Remoção de pré-maxila em paciente com fissura labiopalatina: relato de caso / Removal of the premaxilla in patient with cleft lip and palate: case report

Diversas anomalias craniofaciais acometem os seres humanos, dentre estas podem ser citadas as fissuras labiopalatinas. Ocorrem devido à mal formações congênitas e comprometem o desenvolvimento orofacial e maxilo-mandibular, gerando complicações estéticas e funcionais. O momento para abordagem cirúrgica em pacientes com deformidade deste tipo é crucial para atingir o melhor resultado. Entretanto, muitos deles não procuram atendimento ou não tem acesso aos centros especializados. A pré-maxila em portadores de fissura labiopalatina transforame bilateral, não submetidos a tratamento cirúrgico na infância, é comumente protruída, impedindo o desenvolvimento e função adequada da musculatura perioral/ Ainda, pode causar dificuldades alimentares,de fonação e, principalmente, estético. O objetivo do presente trabalho é relatar o caso de uma paciente acompanhada no serviço de cirurgia bucomaxilofacial OSID/UFBA, portadora de fissura labiopalatina, submetida à remoção de pré-maxila em idade adulta. O fechamento da fenda palatina não foi possível devido a idade da paciente e o grau de desenvolvimento do palato, tendo indicado tratamento com uso de prótese obturadora. Considera-se que quanto mais precoce e associado a uma boa técnica cirúrgica forem realizadas as intervenções primárias, menores serão as sequelas. Consequentemente, os resultados estéticos e funcionais serão mais prováveis, sendo desnecessária a remoção cirúrgica da pre-maxila(AU)

Several craniofacial anomalies affect humans and, among these, it can be cited the cleft lip and palate. These occur due to congenital malformations and compromise the orofacial and maxillo-mandibular development, causing aesthetic and functional complications. The moment of the surgical approach in patients with this type of deformities is crucial to achieve the best outcome, however, many of them do not seek care or have no access to specialized centers. The premaxilla in carries of bilateral cleft lip and palate when they are not submitted to a surgical treatment in childhood, is commonly protruding, impeding the development and function of the perioral musculature, besides difficult feeding, phonation and mainly aesthetic. The aim of this article is to report the case of a patient accompained with the Bucomaxillofacial Surgery Service from OSID / UFBA, with cleft lip and palate, submitted to pre-maxilla removal, in adulthood. The cleft palate closure was not possible due to the age of the patient and degree of development of the palate, indicating treatment with obturator prosthesis. It is considered that, the sooner and associated with a good surgical technique, primary interventions are performed, the fewer the sequelae and consequently the aesthetic and functional results, where, in most cases, surgical removal of the premaxilla will be unnecessary(AU)

Comparing intra-oral wound healing after alveoloplasty using silk sutures and n-butyl-2-cyanoacrylate

OBJECTIVES: The need for proper wound closure is of paramount importance after any intra-oral surgery. Various wound closure techniques have been described in literature using traditional non-absorbable suture materials. These include like synthetic absorbable sutures, surgical staples and tissue adhesives. Cyanoacrylates are among the most commonly used biocompatible tissue adhesives. To evaluate and compare intraoral wound healing using 3-0 silk sutures and n-butyl-2-cyanoacrylate after alveoloplasty.MATERIALS AND METHODS: A total of 20 patients requiring bilateral alveoloplasty in the same arch (upper or lower) were included in this study. Patients with any pre-existing pathology or systemic disease were excluded. After alveoloplasty was performed, the wound was closed using 3-0 braided silk sutures on one side, and using n-butyl-2-cyanoacrylate bio adhesive on the other side. Patients were evaluated based on the following parameters: time required to achieve wound closure; the incidence of immediate and postoperative hemostasis; the time to the use of the first rescue medication; the side where pain first arises; and the side where wound healing begins first.RESULTS: Compared to 3-0 silk sutures, cyanoacrylate demonstrated better hemostatic properties, reduced operative time, reduced postoperative pain and better wound healing.CONCLUSION: These data suggest that cyanoacrylate glue is an adequate alternative to conventional sutures to close the surgical wound after alveoloplasty, and better than are 3-0 silk sutures.

Incidence of Alveoloplasty Post Extraction in prosthetic Patients – A Retrospective Study

An Alveoloplasty is a pre prosthetic procedure that smoothens the jawbone. This procedure is done in areas where teeth have been extracted or lost. Alveoloplasty can be done alone, but is usually done at the time of extraction. The aim of this pre prosthetic procedure is to improve the quality of oral supporting structures that provide better retention and stability to dental prostheses. Reason: This study is done to implement protocols to reduce the need of secondary Alveoloplasty as the procedure causes extra financial and surgical burden to the patients. The aim of the study is to analyze the advantages of Alveoloplasty at the time of extraction. Objective: The objective of this study is to determine whether Alveoloplasty, if performed at the time of extraction saves time and ends in faster prosthetic rehabilitation when compared to secondary Alveoloplasty. Methods: This study was done and 30 cases were selected out of which 15 cases that have undergone extractions have undergone alveoloplasty done on the same day and the remaining 15 patients have undergone alveoloplasty after few days of extraction. Results: Results showed that the mean time taken for the completion of prosthetic replacement is quite higher in cases that had alveoloplasty done on a different day of extraction compared to those cases that had alveoloplasty done on the same day of extraction. Conclusion: We conclude that alveoloplasty done on the same day of extraction aids in faster correction of the edentulism

The changes of dental arch and tooth morphology after maxillary dentition crowded with self -locking brackets / 中国基层医药

Objective To study the clinical value of Time self -locking brackets in relieving the changes of dental arch and tooth morphology after maxillary dentition crowding .Methods From January 2015 to December 2015,80 patients with maxillary dentition in Rizhao Central Hospital were randomly divided into two groups according to the random number method ,with 40 cases in each group.The control group was treated with traditional MBT straight wire brackets (3M Company).The observation group was treated with Time self -locking brackets.And the width of the two groups was compared before and after the intervention.The treatment time and the incidence of complications during the treatment were observed in the two groups.Results After intervention,the width of canine and the length of long,middle bow in the observation group were significantly better than those in the control group ( t＝7.901, 29.820,15.652,all P＜0.05).The treatment time of the observation group was significantly shorter than that of the control group (t＝41.716,P＝0.000＜0.05).The incidence rate of bleeding ,swelling and loosening in the observa-tion group was significantly lower than that in the control group (χ2＝5.212,P＜0.05).The bracket shedding rate in the observation group was significantly lower than that in the control group ( χ2＝5.600,P＜0.05).Conclusion Time self-locking brackets is effective in the treatment of maxillary dentition crowding.The method has the advantages of high effect,simple clinical treatment ,less complication and low shedding rate during treatment.

Fabrication of immediate complete denture using Campagna tray technique / 대한치과보철학회지

An immediate complete denture is considered as restoration for lost natural teeth, which is fabricated following the extraction of the remaining teeth. Current esthetics and function can be retained by using immediate denture without edentulous period. However, the major disadvantages of immediate denture relate to the difficulties associated with taking accurate definitive impression and predicting the results of immediate denture. In this case report, the Campagna tray technique was used to take the final impression in a 49-year-old male patient presented with all remaining teeth diagnosed as hopeless teeth. Surgical templates were used for alveoloplasty after extraction. The immediate complete dentures were then delivered. The clinical assessments of immediate dentures showed good esthetic and functional outcomes. The patient showed high level of satisfaction.

Preprosthetic Surgery: Review of Literature.

Following the loss of natural teeth after extraction, the bone begins to resorb. Th e results of this resorption are accelerated by wearing dentures and tend to aff ect the mandible more severely than the maxilla. Besides, general factors include the presence of nutritional abnormalities and systemic bone disease such as osteoporosis; endocrine dysfunction may aff ect bone metabolism. Preprosthetic surgical treatment must begin with a thorough history and physical examination of the patient. Sometimes, there are contraindications to surgery because the patient suff ers from serious general disease. Specifi c attention should also be given to laboratory tests which could inform us as to a degree of bone resorption. Successful treatment with removable prosthesis is dependent on many factors. One component that can profoundly aff ect treatment success is the condition of the denture-bearing tissues. Every eff ort should be made to ensure that both the hard and soft tissues are developed in a form that will enhance the patient’s ability to wear a denture. It is the responsibility of the practitioner to carefully evaluate and identify the need for any alteration of the denture-bearing areas and to educate the patient as to the importance of accomplishing this vital procedure.

Management of traumatic neuralgia in a patient with the extracted teeth and alveoloplasty: a case report

A majority of patients who sustain injuries to the peripheral sensory nerves of the face and jaws experience a slow but gradual return of sensation that is functional and tolerable, if not the same as before the injuries. However, long-term effects of such injuries are aggravating for many patients, and a few patients experience significant suffering. In some of these patients, posttraumatic symptoms become pathological and are painful. The predominant painful components are (1) numbing anesthesia dolorosa pain, (2) triggered neuralgiaform pain, (3) burning and aching causalgiaform pain, and (4) phantom pain. This is a case report of conservative management of traumatic neuralgia and neuritis as part of posttraumatic pain syndromes in geriatric patients who have undergone the teeth extraction and alveoloplasty.

Alveoloplastia interseptal: una renovada técnica de cierre de las comunicaciones y fístulas bucoantrales / Interseptal alveoloplasty: a renewed technique for closing communications and oral-antral fistula

Se realizó un estudio descriptivo, prospectivo y de intervención terapéutica en 11 pacientes con comunicación y/o fístula bucoantral, tratados con la técnica de alveoloplastia interseptal en el Servicio de Cirugía Maxilofacial del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, en el período 2010-2012, con vistas a describir los resultados obtenidos con este método terapéutico. Entre las variables analizadas figuraron: edad, sexo, causa, diente afectado, condición del seno maxilar, tratamiento preoperatorio, dimensión de la complicación, tiempo de evolución, complicaciones quirúrgicas y evolución posoperatoria. En la serie predominaron los resultados excelentes en comunicaciones y fístulas bucoantrales, con dimensiones entre 3 y 5 mm, localizadas en áreas edentes o con un solo diente adyacente, ubicadas en el reborde alveolar, sin afectación de las paredes bucal o palatina o ambas y con reborde alveolar con trofismo adecuado. Esta técnica proporciona una base ósea con pedículo de tejido blando, lo cual facilita una cicatrización más rápida, con menor riesgo de complicaciones posoperatorias.

A descriptive, prospective and therapeutic intervention in 11 patients with communication and/or oral-antral fistula, treated with the interseptal alveoloplasty technique was carried out in the Maxillofacial Surgery Service from "Saturnino Lora Torres" Clinical Surgical Teaching Provincial Hospital in Santiago from Cuba in the period 2010-2012, aimed at describing the obtained results with this therapeutic method. Among the analyzed variables there were: age, sex, cause, affected tooth, condition of the maxillary sinus, preoperative treatment, magnitude of the complication, duration of the clinical course, surgical complications and postoperative clinical course. In the series the excellent results prevailed in communications and oral-antral fistula, with dimensions between 3 and 5 mm, located in edentulous areas or with a single adjacent tooth, located in the alveolar edge, without damaging the oral or palatine walls or both, and with alveolar edge with adequate trophism. This technique provides a bony base with pedicle of soft tissue, which facilitates a faster scaring, with lower risk of postoperative complications.

Nostril Base Augmentation Effect of Alveolar Bone Graft

BACKGROUND: The aims of alveolar bone grafting are closure of the fistula, stabilization of the maxillary arch, support for the roots of the teeth adjacent to the cleft on each side. We observed nostril base augmentation in patients with alveolar clefts after alveolar bone grafting. The purpose of this study was to evaluate the nostril base augmentation effect of secondary alveolar bone grafting in patients with unilateral alveolar cleft. METHODS: Records of 15 children with alveolar clefts who underwent secondary alveolar bone grafting with autogenous iliac cancellous bone between March of 2011 and May of 2012 were reviewed. Preoperative and postoperative worm's-eye view photographs and reconstructed three-dimensional computed tomography (CT) scans were used for photogrammetry. The depression of the nostril base and thickness of the philtrum on the cleft side were measured in comparison to the normal side. The depression of the cleft side pyriform aperture was measured in comparison to the normal side on reconstructed three-dimensional CT. RESULTS: Significant changes were seen in the nostril base (P=0.005), the philtrum length (P=0.013), and the angle (P=0.006). The CT measurements showed significant changes in the pyriform aperture (P<0.001) and the angle (P<0.001). CONCLUSIONS: An alveolar bone graft not only fills the gap in the alveolar process but also augments the nostril base after surgery. In this study, only an alveolar bone graft was performed to prevent bias from other procedures. Nostril base augmentation can be achieved by performing alveolar bone grafts in children, in whom invasive methods are not advised.

Influence of the Alveolar Cleft Type on Preoperative Estimation Using 3D CT Assessment for Alveolar Cleft

BACKGROUND: The bone graft for the alveolar cleft has been accepted as one of the essential treatments for cleft lip patients. Precise preoperative measurement of the architecture and size of the bone defect in alveolar cleft has been considered helpful for increasing the success rate of bone grafting because those features may vary with the cleft type. Recently, some studies have reported on the usefulness of three-dimensional (3D) computed tomography (CT) assessment of alveolar bone defect; however, no study on the possible implication of the cleft type on the difference between the presumed and actual value has been conducted yet. We aimed to evaluate the clinical predictability of such measurement using 3D CT assessment according to the cleft type. METHODS: The study consisted of 47 pediatric patients. The subjects were divided according to the cleft type. CT was performed before the graft operation and assessed using image analysis software. The statistical significance of the difference between the preoperative estimation and intraoperative measurement was analyzed. RESULTS: The difference between the preoperative and intraoperative values were -0.1+/-0.3 cm3 (P=0.084). There was no significant intergroup difference, but the groups with a cleft palate showed a significant difference of -0.2+/-0.3 cm3 (P<0.05). CONCLUSIONS: Assessment of the alveolar cleft volume using 3D CT scan data and image analysis software can help in selecting the optimal graft procedure and extracting the correct volume of cancellous bone for grafting. Considering the cleft type, it would be helpful to extract an additional volume of 0.2 cm3 in the presence of a cleft palate.

Secondary Alveoloplasty Using Iliac Cancellous Bone Graft in the Cleft Lip and Palate Patients

Maxillar bone of the patients with complete cleft lip and palate showed delayed growth pattern due to defect of bone formation and bony defect of cleft site, maxillary retrusion and defect and displacement of lateral incisor and canine. In the patients with bilateral cleft lip and palate, there are more severe bony defect and hypoplasia which leads to premaxillar instability and maxillary retrusion and makes the Type III malocclusion. In these patients, the reason for secondary bone graft to alveolar cleft after surgery of cleft lip and palate is to provide the stability of maxillary arch, to create bony matrix through which the teeth can erupt and to construct the plateform of the alar base for improving nasal and upper lip symmetry. There are many arguement about preferred timing of bone graft and donor site of bone graft, but we performed secondary bone graft for 16 alveolar cleft patients who is between the ages of 7 to 10 years, and we have followed up during 1 to 5 years. We harvested cancellous bone from iliac bone for donor, performed cancellous bone graft to alveolar cleft, and then sutured gingival flap water tightly, and applied Coe-pak on the operation site for protecting graft site after bone graft. As a result of radiograph for the quality of graft "take", there were little of bony absorption in 70% of cases, partial bony absorption in 30% of cases. By alveoloplasty with bone graft, there were improvement and harmony in nose, upper lip and alveolar arch. The patients with remnant alveolar fistula also were repaired, and permanent teeth were erupted with good shape. Results were satisfactory in the almost patients