ABSTRACT
Introdução: O tratamento de tumores malignos ou benignos, podem resultar em procedimentos cirúrgicos, como a maxilectomia parcial ou total, gerando comunicação bucosinusal nos pacientes. Uma forma de resolver estas alterações maxilofaciais é através do tratamento reabilitador com próteses obturadoras a fim de restabelecer a função mastigatória, estética, fonética e psicológica. Objetivo: o objetivo deste trabalho foi relatar o caso clínico de um paciente oncológico que foi reabilitado com prótese obturadora devido à maxilectomia por neoplasia maligna de seio maxilar. Relato de caso: Paciente de 62 anos, sexo masculino, procurou atendimento odontológico no Centro de Oncologia Bucal da Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) de Araçatuba SP após a realização de uma maxilectomia parcial com comunicação bucosinusal e foi encaminhado para o Curso de Especialização em Prótese Dentária da Faculdade de Odontologia Unesp/Araçatuba-SP para a reabilitação. Foi proposto, primeiramente a realização da prótese obturadora para fechar a comunicação bucosinusal e uma prótese total inferior para o arco antagonista e, posteriormente, a realização de uma prótese facial. Conclusão: O tratamento reabilitador com próteses obturadoras possui um bom resultado estético e funcional, favorecendo uma melhor função mastigatória e fonética, e melhorando consideravelmente a condição psicológica que é muito afetada nos pacientes submetidos a maxilectomia total ou parcial, sendo necessário uma boa interação com toda a equipe multiprofissional envolvida para que haja um melhor tratamento integrado para a reabilitação e melhora da qualidade de vida(AU)
Introduction: The treatment of malignant or benign tumors can result in surgical procedures, such as partial or total maxillectomy, generating oral communication in patients. One way to resolve these maxillofacial changes is through rehabilitative treatment with obturator prostheses in order to reestablish masticatory, aesthetic, phonetic and psychological function. Objective: the objective of this work was to report the clinical case of a cancer patient who was rehabilitated with an obturator prosthesis due to maxillectomy for malignant neoplasia of the maxillary sinus. Case report: A 62-year-old male patient sought dental care at the Oral Oncology Center of the Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) in Araçatuba SP after undergoing a partial maxillectomy with oral cavity and was referred for the Specialization Course in Dental Prosthesis at the Faculty of Dentistry Unesp/Araçatuba-SP for rehabilitation. It was proposed, firstly, to create an obturator prosthesis to close the bucosinusal communication and a total lower prosthesis for the antagonistic arch and, later, to create a facial prosthesis. Conclusion: Rehabilitative treatment with obturator prostheses has a good aesthetic and functional result, favoring better chewing and phonetic function, and considerably improving the psychological condition that is greatly affected in patients undergoing total or partial maxillectomy, requiring good interaction with the entire the multidisciplinary team involved so that there is better integrated treatment for rehabilitation and improved quality of life
Subject(s)
Humans , Male , Middle Aged , Palatal Obturators , Mouth Neoplasms , Maxillofacial Prosthesis , Mouth Rehabilitation , Oral Surgical Procedures , Maxilla/surgeryABSTRACT
A prótese obturadora (PO) permite o restabelecimento estético e funcional de indivíduos maxilectomizados. Os objetivos deste estudo foram: 1. avaliar pelo método de elementos finitos (MEF), o comportamento biomecânico de infraestruturas metálicas de próteses parciais removíveis obturadoras (PPRO) para uma maxila com ressecção do tipo Classe II de Aramany, variando o tipo de conector maior; 2. realizar uma revisão sistemática com meta-análise em rede sobre a eficácia da PO, e outros tratamentos na qualidade de vida de seus usuários. No primeiro estudo, um modelo virtual simulando uma maxila Classe II de Aramany com ressecção óssea do lado esquerdo, e ausência dos dentes 24, 25, 26 e 27 foi construído no programa Rhinoceros® 7.0, a partir de duas tomografias. Em seguida, três infraestruturas de PPRO digitais foram confeccionadas variando o tipo de conector maior: grupo controle com conector maior tipo placa palatina com extensão reduzida (GC), conector maior tipo placa palatina com extensão total (ME), e conector maior tipo barra anteroposterior com extensão reduzida (AP). A análise de elementos finitos foi realizada no software Optistruct 2022, e os resultados analisados no HyperView 2022. Os resultados foram avaliados de forma qualitativa por meio da observação visual das imagens gráficas com variação dos gradientes de cores, de acordo com a distribuição de tensão, e quantitativa por meio da tensão de von Mises (σVM), tensão máxima principal (σmax), tensão mínima principal (σmin) e deslocamento (mm). No segundo estudo foi realizada uma revisão sistemática com meta-análise em rede (PROSPERO #CRD42023430827). Foram incluídos ensaios clínicos randomizados (ECRs) e estudos de intervenção não randomizados (EINRs) com pacientes reabilitados com prótese obturadora como um dos tratamentos de reabilitação. Sete desfechos reportados pelos pacientes foram analisados separadamente para cada desenho de estudo, de acordo com os questionários de QV: aparência, mastigação, dor, contato social, fala, deglutição e QV geral. Os dados foram convertidos para o questionário UW-QOL v4, exceto o contato social que foi convertido para o EORTC QLQ-H&N35. Foi usada meta-análise em rede Bayesiana modelo randômico para calcular as diferenças médias, e intervalos de credibilidade de 95% (Crl) para cada comparação entre tratamentos. A interpretação seguiu a certeza da evidência por meio da abordagem GRADE para meta-análise e a diferença mínima importante (DMI). A revisão incluiu 4 ECRs e 9 EINRs. Sete tratamentos foram avaliados: pré-cirúrgico (considerado sem tratamento), obturador pós-cirúrgico, obturador provisório, obturador convencional, obturador suportado por implante, obturador magnético e retalho, totalizando 120 comparações de tratamentos em todos os sete desfechos. Verificou-se pelos resultados do primeiro estudo que CG e AP apresentaram comportamentos semelhantes, já ME apresentou maiores valores de tensão para praticamente todos os componentes do sistema. Nenhum dos grupos apresentou valores de deslocamento significativos. Para a revisão sistemática, observou-se que a estimativa de efeito de alguns tratamentos alcançou a DMI, entretanto, o intervalo de credibilidade cruzou a linha de efeito nulo, com certeza da evidência muito baixa, portanto, nenhum tratamento foi mais eficaz que o outro. Para ambos os estudos, mais estudos laboratoriais e ensaios clínicos randomizados são incentivados para confirmar as evidências encontradas.
The obturator prosthesis (OP) allows the restoration of speech, aesthetics, and oral function in patients with maxilectomized individuals. The objectives of the study were: 1. to evaluate, using the finite element analysis (FEA) methodology, the biomechanical behavior of metallic infrastructures of removable partial denture obturator (RPDO) for a maxilla with Aramany Class II resection, varying the type of major connector; 2. carry out a systematic review with network meta-analysis on the effectiveness of the OP and other treatments on the quality of life of its users. In the first study, a virtual model simulating an Aramany Class II maxilla with bone resection on the maxillary left side and absence of teeth 24, 25, 26 and 27 was developed using the Rhinoceros® 7.0 program based on two tomography scans. After obtaining the virtual model, three infrastructures digital RPDOs were created varying the type of major connector: major connector with reduced coverage (RPDO1), major connector with extensive coverage (RPDO2) and major connector with anteroposterior bar (RPDO3). The FEA analysis was carried out using the Optistruct 2022 software, and the results were analyzed using the HyperView 2022 software. The results were evaluated qualitatively through visual observation of graphic images with variation of color gradients according to the stress distribution and quantitative von Mises stress (σVM), maximum principal stress (σmax), minimum principal stress (σmin) and displacement (mm). For the second study, the systematic review with network meta-analysis (PROSPERO #CRD42023430827). Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSIs) with obturator prosthesis as one of the treatments were included. Seven patient-reported outcomes were analyzed separately for each study design, according to the QOL questionnaires: appearance, chewing, pain, social contact, speech, swallowing and general QOL. Data were converted to the UW-QOL v4 questionnaire, except social contact, which was converted to the EORTC QLQ-H&N35. Network meta-analysis (NMA) Bayesian random model was used to calculate mean differences (MD) and 95% credibility intervals (Crl) for each treatment comparison. Interpretation followed the certainty of evidence through the GRADE approach for NMA and the least important difference (DMI). The review included 4 RCTs and 9 NRSIs. Seven treatments were evaluated: presurgical (considered no treatment), surgical obturator, interim obturator, obturator, implant-supported obturator, magnet obturator, and flap, totaling 120 treatment comparisons in all seven outcomes. The results of the first study indicate that RPDO1 and RPDO3 showed similar behaviors, while RPDO2 presented the highest stress values for all system components. None of the groups presented significant displacement values. In the systematic review, it was observed that the effect estimates of some treatments reached the DMI, however, for all treatment comparisons, the credibility interval crossed the null effect line with very low certainty of evidence. No treatment showed superiority compared to another for any outcome. For both studies, further laboratory studies and RCTs are encouraged to confirm the evidence.
Subject(s)
Finite Element Analysis , Denture, Partial , Maxillofacial Prosthesis , Mouth Rehabilitation , Network Meta-Analysis , Systematic ReviewABSTRACT
Aim: This study aimed to review the scientific literature to describe the main care and hygiene protocols for different types of maxillofacial prostheses (MFP). Methods: A bibliographic search on the PubMed / Medline database using the following keywords: ["maxillofacial prosthesis" OR "ocular prostheses" OR "palatal obturators"] AND ["Cleaning" OR "disinfection"] AND ["care"] AND ["color stability"] OR ["denture cleansers" OR "cleansing agents"]. Articles addressing materials, cleaning and disinfection protocols, and care related to MFP were included. The following exclusion criteria were applied: no adequate methodology, incompatibility with the area of interest, and unavailability for reading in full. Results: The papers were grouped into the following topics: facial prostheses, ocular prostheses, maxillofacial intraoral prostheses, and retention systems. Conclusion: Despite the MFP changes over time, its degradation decreases upon following the recommendations and post-adaptation care. The guidelines for cleaning and disinfection must be individualized to guarantee the longevity of the prosthesis and the patient health
Subject(s)
Palatal Obturators , Ossicular Prosthesis , Disinfection , Hygiene , Maxillofacial Prosthesis Implantation , Maxillofacial ProsthesisABSTRACT
A odontologia reabilitadora tem como um dos seus ramos a especialidade de Prótese Bucomaxilofacial (PBMF), que visa restaurar ou substituir estruturas perdidas na região facial e no sistema estomatognático artificialmente, podendo ser ou não removidos pelo paciente. O presente trabalho objetiva revisar a leitura a respeito da reabilitação com PBMF e a sua aplicabilidade na clínica odontológica. Os indivíduos com alguma perda de estrutura na região de cabeça e pescoço, devido a traumas físicos e/ou químicos, defeitos congênitos, doenças autoimunes, neoplasias, infecções e parasitas, são pacientes para os quais há a indicação da reposição da parte ausente. As reconstruções podem ser perdas intraorais (área da maxila, mandíbula), extraorais (oculopalpebral, ocular, nasal, facial extensa e auricular) ou conjugadas. Esse é um trabalho multidisciplinar, com especialistas de áreas abrangentes e todos os especialistas trabalham de forma conjunta. Pode-se concluir que, embora seja uma das especialidades mais nobres da odontologia, ainda é muito desconhecida por parte dos estudantes e profissionais das áreas da saúde e são próteses absolutamente fundamentais para a reabilitação e qualidade de vida dos indivíduos que tem a necessidade do uso da prótese PBMF(AU)
Rehabilitating dentistry has as one of its branches the specialty of Oral and Maxillofacial Prosthesis (PBMF), which aims to restore or replace structures lost in the facial region and in the stomatognathic system artificially, which may or may not be removed by the patient. The present study aims to review the reading about rehabilitation with PBMF and its applicability in dental clinic. Individuals with some loss of structure in the head and neck region, due to physical and/or chemical trauma, birth defects, autoimmune diseases, neoplasms, infections and parasites, are patients in whom there is an indication for replacement of the absent part. Reconstructions can be intraoral (maximal area, mandible), extraoral (oculopalpebral, ocular, nasal, extensive facial and auricular) or conjugated losses. It is a multidisciplinary work, with specialists from the comprehensive areas and that all specialists work together. It can be concluded that although it is one of the noblest specialties of dentistry, it is still very unknown to students and health professionals, and they are absolutely fundamental prostheses for the rehabilitation and quality of life of individuals who need the use the PBMFprosthesis(AU)
Subject(s)
Head/abnormalities , Maxillofacial Prosthesis , Neck/abnormalities , Quality of Life , Rehabilitation , Autoimmune Diseases , Congenital Abnormalities , Stomatognathic System/injuries , Mandibular Reconstruction , Oral and Maxillofacial Surgeons , NeoplasmsABSTRACT
Introdução: A granulomatose de Wegener é uma doença autoimune rara que ocorre através de mediadores imunológicos. Sua etiologia permanece desconhecida. No entanto, sabe-se que é caracterizada principalmente pela inflamação dos vasos sanguíneos que acometem preferencialmente as vias aéreas superiores, inferiores e os rins. A doença apresenta altas taxas de morbidade e mortalidade quando não tratada, seu principal tratamento é através do uso de corticoides e imunossupressores. Objetivo: realizar um relato de caso de Granulomatose de Wegener tratando a comunicação orosinusal através de prótese bucomaxilofacial e uma discussão baseada na literatura recente. Relato de caso: paciente do gênero masculino, 40 anos de idade, leucoderma, encaminhado ao serviço de Bucomaxilofacial do Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC) queixando-se de comunicação oronasal em região de palato. Foi tratado com prótese BMF obturadora, o que devolveu ao paciente a capacidade de fonação, deglutição e convívio social. Conclusão: o tratamento com a prótese BMF reestabelece o velamento velofaríngeo, corrige hipernasalidade, melhora a deglutição e dá conforto psicológico ao paciente com estabilidade protética funcional... (AU)
Introduction: Wegeners' Granulomatulosis is a rare autoimmune disease that acts through immunologic mediators. It's etymology remains unknown. However, it is known that it's mainly characterized by the inflammation of blood vessels that affect, by preference, upper and lower airways, as well as kidneys. The disease presents high rates of morbidity and mortality when not treated, and it's main treatments are corticoids and immunosuppressants. Objective: Perform a Wegener's Granulomatulosis case report treating orosinusal communication through the use of a bucomaxilofacial prosthesis and a discussion based on current literature. Case report: Male patient, 40 years of age, leucoderma, brought to the Bucomaxilofacial department of Federal University of Santa Catarina (HU UFSC) with complaints regarding oronasal communication in the palate region. The patient was treated with a BMF prosthetics, which has allowed the patient to resume normal social activities, as well as returning phonation and deglutition. Conclusion: Treatment with a BMF prosthetics reestablishes velopharyngeal veiling, assists in the correction of nasal voice, improves deglutition and offers the patient psychological comfort with functional prosthetic stability... (AU)
Introducción: la granulomatosis de Wegener es una enfermedad autoinmune rara que se presenta a través de mediadores inmunológicos. Su etiologia permanece desconocida. Sin embargo, se sabe que se caracteriza principalmente por la inflamación de los vasos sanguíneos que afectan preferentemente las vías respiratorias superiores e inferiores y los riñones. La enfermedad tiene altas tasas de morbilidad y mortalidad cuando no se trata, su principal tratamiento es mediante el uso de corticosteroides e inmunosupresores. Objetivo: realizar un reporte de caso de Granulomatosis de Wegener en el tratamiento de la comunicación orosinusal mediante prótesis maxilofacial y una discusión basada en la literatura reciente. Caso clínico: paciente de sexo masculino, 40 años, leucoderma, remitido al Servicio Maxilofacial del Hospital Universitario de la Universidad Federal de Santa Catarina (HU-UFSC) por comunicación oronasal en región paladar. Fue tratado con una prótesis obturatriz de BMF, que le devolvió al paciente la capacidad de hablar, tragar y socializar. Conclusión: el tratamiento con la prótesis BMF restablece el velo velofaríngeo, corrige la hipernasalidad, mejora la deglución y proporciona confort psicológico al paciente con estabilidad protésica funcional... (AU)
Subject(s)
Humans , Male , Adult , Autoimmune Diseases , Granulomatosis with Polyangiitis , Maxillofacial Prosthesis , Palate , Phonation , Blood Vessels , Mortality , Adrenal Cortex Hormones , Deglutition , Immunosuppressive AgentsABSTRACT
RESUMEN: La rehabilitación de rebordes severamente atróficos mediante prótesis híbridas con subestructura cromo-cobalto fabricadas por sinterizado láser asegura el ajuste pasivo, aumentando la estabilidad de los tejidos de soporte a largo plazo. Los controles periódicos y enseñanza de técnicas de higiene son fundamentales para el éxito de rehabilitaciones complejas sobre implantes. El propósito de este reporte de caso es realizar la evaluación clínica y radiográfica a 5 años de prótesis híbridas maxilar y mandibular fabricadas mediante sinterizado láser, encontrándose resultados satisfactorios en la evaluación y seguimiento.
ABSTRACT: Rehabilitation of severely atrophic ridges using hybrid cobalt-chrome substructures manufactured by laser sintering ensures passive fit, increasing support tissue stability. Regular check-ups and the teaching of hygiene techniques are essential for the success of complex implant restorations. The purpose of this case report is to perform a 5-year clinical and radiographic evaluation of hybrid maxillary and mandibular prostheses manufactured using laser sintering, achieving satisfactory results in the evaluation and follow-up.
Subject(s)
Humans , Female , Jaw, Edentulous/rehabilitation , Prosthesis Implantation/methods , Atrophy/rehabilitation , Chromium Alloys , Maxillofacial ProsthesisABSTRACT
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)
Subject(s)
Humans , Male , Child , Biocompatible Materials , Temporomandibular Joint Disorders/therapy , Ankylosis/therapy , Maxillofacial Prosthesis , Titanium , Follow-Up Studies , Chromium Alloys , Genioplasty , Mandibular Condyle/injuriesABSTRACT
INTRODUCCIÓN: Un conjunto de cambios patológicos en el sistema estomatognático frente a la pre-sencia de una prótesis total maxilar y una prótesis parcial removible mandibular han sido descritos como el Síndrome de Combinación. El objetivo de este estudio fue determinar la prevalencia del sín-drome y si factores como la edad, el sexo o el tipo de edentulismo mandibular están asociados al mis-mo en los pacientes de la Clínica de la Facultad de Odontología de la Universidad de Cuenca período 2015-2016. MÉTODOS: Estudio observacional,transversal, descriptivo y de correlación. La muestra estuvo cons-tituida por 312 pacientes edéntulos. Se estableció la presencia del síndrome de combinación cuando un paciente presentaba un mínimo de tres signos asociados. Se determinó la prevalencia del síndro-me de combinación en la muestra y la asociación entre las variables sexo, edad, tipo de edentulismo con la presencia de síndrome de combinación. RESULTADOS: La prevalencia del SC resultó en un 21.8%. Padecer de edentulismo parcial clase I de Kennedy (3.6 veces mayor probabilidad que los otros tipos de edentulismo) y ser adulto mayor de 60 años (1.8 veces mayor probabilidad), tuvieron asociación con el desarrollo del síndrome de Combinación. CONCLUSIÓN: La prevalencia de SC es del 21.8%, la progresión de la edad y el edentulismo parcial clase I de Kennedy conducen a una mayor probabilidad para desarrollar el síndrome de combinación y deben evaluarse como factores de riesgo.(au)
BACKGROUND: The set of pathological changes in the stomatognathic system in the presence of a total maxillary prosthesis and a removable partial mandibular prosthesis has been described as the Combi-nation Syndrome. The main purpose of this study was to determine its prevalence and if features such as age, sex or type of mandibular edentulism are associated with the syndrome in the patients of the Odontologic Clinic of the of Faculty of Dentistry, Universidad de Cuenca during the academic period 2015-2016. METHODS: Cuantitative, cross sectional descriptive and correlational study. The sample consisted of 312 edentulous patients. The diagnosis of the syndrome in this study was determined by the presence of a minimum of three associated signs. We determine the prevalence of combiantion syndrome and the as-sociation between sex, age and edentulism type and combination syndrome. RESUlTS: The prevalence of combination syndrome is 21.8%. Adults 60 years or older (1.8 times higher probability) and patients who suffer from Kennedy class I partial edentulism (3.6 times higher probability than other types of edentulism), have a higher probability for developing the syndrome. CONClUSION: The prevalence of CS was 21.8%, age and suffering from Kennedy class I partial edentulism should be considered as risk factors for developing the syndrome.(au)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Prostheses and Implants , Prevalence , Dental Prosthesis/economics , Dentistry , Diagnosis , Mandibular Prosthesis , Maxillofacial ProsthesisABSTRACT
ABSTRACT: There has been little discussion about the quality of life of patients with maxillary defects. This article evaluates the issues related to the condition. We performed a cross-sectional study of patients with maxillary defects from referral centers in Brazil. To avoid subject burden, a questionnaire was developed, based on questions from seven instruments, which dealt with domains and conclusions that were similar to those from other studies. The predictor variable was the patients' score for each question. The outcome measure was the presence of the best-ranked items on the questionnaire as the impact factor. Six experts assessed these items and suggested which questions to include or exclude. Patients scored each item according to its occurrence and importance. Descriptive statistics and the items' rank according to the impact factor were computed to determine whether there is a comprehensive instrument available. Thirteen patients and six professionals were included in this study. The patients' age ranged from 24 to 72 years (mean (standard deviation, SD), 50.41 (14.46) years). We obtained a 60-item instrument from the selected questionnaires and subject interviews. Only 12 (37.5 %) out of the 32 best-rated items were verified by the existing instruments, two (6.25 %) were suggested by professionals and 18 (56.25 %) were conclusions from other studies. To the best of our knowledge, this is the first study to provide many features related to the quality of life in patients with maxillary defects.
RESUMEN: Existe escasa discusión en la literatura sobre la calidad de vida de los pacientes con defectos maxilares. Este artículo evalúa los problemas relacionados con esta condición. Realizamos un estudio transversal de pacientes con defectos maxilares de centros de referencia en Brasil. Se desarrolló un cuestionario basado en preguntas de siete instrumentos, que trataba sobre dominios y conclusiones similares a las de otros estudios. La variable de estimación fue la puntuación de los pacientes para cada pregunta. La medida de resultado fue la presencia de los elementos mejor clasificados en el cuestionario como factor de impacto. Seis expertos evaluaron estos ítems y sugirieron qué preguntas incluir o excluir. Los pacientes puntuaron cada ítem según su ocurrencia e importancia. Se calcularon las estadísticas descriptivas y la clasificación de los ítems según el factor de impacto, para determinar si existe un instrumento completo. Trece pacientes y seis profesionales fueron incluidos en este estudio. La edad de los pacientes osciló entre 24 y 72 años [media (desviación estándar), 50,41 (14,46) años]. Obtuvimos un instrumento de 60 ítems de los cuestionarios y entrevistas de temas seleccionados. Solo 12 (37,5 %) de los 32 ítems mejor calificados se verificaron de acuerdo a los instrumentos existentes, dos (6,25 %) fueron sugeridos por profesionales y 18 (56,25 %) fueron conclusiones de otros estudios. De acuerdo a nuestro conocimiento, este es el primer estudio que proporciona características relacionadas con la calidad de vida en pacientes con defectos maxilares.
Subject(s)
Humans , Adult , Middle Aged , Aged , Maxillary Diseases/pathology , Maxillary Diseases/epidemiology , Maxillary Neoplasms/pathology , Maxillofacial Prosthesis/classification , Maxillofacial Prosthesis/standards , Palatal Obturators , Palate/surgery , Quality of Life , Brazil , Maxillary Neoplasms/surgery , Cross-Sectional Studies , Surveys and Questionnaires , Ethics Committees , Data AnalysisABSTRACT
Maxillectomy is performed to remove the tumor in the palate, maxillary sinus, buccal mucosa or nasal cavity. The resection range depends on the size and the extent of the tumor and it affects speech production or cause nasal regurgitation during feeding. Obturator can occlude an opening such as an oro-nasal fistula and protect the defect area. Successful reconstrucion of the patient's oral cavity who have gone over the maxillectomy is a difficult task. The condition and number of teeth, the remaining support area, and the extent of the defect area have a great influence on manufacturing the obturator. If these factors are disadvantageous, the prognosis of the prosthesis is uncertain. The final obturator must have a sufficient retention in the patient's oral cavity and must not irritate the surrounding tissue and support area where the resection was performed.In this case, a 55 year old female went through the maxillectomy and the only 3 teeth remained. And the retention of the maxillary prosthesis seems to be poor. So that, we fabricated the closed hollow obturator which has reduced weight compared to the conventional obturator. Consequently the closed hollow obturator can give better sealing and the adaptation.
Subject(s)
Female , Humans , Fistula , Maxillary Sinus , Maxillofacial Prosthesis , Mouth , Mouth Mucosa , Nasal Cavity , Palate , Palate, Hard , Prognosis , Prostheses and Implants , ToothABSTRACT
Introdução:Aenorme dificuldade de deglutição e fala apresentada em pacientes que sofreram maxilectomiatotal ou parcial por consequência de patologias bucais, afeta grande parte da população que realizou tal procedimento. A alternativa de minimizar o impacto causado pela sequela deixada após cirurgia em maxila está na confecção de um obturador palatino, que tem como objetivo obstruir a comunicação oronasal.Objetivo:Este trabalho objetivou descrever um relato de caso evidenciando o passo a passo clínico e laboratorial de uma prótese total obturadorae a satisfação do paciente com a mesma.Método:Paciente do gênero masculino, maxilectomizado há seisanos devido a presença de um CarcinomaAdenóideCístico foi reabilitado com prótese total obturadora superior e prótese total convencional inferior. A reabilitação superior seguiu os mesmos passos de uma prótesetotal convencional, com exceção da moldagem funcional, na qual foi feita a moldagem da comunicação bucosinusal com silicona de condensação antes da moldagem do selado periférico e moldagem funcional propriamente dita. Na etapa laboratorial, foi necessáriaa realização de três prensagens a fim de deixar a prótese oca na porção obturadora.Resultados:O tratamento restabeleceu a dimensão vertical perdida, proporcionou uma oclusão adequada, se mostrou melhor esteticamentee o paciente mostrou-se extremamente satisfeito com a reabilitação.Conclusões:Como conclusão, obteve-se uma prótese total obturadora superior com qualidades funcionais e estéticas satisfatórias. Ademais, ao comparar com a antiga, a novamostrou-se satisfatória de acordo com a percepção do usuário epossui um menor peso, favorecendo uma melhor retenção (AU).
Introduction:The enormous difficulty in swallowing and speaking presented in patients who underwent total or partial maxillectomy as a result of oral pathologies affects a large part of the population that performed this procedure. The alternative of minimizing the impact caused by the sequelae left after maxillary surgery is by making a palatal obturator, which aims to obstruct oronasal communication.Objective:This study aimed to describe a case report highlighting the clinical and laboratory step by step of a complete obturator prosthesis and patient satisfaction with it. Methods:A male patient who had been maxillectomized for 6 years due to the presence of a cystic adenoid carcinoma was rehabilitated with superior obturator total denture and inferior conventional total denture. The superior rehabilitation followed the same steps of a conventional total prosthesis, except for the functional molding, in which the bucosinusal communication with condensation silicon was molded before the peripheral sealing molding and the functional molding itself. In the laboratory stage, it was necessary to perform three presses in order to leave the hollow prosthesis in the obturator portion.Results:The treatment restored the lost vertical dimension, provided an adequate occlusion,was better aesthetically and the patient was extremely satisfied with the rehabilitation.Conclusions:In conclusion, a superior total obturator prosthesis with satisfactory functional and aesthetic qualities was obtained. Moreover, when compared to the old one, the new one was satisfactory according to the user's perception and has a lower weight, favoring a better retention (AU).
Introduccion: La enorme dificultad para tragar y hablarpresentada en pacientes que han sufrido una maxillectomía total o parcial como resultado de patologías orales afecta a gran parte de la población que realizó este procedimiento. La alternativa de minimizar el impacto causado por las secuelas que quedan después de la cirugía maxilar es hacer un obturador palatino, que tiene como objetivo obstruir la comunicación oronasal. Objetivo: Este estudio tuvo como objetivo describir un informe de caso que muestra la clínica y el laboratorio paso a paso de una prótesis obturadora completa y la satisfacción del paciente con ella. Método:Un paciente masculino que había sido maxillectomizado durante seis años debido a la presencia de un carcinoma adenoide quístico fue rehabilitado con una prótesis obturadora total superior y una prótesis total inferior convencional. La rehabilitación superior siguió los mismos pasos de una prótesis total convencional, excepto el moldeado funcional, en el cual la comunicación bucosinusal con silicio de condensación se moldeó antes del moldeado de sellado periférico y el moldeado funcional en sí. En la etapa de laboratorio, fue necesario realizar tres prensas para dejar la prótesis hueca en la porción del obturador. Resultados:El tratamiento restableció la dimensión vertical perdida, proporcionó una oclusión adecuada, fue mejor estéticamente y el paciente quedó extremadamente satisfecho con la rehabilitación. Conclusiones:Como conclusión, se obtuvo una prótesis obturadora superior con cualidades funcionales y estéticas satisfactorias. Además, en comparación con el anterior, el nuevo fue satisfactorio de acuerdo con la percepción del usuario y tiene un peso menor, lo que favorece una mejor retención (AU).
Subject(s)
Humans , Male , Middle Aged , Palatal Obturators , Surgery, Oral/rehabilitation , Patient Satisfaction , Maxillofacial Prosthesis , Mouth Rehabilitation , Brazil , Denture, CompleteABSTRACT
Objective: To evaluate the inclusion capacity and bactericidal efficiency of diallyl dimethyl ammonium chloride (PDADMAC) diluted in tetrahydrofuran (THF) upon inclusion in the medical grade silicone polymer structure. Material and Methods: It was diluted the PDADMAC in THF at the concentration of 4wt%. It was included in the silicon paste during its vulcanization process. The contact angle measurements were performed to evaluate whether the biocide inclusion into the silicon paste was successful. All samples were sterilized with gamma radiation at 25KGy-dosage prior to the microbiological tests. Microbiological testing strictly followed the Antibacterial products - Test for antibacterial activity and efficacy JIS Z 2801: 201010 and the used of specific bacteria, as Staphylococcus aureus ATCC 6538P and Escherichia coli ATCC 8739. Results: The results showed that PDADMAC, when dissolved in THF at 4wt%, displayed good incorporation in medical silicone and a broad-spectrum antibacterial response. The results of the tests using Escherichia coli ATCC 8739 and Staphylococcus aureus ATCC 6538P showed that the silicone with no biocide addition did not present antibacterial activity. In contrast, the experimental group plus 2 mL of PDADMAC would have an ideal antibacterial response. Conclusion: Medical grade silicone can be used as a material with antibacterial properties, since it has been able to keep PDADMAC compound attached to its structure, thus acquiring antimicrobial property.
Subject(s)
Silicone Elastomers/analysis , In Vitro Techniques/methods , Maxillofacial Prosthesis , Anti-Bacterial Agents/analysis , Silicone Elastomers , Brazil , Dental Materials , Methylenetetrahydrofolate Reductase (NADPH2)ABSTRACT
With the rapid development of 3D printing, it is widely used in the field of cranio-maxillofacial surgery. Through the individualized production of 3D printing, the backward mode of traditional production relying on manual shaping has been changed to meet the needs of different patients. However, as no clear specification exists for the performance requirements of 3D printing metal powder for cranio-maxillofacial surgery, its long-term development is not feasible. In this paper, the preparation technologies of 3D printing metal powder for cranio-maxillofacial prostheses (i.e., gas atomization, rotating electrode atomization, and radio frequency plasma spheroidization) and 3D printing forming technologies (i.e., selective laser melting, electron beam selective melting, and laser-engineered net shaping) are introduced. The performance requirements of 3D printing metal powder for cranio-maxillofacial prostheses are then summarized according to the characteristics of the preparation and forming technologies described.
Subject(s)
Humans , Lasers , Maxillofacial Prosthesis , Metals , Powders , Printing, Three-DimensionalABSTRACT
A patient who went through maxillectomy can have soft palate defects including oronasal fistulas and suffer from dysphagia and dysarthria due to velopharyngeal insufficiency. This defect causes the food to enter nasal cavity and creates hypernasal sound which debilitates a quality of life. An obturator can rehabilitate the substantial oral tissue defects. The maxillary obturator separates the nasopharynx from the oropharynx during speech and deglutition by closing of the defect. For edentulous obturator patient, it is difficult to obtain proper retention due to reduced peripheral sealing. Therefore, the contours of the defects must be used to maximize the retention, stability, and support. Hollow type obturator can improve physiologic function by reducing weight than the traditional obturator. This case report describes a patient with hemi-maxillectomy who recovers mastication, speech, deglutition, and appearance with a maxillary obturator using physiological border molding of the velopharyngeal area and double-processing method.
Subject(s)
Humans , Deglutition , Deglutition Disorders , Dysarthria , Fistula , Fungi , Mastication , Maxillofacial Prosthesis , Methods , Nasal Cavity , Nasopharynx , Oropharynx , Palatal Obturators , Palate, Soft , Quality of Life , Rehabilitation , Velopharyngeal InsufficiencyABSTRACT
Cirurgias de ressecção parcial ou total da maxila em pacientes oncológicos geram comprometimento funcional e estético, alterando a deglutição, mastigação, fonética e aspiração, diminuindo a qualidade de vida do paciente. Assim, o objetivo deste estudo foi descrever a reabilitação oral de um paciente com prótese total maxilar estendida e uma prótese total mandibular convencional. Tal paciente havia sido submetido à uma cirurgia de ressecção parcial do rebordo alveolar maxilar, sem comunicação bucossinusal, por ser portador de Carcinoma espinocelular grau I. Paciente do sexo masculino, 69 anos, procurou atendimento no Centro de Oncologia Bucal da FOA UNESP, para confecção de suas próteses, após dois anos da realização de sua cirurgia. Foi observado declínio do suporte labial no local onde havia sido feita a ressecção cirúrgica gerando comprometimento estético e funcional ao paciente. Desta forma, foi proposta a realização de confecção de prótese total maxilar estendida e prótese inferior convencional, as quais foram instaladas e ajustadas adequadamente. Após 1 ano de acompanhamento, paciente encontra-se satisfeito com o tratamento, o qual devolveu sua estética, função e fonética(AU)
Surgeries of partial or total resection of the maxilla in oncological patients generate functional and aesthetic impairment, altering swallowing, chewing, phonetics and aspiration, reducing the quality of life of the patient. Thus, the objective of this study was to describe the oral rehabilitation of a patient with maxillary total prosthesis and a conventional mandibular total prosthesis. This patient had undergone surgery of partial resection of the maxillary alveolar ridge, without bucosinusal communication, for being a carrier of grade I squamous cell carcinoma. A 69-year-old male patient sought care at the Oral Oncology Center of FOA - UNESP, for denture after two years of surgery. Decreased lip support was observed in the place where surgical resection had been performed, generating aesthetic and functional impairment to the patient. In this way, it was proposed to make a complete maxillary full prosthesis and conventional lower prosthesis, which were installed and adjusted properly. After 1 year of follow-up, the patient was satisfied with the treatment, which returned his aesthetics, function and phonetics(AU)
Subject(s)
Humans , Male , Aged , Carcinoma, Squamous Cell , Dental Prosthesis , Maxilla/surgery , Maxillofacial Prosthesis , Quality of Life , Alveolar Process/surgeryABSTRACT
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)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Ankylosis , Biocompatible Materials , Maxillofacial Prosthesis , Micrognathism , Temporomandibular Joint Disorders , Chromium Alloys , Dental Prosthesis Design , Mexico , Molybdenum , Osteogenesis, DistractionABSTRACT
Objetivo: avaliar, por meio de extensometria, a infl uência da flange do implante de titânio na deformação superficial do osso. Material e métodos: um bloco de poliuretano simulando um osso tipo I mais corticalizado e menos medular (40 PCF) recebeu um implante de hexágono externo intraoral, sem flange 3,75 mm x 8,5 mm (G1) e um implante de hexágono externo extraoral, com flange 3,75 mm x 8 mm (G2). Em seguida, foram instalados componentes standard com 2 mm de altura de cinta metálica e cilindros metálicos para restauração provisória. Dois extensômetros lineares foram colados na superfície do bloco (mesial e distal de cada implante), e uma carga axial de 100 Ncm em uma máquina de ensaio universal foi aplicada, com cinco medições de microdeformação (µÎµ) para cada implante. Os dados foram submetidos ao teste Shapiro-Wilk para verifi car a homogenidade dos dados e em seguida ao teste t Student. Resultados: as médias e desvios-padrão obtidos foram: G1: 148,2 ± 5,84 e G2: 92,4 ± 11,24 µÆ, com diferença estatística significativa entre os grupos. Conclusão: os implantes extraorais tiveram melhor comportamento mecânico para as cargas axiais do que os implantes intraorais, sendo que a flange melhorou a distribuição da carga na superfície do bloco de poliuretano.
Objectives: to evaluate, by means of extensometry, the influence of the titanium implant flange on the superficial deformation of the bone. Material and methods: a polyurethane block simulating a more corticalized and less spinal type I bone (40 PCF) received an external intraoral hexagon implant with a 3.75 mm x 8.5 mm fl ange (G1) and an extraoral external hexagon implant, with flange 3.75 mm x 8 mm (G2). Subsequently, standard components with 2 mm high of metal strap and metal cylinders were installed for temporary restoration. Two linear strain gauges were glued to the surface of the block (mesial and distal of each implant), and an axial load of 100N in a universal test machine was applied with five microdemorphometric measurements (µÎµ) for each implant. The data were submitted to the Shapiro-Wilks test to verify the homogeneity of the data and then to the t-student test. Results: the means and standard deviations obtained were: G1: 148.2 ± 5.84 and G2: 92.4 ± 11.24 µÎµ, with signifi cant statistical difference between the groups. Conclusion: extraoral implants had better mechanical behavior for axial loads than intraoral implants, and the flange improved the load distribution on the surface of the polyurethane block.
Subject(s)
Humans , Comparative Study , Maxillofacial Prosthesis , Maxillofacial Prosthesis Implantation , Osseointegration , Prostheses and ImplantsABSTRACT
PURPOSE: Accurate color matching of maxillofacial prostheses to skin is important for esthetics. A computerized color matching system specific to human skin has recently been developed. The purpose of this study was to evaluate the accuracy in color and translucency matching of the computerized color matching system across different skin colors. MATERIALS AND METHODS: The silicone was colored to simulate 28 different skin colors (n=5) to serve as “target skin colors”. Using a spectrocolorometer (e-skin), color codes were determined for “replicate skin color” fabrication. CIELAB Delta-E between target skin color-replicate skin color pairs and translucency parameter were calculated. CIELAB Delta-E values were compared with one-way ANOVA and Tukey multiple-comparison. The agreement between L*, a*, b* and translucency parameter of target skin colors and replicate skin color were calculated by a two-way mixed average measures intraclass correlation coefficient. Translucency parameter of target skin color-replicate skin color pairs were compared with Paired t-test (α=.05). RESULTS: The mean CIELAB Delta-E value was 3.83 and significant differences were found among colors. The intraclass correlation coefficient showed excellent reliability for L*, a*, b* and good reliability for translucency parameter (P < .001). The mean translucency parameter of replicate skin colors was significantly higher than that of translucency parameter. CONCLUSION: The computerized color matching system specific to human skin was found to be reliable in terms of color and translucency between target skin colors and replicate skin color.
Subject(s)
Humans , Esthetics , In Vitro Techniques , Maxillofacial Prosthesis , Pigmentation , Reproduction , Silicon , Silicones , Skin , Skin PigmentationABSTRACT
Magnetic resonance imaging (MRI) is an advanced diagnostic tool used in both medicine and dentistry. Since it functions based on a strong uniform static magnetic field and radiofrequency pulses, it is advantageous over imaging techniques that rely on ionizing radiation. Unfortunately, the magnetic field and radiofrequency pulses generated within the magnetic resonance imager interact unfavorably with dental materials that have magnetic properties. This leads to unwanted effects such as artifact formation, heat generation, and mechanical displacement. These are a potential source of damage to the oral tissue surrounding the affected dental materials. This review aims to compile, based on the current available evidence, recommendations for dentists and radiologists regarding the safety and appropriate management of dental materials during MRI in patients with orthodontic appliances, maxillofacial prostheses, dental implants, direct and indirect restorative materials, and endodontic materials.
Subject(s)
Humans , Artifacts , Clothing , Dental Alloys , Dental Implants , Dental Materials , Dentistry , Dentists , Hot Temperature , Magnetic Fields , Magnetic Resonance Imaging , Maxillofacial Prosthesis , Orthodontic Appliances , Radiation, Ionizing , Root Canal Filling MaterialsABSTRACT
Evaluate the color stability of facial silicone pigmented extrinsically under the influence of the hygiene process. Methods: 160 samples were prepared and divided into 8 groups (n = 20) according to the pigmentation technique used: Group 1: Colorless silicone; Group 2: Pigmented exclusively with oil ink; Group 3: Pigmented with oil ink + opacifier; Group 4: Colorless, applying Prime; Group 5: Pigmented with oil ink covered with Prime; Group 6: Pigmented with oil ink + opacifier and covered with Prime; Group 7: Pigmented with oil ink diluted in Prime; Group 8: Pigmented with oil ink + opacifier diluted in Prime. Then the samples were distributed into two subgropus (n=10): 1: neutral soap and 2: 1% hypochlorite solution. The color readings occurred in the initial period and 60 days after the hygiene procedures. For this, it was used a spectrophotometer reflection and CIE-Lab program. The data was tabulated and submitted to analysis of variance (ANOVA) followed by Tukey test (p <0.05). Results: The groups of samples disinfected with soap showed significantly lower color change values than those presented by the samples disinfected with hypochlorite. The best results were presented by the group of samples pigmented with oil ink diluted in prime and sanitized with neutral soap (ΔE=1.21, without opacifier and ΔE=0.82, with opacifier). Conclusions: The association of oil ink diluted in prime and hygiene technique with soap promotes the lower color change of facial silicone pigmented extrinsically