs of all patients were taken immediately after implant installation and at 3 months, 6 months, 1 year, 2 years, and 3 years. To analyze graft height changes over time, we measured the distance between the implant platform and the base of the grafted sinus floor at 3 locations. The radiographs were analyzed by a single examiner. RESULTS: Graft height tended to decrease over time, and a statistically significant difference was observed at 2 years compared to baseline (P < 0.05). There was no statistically significant difference in graft height change according to the surgical approach or tooth type. For residual bone height, a statistically significant difference in graft height change was found between those with 4–7 mm of residual bone height and those with ≥7 mm (P < 0.05). CONCLUSIONS: Graft height after sinus lift procedures significantly decreased at 2 years compared to baseline after sinus augmentation. Further studies should be done with controlled variables, and prospective studies with 3-dimensional images are needed to clarify the factors that influence graft height changes.

Diagnósticos e intervenções de enfermagem em pacientes no pós-operatório de enxerto ósseo alveolar / Nursing diagnoses and interventions in postoperative alveolar bone graft patients / Diagnósticos e intervenciones de enfermería en pacientes en el postoperatorio de injerto óseo alveolar

Objetivo: identificar a frequência dos diagnósticos de enfermagem relacionados à nutrição e as intervenções de enfermagem no pós-operatório de cirurgia de enxerto ósseo alveolar durante a internação. Método: estudo descritivo e quantitativo, realizado em um hospital público especializado. A amostra constituiu-se de 150 pacientes, avaliados por meio de anamnese e observação, com foco na aceitação alimentar. Resultados: os diagnósticos de enfermagem relacionados à nutrição foram elaborados segundo a taxonomia da North American Nursing Diagnosis Association-International (NANDA-I) e evidenciou-se predomínio da disposição para nutrição melhorada. As intervenções propostas de acordo com o referencial da Nursing Interventions Classifications (NIC) relacionaram-se ao ensino da dieta prescrita, promoção do autocuidado e monitoração nutricional. Conclusão: o presente estudo contribuiu para o trabalho interdisciplinar entre a nutrição e a enfermagem no processo de cuidar.

Objective: to identify the frequency of nutrition-related nursing diagnoses and postoperative nursing interventions in alveolar bone graft surgery during hospitalization. Method: this descriptive, quantitative study took place at a specialized public hospital in a sample of 150 patients evaluated by anamnesis and observation focusing on food acceptance. Results: the nutrition-related nursing diagnoses were prepared according to the taxonomy of the North American Nursing Diagnosis Association-International (NANDA-I), and displayed a predominant willingness to improve nutrition. The interventions proposed according to the frame of reference of Nursing Interventions Classifications (NIC) related to teaching prescribed diet, promoting self-care, and monitoring nutrition. Conclusion: this study contributed to interdisciplinary work between nutrition and nursing in the care process.

Objetivo: identificar la frecuencia de los diagnósticos de enfermería relacionados con la nutrición y las intervenciones de enfermería en el postoperatorio de cirugía de injerto óseo alveolar postoperatoria durante la hospitalización. Método: estudio descriptivo y cuantitativo, realizado en un hospital público especializado. La muestra consistió en 150 pacientes, evaluados mediante anamnesis y observación, enfocando la aceptación de alimentos. Resultados: los diagnósticos de enfermería relacionados con la nutrición se elaboraron según la taxonomía de la North American Nursing Diagnosis Association-International (NANDA-I) y pusieron en evidencia un predominio de la disposición de mejorar la nutrición. Las intervenciones propuestas de acuerdo con el marco de la Nursing Interventions Classifications (NIC) fueron relacionados con la enseñanza de la dieta prescrita, la promoción del autocuidado y el monitoreo nutricional. Conclusión: este estudio contribuyó al trabajo interdisciplinario entre la nutrición y la enfermería en el proceso de atención.

Current Methods for the Treatment of Alveolar Cleft

Alveolar cleft is a tornado-shaped bone defect in the maxillary arch. The treatment goals for alveolar cleft are stabilization and provision of bone continuity to the maxillary arch, permitting support for tooth eruption, eliminating oronasal fistulas, providing an improved esthetic result, and improving speech. Treatment protocols vary in terms of the operative time, surgical techniques, and graft materials. Early approaches including boneless bone grafting (gingivoperiosteoplasty) and primary bone graft fell into disfavor because they impaired facial growth, and they remain controversial. Secondary bone graft (SBG) is not the most perfect method, but long-term follow-up has shown that the graft is absorbed to a lesser extent, does not impede facial growth, and supports other teeth. Accordingly, SBG in the mixed dentition phase (6–11 years) has become the preferred method of treatment. The most commonly used graft material is cancellous bone from the iliac crest. Recently, many researchers have investigated the use of allogeneic bone, artificial bone, and recombinant human bone morphogenetic protein, along with growth factors because of their ability to decrease donor-site morbidity. Further investigations of bone substitutes and additives will continue to be needed to increase their effectiveness and to reduce complications.