Fatores associados ao interesse de usuários de prótese total mandibular em terapia implantossuportada e impacto da reabilitação com sobredentadura com implante único / Factors associated with the interest of users of complete mandibular dentures in implant-supported therapy and the impact of rehabilitation with single-implant overdentures

Este estudo objetivou identificar os fatores que influenciam na decisão de substituir uma prótese total convencional mandibular pelo tratamento com implantes dentários, assim como avaliar a satisfação, qualidade de vida e performance mastigatória (PM) após reabilitação com sobredentaduras com implante único (SIU) em pacientes adaptados e não-adaptados a prótese total convencional (PT) mandibular. Inicialmente, foi realizado um estudo transversal com 117 usuários de PTs bimaxilares, avaliados quanto aos desfechos relacionados à prótese (número de PTs mandibulares usadas previamente, tempo de uso e profissional que confeccionou a prótese atual, e quanto ao uso regular ou não da prótese mandibular) e aspectos centrados no paciente (período de edentulismo mandibular, altura óssea mandibular e interesse do paciente em se submeter a terapia com implantes). Do total da amostra, 78 pacientes manifestaram interesse na terapia implantossuportada, e desses apenas 22 foram selecionados e reabilitados com novas PTs bimaxilares. Após critérios de elegibilidade, foram alocados após pareamento em 2 grupos: adaptados à prótese mandibular (Grupo PTA - "adaptados à PT mandibular", n:10) e não adaptados (Grupo PTN - "não adaptados à PT mandibular", n:12). Em cada paciente, foi instalado um único implante na linha média e após o período de osseointegração as próteses mandibulares foram convertidas em sobredentaduras. O desempenho mastigatório foi avaliado pelo método das tamises, a altura óssea mandibular por medição em radiografia panorâmica, satisfação por escala quantitativa com questionário validado e o impacto da saúde oral na qualidade de vida pelo questionário OHIP-Edent-19. O teste Qui-quadrado foi utilizado para análise dos dados e as razões de prevalência ajustadas por meio da regressão multivariada de Poisson no primeiro estudo; para o segundo, a análise estatística em cada grupo e entre grupos foi baseada nos testes não-paramétricos de Wilcoxon e Mann-Whitney. O intervalo de confiança para os testes foi de 95%. A amostra foi predominantemente do sexo feminino, com 66,7% (n=78) dos participantes interessados em PT mandibular implantossuportada e com idade média de 65,68±6,38 anos. A PM não influenciou a escolha pela reabilitação com implantes. A preferência pela PT implantossuportada mandibular foi associada significativamente com maior experiência prévia com PT mandibular (p=0,021) e à insatisfação quanto à retenção (p=0,005). Após a intervenção com implante, todos os pacientes não adaptados passaram a condição de adaptados. Não houve diferença entre PTA e PTN para OHIP-Edent (p=0,276) e PM (p=0,222), a satisfação foi significativa apenas para o critério "conforto em arco inferior" (p=0,043). Para comparações pré e pós-tratamento com sobredentadura, a mediana do OHIP-Edent total diminuiu significativamente em ambos os grupos. Na comparação intragrupo, essa redução foi significativa em PTA apenas para a "limitação funcional" (p=0,026), e em PTN em quase todos os domínios, exceto "disfunção social" e "incapacidade" (p>0,05). Houve aumento estatisticamente significativo para a satisfação geral de 75,41 para 90,25 (p=0,012) em PTN e de 76,10 para 90,50 (p=0,007) em PTA. Os parâmetros "mastigação", "adaptação", "retenção" e "conforto" em arco inferior foram diferentes com significância em ambos os grupos, e "gustação", "fonação" e "dor" em arco inferior foram significativos apenas para o grupo não adaptado (p<0,05). Houve diferença significativa para PM em PTN (p=0,002) e PTA (p=0,047) ao se comparar tipo de reabilitação. Não houve correlação entre PM e OHIP antes e após a reabilitação (p>0,05). Pode-se concluir que a experiência prévia com PT mandibulares convencionais e a insatisfação com a retenção dessas, influenciam o interesse pela reabilitação com sobredentadura implantossuportada mandibular, assim como, a reabilitação com sobredentadura sobre implante único apresenta-se como alternativa aos pacientes não adaptados a PT convencional mandibular, auxiliando na aceitação do uso da prótese mandibular, assim como, comprovando efeito positivo na satisfação, qualidade de vida e performance mastigatória (AU).

This study aimed to identify the factors that influence the decision to replace a conventional mandibular complete denture by treatment with dental implants, as well as to evaluate satisfaction, quality of life and masticatory performance (MP) after rehabilitation with overdentures with a single implant in patients adapted and not adapted to conventional mandibular complete denture (CD). Initially, a cross-sectional study was carried out with 117 users of bimaxillaries CDs, who were evaluated for outcomes related to the denture (number of previous mandibular CDs, time of use and professional who made the current denture, and regarding regular use of the mandibular denture) and aspects centered patients (period of mandibular edentulism, mandibular bone height and the patient's willingness to undergo implant therapy). From the total sample, 78 patients expressed interest in implant-supported therapy, and of these, only 22 were selected and rehabilitated with new bimaxillary CDs. After eligibility criteria, they were allocated after pairing into 2 groups: adapted to mandibular prosthesis (PTA Group - "adapted to mandibular CD", n:10) and non-adapted (PTN Group - " not adapted to mandibular CD", n:12). In each patient, a single implant was installed in the midline and after the osseointegration period, the mandibular prostheses were converted into overdentures. Masticatory performance was evaluated by the sieve method, mandibular bone height by paranoid radiographic measurement, satisfaction by quantitative scale with a validated questionnaire and the impact of oral health on quality of life by the OHIP-Edent-19 questionnaire. The chi-square test was used for data analysis and the prevalence ratios adjusted by means of multivariate Poisson regression in the first study; on the second, the statistical analysis in each group and between groups was based on the non-parametric-Wilcoxon and Mann-Whitney tests. The confidence interval for the tests was 95%. The sample was composed predominantly by women, with 66.7% (n=78) of the participants interested in implantsupported mandibular CD, with mean age 65.68±6.38 years. MP was not influenced by the choice by dental implants rehabilitation. Preference for mandibular implant-supported CD was significantly associated with longer previous experience in mandibular CD (p=0.021) and with dissatisfaction regarding retention (p=0.005). After the implant intervention, all non-adapted patients became adapted. There was no difference between PTA and PTN for OHIP-Edent (p=0.276) and MP (p=0.222), satisfaction was significant only for the criteria "comfort in the lower arch" (p=0.043). For pre- and post-treatment comparisons with overdentures, the median total OHIP-Edent decreased significantly in both groups. In the intragroup comparison, this reduction was significant in PTA only for "functional limitation" (p=0.026), and in PTN in almost all domains, except "social dysfunction" and "disability" (p>0.05). There was a statistically significant increase in overall satisfaction from 75.41 to 90.25 (p=0.012) in PTN and from 76.10 to 90.50 (p=0.007) in PTA. The parameters "chewing", "adaptation", "retention" and "comfort" in the lower arch were significantly different in both groups, and "gustation", "phonation" and "pain" in the lower arch were significant only for the group not adapted (p<0.05). There was a significant difference for MP in PTN (p=0.002) and PTA (p=0.047) when comparing the type of rehabilitation. There was no correlation between MP and OHIP before and after rehabilitation (p>0.05). It can be concluded that the previous experience with conventional mandibular CD and the dissatisfaction with the retention of these, influence the rehabilitation with mandibular implant-supported overdenture, as well as the rehabilitation with overdenture on single implant presents itself as an alternative for patients not adapted to mandibular conventional CD, helping to accept the use of mandibular prosthesis, as well as proving a positive effect on satisfaction, quality of life and masticatory performance (AU).

Mandibular reconstruction using customized three-dimensional titanium implant

Mandibular defects lead to severe deformation and functional deficiency. Vascularized osteocutaneous tissue has been widely used to reconstruct the mandible. However, it is technically challenging to shape this type of grafts in such a manner that they resemble the configuration of the mandible. A 48-year-old female patient who underwent anterolateral thigh (ALT) flap coverage after a tongue cancer excision was diagnosed with a tumor recurrence during the follow-up. A wide excision mandibulectomy and mandibular reconstruction with an ALT flap and a titanium implant were performed. The prefabricated titanium implant was fixed to the condyle. Then, an ALT flap was harvested from the ipsilateral thigh and anastomosed. After confirming that the circulation of the flap was intact, the implant was fixed to the parasymphysis. On the radiograph taken after the surgery, the prosthesis was well positioned and overall facial shape was acceptable. There was no postoperative complication during the follow-up period, 1 year and 2 months. The prefabricated implant allows the restoration of facial symmetry without harvesting autologous bone and it is a safe and effective surgical option for mandibular reconstruction.

Evaluation of the inclination effect of non-splinted implants on the prosthetic behavior of overdentures in mandible edentulous patients / Evaluación del efecto de la inclinación de implantes no ferulizados sobre el comportamiento protésico de sobredentaduras en pacientes desdentados mandibulares

ABSTRACT. Introduction: the aim of this study was to evaluate the sagittal inclination of implants with respect to the occlusal plane of mandibular overdentures and their effect on the prosthetic behavior of the overdentures. Methods: 52 implants were evaluated in 26 fully mandible edentulous adults (two interforaminal implants per patient), rehabilitated with ball attachments and overdenture. Cephalometric tracing was conducted, evaluating the sagittal inclination of the implant to mandibular plane (MI), occlusal plane (OI), compensation angle (CA), and anterior facial height. The following clinical variables of prosthetic behavior were assessed: the need for prosthesis rebasing, changes in prosthetic accessories, and loosening of the prosthetic attachment. The variables were described with measurements of central tendency and dispersion. Intragroup comparisons were made with the Student's t test (p < 0.05) and correlations with the Pearson coefficient. Results: 26 patients were evaluated: 70.4% females and 29.6% males. The average age was 67.93 ± 8.6 years. The follow-up period ranged from 24 to 30 months. The average MI was 78.89 ± 10.9 degrees. There was a statistically significant correlation (r = 0.6) between MI and OI in patients who underwent a change in accessories and between MI and bone loss (r = 0.557) (p = 0.007). The average MI was higher in patients subjected to rebasing (89.70 ± 11.7 degrees), compared with those who were not subjected to rebasing (76.91 ± 9.8 degrees). A relationship with prosthetic pillar loosening could not be determined. Conclusions: the sagittal inclination of implants with respect to the occlusal plane in overdentures affects bone loss, leading to a change of accessories as well as prosthesis rebasing after two years of service.

RESUMEN. Introducción: el objetivo del presente estudio consistió en evaluar la inclinación sagital de los implantes con respecto al plano oclusal de sobredentaduras mandibulares y su efecto sobre el comportamiento protésico de las mismas. Métodos: se evaluaron 52 implantes en 26 adultos desdentados totales inferiores (dos implantes interforaminales por paciente), rehabilitados con pilares tipo bola y sobredentadura. Se realizaron trazos cefalométricos y se evaluó la inclinación sagital del implante con respecto al plano mandibular (MI), el plano oclusal (OI), el ángulo de compensación (CA) y la altura facial anterior. Se evaluaron variables clínicas de comportamiento protésico: necesidad de rebase de la prótesis, cambio de aditamentos retentivos y aflojamiento del pilar protésico. Las variables se describieron con medidas de tendencia central y dispersión. Las comparaciones intragrupales se hicieron con prueba t de Student (p < 0,05), y las correlaciones con el coeficiente de Pearson. Resultados: se evaluaron 26 pacientes: 70,4% mujeres y 29,6% hombres. La edad promedio fue de 67,93 ± 8,6 años. El rango de seguimiento fue de 24 a 30 meses. El MI promedio fue de 78,89 ± 10,9 grados. Hubo una correlación (r = 0,6) estadísticamente significativa entre MI y OI en los pacientes a quienes se les realizó cambio de aditamentos y entre MI y la pérdida ósea (r = 0,557) (p = 0,007). La MI promedio fue mayor en aquellos pacientes a quienes se les hizo rebase (89,70 ± 11,7 grados), en comparación con los que no tuvieron rebase (76,91 ±9,8 grados). No se pudo determinar la relación con el aflojamiento del pilar protésico. Conclusiones: la inclinación sagital de los implantes con respecto al plano oclusal de las sobredentaduras tiene un efecto sobre la pérdida ósea, lo que conlleva al cambio de aditamentos y rebase de la prótesis después de dos años de observación.

Segundos molares mandibulares permanentes impactados en pacientes de 8 a 15 años del programa de presupuesto participativo de Medellín, Colombia / Impactation of Permanent Mandibular Second Molars in 8 to 15 Year-Old Patients from the Participative Budget Program in Medellín, Colombia

Antecedentes: La impactación de segundos molares mandibulares permanentes (2MM) se presenta con variaciones considerables según el grupo poblacional. Además de los problemas asociados a esta alteración, podrían requerir tratamientos múltiples y complejos. Por lo tanto, el diagnóstico temprano de una alteración en el proceso de erupción del 2MM es imperativo para reducir el riesgo de impactación, la dificultad de tratamiento y la aparición de problemas asociados en las poblaciones. Propósito: Describir las características de impactación del 2MM en pacientes de 8 a 15 años en una muestra de Medellin, Colombia. Métodos: En este estudio descriptivo retrospectivo se evaluaron 1756 radiografias panorámicas de las cuales 95 presentaron impactación de 2MM. Estas se analizaron según sexo, localización en la mandíbula y tipo de inclinación, y se realizaron 13 mediciones lineales y angulares para identificar parámetros dentoesqueléticos característicos del lado de la impactación. Para el análisis de los datos se utilizó estadística descriptiva y la prueba T (p < 0,05). Resultados: La prevalencia de impactación fue del 5,4 %. La impactación bilateral con inclinación mesial fue la más frecuente. El lado izquierdo predominó en impactaciones unilaterales. El único parámetro dentoesquelético característico de impactación fue el ángulo de inclinación del 2MM con respecto al plano oclusal, con mayor severidad en el lado izquierdo. Conclusiones: Un ángulo igual o mayor a 112,94° podría indicar riesgo de impactación contra el primer molar mandibular permanente. Por lo tanto, este parámetro debería incluirse en el análisis radiográfico para el diagnóstico temprano de impactación del 2MM.

Background: Impactation of permanent mandibular second molars (2MM) occurs with significant variations according to the population group. In addition to the problems associated with it, they could require multiple and complex treatments. Therefore, the early diagnosis of an alteration in the 2MM eruption process is a must to reduce the impactation risk, the treatment difficulty and the occurrence of related problems in the populations. Purpose: To describe the 2MM impactation characteristics in an 8 to 15 year-old patient sample in Medellin, Colombia. Methods: This retrospective descriptive study evaluated 1 756 panoramic radiographs and 95 of them showed 2MM impactation. The latter were analyzed based on the sex, location in the mandible and type of inclination; 13 linear and angle measurings were then carried out in order to identify dental-skeletal parameters characteristic in the impactation side. The data analysis used descriptive statistics and a T test (p < 0.05). Results: The impactation prevalence was 5.4% and the bilateral impactation with mesial inclination was the most frequently found. Unilateral impactations prevailed in the left side of the mandible/maxilla. The only dental-skeletal parameter of impactation was the 2MM inclination angle regarding the occlusal plane, with a greater severity on the left side. Conclusions: An angle of 112.94° or greater could indicate an impactation risk on the permanent mandibular first molar. Therefore, this parameter should be included in the radiographic analysis when diagnosing the early 2MM impactation.

Comparação dos sistemas de retenção para overdenture / Comparison of different attachment systems for overdenture

As próteses totais convencionais inferiores são as mais difíceis de adaptar, devido à perda óssea ser maior e consequentemente à baixa estabilidade e pouca retenção. Entretanto, com o aparecimento dos implantes osse-ointegráveis surgiram os tratamentos com próteses do tipo overdenture, as quais oferecem melhor estabilidade e retenção. O objetivo deste trabalho foi comparar os três principais tipos de sistemas de retenção para a pró¬tese overdenture encontrada na literatura. Para isso, foram realizadas pesquisas com os termos "overdenture"; "attachment", "implant-supported", "dental prosthesis", "denture" e "oral rehabilitation" nas bases de dados PubMed, Science Direct e Scielo. Os sistemas barra-clipe e esférico apresentaram semelhanças estatísticas quanto à retenção e estabilidade. Já o sistema magnético apresentou pouca retenção e baixa estabilidade

The conventional lower total prosthesis is the most difficult dental prosthesis to adapt in the patients mouth, due to bone loss be greater in this region, which consequently decreases stability and retention of the prosthe¬sis. However, the appearance of osseointegrated implants gave rise to treatments with overdenture prostheses, which offer better stability and retention to the prostheses. The aim of this study was to compare the three main types of overdenture prosthesis restraint systems found in the literature. For this research, we used the terms: "overdenture"; "attachment", "implant-supported", "dental prosthesis", "denture" and "oral rehabilitation" in the databases of PubMed, Science Direct and Scielo. The clip bar and spherical systems presented statistical similarities regarding retention and stability. Already, the magnetic system presented little retention and low stability

Comparación de proporciones áuricas encontradas antes y después de la rehabilitación con prótesis totales / Comparative study of auric proportions found before and after rehabilitation with dentures

Introducción: La belleza tiene una "proporción ideal" que se presenta en ciertas formas geométricas de la naturaleza con las características de ser armónicas, simétricas y equilibradas. Según Ricketts "es necesario utilizar proporciones áuricas ya que son atractivas y recordadas en el sistema límbico como bellas, armónicas y equilibradas". Objetivo: comparar proporciones faciales en el paciente desdentado sin prótesis y después de la rehabilitación con prótesis totales. Métodos: se obtuvieron los datos de 41 pacientes rehabilitados en la Clínica Odontológica de Prótesis Totales del Departamento de Prótesis, de la Universidad de Chile. Ellos fueron fotografiados mediante el equipo de Cone beam computed volumetric tomography con escaneo facial integrado y luego se midieron y compararon tres proporciones faciales antes y después de la rehabilitación con prótesis removible, y se observó cómo estas proporciones se acercaban o alejaban de la proporción áurica. El análisis estadístico de los datos obtenidos se realizó utilizando el software STATA 11. Se aplicaron las pruebas de Shapiro-Wilk y t de Student. Resultados: en la proporción 1 antes de la rehabilitación, se observó que 51,2 por ciento de los pacientes presentó proporción áurica y después de la rehabilitación se obtuvo que 63,4 por ciento presentó proporción áurica. En la proporción 2 antes de la rehabilitación, se observó que 22 por ciento de los pacientes presentó proporción áurica y después de la rehabilitación se obtuvo que 17,1 por ciento presentó proporción áurica. En la proporción 3 antes de la rehabilitación, se observó que ningún paciente presentó una proporción áurica y después de la rehabilitación se obtuvo que 7,3 por ciento presentó proporción áurica. Conclusiones: en esta muestra se presenta un cambio significativo en las proporciones faciales encontradas antes y después de la rehabilitación con prótesis en el paciente adulto mayor. La proporción ángulo externo del ojo a Stomion, en proporción con Stomion a Menton es la que muestra mayor cercanía a la proporción áurica antes y después de la rehabilitación con prótesis totales(AU)

Introduction: beauty has an "ideal proportion" that occurs in certain shapes of nature with the characteristics of being harmonious, symmetrical and balanced. According to Ricketts, you need to use auric proportions as they are attractive and remembered in the limbic as beautiful, harmonious and balanced system. Objective: to compare facial auricle proportions in the edentulous patient without dentures and after rehabilitation with dentures. Methods: we obtained data of 41 patients rehabilitated with total dental prostheses at the Clinic Department of Prosthodontics, University of Chile. They were photographed by the team of Cone beam computed volumetric tomography with facial scanning integrated and then measured and compared three facial proportions before and after rehabilitation with removable prosthesis, watching these ratios approaching or receding from the auric proportion. Statistical analysis of the data was performed using software STATA version 11. The tests Shapiro-Wilk and Student-T test were applied. Results: in the facial proportion 1 before rehabilitation, was observed that 51.2 percent of patients have auric proportion and after rehabilitation was obtained that 63.4 percent had auric proportion. In the facial proportion 2 before rehabilitation, was observed that 22 percent of patients had auric proportion and after rehabilitation was obtained that 17.1 percent had auric proportion. In the facial proportion 3 before rehabilitation, was observed that no patient had auric proportion and after rehabilitation we found that 7.3 percent had auric proportion. Conclusions: in this sample shows a significant change in facial proportions found before and after prosthetic rehabilitation in the elderly patients. Proportion external angle of the eye Stomion in proportion to Stomion Menton is showing closer to the auric ratio before and after rehabilitation with dentures(AU)

Tratamiento de fracturas mandibulares / Treatment of mandibular fractures

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.

Quando a satisfação autorrelatada do paciente com a prótese implantossuportada mandibular influencia na colocação de uma prótese total fixa na maxila: os benefícios do planejamento e colocação 3D baseados na TCFC e nos guias estereolitográficos – acompanhamento de dois anos e 11 meses / When the self-reported patient satisfaction with implant-supported mandibular denture influences on the use of implant-supported maxillary prostheses: the benefi ts of a 3-D implant planning and placement based on CBCT and stereolithographic guides – two year and 11-month follow-up

Este relato mostra um paciente de 72 anos de idade onde sua prótese total inferior sobre implantes motivou-a para usar uma prótese total fixa na maxila. Após os procedimentos de TCFC e protéticos no plano de tratamento, guias estereolitográficos foram construídos para uma colocação de implantes dentários sem levantamento de retalho. Cinco implantes foram colocados nas regiões 14, 13, 11, 22, e 24 com torque de inserção de 32 Ncm. A prótese total fixa definitiva foi entregue em até 48 horas. Após dois anos e 11 meses, não foram registradas complicações. Quando adequadamente indicada, a cirurgia virtual guiada tem se tornado uma realidade efetiva para pacientes idosos.

This case reports on a 72 years-old patient whose complete mandibular implant-supported prosthesis motivated her to use a fi xed appliance in the maxilla. After CBCT and prosthodontic procedures for treatment planning, stereolithographic guides were constructed for a flapless dental implant placement. Five implants were placed in the regions of 14, 13, 11, 22 and 24 with a 32 Ncm insertion torque. The final maxillary implant-supported prosthesis was delivered until 48 hours. After two years and 11 months, no complications were reported. When properly indicated, virtual guided surgery has become an effective possibility for elderly patients.

Reemplazo articular temporomandibular debido a queratoquiste odontogénico / Temporomandibular joint replacement because of odontogenic keratocyst

Existen disímiles condiciones que hacen necesario el reemplazo articular temporomandibular; dentro de las más frecuentes se encuentran la anquilosis, la osteoatrosis, estadíos avanzados del Síndrome de disfunción temporomandibular, daño articular postrauma y procesos neoplásicos o tumorales. Los queratoquistes odontógenos que se agrupan para su estudio dentro de los quistes odontogénicos del desarrollo, representan cerca del 7 al 10 por ciento de todos los quistes maxilo-mandibulares. Se dice que tienen dos picos de incidencia entre la segunda y tercera década de vida y entre los 50 y 60 años de edad, con una ligera predilección por el sexo masculino. Aparece más frecuentemente en la región del tercer molar de la mandíbula con extensión a la rama ascendente El presente trabajo tuvo como objetivo mostrar el caso de un paciente masculino de 57 años de edad en el que fue necesario el reemplazo articular temporomandibular debido a un queratoquiste odontogénico que involucraba la totalidad de la rama mandibular derecha, incluyendo el proceso condíleo y coronoideo, así como el ángulo hasta el tercio posterior del cuerpo mandibular. Tras un año de realizada la intervención quirúrgica la evolución del paciente fue satisfactoria(AU)

Temporomandibular joint replacement is required in a variety of conditions. Among the most frequent are ankylosis, osteoarthrosis, advanced stages of the temporomandibular dysfunction syndrome, post-traumatic joint damage, and neoplastic or tumoral processes. Odontogenic keratocysts, which are classified as developmental odontogenic cysts for study purposes, constitute 7-10 per cent of all maxillomandibular cysts. Two peaks have been identified in their incidence: between the second and third decades of life, and between 50 and 60 years of age, with a slight predominance of the male sex. They are most common in the third molar area of the mandibule, with expansion to the ascending branch. A case is presented of a male 57-year-old patient requiring temporomandibular joint replacement due to an odontogenic keratocyst involving the entire right mandibular branch, including the condylar and coronoid processes, as well as the angle as far as the posterior third of the mandibular body. One year after surgery, the patient's evolution was satisfactory(AU)

Plate related complication after mandibular reconstruction / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the complications and factors associated with titanium plates in mandibular reconstruction with different methods.</p><p><b>METHODS</b>A retrospective analysis of 660 patients who received primary reconstruction of the mandible was conducted. The characters of the mandibular defect and methods of reconstruction were recorded. The complications and factors associated with the reconstruction were analyzed.</p><p><b>RESULTS</b>The majority of mandibular defect was in a shape of L (n = 324 ). The total complication rate was 14.7% (97/660), which included screw loosening 5.8% (38/660), plate fracture 3.3% (22/660), plate exposure 3.8% (25/660), infection 7.4% (49/660) and malunion or ununion 2.9% (19/660). The mandibular defects reconstructed by reconstructive plates had a higher complication rate than that by bone grafts. The complication rate was 10.8% (63/586) in cases reconstructed by bone grafts with miniplates. The complications were associated with radiation therapy and diabetes. Radiation therapy had a significant effect on plate exposure.</p><p><b>CONCLUSIONS</b>Reconstruction with bone grafts can minimize the rate of plate related complication. The complications were associated with radiation therapy and diabetes.</p>

Reconstrucción con placa 2.4 mm. angulada con cabeza condilar de articulación temporo-mandibular en fracturas compleja de mandíbula: reporte de un caso / Temporomandibular joint reconstruction with a 2.4 mm. angled plate with condylar head in a complex mandible fracture: a case report

El trauma maxilofacial es muy frecuente y se encuentra asociado a una alta incidencia de fracturas faciales en diferentes combinaciones. Este puede ser causado por hechos viales, violencia personal, prácticas deportivas y heridas por proyectil percutido por arma de fuego, siendo estas últimas, lesiones devastadoras que pueden comprometer la vida del paciente. Teniendo en cuenta que el Hospital Universitario de los Andes es uno de los centros asistenciales más importantes de Venezuela, en el manejo del trauma de alta energía, incluyendo el trauma facial, reportamos el caso de un paciente masculino de 33 años, remitido a esta institución por presentar trauma mandibular secundario a herida por arma de fuego, el cual generó una fractura compleja del ángulo, rama y cóndilo izquierdo de la mandíbula. Esta lesión fue resuelta a través de reducción directa, osteosíntesis y hemiartroplastia con un solo implante. Mediante este procedimiento se logró obtener un adecuado resultado funcional y estético. El principal objetivo, a favor preservar la biomecánica de la Articulación Temporomandibular (ATM) afectada, a través del uso de implantes y técnicas especiales, desarrolladas para tal fin

Maxillofacial trauma is very common and is associated with a high incidence of facial fractures in different combinations. This can be caused by traffic accidents, personal violence, sports, and gunshot wound, being devastating injuries that can compromise the patient’s life. The Hospital Universitario de Los Andes is one of the most important health centers in Venezuela in the management of high energy trauma, including facial trauma. We report the case of a 33 year old male pacient, received in this institution for a mandible trauma secondary to a gunshot wound, generating an angle, branch and the left condyle complex fracture of the mandible. This lesion was treated by direct reduction, osteosynthesis and hemiarthroplasty with a single implant. This procedure is able to obtain adequate functional and cosmetic results. The main objective was to preserve the biomechanics of the affected temporomandibular joint, through the use of implants and techniques developed for this purpose

Augmentation Genioplasty Using the Multiporous High Density Polyethylene(Medpor(R))

Microgenia is that the mental protuberance is small state because of symphysis did not developed properly while occlusion and size of mandible are normal. One or two-step sliding advancement genioplasty is mainly performed to make good aesthetic harmony with face, but in slight or moderate degree of microgenia patients who do not want general anesthesia or osteotomy, the multiporous high-density polyethylene(Medpor(R)) can be used. It is easy to carve and bend, and has a variety of size and shape to fit the contour of the chin anatomy. Under the local anesthesia. a vertical incision which can preserve mentalis muscle is made about 2 cm at inferior labial sulcus along inferior frenulum in the jaw midline. Subperiosteal dissection is performed to make a pocket. Seperated Medpor(R)s are inserted in each side and reassembled into one in the midline. To minimize bone erosion, implant has to be placed on the inferior side of mandible edge and fixed with screw. Bandage compression was applied for 3 days and antibiotics was treated for 7 days postoperatively. This technique has a small incision, easy procedure and faster recovery. During the follow-up period, there were no specific complications and patients were all satisfied to their result.

Application of computer aided design-computer aided manufacture technique in mandible defect reconstruction with individual titanium prosthesis / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the application of computer aided design-computer aided manufacture (CAD-CAM) technique in the reconstruction of mandible defect with individual titanium prosthesis.</p><p><b>METHODS</b>Six patients with large mandibular ramus and angle tumor were spiral CT scanned preoperatively, and the CAD-CAM was used to design and make individual titanium prosthesis for reconstructing the mandibular defects after resection of the tumor. The prosthesis were assembled during operation. Postoperative follow-up period was 9 - 38 months.</p><p><b>RESULTS</b>The design and manufacture of titanium prosthesis by use of CAD-CAM technique was convenient and the prosthesis fitted the defects very well. The outline of the face, the occlusion and function were restored. After 9 - 38 months of follow-up, the mandibular symmetry was good.</p><p><b>CONCLUSIONS</b>The application of CAD-CAM provided accurate simulation and fast manufacturing process for the titanium prosthesis in the repair of mandibular defect.</p>

Reabilitação com implantes para mandíbula posterior atrófica: relato de caso clínico / Rehabilitation with implants to the posterior atrophic mandible: case report

Os implantes osseointegrados curtos têm sido utilizados nos últimos anos como uma alternativa confi ável para a reabilitação de rebordos atrésicos em altura. Neste artigo, um caso clínico ilustra a discussão da literatura recente que corrobora o uso de implantes curtos em detrimento a técnicas cirúrgicas reconstrutivas como os enxertos.

Reverse engineering and rapid prototyping technique for restoration of mandibular bone defect / 生物医学工程学杂志

The application principle and procedure of reverse engineering and rapid prototyping techniques are introduced in this paper. The description is concentrated on the applications of the above techniques in medical field, especially in reconstructive surgery of mandibular bone defect.

Remplazo total de mandíbula con alambre Kirschner / Total jaw replacement with Kirschner wire

El hueso mandibular, por su disposición anatómica en la región facial, aporta considerables requisitos estéticos, por lo que cualquier evento que altere su morfofisiología repercute en la apariencia personal y en funciones elementales del ser humano. Se presenta el caso clínico de una paciente en quien una osteólisis masiva mandibular no permitió la conservación de este y mediante la reconstrucción simultánea con alambre tipo Kirschner, se posibilitó un resultado estético y funcional aceptables(AU)

The mandibular bone due to its anatomical disposition in the facial region presents considerable aesthetic requirements, since any event altering its morphophysiology influences on the personal appearance and on elementary functions of the human being. The clinical case of a patient in whom a massive mandibular osteolysis did not allow its preservation is presented. An acceptable aesthetic and functional result was possible by the simultaneous reconstruction with Kirschner wire(AU)

Osteointegração da hidroxiapatita sintética no processo alveolar da mandíbula de cães: aspectos clínicos e radiográficos / Osteointegration of synthetic hydroxyapatite in alveolar process of the jaw of dogs: clinical and radiographic aspects

Avaliou-se o efeito da hidroxiapatita sintética na regeneração do osso alveolar e o efeito no tecido vivo de cães. Em dois grupos de 14 cães adultos hígidos, pesando entre 10 e 15kg, foram criados defeitos de 6 x 5mm na superfície vestibular do processo alveolar mandibular direito até atingir a raiz do quarto pré-molar. Em um grupo (tratado), o defeito foi preenchido com hidroxiapatita sintética; o grupo sem tratamento foi usado como controle. Efetuaram-se avaliações clínicas diárias durante uma semana, avaliações radiográficas após a cirurgia e aos oito, 21, 42, 60, 90 e 120 dias do pós-operatório. Vinte e quatro cães apresentaram inflamação, sendo a recuperação no grupo tratado mais lenta. Todos os animais tiveram sangramento com a hidroxiapatita. No grupo-controle houve aumento crescente da radiopacidade dos defeitos, no entanto, aos 120 dias do pós-operatório, os defeitos ainda eram visíveis. No grupo tratado, inicialmente a radiopacidade foi maior que a do osso normal, com diminuição gradual até se tornar semelhante à do osso vizinho, 60 dias após a cirurgia. A hidroxiapatita T290800-1 acelerou o preenchimento do defeito provocado no processo alveolar e acarretou inflamação e hemorragia gengival, o que, no entanto, não contra-indicou o seu uso.

The effect of the synthetic hydroxyapatite on the regeneration of the alveolar bone of dogs and on the alive tissue were evaluated. In two groups of 14 adult healthy dogs, weighing from 10 to 15kg, some defects around 6 x 5mm were provoked on the vestibular surface of the right jaw alveolar process until reaching the root of the forth premolar. In one group, the defect was infilled with synthetic hydroxyapatite. The no treated group dogs were used as control. Clinical evaluations were daily performed over one week, as well as radiographic evaluations after surgery, and on 8, 21, 42, 60, 90 and 120 days after surgery. Twenty-four dogs showed inflammation and the recovery in the treated group was slower than in the control group. Bleeding at the presence of hydroxyapatite was observed in all the animals. The radiographic examination presented an increasing radiopacity in the control group; however, this defect was still visible on day 120 after operation. Initially, in the treated group, radiopacity was higher than that of the normal bone and a gradual decrease occurred until becoming similar to the adjacent bone on day 60 days after surgery. The hydroxyapatite T290800-1 accelerated the infilling of the defect provoked in the alveolar process and caused gingival inflammation and hemorrhage; however, this does not contraindicate its use.

A study on individual mandibular prostheses according to 3D reconstruction of CT images and CNC simulation method / 中国医疗器械杂志

The new method of manufacturing individual mandibular prostheses, in combination with CT data and CNC technique, can duplicate bone tissues accurately, and can have the individual mandibular prosthesis made to order, and repair the mandibular defect (especially the lager mandibular segmental defect).

Carga imediata em mandíbulas edêntulas: uma alternativa reabilitadora com barras pré-fabricadas. Descrição da técnica e caso clínico / Immediate loading in edentulous mandible: a rehabilitation alternative with pre fabricated prosthetic frameworks. Description of the technique and clinical case

A carga imediata em Implantodontia é um conceito bem definido na literatura, com elevados índices de sucesso, desde que se estabeleça um protocolo cirúrgico adequado atingindo estabilidade primária, ausência de trauma cirúrgico e uma distribuição espacial dos implantes que favoreça a biomecânica. A reabilitação protética deve manter os implantes esplintados por meio de barras rígidas, preferencialmente, com assentamento passivo, evitando, dessa forma, micromovimentações que possam induzir a formação de uma cápsula fibrosa. No entanto, existe uma grande dificuldade na obtenção desta barra, em função da fundição, pontos de solda e necessidade de metais específicos. Essas considerações descritas fizeram com que novas técnicas fossem desenvolvidas com o objetivo de facilitar o tratamento, dentre elas a utilização de cirurgias guiadas e barras protéticas, pré-fabricadas em metal biocompatível, que possibilitam que o processo de reabilitação bucal do paciente seja realizado em um único dia, além de diminuir consideravelmente o custo. O objetivo deste artigo é descrever a técnica Neopronto que é um sistema para prótese tipo protocolo inferior, ilustrando com um caso clínico

Reconstruction correction to Reconstrction of mandibular bone defects by using the techniques correction to teachniques of the reverse engineering and rapid prototyping / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility of designing and fabricating customized titanium bone substitutes to restore mandibular bone defects using reverse engineering (RE) and rapid prototyping (RP) techniques.</p><p><b>METHODS</b>Titanium tray for mandibular defects were designed and fabricated through multi-step procedures of reverse engineering and rapid prototyping, then in operation it was filled with cancellous bone and fixed.</p><p><b>RESULTS</b>The bone substitutes fabricated by this method had been successfully put into clinical use for maxillofacial surgery in 2 patients and got a satisfactory result.</p><p><b>CONCLUSIONS</b>Reverse engineering combining with rapid prototyping could accomplish the design and manufacture of implant for the restoration of mandibular bone defects.</p>