The new bone formation in human maxillary sinuses using two bone substitutes with different resorption types associated or not with autogenous bone graft: a comparative histomorphometric, immunohistochemical and randomized clinical study

Abstract Objective The aim of this study is to evaluate the new bone and connective tissue formation and the biomaterial remaining after maxillary sinus bone augmentation using 5 different bone substitutes. The osteocalcin immunolabeling was performed to demonstrate their calcification and the possibility of receiving dental implants. Methodology 40 patients underwent maxillary sinus bone augmentation and were divided in 5 groups: Group 1 with 8 maxillary sinuses were grafted with autogenous bone graft (AB); Group 2 with 8 maxillary sinuses grafted with bioactive glass (BG); Group 3 with 8 maxillary sinuses grafted with bioactive glass added to autogenous bone graft (BG + AB) 1:1; Group 4 with 8 maxillary sinuses grafted with Bio-Oss (BO) and Group 5 with 8 maxillary sinuses grafted with Bio-Oss added to autogenous bone graft (BO + AB) 1:1. Results In group AB, 37.8% of bone was formed in the pristine bone region, 38.1% in the intermediate and 44.5% in the apical region. In group BG, 43.6% was formed in the pristine bone, 37% in the intermediate and 49.3% in the apical region. In group BG + AB 1:1, 39.0% was formed in the pristine bone region, 34.8% in the intermediate and 36.8% in apical region. In group BO, 33.4% was formed in the pristine bone, 32.5% in the intermediate and 34.3% in the apical region. In group BO + AB 1:1, 32.8% was formed in the pristine bone, 36.1% in intermediate and 27.8% in the apical regions. The immunolabeling for osteocalcin showed an intensive staining for all groups, which could demonstrate the calcification of the bone formed. Conclusion This study showed that the groups evaluated formed a suitable lamellar bone in the maxillary sinus reconstruction after six months of bone healing, thus being indicated to receive dental implants.

Bioactive glass added to autogenous bone graft in maxillary sinus augmentation: a prospective histomorphometric, immunohistochemical, and bone graft resorption assessment

Abstract Objective The aim of this study was to compare the bone resorption rate, histomorphometry and immunohistochemical findings of bioactive glass (Biogran; Biomet, Warsaw, IN, USA) mixed with autogenous bone grafts (1:1) and autogenous bone graft isolate in maxillary sinus elevation surgery. Material and Methods A total of 9 maxillary sinuses were grafted with Biogran with autogenous bone graft (group 1) and 12 were mixed with autogenous bone graft (group 2). Postoperative cone beam computed tomography (CBCT) was used to measure the initial graft volume after 15 days (T1), and 6 months later, another CBCT scan was performed to evaluate the final graft volume (T2) and determine the graft resorption rate. The resorption outcomes were 37.9%±18.9% in group 1 and 45.7%±18.5% in group 2 (P=0.82). After 6 months, biopsies were obtained concurrent with the placement of dental implants; these implants were subjected to histomorphometric analysis and immunohistochemical analysis for tartrate-resistant acid phosphatase (TRAP). Results The average bone formation in group 1 was 36.6%±12.9 in the pristine bone region, 33.2%±13.3 in the intermediate region, and 45.8%±13.8 in the apical region; in group 2, the values were 34.4%±14.4, 35.0%±13.9, and 42.0%±16.6 of new bone formation in the pristine bone, intermediate, and apical regions, respectively. Immunostaining for TRAP showed poor clastic activity in both groups, which can indicate that those were in the remodeling phase. Conclusions The similarity between the groups in the formation and maintenance of the graft volume after 6 months suggests that the bioactive glass mixed with autogenous bone (1:1) can be used safely as a bone substitute for the maxillary sinus lift.

Symptomatic mucous retention cysts of the maxillary sinus: case report

The retention mucous cyst of the maxillary sinus is a benign lesion that occurs in the interior of the maxillary sinus due ductal obstruction. In the majority of the cases it is asymptomatic, and discovered on routine radiographic examinations. However, in some cases, this cyst can become large and cause symptoms as paresthesia, sensitivity to palpation, chronic headache, nasal blockage, and dizziness. Conservative treatment is conduct in most cases. Symptomatic retention cysts are treated by enucleation or curettage. Objective and case report: This study aimed to report a clinical case of symptomatic mucous retention cyst accidentally discovered in a patient treated by surgically-assisted rapid maxillary expansion. Conclusion: The curettage of the cyst allowed for the regression of symptoms and at 12 months postoperatively the patient is free of symptoms and no signs of recurrence of lesion were noted.

Cierre de fístula buco-sinusal con injerto pediculado de la bola adiposa de Bichat: Protocol propuesto / Closure of oroantral fistula with Bichat´s buccal fat pad: Proposed protocol

A fístula buco-sinusal (FBS) consiste na comunicação persistente entre o seio maxilar e a cavidade oral, ocorrendo mais frequentemente após a exodontia dos molares superiores. Os sinais e sintomas mais frequentes são: cefaleia, sinusite maxilar, dor, transtornos na deglutição e tosse noturna. FBS menores que 2mm de diâmetro tendem a fechar espontaneamente, na grande maioria dos casos, sem a necessidade de abordagem cirúrgica. Casos de FBS, maiores que 3 mm necessitam de intervenção cirúrgica. Técnicas cirúrgicas que utilizam retalhos locais (palatino, vestibular ou combinado), enxerto ósseo e o enxerto pediculado do corpo adiposo da bochecha têm sido empregadas para esse propósito. Este trabalho tem por objetivo descrever um caso clínico de FBS utilizando-se a técnica do enxerto pediculado do corpo adiposo da bochecha, enfocando sua anatomia e discutindo as vantagens e limitações com relação às técnicas mais utilizadas... (AU)

The oroantral fistula (OAF) is the persistent communication between maxillary sinus and the oral cavity, occurring most often after extraction molar teeth due to its proximity to the maxillary sinus. Headache, sinusitis, pain, swallowing disorders and nocturnal cough are some of the reported symptoms. Less than 2mm diameter OAF tend to close spontaneously in most cases without the need for surgical approach. 3mm OAF or greater cases require surgical intervention. Surgical techniques using flaps (palatal, buccal or combined), bone graft and pedicle graft of buccal fat pad have been employed for this purpose. This paper aims to describe a clinical case of OAF treated with the technique of pedicle graft of buccal fat pad, focusing on their anatomy and discussing the advantages and limitations regarding the most used techniques... (AU)

La fistula buco-sinusal (FBS) consiste en una comunicación persis tente entre el seno maxilar y la cavidad bucal y se presenta con mayor frecuencia después de exodoncias de molares superiores. Los signos y síntomas que la caracterizan son: cefalea, sinusitis maxilar, dolor, trastornos en la deglución e tos nocturna. FBS menores de 2mm de diámetro, tienden a cerrar espontáneamente en la gran mayoría de los casos, sin necesidad de abordaje quirúrgica. Las fistulas mayores de 3mm necesitan intervención quirúrgica. Diferentes técnicas que utilizan colgajos locales (palatinos, vestibulares o combinados), in jertos ósseos y injertos pediculados de la bola adiposa de la mejilla se han empleado para este propósito. El objetivo de este trabajo fue describir un caso clínico de FBS que fue tratado quirúrgicamente con injerto pediculado de bola adiposa de la mejilla, haciendo énfasis en la anatomía relacionada así como discutir las ventajas y limitaciones con relación a las técnicas quirúrgicas utilizadas... (AU)

Aspectos técnicos do tratamento do cisto ósseo traumático: relato de caso / Technical aspects of treatment of the traumatic bone cyst: case report

Objetivo: Este trabalho objetiva relatar um caso clínico de um cisto ósseo traumático, enfatizando a técnica cirúrgica. Relato do caso: Paciente gênero feminino, 15 anos de idade, foi encaminhada ao departamento de cirurgia oral e maxilofacial, Universidade Federal de Campina Grande, para avaliação de lesão intra-óssea em região anterior da mandíbula. O exame radiográfico evidenciou área radiolúcida unilocular e assintomática associada ao ápice dos incisivos inferiores esquerdo, que apresentavam vitalidade pulpar. A paciente não referia trauma na infância, apesar de apresentar cicatriz na região submentual. Foi feito o diagnóstico clínico de cisto ósseo traumático, sendo a exploração cirúrgica e curetagem do defeito ósseo o tratamento de escolha. No pós-operatório de um ano, a paciente evolui satisfatoriamente, sem queixas clínicas. Conclusão: Por apresentar comportamento não-agressivo, o cisto ósseo traumático responde adequadamente ao tratamento conservador através da curetagem cirúrgica.

Objective: This study aim report a clinical case of a traumatic bone cyst, emphasizing the surgical technique. Case report: Patient female, 15 years-old, was referred to the oral and maxillofacial surgery department, Federal University of Campina Grande, for evaluation intra-osseous lesion in the anterior mandible. Radiographic examination evidenced a unilocular area asymptomatic and associated to the apex of the under left incisive, who presented pulp vitality. The patient reported no trauma in childhood, although presenting a scar on the submental region. The clinical diagnosis of traumatic bone cyst was performed, surgical exploration and curettage of the bone defect was the treatment of choice. Postoperative period of one year, the patient progressed satisfactorily without clinical complaints. Conclusion: Presentation non-aggressive behavior, the traumatic bone cyst responds adequately to conservative treatment by surgical curettage.

Cisto ósseo simples: relatos de casos / Simple bone cyst: case reports

Geralmente diagnosticado em radiografias de rotina, o cisto ósseo simples ocorre com pouca freqüência. A etiologia é desconhecida e o diagnóstico diferencial pode estar associado com cisto dentígero, tumor odontogênico ceratocístico, tumor odontogênico adenomatóide, ameloblastoma e granuloma central de células gigantes. O tratamento é cirúrgico, através de perfuração do osso cortical. Na maioria dos casos, de uma cavidade vazia, sem qualquer cápsula ou revestimento epitelial, são encontrados, mas pode ter conteúdo líquido. A perfuração do osso cortical mandibular provoca uma resposta que resulta com a reparação óssea da cavidade vazia. Este artigo analisa o assunto e apresenta dois casos desta entidade e discute os possíveis fatores interferentes no processo de cura da lesão... (AU)

Usually diagnosed in routine radiographs, the simple bone cyst occurs infrequently. Etiology is unknown and differential diagnosis has to be made with dentigerous cyst, keratocystic odontogenic tumor, adenomatoid odontogenic tumor, ameloblastoma and central giant cell granuloma. Treatment is surgical, by perforating the cortical bone. In most cases an empty cavity, without any capsule or epithelial covering, is encountered, but it may have a liquid content. Perforation of the mandibular cortical bone elicits a response that results in bone repair of the empty cavity. This article reviews the subject and presents two cases of this entity and discusses the possible factors that could interfere in healing course... (AU)

Cisto dentígero: modalidades de tratamento / Dentigerous cyst: modalities of treatment

Introdução: O cisto dentígero é o segundo cisto odontogênico mais frequente nos maxilares. É uma lesão benigna, derivada do epitélio odontogênico da coroa de um dente não erupcionado, porém de etiopatogenia incerta. São geralmente radiotransparentes e, mais comumente, uniloculares. Estas lesões são observadas em exames de rotina ou quando não ocorre o irrompimento de um dente permanente. Os terceiros molares inferiores e os caninos superiores são os dentes mais acometidos, sendo também alta a ocorrência desta lesão em dentes supranumerários e associados a odontomas. O cisto dentígero ocorre principalmente nas três primeiras décadas de vida, tendo um crescimento lento e assintomático; pode atingir dimensões consideráveis, causando deformidade facial, impactação e deslocamento de dentes e/ou estruturas adjacentes. Objetivo: Definição das técnicas de marsupialização e enucleação, bem como consideração de critérios objetivos importantes para o plano de tratamento, como tamanho do cisto, idade, proximidade com estruturas anatômicas e importância clínica do dente envolvido. Apesar das peculiaridades clínicas de cada caso e do método de tratamento escolhido, o prognóstico destas lesões é favorável, quando se emprega apropriada terapêutica. Material e Método: O presente estudo apresentará um relato de caso tratado através da manobra de descompressão seguida de enucleação, bem como uma discussão acerca das modalidades de tratamento. Resultado: O paciente encontra-se em pós-operatório de dois anos sem sinais de recidiva da lesão e ausência de parestesias em face. Conclusão: A técnica empregada preservou a função neurossensorial e mostrou-se eficiente para a cura da lesão.

Introduction: The dentigerous cyst is the second most common odontogenic cyst in the jaws. It is a benign lesion of odontogenic epithelium derived from the crown of a tooth that has not erupted, but of uncertain etiology. They are generally radiolucent and usually unilocular. These lesions are observed in routine examinations or when the eruption of a permanent tooth is delayed. The third molars and maxillary canines are the most affected teeth, and also the high occurrence of this lesion is associated with supernumerary teeth and odontomas. The dentigerous cyst occurs mainly in the first three decades of life, It's growth is slow, asymptomatic and can reach considerable size causing facial deformity, displacement and impaction of teeth and/or surrounding structures. Objective: Definition of marsupialization and enucleation techniques as well as consideration of important objective criteria for the treatment plan like cyst size, age, proximity to anatomical structures and clinical importance of the involved tooth. Despite the clinical peculiarities of each case and the chosen treatment method, the prognosis of these lesions are favorable when appropriate therapy is used. Material and Method: This study will present a case report treated by maneuver of decompression followed by enucleation and discussion of treatment modalities. Result: The patient is on two years of postoperative without signs of relapse and absence of paresthesias in the face. Conclusion: The technique preserved the neurosensory function and was effective for the extinction of the lesion.

A six-year retrospective study of maxillofacial fractures from radiographic findings in Brazil / Estudo retrospectivo de seis anos de fraturas maxilofaciais provenientes de achados radiográficos realizado no Brasil

Objective: this study aimed to present the causes and prevalence of maxillofacial fractures that occurred in the region of Araraquara-SP ? Brazil, during a 6-year period. Methods: information regarding age, gender, etiology, and maxillofacial fracture site, as well as type of radiographic examination were evaluated. Data were gathered from the radiographic examination and radiographic report of the Division of Dentomaxillofacial Radiology, and from charts of the Division of Oral and Maxillofacial Surgery of patients attending for maxillofacial fractures from 2004 to 2009. A descriptive statistical analysis was developed using Epi-Info 3.5.1. Results: from a total of 11,728 patients assisted, 407 patients presented maxillofacial fractures. The prevalent age ranged from 21 to 30 years old. From the total patients, 322 were men and 85 were women (ratio of men to women was 3.8:1). Panoramic radiography (n = 306) was most frequently used to observe maxillofacial fractures. Mandibular fractures were frequent in the body of the mandible (n = 127), followed by symphysis (n = 102), and the prevalent cause was traffic accidents (n = 161). Conclusion: more than half of affected individuals were younger than 40 years of age. The body of the mandible was the most common fracture location vi sualized by panoramic radiography for traffic accidentsand fights.

Estudo comparativo sobre a eficácia de duas drogas de ação anti-inflamatória (Etoricoxib e Diclofenaco) após exodontia de terceiros molares inferiores inclusos. / Comparative study of the efficacy of two different anti-inflammatory drugs (Etoricoxib and Diclofenac) following removal of impacted lower third molars.

Neste trabalho, os autores compararam clinicamente a eficácia de duas drogas de ação anti-inflamatória: o Etoricoxib (Arcoxia®) e Diclofenaco (Olfen®) no controle da dor pós-operatória, na exodontia de terceiros molares inclusos. Foram selecionados 15 pacientes adultos da Disciplina de Cirurgia e Traumatologia Buco-Maxilo-Facial da Faculdade de Odontologia de Araraquara - Unesp que necessitavam de extrações de terceiros molares inferiores bilateralmente. As drogas foram administradas na primeira e na segunda cirurgia aleatoriamente. A dor foi avaliada por meio de escala analógica visual, por 72 horas pós-operatórias. Concluiu-se, após a análise dos resultados, que não houve diferenças estatísticas significantes entre as duas drogas no controle da dor pós-operatória.

In this article the authors clinically compare the efficacy of two different anti-inflammatory drugs - Etoricoxib (Arcoxia®) and Diclofenac (Olfen®) - in the control of postoperative pain resulting from the surgical removal of impacted lower third molars. Fifteen patients requiring the extraction of bilaterally impacted lower third molars were selected at the Department of Oral and Maxillofacial Surgery at the Araraquara School of Dentistry - UNESP. The drugs were randomly administered during the first and second surgical procedures. Pain was evaluated by means of a visual analogic scale for 72 hours following the surgical procedure. After statistical analysis of the results, the authors concluded that there were no significant differences in terms of postopoerative pain control between the two drugs studied.

Deep venous thrombosis prophylaxis in oral and maxillofacial surgery: A Brazilian survey.

Background : Deep venous thrombosis (DVP) is a frequent disease. Prophylaxis is the best means to reduce its incidence, for lowering morbidity and mortality rates and treatment costs caused by its complications. Objective : To evaluate the knowledge and use of any kind of DVT prophylaxis by Brazilian Oral and Maxillofacial surgeons. Materials and Methods : A questionnaire was sent to all Oral and Maxillofacial surgeons associated to the Brazilian College of Oral and Maxillofacial Surgeons that have a valid e-mail address. The data retrieved was evaluated and tabulated. Results : Of the 1100 questionnaires sent, only 4% were retrieved. The 42 retrieved were included in the study. Twenty six of the surgeons do not use any kind of deep venous thrombosis (DVT) prophylaxis, 11 use mechanical means as elastic compressive stockings or pneumatic compressive devices for prophylaxis, and 5 uses low-molecular weight heparins (LMWH) as the choice for prophylaxis. Conclusion : The data collected, despite the low rate of participation (4%) by the surgeons, shows that this subject still does not receive proper attention. Whereas other medical specialties make routine use of prophylactic means maybe the maxillofacial surgeons lack concern on that matter.

Estudo comparativo da inclinação do plano oclusal de modelos para cirurgia ortognática montados em dois tipos de articuladores semiajustáveis / Comparative study of occlusal plane angulation of dental casts for orthognathic surgery mounted in two types of semi-adjustable articulators

Objetivo: este estudo busca comparar a inclinação do plano oclusal obtida em dois tipos diferentes de articuladores semiajustáveis com aquela obtida na telerradiografia em norma lateral. Metodologia: 20 pacientes a serem submetidos à cirurgia ortognática tiveram seus modelos de gesso montados em 2 diferentes articuladores semiajustáveis por meio da transferência com arcos faciais da posição da maxila e registro oclusal para a mandíbula. Após montagem, à inclinação do plano oclusal nos articuladores foi mensurada e comparada com a inclinação mensurada nas telerradiografias cefalométricas laterais e entre os articuladores entre si. Os resultados obtidos foram submetidos a análise estatística pertinente. Resultados: os valores médios dos ângulos obtidos nos articuladores Bio Art (7,55º) e Kavo (-5,70º) diferem entre si em 13,25º, sendo essa diferença estatisticamente significante (p=0,00). Quando comparados individualmente à telerradiografia (5,075º), o articulador Bio Art apresentou valor mais próximo, com uma diferença de 2,475º, enquanto que o articulador Kavo apresentou uma diferença de 10,775º. Conclusão: os dois modelos de articuladores semiajustáveis testados não reproduzem, com fidelidade, a inclinação do plano oclusal maxilar de pacientes portadores de deformidades dentofaciais; a diferença encontrada entre o articulador Bio Art e a telerradiografia foi menor do que aquela encontrada entre o articulador Kavo e a telerradiografia.

Purpose: The aim of this study was to compare occlusal plane angulation measured in two different types of semi-adjustable articulators with that obtained on the lateral cephalometric radiograph. Materials and Methods: 20 patients due to undergo orthognathic surgery had dental casts mounted in two different types of semi-adjustable articulators through face bow transfer from the position of the maxilla and occlusal recording to the mandible. After mounting, the inclination of the occlusal plane in the articulators was measured and compared with the inclination measured at on both articulators and compared with the inclination measured on the lateral cephalometric radiographs and between the articulators themselves. The results obtained werestatistically analyzed. Results: Mean angulation values for the Bio Art (7.55º) and Kavo (-5.70º) articulators differ by 13.25º, which is statistically significant (p=0.00). When individually compared to the lateral cephalometric radiograph (5.075º), the Bio Art articulator showed more similar angulation values, with a difference of 2.475º, while the Kavo articulator presented a difference of 10.775º. Conclusion: Neither of the models of semi-adjustable articulators accurately reproduced the inclination of the maxillary occlusal plane of patients with dentofacial deformities; the difference between the two articulators tested and the lateral cephalometric radiograph was lower for the Bio Art than for the Kavo articulator.

Bone regeneration in surgically created defects filled with autogenous bone: an epifluorescence microscopy analysis in rats

Although the search for the ideal bone substitute has been the focus of a large number of studies, autogenous bone is still the gold standard for the filling of defects caused by pathologies and traumas, and mainly, for alveolar ridge reconstruction, allowing the titanium implants installation. OBJECTIVES: The aim of this study was to evaluate the dynamics of autogenous bone graft incorporation process to surgically created defects in rat calvaria, using epifluorescence microscopy. MATERIAL AND METHODS: Five adult male rats weighing 200-300 g were used. The animals received two 5-mm-diameter bone defects bilaterally in each parietal bone with a trephine bur under general anesthesia. Two groups of defects were formed: a control group (n=5), in which the defects were filled with blood clot, and a graft group (n=5), in which the defects were filled with autogenous bone block, removed from the contralateral defect. The fluorochromes calcein and alizarin were applied at the 7th and 30th postoperative days, respectively. The animals were killed at 35 days. RESULTS: The mineralization process was more intense in the graft group (32.09 percent) and occurred mainly between 7 and 30 days, the period labeled by calcein (24.66 percent). CONCLUSIONS: The fluorochromes showed to be appropriate to label mineralization areas. The interfacial areas between fluorochrome labels are important sources of information about the bone regeneration dynamics.

Osteotomia sagital da crista alveolar para instalação de implantes Bicon / Mandibular ridge split expansion for Bicon Implant placement: technical report

As atrofias ósseas representam um desafio para os cirurgiões que se propõem a reabilitá-las. No passado, a única opção viável era a enxertia do tipo aposicional, provenientes dos mais variados sítios doadores. Entretanto, a enxertia óssea requer um segundo sítio cirúrgico, que com certa frequência aumenta a morbidade pós-operatória, sem mencionar a necessidade de espera para a incorporação do enxerto e posterior instalação dos implantes. A osteotomia sagital da crista alveolar representa uma opção mais rápida, pois elimina a necessidade de espera para incorporação do enxerto ósseo e segura. Possibilitando a reabilitação de áreas edêntulas que apresentem as cristas alveolares afiladas, que sem a utilização de algum tipo de procedimento de enxertia adicional inviabilizariam a sua reabilitação de forma satisfatória. Os autores apresentam neste artigo um caso clínico de reabilitação unitária, em que demonstram detalhes da técnica cirúrgica para expansão de rebordos alveolares associado à instalação mediata de implantes Bicon, para casos em que a espessura óssea do rebordo alveolar mandibular se mostrar insuficiente para a colocação de implantes.

This case report presents details of a new surgical technique for mandibular ridge sagittal osteotomy and expansion associated to immediate dental implants in atrophic ridges. The bone atrophies represents a challenge for the surgeons that intends to modify this situation. In the past, the only viable option was the onlay bone graft. However, the bone graft requests a second surgical site that certainly increases the postoperative morbidity, without mentioning the longer treatment time required. The sagittal osteotomy of the alveolar crest represents a faster option, because it eliminates the time requested for bone graft integration, providing rehabilitation of edentulous areas with thin alveolar crests that otherwise would need additi onal surgical procedures for a satisfactory result. The authors report a clinical case in which this technique was used with the installation of a Bicon dental implant in the same surgical time, showing all the steps for this single-tooth rehabilitation.

Lip cavernous hemangioma in a young child

Hemangiomas are benign tumors of infancy and childhood, characterized by a phase of fast growth with endothelial cell proliferation, occurring in 10-12 percent of children at 1 year of age. It is known that hemangiomas of infancy are most commonly located on the head and neck region (around 60 percent of cases) and occur more frequently in the lips, tongue, and palate. Approximately 50 percent of hemangiomas have complete resolution, and 90 percent of them are resolved up to the age of 9. Complications occur in only 20 percent of the cases, the most common problem being ulceration with or without infection. The treatment depends on lesion location, size and evolution stage, and the patient's age. Surgery is usually indicated when there is no response to systemic treatments, or even for esthetic reasons, being performed as a simple excision in combination or not with plastic surgery. This paper reports a case of lip cavernous hemangioma in a 4-year-old child, who was submitted to 3 sessions of vascular sclerosis due to the size of the lesion, before undergoing simple excision of the hemangioma. Two years of postoperative clinical follow-up shows treatment success with no recurrence of the lesion.

Hemangiomas são tumores benignos da infância que se caracterizam por uma fase de crescimento rápido com proliferação de células endoteliais, ocorrendo em 10 a 12 por cento das crianças com 1 ano de idade. Sua localização mais comum é nos lábios, na língua, mucosa jugal e no palato. Aproximadamente 50 por cento dos casos de hemangioma mostram completa resolução e 90 por cento deles resolvem-se até os 9 anos de idade. As complicações ocorrem em apenas 20 por cento dos casos e o problema mais comum é a ulceração com ou sem infecção. O tratamento depende da localização, do tamanho e do estágio evolutivo da lesão, bem como da idade do paciente. A cirurgia geralmente é indicada quando não há resposta aos tratamentos sistêmicos ou por razões estéticas, podendo ser empregada sob forma de exérese simples com ou sem plástica. Este artigo apresenta um caso de hemangioma cavernoso labial em uma criança de 4 anos de idade, a qual, devido ao tamanho da lesão, foi submetida a 3 sessões de esclerose vascular seguido de exérese simples da lesão, com acompanhamento clínico de 2 anos de pós-operatório.

Adesivos à base de cianoacrilato para síntese de tecido mole / Cyanoacrylate adhesives for the synthesis of soft tissue

Fundamentos - Adesivos teciduais têm sido muito usados para síntese de ferida, em função de ser um método indolor, rápido e de fácil execução. Objetivos-Analisar e comparar compatibilidade dos adesivos, etil- cianoacrilato (Super Bonder) e butilcianoacrilato (Histoacryl), e a reparação de incisões em dorso de ratos entre o fio de sutura e os respectivos adesivos. Métodos - Foram usados 15 ratos. Realizaram-se duas lojas cirúrgicas no dorso. Em cada uma, foi implantado um tubo de polietileno (10mm x 1mm), os quais foram preenchidos com os adesivos Super Bonder (lado direito) e Histoacryl (lado esquerdo). As incisões, do lado esquerdo, foram coaptadas com Super Bonder, e as do lado direito, com Histoacryl. Uma incisão mediana, entre as duas incisões,foi realizada e suturada com fio de seda. Os animais foram mortos, depois de 7(sete), 35(trinta) e 120 (cento e vinte dia) dias. Resultados: Os adesivos usados, no presente estudo, não promoveram reação inflamatória, quando usados para síntese das incisões. Porém, estes adesivos, quando implantados no subcutâneo, promoveram reação inflamatória até 120 (cento e vinte dia) dias, no entanto, a reação é mais intensa com Histoacryl. Conclusões: Super Bonder e Histoacryl permitem o processo cicatricial dos tecidos incisados; facilitam a sutura das incisões. Desta forma, estes podem ser utilizados para sínteses de feridas, lacerações ou incisões cutâneas.

Background: Tissue adhesives have been used for the synthesis of wound due to their painless application and quick and easy handling. Objectives: The purpose of this study was to analyze and compare the compatibility of the adhesives ethylcyanoacrylate (Super Bonder) and butyl-cyanoacrylate (Histoacryl), and to compare the reparation of incisions in the dorsum of rats with suture and the respective adhesives. Methods: Fifteen rats were used. Two surgical pockets were created in their dorsum. A polyethylene tube (10mm x 1mm) was implanted in each one. Each tube was filled with the adhesives Super Bonder(left side) and Histoacryl (right side). The incisions on the left side were closed with Super Bonder, and the incisions on the right side, with Histoacryl. A median incision between the two other incisions was made and closed with braided silk suture. The animals were killed after, 7, 35 and 120 days. Results: The adhesives used in the present study did not promote inflammatory reaction when used for the synthesis of incisions. However, when implanted subcutaneously, they caused an inflammatory reaction within 120 days. Reaction is more severe with Histoacryl. Conclusions: Super Bonder and Histoacryl can be used effectively in the healing of incised tissues; they aid in the suture of incisions. However, these adhesives can be used for the synthesis of wounds, lacerations or cutaneous incisions.

Reabilitação de maxila atrófica com aconragem zigomática: relato de caso / Rehabilitation of atrophic maxilla with zygomatic anchorage: case report

A reabilitação protética de maxila atrófica representa um grande desafio para o cirurgião-dentista, mesmo após o advento dos implantes osseointegrados. Isso se deve ao fato de a maxila apresentar características anatômicas que dificultam o procedimento, tais como: osso predominantemente do tipo esponjoso (classe III e IV), proximidade da fossa nasal, seio maxilar e forame incisivo. Os pacientes portadores de reabsorção do processo alveolar, pneumatização exacerbada do seio maxilar para anterior e aqueles que sofreram grandes ressecções tumorais não são bons candidatos à instalação de implantes convencionais. Nesses casos, o tratamento seria baseado em grandes reconstruções ósseas, o que resultaria em alto grau de morbidade, aumento dos custos, diminuição da previsibilidade e necessidade de internação. A fim de solucionar os casos mais rapidamente e possibilitar a reabilitação de pacientes com defeitos maxilares, a ancoragem zigomática surge como alternativa cirúrgica com índices de sucesso próximo dos obtidos pelos implantes convencionais. O objetivo deste estudo é o de relatar um caso clínico de reabilitação de maxila atrófica, utilizando implantes zigomáticos bilaterais e implantes convencionais.

The prosthetic rehabilitation of atrophic maxilla represents a great challenge for the surgeon dentist, exactly after the advent of the osseointegrated implants. This if must to the fact of the jaw present anatomical characteristics that make it difficult the procedure such as: bone, predominantly, of the spongy type (classroom III and IV), proximity of nasal cavity, the sinus to maxillaries and the incisive foramen. The carrying patients of resorption of the alveolar process, exacerbate pneumatization of the sinus to maxillaries for previous and those that had suffered great tumor resection are not good candidates to the installation of conventional implantations. On these cases, the treatment would be based on great bones reconstructions what it would result in high degree of morbidity, increase of the costs, reduction of the previsibility and necessity of internment. In the intention of solve the case more quickly and make possible the reconstruction of defect maxillaries the zygomatic anchorage appear as alternative surgical for this patient present index of success next of the 97%, approach of the get for the implantation conventional. The aim of this study was to tell a clinical case of rehabilitation of atrophic jaw by using of zygomatic anchorage bilateral and conventional implants.

Reconstrução de maxila atrófica utilizando enxerto ósseo homógeno / Reconstruction the atrophic jaws using homogenous bone graft

A reabilitação oral de pacientes portadores de maxila atrófica tem sido bastante discutida na literatura. Técnicas e materiais vêm sendo desenvolvidos, visando à recuperação do tecido ósseo para a instalação de implantes. O enxerto autógeno é o material de escolha para a grande maioria dos casos, no entanto o aumento no tempo operatório, a morbidade cirúrgica e as possíveis complicações inerentes à abordagem da área doadora nem sempre o tornam viável. Já os enxertos ósseos homógenos oferecem como principais vantagens a eliminação da abordagem de um segundo sítio cirúrgico e quantidade suficiente de osso, o que reduz o tempo e a morbidade. Portanto, o enxerto homógeno fresco congelado é uma alternativa para as reconstruções dos rebordos atróficos devido a sua capacidade de remodelação, incorporação e qualidade que permitem resistir às cargas funcionais quando da instalação de implantes osseointegráveis. O presente estudo pretende relatar um caso clínico de reconstrução óssea de rebordo alveolar, utilizando enxerto homógeno.

Oral rehabilitation of patients with maxilla atrophic has been sufficiently argued in literature. Techniques and materials come being developed aiming at to the recovery of the tissue bone for the installation of implants. Autogenous bone grafts are the material of choice for the great majority of the cases due to the potential of osteogenesis and osteoinduction. However, the increase in the operatory neither time, the surgical morbity and the possible inherent complications to the boarding of the area giver nor makes always it viable. Already the homogenous bone grafts offer as to main advantages to the elimination of the boarding of as a surgical small farm and enough amount of bone, what it reduces the time and the morbity. Therefore, homogenous grafts is a viable alternative for the reconstructions of the atrophic rims of form that presents capacity of remodeling, incorporation and quality that allow to resist functional loads when of the installation of osseointegrated implants. The present study it intends to present a case of bone reconstruction of alveolar rim being used homogenous bone grafts.

Cloridrato de tramadol/paracetamol no controle da dor pós-operatória em cirurgias de terceiros molares inclusos / Tramadol/acetaminophen in the control of postoperative pain for impacted third molar surgery

Este estudo comparou a eficácia analgésica dos fármacos tramadol/paracetamol, paracetamol e dipirona no tratamento de pacientes submetidos à extração de terceiros molares inclusos. Trinta pacientes foram selecionados. Em cada paciente, dois terceiros molares inclusos foram extraídos do mesmo lado. Para avaliar a eficácia dos analgésicos, estes foram divididos em 3 grupos: A (tramadol/paracetamol), B (dipirona) e C (paracetamol), sendo administrados de forma duplo-cega; 1 comprimido a cada 6 horas, durante 48 horas. A intensidade da dor foi avaliada por uma escala visual analógica (escore 0 ? 4: sem dor ? insuportável). A análise estatística foi realizada no software InStat, nível de significância de a=0,05. O teste de Kruskal-Wallis mostrou que os três fármacos apresentaram o mesmo resultado durante a primeira etapa de aferição (P=0,135). O teste de Friedman revelou uma diminuição no nível da dor com o passar do tempo, sendo essa diminuição similar para 3 analgésicos. Entre a primeira e a última aferição, foi observada uma diferença estatisticamente significante para os analgésicos A e B, mas não, para o C. Concluímos que o tramadol/paracetamol foi eficaz no controle de dor pós-operatória de extração de terceiro molar incluso e que a dipirona foi tão eficaz quanto o tramadol/paracetamol. O paracetamol, entrentanto, possui um menor efeito em relação aos outros analgésicos.

This study compared the effectiveness of the three analgesics in the control of postoperative pain in impacted third molar surgeries. Thirty patients were selected who needed removal of only two impacted third molars at the same side. Randomized, double-blind trials were applied to evaluate the efficacy of analgesics. Analgesics were divided in: A (tramadol/acetaminophen), B (sodic dipyrone) e C (acetaminophen) -1 tablet each 6 hours during 48 hours. The intensity of the pain was evaluated by the patients according with a visual analogical scale (score 0 ? 4: no pain ?insupportable). Statistical analysis at InStat software, the significance level of a=0.05. Kruskal-Wallis test showed that the three medicaments presented the same result during the first stage of measurements (P=0.135). Friedman test showed a decrease in the level of pain with passing of the time, being this decrease similar for the three analgesics. A significant difference between first and the last gauging could be observed for the A and B analgesics. The same trend could be seen for drug C, although not to reach significance statistics. Tramadol/acetaminophen was efficient in the control of postoperative pain in impacted third molars surgeries, when it compared with dipyrone and acetaminophen.

Avaliação histológica de agentes hemostáticos implantados em mandíbulas de coelhos / Histologic evaluation of hemostatic agents in the rabbit mandible

Objetivo: O objetivo deste estudo foi o de avaliar histologicamente o processo de reparo ósseo de cavidades cirúrgicas confeccionadas em mandíbulas de coelhos, sob a influência dos agentes hemostáticos Avitene®, Surgicel® e Hemospon®, comparando-os com os resultados do coágulo sangüíneo. Metodologia: Foram utilizados 12 coelhos, os quais receberam osteotomias mandibulares bilaterais com o auxílio de uma trefina de 6 mm de diâmetro. No Grupo I, as cavidades foram preenchidas por Avitene®, no Grupo II, por Surgicel®, no Grupo III, por Hemospon®, e, no Grupo IV, por Coágulo (controle). Os animais foram sacrificados nos períodos de 15, 30 e 60 dias de pós-operatório, sendo os espécimes submetidos à análise histológica. Resultados: Os resultados mostraram que, em todas as cavidades tratadas com os diferentes agentes hemostáticos havia algum grau de infiltrado inflamatório, porém o grupo III (Hemospon®) apresentou a resposta inflamatória mais intensa e prolongada, com atraso na reparação óssea. Conclusão: Concluímos que Avitene® e o Surgicel®, de forma geral, não interferiram com o processo de reparação óssea. O Hemospon® foi o material implantado com resposta inflamatória mais persistente e intensa, promovendo atraso na reparação óssea da cavidade cirúrgica.

Purpose: The purpose of this study was to histologically evaluate the process of bone regeneration in defects of the rabbit mandible in the presence of the hemostatic agents Avitene® , Surgicel® and Hemospon® , and to compare the outcomes with those of empty control defects. Methodology: Bilateral defects of the mandible were surgically created with a trephine burr 6 mm in diameter in 12 rabbits. In group I the defects were filled with Avitene®, in group II with Surgicel® and in group III with Hemospon® , while those in group IV served as controls. The animals were sacrificed at 15, 30 and 60 days, the specimens being submitted to histological analysis. Results: The results showed an inflammatory reaction in all defects in the presence of a hemostatic agent, but in group III (Hemospon®) this was prolonged and intense, causing bone repair to be delayed. In contrast, Avitene® and Surgicel® did not influence the bone repair process. Conclusion: It was concluded that Hemospon® was the packed hemostatic that showed the most intense and prolonged inflammatory reaction, causing a delay in the repair of the bone defect.

Adesivos de cianoacrilato para fixação de xenoenxertos / Cyanoacrylate adhesives for fixation of xenografts

O objetivo deste trabalho foi o de avaliar histologicamente os adesivos à base de etil-cianoacrilato e de butil-2-cianoacrilato na fixação de enxertos ósseos bovinos, em osso parietal de coelho. Vinte coelhos adultos receberam enxerto de osso bovino inorgânico liofilizado em bloco, sobre osso parietal. Previamente, foram realizadas osteotomias no osso bovino, com uma trefina de 6 mm. Os enxertos foram fixados com etil-cianoacrilato no grupo I (GI) e, com butil-2-cianoacrilato, no grupo II (GII). Após 5, 15, 30, 60 e 120 dias, os animais foram sacrificados, e as peças foram processadas segundo técnica histológica para coloração em H.E. Em 15 dias, em GI e GII, foram observadas discreta reação inflamatória. Notou-se presença de neoformação óssea adjacente ao enxerto em 30 dias, no GI e aos 60 dias, no GII. Aos 120 dias, tecido conjuntivo no interior do enxerto, pontos de neoformação óssea, presença de adesivo e os enxertos não se apresentaram incorporados ao leito receptor em todos os espécimes (GI e GII). Concluímos que tanto etil-cianoacrilato quanto butil-2-cianoacrilato foram biocompatíveis. Ambos os adesivos fixaram os xenoenxertos, promovendo estabilidade adequada para neoformação óssea no interior do enxerto e na interface enxerto/leito receptor, no entanto uma avaliação adicional a longo prazo é necessária para verificar a degradação completa dos adesivos.

The aim of this study was to histologically evaluate ethyl-cyanoacrylate and butyl-2-cyanoacrylate adhesives for fixation of bovine bone grafts on parietal bone of the rabbit. Twenty adult rabbits received a graft of freeze-dried inorganic bovine bone on parietal bone. Prior to the graft, osteotomies were performed on bovine bone with a 6mm-trephine. The grafts were fixed with ethyl-cyanoacrylate in group I (GI) and with butyl-2-cyanoacrylate in group II (GII). The animals were sacrificed after 5, 15, 30, 60 and 120 days and the specimens submitted to the routine laboratory procedures for H.E. staining. At 15 days, a slight inflammatory reaction was observed in both GI and GII. The presence of new bone formation around the graft was noted at 30 days in GI and at 60 days in GII. After 120 days, there was connective tissue within the graft, regions of new bone formation and presence of adhesive, none of the grafts being incorporated into the host bed in either GI or GII. We concluded that both ethyl-cyanoacrylate and butyl-2-cyanoacrylate were biocompatible and both adhesives fixed the xenografts, providing adequate stability for new bone formation inside the graft and on the graft/host bed interface. However, an additional evaluation long-term is necessary to verify the complete degradation of the adhesives.