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1.
Int. j. odontostomatol. (Print) ; 14(4): 664-669, dic. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1134555

ABSTRACT

RESUMEN: El objetivo de este estudio fue evaluar la relación entre la clase esqueletal sagital y las condiciones transversales o verticales en sujetos con deformidad facial sin presencia de asimetría facial; Se realizó un análisis cefalomét rico de la clase esqueletal sagital, transversal y vertical en 115 sujetos con indicaciones de cirugía ortognática. Se consideró algunos datos del análisis cefalométrico de Steiner y el análisis cefalométrico de Ricketts en sentido sagital para determinar la clase esqueletal facial. A nivel transversal se determinó la dimensión transversal facial, dimensión transversal maxilar y dimensión transversal mandibular. A nivel vertical se determinó la dimensión vertical oclusal y dimensión vertical total. Al comparar las mediciones transversales y verticales entre sujetos de sexo femenino y masculino, se observó que los hom- bres presentaban mayores dimensiones que las mujeres (p=0,0001) en todos los análisis realizados. Los sujetos clase III presentaron mayor dimensión transversal facial (p=0,0002) y transversal mandibular (p=0,001) que los sujetos clase II. Además, se observó que los sujetos clase III presentaban mayor dimensión vertical total (p=0,002) que los sujetos clase II; Es posible concluir que existe características faciales transversales y verticales que se pueden relacionar con la posición sagital de las estructuras maxilo-mandibulares.


ABSTRACT: The aim of this study is to evaluate the relationship between sagittal skeletal class and transverse or vertical conditions in subjects with facial deformity without presence of facial asymmetry; A comparative study was conducted between the results of the cephalometric analysis of the sagittal, transverse and vertical skeletal class in 115 subjects with indications for orthognathic surgery. The Steiner cephalometric analysis in the sagittal direction was used to determine the facial skeletal class and the Ricketts cephalometric analysis in the sagittal analysis. At the transverse level it was determined the facial transverse dimension, maxillary transverse dimension and mandibular transverse dimension. At a vertical level it is determined the occlusal vertical dimension and total vertical dimension. When comparing cross-sectional and vertical measurements between female and male subjects, it was observed that male subjects presented greater dimensions than female subjects (p=0.0001). Class III subjects present greater facial transverse dimension (p=0.0002) and mandibular transverse dimension (p=0.001) than class II subjects. Also, it was observed that class III subjects had a greater total vertical dimension (p=0.002) than class II subjects; It is possible to conclude that there are facial characteristics transverse and vertical that can be related with the sagittal position of the maxillo-mandibular structures.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Orthognathic Surgical Procedures/methods , Malocclusion, Angle Class II/surgery , Malocclusion, Angle Class III/surgery , Cephalometry/methods , Data Interpretation, Statistical , Sex Distribution , Helsinki Declaration , Informed Consent
2.
Medwave ; 20(11): e8072, dic. 2020.
Article in Spanish | LILACS | ID: biblio-1146067

ABSTRACT

INTRODUCCIÓN La cirugía ortognática, al ser un procedimiento quirúrgico invasivo, puede presentar importantes morbilidades postoperatorias para el paciente. Dentro de las complicaciones descritas con mayor frecuencia, está la infección del sitio quirúrgico. En vista de esto, la administración de antibióticos profilácticos previo a este tipo de procedimientos se presenta como una práctica frecuente. Sin embargo, el costo-beneficio del uso de antibióticos, el tipo de antibiótico, la vía de administración, la posología, y el esquema a utilizar no han sido claramente definidos y se presentan como una temática controversial. En este resumen de evidencia, se comparará la utilidad del esquema profiláctico de largo plazo contra el de corto plazo. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos cinco revisiones sistemáticas que en conjunto incluyeron nueve estudios primarios, de los cuales, todos corresponden a ensayos aleatorizados. Concluimos que dar un esquema profiláctico antibiótico de largo plazo probablemente disminuye el riesgo de infección del sitio quirúrgico y podría aumentar el riesgo de estadía hospitalaria mayor a dos días, pero en este último punto, la certeza de la evidencia es baja.


INTRODUCTION Orthognathic surgery, being an invasive surgical procedure, may present significant postoperative morbidities for the patient. Among the most frequently described complications is surgical site infection. The administration of prophylactic antibiotics prior to this type of procedure is a common practice, however, the cost-benefit of the use of antibiotics, the type of antibiotics, the route of administration, the dosage, and the regimen to be used have not been clearly defined and are still considered a controversial issue. In this summary of evidence, we will compare long-term antibiotic prophylaxis with short-term prophylaxis. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified five systematic reviews including nine studies overall, of which all nine were randomized trials. We conclude that administering a long-term prophylactic antibiotic regimen probably decreases the risk of surgical site infection and that it may increase the risk of hospital stay longer than two days, nevertheless, regarding this last point, the certainty of the evidence is low.


Subject(s)
Humans , Surgical Wound Infection/prevention & control , Antibiotic Prophylaxis/methods , Orthognathic Surgical Procedures/methods , Anti-Bacterial Agents/therapeutic use , Treatment Outcome , Systematic Reviews as Topic , Anti-Bacterial Agents/administration & dosage
3.
Int. j interdiscip. dent. (Print) ; 13(1): 44-46, abr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1114893

ABSTRACT

AIM: Short implants are manufactured for use in atrophic regions of the jaw. Therefore, the current does not sufficiently reveal a direct correlation between the impact of implant length on implant survival. The purpose of this systematic review was to compile the evidence of short implant survival in atrophied jaws. METHODS: Electronic and manual literature searches were performed by two independent reviewers in several databases, including MEDLINE, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to September 2015 using the following terms in some combinations: "short implant", "mandible/atrophied jaws", and "implant survival/ survival rate/ survival analysis". RESULTS: The 19 included studies present in average 5.5 years (range 1.0-20.0 years) follow-up and 96.1% (range 73.4-100.0 percent) survival rate of the short implants in atrophied mandibular. CONCLUSIONS: This systematic review found evidences regarding to safety of short implant placement in atrophied jaws although stronger evidence is essential to confirm this finding.


Subject(s)
Humans , Dental Implants , Dental Implantation, Endosseous/methods , Orthognathic Surgical Procedures/methods , Atrophy , Survival Analysis , Jaw , Mandible
4.
Int. j. odontostomatol. (Print) ; 13(3): 252-257, set. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1012418

ABSTRACT

RESUMEN: La reabsorción condilar como complicación postoperatoria en cirugía ortognática es una causa frecuente de recidiva de anomalías dentomaxilares, existiendo diversos factores que se relacionan con su aparición. El objetivo de este estudio fue describir mediante una revisión narrativa la reabsorción condilar como complicación postoperatoria en cirugía ortognática. Se realizó una búsqueda electrónica de la literatura en las bases de datos electrónicas PubMed, EBSCO, TripDatabase y Epistemonikos sin límite de años, en idioma inglés y español, incluyendo revisiones sistemáticas, ensayos clínicos y estudios observacionales. Se excluyeron reportes de casos, estudios en animales y aquellos que no relacionaran la complicación con cirugía ortognática. Se evaluaron los estudios según grado de recomendación y calidad de reporte. Veintiún artículos fueron seleccionados según los criterios de selección establecidos en esta revisión. La literatura reportada sugiere que la reabsorción condilar es una patología de frecuencia relativa en pacientes postoperados de cirugía ortognática (1,4-32 % de los casos) y que está asociada a factores de riesgo preoperatorios tales como género, edad, tipo de anomalía dentomaxilar y técnica quirúrgica utilizada. La reabsorción condilar es una complicación postoperatoria a cirugía ortognática que debemos considerar en la planificación del tratamiento e identificar pacientes con factores de riesgo. Luego de la intervención quirúrgica es de vital importancia realizar un seguimiento estricto a este tipo de pacientes e identificar de forma temprana cambios clínicos y radiográficos. Finalmente, es importante seguir investigando sobre esta materia para establecer criterios de prevención y diagnóstico, con mayor claridad.


ABSTRACT: Condylar resorption as a complication following orthognathic surgery is considered to cause dento-facial anomalies, relating to different pre and intra-operative factors. The aim of the research was to describe condylar resorption as a postoperative complication after orthognathic surgery. A review of the literature was made in four databases: PubMed, EBSCO, Trip database and Epistemonikos. The search was carried out without year limiting, articles in English and Spanish, including systematic reviews, observational studies and clinical trials. Exclusion criteria were applied for report cases, animal studies and articles that do not relate condylar resorption with orthognathic surgery. Quality of evidence and strength of the recommendations were assessed for the chosen studies. For this study 21 articles were selected following the inclusion criteria. The literature found reported that condylar resorption is a relatively frequent complication following orthognathic surgery (1.4-32 % of frequency) and that it can be associated with several factors such as genre, age, dento-maxillary anomaly and surgical technique. Condylar resorption is a complication that we must consider in the planning of orthognathic surgery, in order to identify risk factors and patients who are more likely to present this post-surgical complication. Following surgery, strict follow-up is a key factor to determine early clinical and radiographic changes. Finally, further research is needed to establish stronger prevention and diagnostic criteria.


Subject(s)
Humans , Bone Resorption/complications , Mandibular Diseases/physiopathology , Mandibular Condyle/abnormalities , Mandibular Condyle/physiopathology , Postoperative Complications , Temporomandibular Joint , Temporomandibular Joint Disorders/surgery , Orthognathic Surgical Procedures/methods
5.
Int. j. odontostomatol. (Print) ; 13(1): 5-10, mar. 2019. graf
Article in Spanish | LILACS | ID: biblio-990057

ABSTRACT

RESUMEN: La hiperplasia condilar (HC) es un término genérico de una condición patológica que se utiliza para describir situaciones que causan el crecimiento excesivo y sobredesarrollo del cóndilo mandibular, repercutiendo así también en la mandíbula, es la responsable de alrededor del 50 % de las asimetrías faciales y se presenta con mayor frecuencia entre los 11 y 30 años de edad. Se presenta un caso clínico de una paciente femenina de 21 años de edad que presentaba hiperplasia condilar unilateral izquierda con compensación alveolodentaria. Se realizó condilectomía alta con abordaje endoaural para retirar 5 mm de la parte superior del cóndilo y osteotomía mandibular mediante abordaje intraoral circunvestibular, con disección y preservación del nervio dentario inferior, retirando 8 mm del aspecto inferior de la mandíbula de acuerdo a los requerimientos estéticos. El brindar un tratamiento adecuado a la hiperplasia condilar enfocado a corregir las secuelas tanto funcionales como estéticas es de gran beneficio al paciente ya que le permite mejorar su calidad de vida, el correcto diagnóstico es vital para poder planear un tratamiento exitoso.


ABSTRACT: Condylar hyperplasia (CH) is a generic term for a pathological situation that is used to describe conditions that cause excessive growth and overdevelopment of the mandibular condyle and also impacting on the jaw, this bone formation is responsible about of 50 % of all deformities facial and it occurs most frequently between 11-30 years old. This case report is about a 21-years old female who showed unilateral condylar hyperplasia of left side with alveolodentary compensatory. Was carried out high condilectomy through an endoaural approach removing 5 mm of the upper condyle and the mandibular osteotomy was performed through intraoral approach with dissection and preservation of the inferior alveolar nerve, removing 8 mm of the inferior aspect of the mandible according to the aesthetic requirements. An appropriate treatment for the condylar hyperplasia focused on correcting the side effects such as functional or aesthetic it's of great benefit for the patient because it allows improve their quality of life. A correct diagnosis is very important to planning a successful treatment.


Subject(s)
Humans , Female , Young Adult , Mandibular Diseases/surgery , Mandibular Condyle/surgery , Radiography, Panoramic , Mandibular Diseases/pathology , Mandibular Diseases/diagnostic imaging , Esthetics, Dental , Facial Asymmetry/surgery , Orthognathic Surgical Procedures/methods , Hyperplasia , Mandibular Condyle/pathology , Mandibular Condyle/diagnostic imaging
6.
Dental press j. orthod. (Impr.) ; 23(6): 80-89, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-975031

ABSTRACT

Abstract Facial asymmetry is a condition that compromises function and social interactions and, consequently, the quality of life. Orthodontic-surgical treatment may be indicated to achieve a stable occlusion and significant improvement in facial aesthetics. The virtual planning of the maxillary, mandibular and chin movements can be done prior to surgery. These movements can be successfully performed with the use of prototyped guides obtained from virtual planning. The aim of this article is to show the state of the art of treatments of facial asymmetries, and emphasize how important is the multi-disciplinary approach to achieve predictable aesthetic and functionally stable results in a patient with facial asymmetry and chin protrusion.


Resumo A assimetria facial é uma condição capaz de comprometer a função oclusal e as interações sociais e, consequentemente, a qualidade de vida dos indivíduos. Nessas condições, para se obter oclusão estável e melhora significativa na estética facial, o tratamento ortodôntico-cirúrgico pode estar indicado. A simulação virtual da cirurgia permite planejar de forma adequada, e antecipada, os movimentos cirúrgicos a serem efetuados na maxila, mandíbula e mento. Esses movimentos são, então, realizados com sucesso graças ao uso de guias prototipados obtidos a partir do planejamento virtual. Assim, os objetivos do presente artigo consistem em relatar o estado da arte no planejamento virtual do tratamento de um paciente com assimetria facial e protrusão do mento, e enfatizar a importância da abordagem multidisciplinar para se atingir resultados estéticos previsíveis e funcionalmente estáveis.


Subject(s)
Humans , Male , Esthetics , Facial Asymmetry/surgery , Facial Asymmetry/therapy , Orthognathic Surgical Procedures/methods , Orthognathic Surgery/methods , Orthodontics, Corrective , Osteotomy/methods , Patient Care Planning , Cephalometry , Chin/surgery , Osteotomy, Le Fort/methods , Surgery, Computer-Assisted/methods , Dental Occlusion , Facial Asymmetry/diagnostic imaging , Dentofacial Deformities/surgery , Dentofacial Deformities/therapy , Malocclusion/surgery , Malocclusion/therapy , Malocclusion/diagnostic imaging , Mandible/surgery , Mandible/diagnostic imaging , Maxilla/surgery , Maxilla/diagnostic imaging
7.
Dental press j. orthod. (Impr.) ; 23(3): 36.e1-36.e6, May-June 2018. graf
Article in English | LILACS | ID: biblio-953028

ABSTRACT

ABSTRACT In the current era of expedited orthodontics, among many clinicians, tertiary care hospitals and patients, surgery first orthognathic approach (SFOA) has gained popularity. The advantages of SFOA (face first approach) are the reduced overall treatment duration and the early improvement in facial esthetics. In SFOA, the absence of a presurgical phase allows surgery to be performed first, followed by comprehensive orthodontic treatment to achieve the desired occlusion. The basic concepts of surgery early, surgery last, SFOA and Sendai SFOA technique along with its variations are reviewed in the present article. The recent advancement in SFOA in the context of preoperative preparation, surgical procedures and post-surgical orthodontics with pertinent literature survey are also discussed.


RESUMO Na presente era da Ortodontia de resultados acelerados, a cirurgia ortognática com benefício antecipado (COBA) ganhou popularidade entre muitos clínicos, hospitais terciários e pacientes. A vantagem da COBA é a redução da duração total do tratamento, juntamente com a melhora precoce da estética facial. Na COBA, a ausência de uma fase pré-cirúrgica permite que a cirurgia seja realizada antes e, só então, venha o tratamento ortodôntico abrangente para se alcançar a oclusão desejada. Os conceitos básicos de cirurgia primeiro, cirurgia por último, COBA e a técnica COBA de Sendai, bem como suas variações, são aqui revistos. Também são discutidos no presente artigo, junto com a revisão da literatura pertinente, os recentes avanços da COBA no contexto do preparo pré-cirúrgico, dos procedimentos cirúrgicos e da Ortodontia pós-cirúrgica.


Subject(s)
Humans , Orthodontics, Corrective/methods , Orthodontics, Corrective/trends , Orthognathic Surgical Procedures/methods , Orthognathic Surgical Procedures/trends , Malocclusion/therapy , Patient Care Planning , Time Factors , Clinical Protocols , Esthetics, Dental
8.
Dental press j. orthod. (Impr.) ; 23(3): 80-93, May-June 2018. graf
Article in English | LILACS | ID: biblio-953026

ABSTRACT

ABSTRACT Dentofacial deformities usually are surgically treated, and 3D virtual planning has been used to favor accurate outcomes. Cases reported in the present article show that orthognathic surgery carried out to correct facial asymmetries does not comprise only one treatment protocol. 3D virtual planning might be used for surgical planning, but it should also be used to diagnose the deformity, thus allowing for an analysis of the best-recommended possibilities for the orthodontic preparation that suits each individual case.


RESUMO As deformidades dentofaciais são, geralmente, tratadas de forma cirúrgica, e o planejamento virtual 3D tem sido utilizado para aumentar a precisão dos resultados. Os casos exemplificados no presente artigo mostram que a cirurgia ortognática para correção das assimetrias faciais não apresenta um único protocolo de tratamento. O planejamento virtual 3D pode ser adotado para planejar a cirurgia, mas também deve ser utilizado na fase de diagnóstico da deformidade, assim permitindo uma análise das possibilidades mais indicadas para o preparo ortodôntico mais adequado em cada caso.


Subject(s)
Humans , Female , Adult , Patient Care Planning , Imaging, Three-Dimensional , Facial Asymmetry/surgery , Facial Asymmetry/diagnostic imaging , Orthognathic Surgical Procedures/methods , Radiography, Panoramic , Tomography Scanners, X-Ray Computed , Dentofacial Deformities/surgery , Dentofacial Deformities/diagnostic imaging
9.
Int. j. morphol ; 36(1): 14-21, Mar. 2018. tab
Article in English | LILACS | ID: biblio-893179

ABSTRACT

SUMMARY: Recent technical and technological advancements in orthognathic surgery concepts, intricate in the diagnosis and treatment planning for corrections of dento-facial deformities, have achieved stable oro-dental functional occlusion and facial esthetic harmony. Undeniably, this can be attributed to the integration of modern, innovative and advanced facial analysis and computer-aided imaging exams into well-orchestrated and executed orthodontic and surgical methods. Three-Dimensional (3-D) virtual planning is a fine example. Today, the acquisition of 3-D images of a patient's craniofacial complex via cone-beam computed tomography (CBCT), supported by software tools allowing the construction of 3-D dynamic and interactive visual models, eliminates the uncertainty experienced with two-dimensional images. Thereby allowing for a more accurate or predictable treatment plan and efficient surgery, especially for patients with complex dento-facial deformities. This review article aims to describe the current benefits as well as shortcomings of 3-D virtual planning via discussing examples and illustrations from orthognathic procedures, attained from the reported English and Spanish literature during the last 10 years. It is designed to deliver updated and practical guidelines for dental practitioners and specialists (particularly, oral and maxillofacial), as well as researchers involved in 3-D virtual approaches as an alternative to conventional/traditional surgical planning; thereby validating its superiority or benefits in terms of outcome prediction for soft and hard tissues, operational timeand cost-effectiveness; for its integration in day-to-day practise.


RESUMEN: Los recientes avances técnicos y tecnológicos en los conceptos de la cirugía ortognática, involucrados en la planificación del diagnóstico y tratamiento para la corrección de deformidades dento-faciales han sido notablemente considerables en lograr una oclusión oro-dental funcional y una estética facial armónica. Innegablemente, esto se puede atribuir a la integración de análisis faciales avanzados, modernos e innovadores y exámenes de imágenes asistidos por computadora a métodos ortodonticos y quirúrgicos bien orquestados y ejecutados. La planificación virtual tri-dimensional (3-D) es un buen ejemplo. Hoy, la adquisición de imágenes 3-D del complejo cranio-facial de pacientes vía tomografía computarizada cone beam (TCCB), apoyada por herramientas computacionales, permite la construcción de modelos visuales 3-D dinámicos e interactivos, eliminando la incertidumbre experimentada con las imágenes bi-dimensionales. Permitiendo, de este modo, un plan de tratamiento más preciso o predecible y una cirugía más eficaz, especialmente para pacientes con deformaciones dento-faciales complejas. Este artículo de revisión tiene como objetivo el describir los actuales beneficios, así como las limitaciones de la planificación virtual a través de la discusión de ejemplos de procedimientos ortognáticos, obtenidos de la literatura reportada en inglés y español durante los últimos 10 años. Fue diseñado para entregar una actualización resumida y una guía práctica para los practicantes y especialistas interesados (particularmente, oro y maxilofaciales), explícitamente, así como a los investigadores involucrados en aproximaciones 3-D como una alternativa a la planificación quirúrgica convencional/tradicional; validando así su superioridad o beneficios en términos de predicción de resultados para tejidos blandos y duros, efectividad en tiempo operacional y costos; para su integración en la práctica cotidiana.


Subject(s)
Humans , Patient Care Planning , Imaging, Three-Dimensional/methods , Cone-Beam Computed Tomography/methods , Orthognathic Surgical Procedures/methods , User-Computer Interface , Cephalometry , Orthognathic Surgical Procedures/instrumentation
10.
Article in Spanish | LILACS | ID: biblio-900280

ABSTRACT

RESUMEN: En la actualidad, el trabajo interdisciplinario es fundamental para la resolución de casos complejos. En el tratamiento de las alteraciones bucales, distintas especialidades pueden aportar a la resolución de un caso. Muchas veces la ortodoncia y periodoncia actúan en combinación para devolver el estado de salud oral al paciente. El caso que se presenta a continuación corresponde al reporte clínico de una pieza dentaria que, encontrándose fuera del reborde alveolar, fue ubicada a través del tratamiento de ortodoncia en la posición adecuada, permitiendo así una recuperación ósea en la zona que mejora el pronóstico de la pieza y del implante en caso de requerirse un reemplazo.


ABSTRACT: Multidisciplinary work is currently very relevant for the resolution of complex cases. In the buccal alterations treatment, many dental specialties can contribute to resolve a case. Orthodontic and periodontic treatments work often together to recover the oral health of a patient. The following case is a report of a tooth with its apical portion outside the alveolar bone. It was repositioned by orthodontic treatment, resulting in bone recovery in that area. This improved the prognosis of the tooth and the implant in case a replacement was needed.


Subject(s)
Humans , Female , Adolescent , Tooth Movement Techniques/methods , Orthognathic Surgical Procedures/methods , Alveolar Process , Bone Regeneration
11.
Braz. dent. j ; 28(3): 385-390, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-888642

ABSTRACT

Abstract This study aimed to assess the performance of surgeons in determining the amount of graft material required for maxillary sinus floor augmentation in a preoperative analysis using cone-beam computed tomography images. A convenience sample of 10 retrospective CBCT exams (i-CAT®) was selected. Scans of the posterior maxilla area with an absence of at least one tooth and residual alveolar bone with an up to 5 mm height were used. Templates (n=20) contained images of representative cross-sections in multiplanar view. Ten expert surgeons voluntarily participated as appraisers of the templates for grafting surgical planning of a 10 mm long implant. Appraisers could choose a better amount of graft material using scores: 0) when considered grafting unnecessary, 1) for 0.25 g in graft material, 2) for 0.50 g, 3) for 1.00 g and 4) for 1.50 g or more. Reliability of the response pattern was analyzed using Cronbach's a. Wilcoxon and Mann-Whitney tests were performed to compare scores. Regression analysis was performed to evaluate whether the volume of sinuses (mm3) influenced the choose of scores. In the reliability analysis, all values were low and the score distribution was independent of the volume of the maxillary sinuses (p>0.05), which did not influence choosing the amount of graft material. Surgeons were unreliable to determine the best amount of graft material for the maxillary sinus floor augmentation using only CBCT images. Surgeons require auxiliary diagnostic tools to measure the volume associated to CBCT exams in order to perform better.


Resumo O objetivo deste estudo foi avaliar o desempenho dos cirurgiões na determinação da quantidade de material de enxerto necessária para a elevação do assoalho do seio maxilar em uma análise pré-operatória, utilizando imagens de tomografia computadorizada de feixe cônico. Foi selecionada uma amostra de conveniência de 10 exames retrospectivos CBCT (i-CAT®). Os exames foram da área da maxila posterior que possuíam ausência de pelo menos um dente e com osso alveolar residual de altura igual ou inferior a 5 mm. Os templates (n=20) continham imagens de secções transversais representativas numa vista multiplanar. Dez experientes cirurgiões voluntariamente participaram como avaliadores dos templates para o planejamento cirúrgico de enxerto para um implante de 10 mm de comprimento. Os avaliadores escolheram a melhor quantidade de material de enxerto usando os escores: 0) quando o enxerto era desnecessário, 1) para 0,25 g de enxerto, 2) para 0,50 g, 3) para 1,00 g, e 4) para 1,50 g ou mais. A confiabilidade do padrão de resposta foi analisada utilizando a a de Cronbach. Os testes de Wilcoxon e Mann-Whitney foram utilizados para comparar os escores. A análise de regressão foi realizada para avaliar se o volume dos seios (mm3) influenciou a escolha dos escores. Na análise de confiabilidade, todos os valores foram baixos e a distribuição dos escores foi independente do volume dos seios maxilares (p>0,05), o que não influenciou a escolha da quantidade de material de enxerto. Os cirurgiões apresentaram falta de confiabilidade ao determinar a melhor quantidade de material de enxerto para o aumento do assoalho do seio maxilar utilizando somente as imagens de TCFC. Assim, os cirurgiões necessitam de ferramentas de diagnóstico auxiliares para mensuração de volume associada à TCFC para um melhor desempenho.


Subject(s)
Humans , Adult , Middle Aged , Clinical Competence , Cone-Beam Computed Tomography/methods , Orthognathic Surgical Procedures/methods , Sinus Floor Augmentation/methods , Surgery, Oral , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/surgery , Reproducibility of Results , Retrospective Studies
12.
Rio de janeiro; s.n; 2017. 135 p. ilus.
Thesis in Portuguese | LILACS, BBO | ID: biblio-1008772

ABSTRACT

O sucesso da cirurgia ortognática depende da técnica cirúrgica e da acurácia do planejamento. O planejamento em cirurgia ortognática tem evoluído muito nas últimas duas décadas, especialmente em relação ao desenvolvimento do planejamento cirúrgico virtual tridimensional. O objetivo deste estudo foi avaliar, através de metodologia tridimensional, a acurácia do planejamento cirúrgico virtual realizado pelo programa Dolphin Imaging®. A amostra do trabalho foi composta por 10 indivíduos, de ambos os sexos, sem crescimento, portadores de má oclusões de Classe II ou classe III, que necessitassem de cirurgia bimaxilar mais mentoplastia, para correção da deformidade, acompanhados de forma prospectiva. Todos os pacientes foram operados pela equipe de cirurgia bucomaxilofacial do Hospital Universitário Pedro Ernesto. A documentação dos pacientes era composta por tomografia computadorizada de feixe cônico (CBCT), modelos das arcadas e fotografias pré-operatórias e CBCT pós-operatória. Os planejamentos virtuais foram realizados pelo módulo cirúrgico do programa e transferidos para o momento da cirurgia, através de uma goteira interoclusal obtido por prototipagem. A acurácia foi avaliada com o uso dos programas ITK-Snap 3.6, Geomagic Qualify® 2013 e MeshValmet® 3.0. Foram feitas avaliações para a diferença entre o planejamento virtual e o obtido na cirurgia real em relação à superfície dos segmentos, com avaliação utilizando o valor de Root Mean Square (RMS) do deslocamento de cada fragmento, e em relação aos deslocamentos translacionais das regiões anatômicas de interesse, medidos através do cálculo do deslocamento tridimensional dos centroides das estruturas avaliadas. Os dados das distâncias entre superfícies, considerando o RMS, foram realizados pelo teste de Wilcoxon para uma amostra. Os dados da diferença de posicionamento entre os centroides foram calculados pelo teste t, pareado e complementados pelo método de Altman-Bland e por gráficos de Concordância-sobrevivência. Os resultados mostraram que houve diferença estatisticamente significativa em relação à avaliação da distância entre as superfícies para o posicionamento da mandíbula (p=0,013) e do mento (p=0,013) e em relação ao posicionamento dos centroides na direção transversal do ramo direito (p=0,034), quando considerado o sentido do deslocamento, e na direção vertical dos ramos direito (p=0,005) e esquerdo (p=0,025), quando não considerado o sentido do deslocamento. Em relação à medida de relevância clínica aceitável, comumente considerada de 2mm, observou-se acurácia para os segmentos da maxila, proximais (ramos) e distais (corpo) da mandíbula, mas não observou-se para o segmento do mento. Concluiu-se que o planejamento cirúrgico virtual, realizado pelo módulo cirúrgico do Dolphin Imaging®, apresenta boa acurácia para determinar o posicionamento dos segmentos da maxila, ramos e corpo mandibular, mas não pode ser considerado como tendo adequada acurácia para o posicionamento do mento sem uso de posicionador específico.


The success of orthognathic surgery depends on the surgical technique and on the accuracy of its planning. Planning in orthognathic surgery has evolved over the last two decades especially due to the development of three-dimensional virtual surgical planning. The objective of this study was to assess the accuracy of virtual surgical planning performed by the Dolphin Imaging© software through a three-dimensional methodology. The sample consisted of 10 individuals of both genders, after the growth period, with Class II or Class III malocclusions, requiring bimaxillary surgery and genioplasty. Those patients were followed up prospectively. The maxillofacial surgery staff of Pedro Ernesto University Hospital conducted all surgeries. Patient documentation consisted of preoperative cone beam computed tomography (CBCT), plaster models of upper and lower arches, photographs, and postoperative CBCT. The virtual planning were performed with the surgical module of the software. A prototyped interocclusal splint was used to transfer the digital planning to the real surgery. The accuracy was tested using the softwares ITK-Snap 3.6, Geomagic Qualify 2013© and MeshValmet 3.0. The difference between the virtual planning and actual surgery was calculated for the segments, using the root mean square (RMS) value of displacement of each individual fragment, and the translational displacements of the anatomical regions of interest (ROI) were measured through the three-dimensional displacement of the 3D centroid of each model. The data of the distances between surfaces considering RMS was analyzed by the Wilcoxon rank test. The data of differences between the centroids positions was calculated by the paired t-test and complemented by the Altman-Bland method and the Survival Agreement. The results showed that the distance between the surfaces were significantly different when considering the mandible position (p = 0.013) and the chin (p = 0.013). According to the position of the centroids it was found significant difference in the transverse direction of the right ramus (p = 0.034) when the direction of the displacement was taken into account and in the vertical direction of the right ramus (p = 0.005) and left ramus (p = 0.025) when the direction of the displacement was not considered. Considering a clinical relevance threshold of 2mm, it can be assumed that the segments of the maxilla, proximal (ramus) and distal (body) of the mandible were accurate, but the chin segment was not. It was concluded that the virtual surgical planning performed by the Dolphin Imaging© surgical module is accurate to determine the positioning of the maxilla, ramus and mandibular body segments, but can not be considered as having adequate accuracy for the positioning of the chin without the use of a specific positioner


Subject(s)
Humans , Male , Female , Adult , Young Adult , Software Validation , Computer-Aided Design , Imaging, Three-Dimensional , Surgery, Computer-Assisted , Orthognathic Surgical Procedures/methods , Malocclusion/surgery , Data Accuracy
13.
Int. j. med. surg. sci. (Print) ; 3(3): 943-950, sept. 2016. ilus
Article in Spanish | LILACS | ID: biblio-1087621

ABSTRACT

Las fracturas y secuelas mandibulares son de difícil resolución en el ámbito de la cirugía maxilofacial, sus componentes hacen que su reducción no solo sea anatómica, sino también funcional. El objetivo de este artículo es realizar una revisión de los conocimientos más actuales en el tratamiento de fracturas y secuelas mandibulares y la presentación de un caso de secuela de trauma mandibular. El trata-miento de estas fracturas ha ido cambiando durante los últimos años, sirviéndose de nuevas tecnologías para lograr una mejor reducción a través de elementos de osteosíntesis, que propician abordajes más pequeños y con menor comorbilidad. Así el los nuevos sistemas de placas de titanio como miniplacas, placas de reconstrucción o autobloqueantes brindan excelentes resultados en traumas de alta energía con reducciones anatómicas más estables. La tecnología a través de sistemas de reconstrucción 3D y TAC intraoperatorios han logrado mejores resultados en la resolución de estos traumas.


Treatment of mandibular fractures and their sequelae are difficult to resolve in the maxillofacial surgery field, their components cause that reduction must not only be anatomic, but functional as well. The aim of this article is to present a review about actual knowledge in mandibular fracture treatmentand report a case of mandibular trauma. The treatment of these fractures has been changing through theyears; the new technologies achieve better reduction with the osteosynthesis systems, which results inreduced approaches and lesser morbidity. Presently, titanium plates systems like mini-plates, reconstruction plates or blocking plates offer excellent results in high energy traumas through anatomic and stable reductions. The technology of 3D reconstruction systems and intra-operatory CT accomplishes better results in trauma treatment.


Subject(s)
Humans , Male , Child , Orthognathic Surgical Procedures/methods , Fracture Fixation, Internal/methods , Mandibular Fractures/surgery , Wounds and Injuries/complications , Tomography, X-Ray Computed , Mandibular Prosthesis Implantation/methods , Imaging, Three-Dimensional , Jaw Fractures/surgery , Mandibular Fractures/etiology
14.
Dental press j. orthod. (Impr.) ; 20(5): 28-34, tab, graf
Article in English | LILACS | ID: lil-764541

ABSTRACT

Introduction:Cone-Beam Computed Tomography (CBCT) is essential for tridimensional planning of orthognathic surgery, as it allows visualization and evaluation of bone structures and mineralized tissues. Tomographic slices allow evaluation of tooth inclination and individualization of movement performed during preoperative decompensation. The aim of this paper was to assess maxillary and mandibular incisors inclination pre and post orthodontic decompensation in skeletal Class III malocclusion.Methods:The study was conducted on six individuals with skeletal Class III malocclusion, surgically treated, who had Cone-Beam Computed Tomographic scans obtained before and after orthodontic decompensation. On multiplanar reconstruction view, tomographic slices (axial, coronal and sagittal) were obtained on the long axis of each incisor. The sagittal slice was used for measurement taking, whereas the references used to assess tooth inclination were the long axis of maxillary teeth in relation to the palatal plane and the long axis of mandibular teeth in relation to the mandibular plane.Results:There was significant variation in the inclination of incisors before and after orthodontic decompensation. This change was of greater magnitude in the mandibular arch, evidencing that natural compensation is more effective in this arch, thereby requiring more intensive decompensation.Conclusion:When routinely performed, the protocols of decompensation treatment in surgical individuals often result in intensive movements, which should be reevaluated, since the extent of movement predisposes to reduction in bone attachment levels and root length.


Introdução: a tomografia computadorizada de feixe cônico (TCFC) é essencial para o planejamento tridimensional de cirurgias ortognáticas, pois permite a visualização e avaliação de estruturas ósseas e tecidos mineralizados. Os cortes tomográficos permitem avaliar a inclinação dos dentes e individualizar o movimento realizado durante a descompensação dentária.Objetivo: o objetivo do presente estudo foi avaliar a inclinação dos incisivos superiores e inferiores antes e depois da descompensação ortodôntica da má oclusão de Classe III esquelética.Métodos:o estudo foi realizado em seis indivíduos com má oclusão de Classe III esquelética que passaram por tratamento cirúrgico e apresentaram exames de TCFC feitos antes e depois da descompensação ortodôntica. A reconstrução multiplanar foi feita a partir dos cortes tomográficos (axial, coronal e sagital) adquiridos no eixo longitudinal de cada incisivo. O corte sagital foi usado para a realização de medições, e as referências usadas para avaliar a inclinação dentária foram o eixo longitudinal dos dentes superiores em relação ao plano palatino e o eixo longitudinal dos dentes inferiores em relação ao plano mandibular.Resultados:houve uma variação significativa entre a inclinação dos incisivos antes e depois da descompensação ortodôntica. A alteração foi maior na arcada inferior, evidenciando que a compensação natural é mais efetiva nessa arcada, o que exige uma descompensação mais extensa.Conclusão:quando realizados rotineiramente, os protocolos de tratamento para descompensação em pacientes cirúrgicos geralmente resultam em movimentação extensa, que deve ser reavaliada, já que a extensão do movimento predispõe à perda de inserção e à redução do comprimento da raiz.


Subject(s)
Humans , Male , Female , Adult , Cone-Beam Computed Tomography/methods , Orthognathic Surgical Procedures/methods , Malocclusion, Angle Class III/therapy , Malocclusion, Angle Class III/diagnostic imaging , Orthodontics, Corrective , Tooth Extraction , Tooth Migration/etiology , Tooth Movement Techniques , Treatment Outcome , Precision Medicine , Incisor/abnormalities , Incisor/diagnostic imaging , Malocclusion, Angle Class III/prevention & control
15.
Dental press j. orthod. (Impr.) ; 19(4): 71-79, Jul-Aug/2014. tab, graf
Article in English | LILACS | ID: lil-725427

ABSTRACT

INTRODUCTION: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. METHODS: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. RESULTS: During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between centroid and gingival changes suggested that upper and lower arch premolars buccaly proclined during the pre-surgical period. CONCLUSIONS: Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods. .


INTRODUÇÃO: esse estudo avaliou as alterações tridimensionais ocorridas na morfologia das arcadas dentárias de pacientes submetidos ao tratamento ortodôntico-cirúrgico para a correção da má oclusão de Classe II, em três períodos distintos: (T1) modelos iniciais, (T2) modelos pré-cirúrgicos imediatos (de 1 a 15 dias antes da cirurgia) e (T3) modelos pós-cirúrgicos (mínimo de 6 meses após a remoção do aparelho ortodôntico). MÉTODOS: pontos previamente demarcados em cada modelo foram digitalizados por meio do digitalizador tridimensional MicroScribe-3DX, cujas coordenadas, armazenadas em planilhas do programa Excel, deram origem a valores que possibilitaram a avaliação da largura, comprimento e profundidade das arcadas dentárias. RESULTADOS: durante o preparo ortodôntico, houve aumentos nas distâncias transversais superiores e inferiores medidas na região de pré-molares que se mantiveram no período total de acompanhamento. Apenas a distância intercaninos superior apresentou alterações de aumento durante o preparo ortodôntico, assim como a largura da arcada superior, que diminuiu durante a fase de finalização. A profundidade de ambas as arcadas manteve-se estável nas fases avaliadas. Diferenças entre as mudanças dos pontos centroide e gengival sugerem que os pré-molares superiores e inferiores inclinaram para vestibular durante o preparo ortodôntico pré-cirúrgico. CONCLUSÇÕES: conclui-se que as arcadas dentárias superiores e inferiores sofreram expansão transversal na região de pré-molares durante o preparo ortodôntico pré-cirúrgico, com tendência à inclinação vestibular de todos os dentes posteriores. Após a cirurgia, as dimensões transversais ...


Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Dental Arch/pathology , Imaging, Three-Dimensional/methods , Malocclusion, Angle Class II/therapy , Orthodontics, Corrective/methods , Orthognathic Surgical Procedures/methods , Anatomic Landmarks/pathology , Bicuspid/pathology , Cephalometry/methods , Cuspid/pathology , Models, Dental , Dental Arch/surgery , Follow-Up Studies , Image Processing, Computer-Assisted/methods , Malocclusion, Angle Class II/surgery , Mandible/pathology , Mandible/surgery , Maxilla/pathology , Maxilla/surgery , Molar/pathology , Osteotomy, Le Fort/methods , Osteotomy, Sagittal Split Ramus/methods , Retrospective Studies
17.
Dental press j. orthod. (Impr.) ; 18(4): 134-143, July-Aug. 2013. ilus
Article in English | LILACS | ID: lil-695116

ABSTRACT

INTRODUCTION: Distraction Osteogenesis (DO) became an alternative for the treatment of severe craniofacial skeletal dysplasias. The rigid external distraction device (RED) is successfully used to advance the maxilla and all the maxillary-orbital-frontal complex (monobloc) in children, adolescents and adults. This approach provides predictable and stable results, and it can be applied alone or with craniofacial orthognathic surgical procedures. OBJECTIVE: In the present article, the technical aspects relevant to an adequate application of the RED will be described, including the planning, surgical and orthodontic procedures.


INTRODUÇÃO: a Distração Osteogênica (DO) tornou-se uma alternativa para o tratamento das displasias craniofaciais esqueléticas severas. O aparelho distrator externo rígido (RED) é utilizado com êxito para avançar a maxila e todo o complexo maxilar-orbital-frontal (monobloco) em crianças, adolescentes e adultos. Essa abordagem proporciona resultados previsíveis e estáveis, podendo ser aplicada isoladamente ou junto a procedimentos cirúrgicos ortognáticos craniofaciais. OBJETIVO: no presente artigo, serão descritos os aspectos técnicos pertinentes a uma adequada aplicação do RED, incluindo o planejamento, procedimentos cirúrgicos e ortodônticos.


Subject(s)
Adolescent , Adult , Child , Humans , Cleft Lip/complications , Cleft Palate/complications , External Fixators , Maxilla/abnormalities , Orthodontic Appliance Design/methods , Orthognathic Surgical Procedures/methods , Osteogenesis, Distraction/instrumentation , Maxilla/surgery , Osteogenesis, Distraction/methods , Syndrome
18.
Indian J Cancer ; 2012 Apr-June; 49(2): 209-214
Article in English | IMSEAR | ID: sea-144574

ABSTRACT

Background: Oronasal communication occurs after total maxillectomy for advanced sinonasal cancers. This results in feeding, breathing and cosmetic impairment. Various methods have been described to close off the palatal defect from the oral cavity to improve the function of speech and deglutition. Aims: The object of this article is to describe our experience of preservation of palatal mucoperiosteum for oronasal separation. Materials and Methods: Retrospective review of clinical and operative records of 31 total maxillectomy patients where oronasal separation was achieved by the conventional technique of applying a maxillary obturator. The postoperative complications arising from the use of maxillary obturator for oronasal communication after total maxillectomy in these 31 patients were analysed. To avoid the complications encountered in these 31 patients we preserved and used the ipsilateral palatal mucoperiosteum for oronasal separation. This new technique was applied in 12 patients. The results are presented and compared. Results : A total of 43 patients underwent total maxillectomy for advanced sinonasal tumors. In 31 patients the conventional maxillary obturator was used for oronasal separation. Among these patients, 30 had crustation of the maxillary cavity, nasal regurgitation and cheek skin retraction in 15 each, trismus in eight, infection of skin graft donor site in seven, cheek movement during respiration in five and ill-fitting prosthesis in three. In 12 patients palatal mucoperiosteum was preserved and used for oronasal separation. The complications encountered in oronasal separation by palatal prosthesis were avoided in the modified procedure. Conclusions: We found that oronasal separation by preservation of palatal mucoperiosteum following total maxillectomy allowed excellent palatal function, prompt rehabilitation and minimal complications without compromising the prognosis.


Subject(s)
Humans , Maxilla/surgery , Maxillary Sinus Neoplasms/surgery , Maxillofacial Prosthesis , Nasal Surgical Procedures/methods , Orthognathic Surgical Procedures/methods , Palate/surgery , Surgical Flaps , Temporal Muscle/surgery
19.
Article in English | IMSEAR | ID: sea-139970

ABSTRACT

The odontogenic keratocyst (OKC), first described by Phillipsen in 1956, has metamorphosized as a keratocystic odontogenic tumor (KCOT) as reported in WHO classification of head and neck tumors in 2005. KCOT is a benign intraosseous neoplasm of the jaw and its occurrence in maxilla is unusual and its appearance in maxillary antrum along with maxillary impacted third molar is very uncommon. This article reports a case of KCOT associated with impacted maxillary third molar in right maxillary antrum and describes its rare site of occurrence.


Subject(s)
Female , Humans , Maxillary Diseases/complications , Maxillary Diseases/pathology , Maxillary Diseases/surgery , Middle Aged , Molar, Third/pathology , Odontogenic Cysts/complications , Odontogenic Cysts/pathology , Odontogenic Cysts/surgery , Odontogenic Tumors/complications , Odontogenic Tumors/pathology , Odontogenic Tumors/surgery , Orthognathic Surgical Procedures/methods , Tooth, Impacted/complications , Tooth, Impacted/surgery , Treatment Outcome
20.
Article in Portuguese | LILACS, BBO | ID: lil-568506

ABSTRACT

Objetivo: Avaliar comparativamente o prognostico do planejamento cirurgico por software com o metodo manual. Metodo: Radiografias laterais cefalometricas e modelos de estudo pre e pos-cirurgia de vinte pacientes Classe III (12 mulheres e 8 homens, media de idade: 22,5 ñ 2,3) que tinham se submetidos a cirurgia no Departamento de Ortodontia. Para o planejamento manual, com combinacao de oclusogramas pre e pos-cirurgia com radiografias cefalometricas laterais de cada paciente, foram feitas analises tridimensionais. Prognosticos da movimentacao esqueletica foram elaborados. Em seguida, mensurou-se tridimensionalmente a movimentacao esqueletica. Quinze variaveis angulares e lineares foram avaliadas e os resultados analisados estatisticamente. Para cada paciente, o prognostico manual e por software antes e apos a cirurgia foram comparados entre si. O teste t pareado foi usado para verificar possiveis diferencas (p<0,05). Resultados: Nao foram observadas diferencas entre os metodos. Conclusao: O Software Dolphin Imaging (versao 10) tem boa acuracia para a predicao do resultado pre e pos-cirurgico de cirurgias ortognaticas.


Objective: To evaluate the proximity of computer imaging soft ware surgical planning prediction methods, with standard manual methods. Method: Lateral cephalometry radiographs and study cast records of pre and post surgery of twenty longface Cl III patients (12 Females and 8 Males, mean age: 22.5 ñ 2.3), that had been undergone surgery in Department of Orthodontics. For manual prediction, with combination of pre and post surgical occlusograms with lateral cephalometric radiograph tracings of each samples, three dimensional analysis was done. Predictions of skeletal movement with tacing overlay method, has prepared. Finally, measured the rate of skeletal movements at in three dimensional of spaces. Fifteen angular and linear variables were measured, and the results, analyzed using the statistical soft ware statistics. For each patient, the manual and computer soft ware prediction before and after surgery were compared with each other. The paired t-test was used to evaluate possible differences between manual and computer soft ware prediction (p<0.05). Results: The difference of the variables of the soft ware prediction in the pre and postsurgical stages in comparison with standard manual prediction method was insignificant. Conclusion: Dolphin Imaging software (version 10.0) has a good accuracy for prediction of pre and postsurgical outcome of orthognathic samples.


Subject(s)
Humans , Male , Female , Adult , Malocclusion, Angle Class III/diagnosis , Orthognathic Surgical Procedures/methods , Software Validation , Statistics, Nonparametric
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