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

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

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

Effects of alveolar bone displacement with segmental osteotomy: micro-CT and histomorphometric analysis in rats

Abstract The purpose of this study was to evaluate the effects of segmental osteotomy on the blood vessels and osteoclasts in rats using micro-computed tomography (micro-CT) and histomorphometric analysis. After segmental osteotomy was performed around the maxillary first molars of 36 male Sprague-Dawley rats (n = 72), the samples were divided into a control group (no displacement), 0.5 D group (0.5 mm buccal displacement) and 1.0 D group (1.0 mm buccal displacement) (n = 24/group). At 1, 2, 4 and 8 weeks after surgery, changes in the blood vessel volume were investigated using micro-CT with perfusion of radiopaque silicone rubber. Tartrate-resistant acid phosphatase (TRAP) staining was used for histomorphometric analysis. Two-way repeated measures analysis of variance (rmANOVA) was performed to compare the volume of blood vessels and number of TRAP-positive osteoclasts among the groups. Regarding blood vessel volume, the displacement groups had no significant effects, while the time points had significant effects (p = 0.014). The blood vessel volume at 1 week was significantly smaller than that at 2, 4, and 8 weeks (p = 0.004, p = 0.026, and p = 0.005, respectively). Regarding TRAP cell count, the displacement groups had no significant effects, while the time points had significant effects (p < 0.001). The number of TRAP-positive osteoclasts at 8 weeks was significantly smaller than that at 1, 2, and 4 weeks (p < 0.001, p < 0.001, and p = 0.002, respectively), and the count at 4 weeks was smaller than that at 1 week (p = 0.011). Therefore, a regional osteoclast-related acceleratory phenomenon was maintained until 4 weeks after surgery.

Steroidal and non-steroidal cyclooxygenase-2 inhibitor anti-inflammatory drugs as pre-emptive medication in patients undergoing periodontal surgery

The aim of the present study was to compare the pre-emptive use of a cyclooxygenase-2 (COX-2) inhibitor with a well established steroidal anti-inflammatory drug for pain and edema relief following periodontal surgery for crown lengthening. Thirty patients requiring periodontal surgery were randomly assigned to receive one of the following medications: selective COX-2 inhibitor or steroidal anti-inflammatory drug, 60 min before the surgical procedure. To examine patient anxiety, a Corah's dental anxiety scale was applied before surgery. Using a visual analog scale, the extent of pain/discomfort during the trans-operative period and immediately after the surgery was measured. Additionally, intensity of pain/discomfort and edema were examined 4, 8, 12 and 24 h postoperatively. With regard to anxiety, no statistical differences between the groups were observed (p>0.05). With respect to the extent of pain/discomfort during the trans-operative, immediate and late postoperative period, data demonstrated no significant differences (p>0.05) between the COX-2 inhibitor and steroidal groups. With regard to edema, intragroup analysis did not reveal any statistically significant difference (p>0.05) during the 24 h following surgery in either group. In conclusion, both anti-inflammatory drugs presented a similar potential for pain and edema relief following periodontal surgery.

O objetivo do presente estudo foi comparar a utilização pré-emptiva de medicamento inibidor da COX-2 (cicloxigenase-2) com uma droga antinflamatória esteroidal amplamente utilizada, para o controle da dor e edema após cirurgia periodontal para aumento de coroa. Trinta pacientes que necessitavam de cirurgia periodontal foram aleatoriamente designados a receber uma das seguintes medicações: inibidor seletivo da COX-2 ou a droga antinflamatória esteroidal, 60 min antes do procedimento cirúrgico. Para avaliar a ansiedade do paciente, a escala de ansiedade ao tratamento dental de Corah foi aplicada antes da cirurgia. Com a utilização de escala analógica visual a extensão de dor/desconforto durante o período trans-cirúrgico e imediatamente após a cirurgia foi mensurada. Adicionalmente, a intensidade de dor/desconforto e edema foram avaliados no periodo pós-operatório tardio 4, 8, 12 e 24 h após o procedimento cirúrgico. Com relação à ansiedade, não foi observada diferença estatística entre os grupos (p>0,05). Com relação à extensão de dor/desconforto durante os períodos trans-cirúrgico e pós operatório imediato e tardio, os dados não demonstraram diferenças entre o grupo que recebeu o inibidor seletivo da COX-2 e o aintinflamatório esteroidal (p>0,05). A avaliação do edema, intragrupo, não revelou diferença estatística durante as primeiras 24 h em nenhum dos grupos estudados (p>0,05). Em conclusão, ambas as drogas antiinflamatórias utilizadas apresentaram um potencial similar no controle da dor e edema após cirurgia periodontal.

Myofibroblastic sarcoma of the mandible: a case report

Myofibroblastic sarcoma is a rare tumor that mostly develops in the soft tissues of the head and neck. Within the oral cavity, a tongue lesion is the most common. A myofibroblastic sarcoma tends to recur locally instead of metastasizing. We encountered a myofibroblastic sarcoma of the mandible of a 9-year-old male and performed mass excision and additional marginal alveolectomy. So far, there is neither recurrence nor metastasis. We report this case because of the uncommon location of this tumor type and its surgical approach compared to other forms of sarcomas.

A modified double pedicle graft technique and other mucogingival interceptive surgeries for the management of impacted teeth: a case series.

Maxillary canine is one of the most common teeth that are impacted. This accounts for 1-2% of all patients who attend orthodontic treatment. The key to achieve maximal eruption of these teeth is their surgical exposure and the role of periodontist in such situations is to provide a functional and satisfactory width of attached gingiva on the labial surface. There are different techniques to surgically expose the impacted teeth, namely--gingivectomy technique, apically positioned flap, closed eruption technique, modified apically positioned flap, double pedicle flap and free gingival graft. Selection of the procedure is dependent on the positioning of the tooth in relation to mucogingival junction and attached gingiva. In the present case series we describe three different techniques for uncovering of impacted teeth, which are apically positioned flap, closed eruption technique and a modified double pedicle graft specially planned for the situation. These procedures when selected diligently using sound selection criteria will create adequate width of attached gingiva which minimizes or eliminates the future mucogingival problems.

Efeitos da corticotomia alveolar na estrutura óssea e na movimentação ortodôntica / Effect of localized alveolar corticotomies on the alveolar bone structure and orthodontic tooth movement

No presente estudo investigou-se os efeitos de corticotomias alveolares localizadas (CAL) na estrutura do osso alveolar e como a movimentação ortodôntica foi afetada pelo trauma cirúrgico resultante da CAL. No primeiro experimento, dezesseis cães sem raça definida (SRD) adultos e machos foram, aleatoriamente, divididos em quatro grupos. Os animais do grupo controle foram sacrificados antes da cirurgia e os cães dos grupos experimentais G7, G14 e G28, respectivamente aos, 7, 14 e 28 dias após a realização de CAL. Corticotomias alveolares localizadas foram realizadas nas corticais vestibular e lingual, circunscrevendo o terceiro pré-molar inferior direito, com o lado esquerdo servindo como controle intra-animal. A análise da densidade óssea revelou diminuição localizada da densidade do osso alveolar, com redução máxima acontecendo uma semana pós-CAL e recuperação progressiva, porém parcial, dos valores de densidade óssea inicial, duas e quatro semanas, após a realização das cirurgias. Os estudos histomorfométricos e de microscopia eletrônica de varredura mostraram que o osso trabecular, adjacente às áreas traumatizadas pelas CAL, sofreu mudanças fisiológicas e estruturais consistentes com o desenvolvimento de osteopenia (aumento dos espaços trabeculares e diminuição da densidade óssea). No segundo experimento, outros cinco cães SRD tiveram os arcos dentários submetidos, à movimentação ortodôntica, sendo o quadrante inferior direito, imediatamente após a realização de CAL e o esquerdo serviu como controle. Após dez semanas de aplicação de forças ortodônticas, recíprocas e constantes, nos segundos e quartos pré-molares inferiores, maior movimentação dentária e menor perda de ancoragem, foram registradas no lado submetido à CAL. Os resultados demonstraram que a realização de corticotomias alveolares localizadas afetou a estrutura do osso trabecular adjacente, reduzindo a densidade óssea e potencializando a movimentação ortodôntica. Finalmente...

Histologic evaluation of the effect of nicotine administration on bone regeneration: a study in dogs

O objetivo do presente estudo foi avaliar histometricamente a influência da nicotina sobre a regeneração óssea de defeitos criados cirurgicamente em rebordos alveolares edêntulos de cães. Defeitos ósseos foram criados cirurgicamente em um dos lados da mandíbula de dezesseis cães e foram deixados para que curassem espontanea-mente. Os animais foram aleatoriamente designados para um dos seguintes grupos: Grupo 1 - controle (n = 8) e Grupo 2 - administração subcutânea de nicotina (2 mg/kg) duas vezes ao dia durante 4 meses (n = 8). Os animais foram sacrificados, e secções semi-seriadas descalcificadas, obtidas. Os parâmetros histométricos avaliados foram altura, largura, área e densidade do tecido ósseo neoformado. A análise intergrupos (Mann-Whitney "rank sum test") demonstrou que a administração de nicotina não influenciou altura, largura e área de tecido ósseo neoformado (p > 0,05). Entretanto, a administração de nicotina influenciou significativamente a densidade do tecido ósseo neoformado (p < 0,001). Dentro dos limites do presente estudo, pode-se concluir que a nicotina pode afetar, mas não impedir a regeneração de defeitos ósseos criados cirurgicamente em mandíbulas edêntulas de cães.

Prospective study on results of the surgical crown lengthening and its associated factors / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To observe the results of surgical crown lengthening procedure and the factors which affected the success of the surgery.</p><p><b>METHODS</b>Crown lengthening surgery was performed on 27 teeth. The distance between margin of tooth and bone crest (MT-B) was obtained greater than 4 mm during the surgeries on 10 teeth which were considered as satisfying group. The other 17 teeth were as temporized group with MT-B < or = 3 mm. The position of the tooth margin was evaluated before surgery, immediately after suturing, and at 4 - 6 weeks after surgery. The occlusal force and tooth mobility were measured immediately after restoration, at 3 and 6 months after surgery.</p><p><b>RESULTS</b>MT-B was obtained > or = 4 mm and all margins and sites of the teeth were exposed in satisfying group (10/10). At least 1 site with MT-B < 3 mm in temporized group in which there still were 11 sites (16%) in 5 teeth (29%) with subgingival tooth margin at 4 - 6 weeks after surgery. There were more teeth showing increased mobility in temporized group (12/17) than in satisfying group (1/10) after surgery (P < 0.05). The occlusal force of the teeth after surgery and restoration in temporized group was significantly lower than that of their counterpart teeth (P < 0.01), but it was not the case in satisfying group (P > 0.05).</p><p><b>CONCLUSIONS</b>It is suggested that ideal exposure of tooth margin could be obtained if 4 mm from tooth margin to alveolar crest could be created during the crown lengthening surgery. The teeth both with 4 - 5 mm subgingival margin sites and factors limiting surgical performance are not the suitable indications for the surgical crown lengthening.</p>

Complicaciones trans y postoperatorias en la extracción dental: estudio de 81 casos / Trans-operative and post-operative complications for dental extraction a review of 81 cases

Estudio prospectivo que se realizó en 81 pacientes adultos de ambos sexos, a los cuales por indicaciones terapéuticas se les practicaron extracciones dentales por vía alveolar o disección según el caso, con un seguimiento clínico y radiográfico de 12 días a partir de la cirugía. Los procedimientos quirúrgicos se realizaron con instrumental y técnica convencionales, sutura no absorbible y medicamentos sólo en casos indispensables, encontrándose que las complicaciones más frecuentes aunque poco severas fueron la hemorragia leve y el dolor moderado en el postoperatorio inmediato, así como la inflamación y osteítis alveolar aguda pero en menor proporción, en el postoperatorio mediato

Fenestración patológica osteogingival / Gingivo-osseous pathological fenestration

Se reporta el caso de un niño de 5 años de edad, saludable, quien muestra fenestración patológica ósteogingival en múltiples piezas dentales, como resultado de un proceso de caries rampante de larga evolución, sin tratamiento. Esta entidad, muy poco conocida y reportada, se relaciona con múltiples factores locales, y ha sido observada en grupos étnicos indígenas y en países del tercer mundo, tales como la India, Ecuador, Paraguay, Bolivia y Perú, donde la población infantil sufre un alto grado de desnutrición