Effectiveness of disk repositioning and suturing comparing open-joint versus arthroscopic techniques: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to present a systematic review of the effectiveness of discopexy in managing internal derangement of the temporomandibular joint (TMJ). STUDY DESIGN: We searched MEDLINE through PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials and grey literature accessed through Google Scholar, Openthesis, and hand-searching from inception to July 2020. The search strategy yielded 363 potentially relevant studies. After screening titles and abstracts, 41 full-text articles were assessed for eligibility and 7 studies were included in the meta-analysis. RESULTS: There was an overall decrease in visual analog scale (VAS) pain score of 4.59 cm (95% confidence interval [CI], 2.03-7.16; P < .001) during the follow-up time and an overall increase of 10 mm (95% CI, 6.93-13.01; P < .001) in mouth opening after TMJ surgeries with discopexy. CONCLUSIONS: The available evidence showed an overall decrease in VAS pain score and an improvement in mouth opening after TMJ surgeries with discopexy. Changes in maximal interincisal opening were greater after arthroscopic disk repositioning compared to open-joint procedure.

Can palatal splint improve stability of segmental Le Fort I osteotomies?

OBJECTIVES: The purpose of this study was to evaluate the influence of a palatal splint on stability in multi-segment maxillary osteotomies. SETTING AND SAMPLE POPULATION: Retrospective series of fifty-one adult patients, consecutively operated with bilateral sagittal split osteotomy (BSSO) and three-piece maxillary osteotomies, divided according to the use of a palatal splint (Group 1, n = 30) or no palatal splint (Group 2, n = 21). MATERIALS AND METHODS: Maxillary surgical casts (T1) and post-retention casts (T2), taken at least six months after discontinuation of orthodontic retention, were digitized (MicroScribe-3DX), measured and compared. Fifty-one landmarks were identified on the maxillary, transverse dimension changes and arch length were calculated. Longitudinal changes in all measurements were assessed by t test. RESULTS: Post-surgical transverse instability in group 1 ranged from 0.3 ± 0.4 to -1.3 ± 0.2 mm and was statistically significantly smaller than in group 2 that ranged from -1.0 ± 0.3 to -2.5 ± 0.5 mm. CONCLUSIONS: The use of a palatal splint after segmental Le Fort I maxillary osteotomy improved transverse stability in the posterior region. The post-surgical transverse instability occurred only between canine gingival points and thus suggesting no clinical relevance.

Flutracking weekly online community survey of influenza-like illness annual report, 2016

Flutracking is a national online community influenza-like illness (ILI) surveillance system that monitors weekly ILI attack rates and seriousness of disease in the Australian community. This article reports on the 2016 findings. From 2015 to 2016 there was an 11.4% increase in participants to 30,998 completing at least one survey with a peak weekly response of 27,094 participants and a minimum weekly response of 26,123. The 2016 Flutracking national weekly percentage of participants with fever and cough peaked in late August at 2.7%, one week earlier than the national counts of laboratory confirmed influenza peaked. A lower percentage of participants took 2 or more days off from work or normal duties and sought medical advice in 2016 (peak level 1.6% and 1.0% respectively) compared with 2015 (peak level 2.0% and 1.3% respectively). Flutracking fever and cough peaked in the same week as death rates for influenza and pneumonia recorded by the NSW Registry of Births, Deaths and Marriages. The percentage of participants aged 0 to 14 years with cough and fever was higher than all other age groups in 2016. Overall, Flutracking surveillance demonstrated that the attack rates and seriousness of disease for the 2016 season at the community level were lower than 2015 and 2014.

From ideal occlusion to dentofacial deformity and back to ideal: an osteochondroma treatment with lingual orthodontics.

This original case report describes the morphologic changes caused by a mandibular condylar osteochondroma (OC) on a female patient and its treatment. The changes were identified by comparing her final records from a previous orthodontic treatment, without the presence of OC, to records taken before a second treatment, with a developed OC. The diagnostics and treatment for the OC and its consequences were described and discussed in this paper. Treatment included orthodontics with a lingual appliance, low condylectomy on the affected side, high condylectomy on the contralateral side, bilateral disc repositioning and orthognathic surgery. It was concluded that the OC caused a Class III subdivision malocclusion, midline deviation and an edge-to-edge bite on the left side, a cant of the occlusal plane on the Z-axis and a deviation of the pogonion to the left. Treatment was successful and stable long term (36 months) with good occlusal, aesthetical and functional results.

Insights From Flutracking: Thirteen Tips to Growing a Web-Based Participatory Surveillance System.

Flutracking is a weekly Web-based survey of influenza-like illness (ILI) in Australia that has grown from 400 participants in 2006 to over 26,000 participants every week in 2016. Flutracking monitors both the transmission and severity of ILI across Australia by documenting symptoms (cough, fever, and sore throat), time off work or normal duties, influenza vaccination status, laboratory testing for influenza, and health seeking behavior. Recruitment of Flutrackers commenced via health department and other organizational email systems, and then gradually incorporated social media promotion and invitations from existing Flutrackers to friends to enhance participation. Invitations from existing participants typically contribute to over 1000 new participants each year. The Flutracking survey link was emailed every Monday morning in winter and took less than 10 seconds to complete. To reduce the burden on respondents, we collected only a minimal amount of demographic and weekly data. Additionally, to optimize users' experiences, we maintained a strong focus on "obvious design" and repeated usability testing of naïve and current participants of the survey. In this paper, we share these and other insights on recruitment methods and user experience principles that have enabled Flutracking to become one of the largest online participatory surveillance systems in the world. There is still much that could be enhanced in Flutracking; however, we believe these principles could benefit others developing similar online surveillance systems.

Orthodontic Traction of Impacted Canine Using Cantilever.

The impaction of the maxillary canines causes relevant aesthetic and functional problems. The multidisciplinary approach to the proper planning and execution of orthodontic traction of the element in question is essential. Many strategies are cited in the literature; among them is the good biomechanical control in order to avoid possible side effects. The aim of this paper is to present a case report in which a superior canine impacted by palatine was pulled out with the aid of the cantilever on the Segmented Arch Technique (SAT) concept. A 14.7-year-old female patient appeared at clinic complaining about the absence of the upper right permanent canine. The proposed treatment prioritized the traction of the upper right canine without changing the occlusion and aesthetics. For this, it only installed the upper fixed appliance (Roth with slot 0.018), opting for SAT in order to minimize unwanted side effects. The use of cantilever to the traction of the upper right canine has enabled an efficient and predictable outcome, because it is of statically determined mechanics.

Disc repositioning: does it really work?

Although limited, there is evidence to support the assumption that temporomandibular joint (TMJ) articular disc repositioning indeed works; to date, there is no evidence that TMJ articular disc repositioning does not work. Despite the controversy among professionals in private practice and academia, TMJ articular disc repositioning is a procedure based on (still limited) evidence; the opposition is based solely on clinical preference and influenced by the ability to perform it or not.

Temporomandibular joint condylar changes following maxillomandibular advancement and articular disc repositioning.

PURPOSE: To evaluate condylar changes 1 year after bimaxillary surgical advancement with or without articular disc repositioning using longitudinal quantitative measurements in 3-dimensional (3D) temporomandibular joint (TMJ) models. METHODS: Twenty-seven patients treated with maxillomandibular advancement (MMA) underwent cone-beam computed tomography before surgery, immediately after surgery, and at 1-year follow-up. All patients underwent magnetic resonance imaging before surgery to assess disc displacements. Ten patients without disc displacement received MMA only. Seventeen patients with articular disc displacement received MMA with simultaneous TMJ disc repositioning (MMA-Drep). Pre- and postsurgical 3D models were superimposed using a voxel-based registration on the cranial base. RESULTS: The location, direction, and magnitude of condylar changes were displayed and quantified by graphic semitransparent overlays and 3D color-coded surface distance maps. Rotational condylar displacements were similar in the 2 groups. Immediately after surgery, condylar translational displacements of at least 1.5 mm occurred in a posterior, superior, or mediolateral direction in patients treated with MMA, whereas patients treated with MMA-Drep presented more marked anterior, inferior, and mediolateral condylar displacements. One year after surgery, more than half the patients in the 2 groups presented condylar resorptive changes of at least 1.5 mm. Patients treated with MMA-Drep presented condylar bone apposition of at least 1.5 mm at the superior surface in 26.4%, the anterior surface in 23.4%, the posterior surface in 29.4%, the medial surface in 5.9%, or the lateral surface in 38.2%, whereas bone apposition was not observed in patients treated with MMA. CONCLUSIONS: One year after surgery, condylar resorptive changes greater than 1.5 mm were observed in the 2 groups. Articular disc repositioning facilitated bone apposition in localized condylar regions in patients treated with MMA-Drep.

Coronoid process hyperplasia: an unusual cause of mandibular hypomobility.

A large number of disorders affecting the masticatory system can cause restriction of mouth opening. The most common conditions related to this problem are those involving the temporomandibular joint (TMJ) and the masticatory muscles, when facial pain also is an usual finding. Congenital or developmental mandibular disorders are also possible causes for mouth opening limitation, although in a very small prevalence. Coronoid process hyperplasia (CPH) is an example of these cases, characterized by an excessive coronoid process growing, where mandibular movements become limited by the impaction of this structure on the posterior portion of the zygomatic bone. This condition is rare, painless, usually bilateral and progressive, affecting mainly men. Diagnosis of CPH is made based on clinical signs of mouth opening limitation together with imaging exams, especially panoramic radiography and computerized tomography (CT). Treatment is exclusively surgical. This paper presents a case of a male patient with bilateral coronoid process hyperplasia, initially diagnosed with bilateral disk displacement without reduction, and successfully treated with intraoral coronoidectomy. It is emphasized the importance of differential diagnosis for a correct diagnosis and, consequently, effective management strategy.

Coronoid process hyperplasia: an unusual cause of mandibular hypomobility

A large number of disorders affecting the masticatory system can cause restriction of mouth opening. The most common conditions related to this problem are those involving the temporomandibular joint (TMJ) and the masticatory muscles, when facial pain also is an usual finding. Congenital or developmental mandibular disorders are also possible causes for mouth opening limitation, although in a very small prevalence. Coronoid process hyperplasia (CPH) is an example of these cases, characterized by an excessive coronoid process growing, where mandibular movements become limited by the impaction of this structure on the posterior portion of the zygomatic bone. This condition is rare, painless, usually bilateral and progressive, affecting mainly men. Diagnosis of CPH is made based on clinical signs of mouth opening limitation together with imaging exams, especially panoramic radiography and computerized tomography (CT). Treatment is exclusively surgical. This paper presents a case of a male patient with bilateral coronoid process hyperplasia, initially diagnosed with bilateral disk displacement without reduction, and successfully treated with intraoral coronoidectomy. It is emphasized the importance of differential diagnosis for a correct diagnosis and, consequently, effective management strategy.

Um grande número de distúrbios pode provocar limitação no grau de abertura bucal. As condições mais comuns relacionadas com esse problema são aquelas que envolvem a articulação temporomandibular (ATM) e músculos mastigatórios, em que, além da limitação, a dor facial é um achado comum. Distúrbios congênitos ou de desenvolvimento da mandíbula também são possíveis causas para limitação de abertura bucal, embora possuam uma baixa prevalência. A hiperplasia do processo coronóide (HPC) é um exemplo dessas causas, caracterizada por um desenvolvimento excessivo do processo coronóide, em que o movimento mandibular torna-se limitado pela impacção dessa mesma estrutura na parte posterior do osso zigomático. Esta condição é rara, indolor, geralmente bilateral e progressiva, afetando principalmente homens. O diagnóstico de HPC é feito por meio dos sinais clínicos de abertura bucal limitada associado com exames de imagem, especialmente a radiografia panorâmica e tomografia computadorizada (TC). O tratamento é exclusivamente cirúrgico. O objetivo desse artigo é apresentar um caso de paciente do sexo masculino com hiperplasia bilateral do processo coronóide, inicialmente diagnosticado com deslocamento de disco sem redução bilateral, e tratado com sucesso com coronoidectomia intraoral. Assim, é enfatizada a importância do diagnóstico diferencial para um correto diagnóstico e, consequentemente, estratégias efetivas de tratamento.

Estabilidade sagital da condiloplastia associada à cirurgia ortognática para o tratamento do osteocondroma mandibular / Post surgical stability of conservative condylectomy for treatment of osteochondroma of the mandibular condyle

O propósito deste estudo foi avaliar alterações das estruturas esqueléticas,dentárias e a estabilidade da técnica da condiloplastia, reposicionamento do disco articular e cirurgia ortognática como tratamento integral do paciente portador de osteocondroma condilar. Foram analisadas telerradiografias laterais de 15 pacientes (12 femininos, três masculinos), idade média de 32,3 anos (entre, 13 e 56 anos), com osteocondroma condilar ativo unilateral consecutivamente tratado. Os pacientes foram submetidos à condiloplastia,reposicionamento do disco articular e cirurgia ortognática simultânea. O acompanhamento pós-cirúrgico foi de 19 meses em média. As telerradiografias da amostra foram tomadas em três intervalos: pré-cirúrgico (T1). pós-cirúrgico imediato (T2) e pós-cirúrgico tardio (T3) e avaliadas por meio da análise cefalométrica. No pós-cirúrgico imediato observou-se diminuição da inclinação do plano oclusal em -2,85° ± 4,53°, o complexo maxilomandibulargirou no sentido anti-horário com avanço do ponto Me em 5,32 ± 5,58 mm, pogonio 4,99 ± 5,15 mm, ponto B 3,41 ± 4,18 mm e ponto A 1,00 ± 1,54 mm. O acompanhamento em longo prazo mostrou que houve pequenas mudanças na sobremordida (-0,56 ± 0,51mm) e no ângulo SNGoMe (0,93° ± 1,53°). O ponto Me mostrou instabilidade horizontal de -1,21 ± 1,94 mm e o ponto ENP apresentou instabilidade vertical de -1,48 ± 1,67 mm. A proservação em longo prazo mostrou sólida estabilidade dentoesquelética na maioria dasáreas estudadas com instabilidade isolada horizontal do ponto Me e vertical do ponto ENP que não foram relacionadas com a recidiva do tumor.

The aim of this study was to evaluate the stability of the conservative condylectomy technique and articular disc repositioning as the surgical treatment approach for management of mandibular condylar osteochondroma, with appropriate Orthognathicsurgery. Fifteen patients (12 females and 3 males), average age of 32.3 years (range, 13 to 56 yeers), with unilateral active osteochondroma of the mandibular condyle were analyzed. All patients underwent conserva tive condylectomy, recontouring of the remaining condylarneck stump and articular disc repositioned and indicated orthognatic surgical procedures. Average post surgical follow-up was 19 months. Each patient's lateral cephalograms weretraced at 3intervals (presurgery, immediate post surgery and long-term follow-up). Immediate after surgery the oclusal plane angle decreased -2.8 ± 4.50, the maxillomandibular complexrotated counter-clockwise with advancement at menton 5.3 ± 5.6 mm, pogonion 5.0 ± 5.1 mm, B point 3.4 ± 4.2 mm and A point 1.0 ± 1.5 mm. The long-term follow-up showedsigniticant changes in overbite (-0.6 ± 0.5 mm) and SNGoMe (0,93° ± 1,53°). Horizontally and vertically small instabilities occurred in Me (-1.21 s: 1.94 mm) and PNS (-1.48 ± 1.67mm) respectively. The treatment protocol studied produced counterclockwise rotation andmaxillofacial mandibular advancement. The long-term follow-up showed solid dental and skeletal stability with horizontal instability of Me and PNS in the vertical direction.

Single-stage comprehensive surgical treatment of the rheumatoid arthritis temporomandibular joint patient.

PURPOSE: To prospectively evaluate the outcomes of single-stage reconstruction of patients with rheumatoid arthritis (RA) with temporomandibular joint (TMJ) pathologic features and an associated dentofacial deformity. PATIENTS AND METHODS: Fifteen patients (12 females, 3 males) with RA underwent TMJ reconstruction, with or without a Le Fort I osteotomy in a single operation. Clinical and radiographic examinations were performed before surgery, immediately after surgery, and at the longest follow-up intervals. Numeric analog scales were used for subjective evaluation of TMJ pain, jaw function, diet, and disability. The maximal interincisal opening, lateral excursions, and TMJ crepitus were recorded at each visit. Standardized cephalometric acetate tracings were superimposed to assess for surgical (immediately after surgery compared with before surgery) and postoperative (longest follow-up interval compared with immediately after surgery) changes. RESULTS: The average patient age was 27.4 years (range 15 to 61), and the follow-up was 34.3 months (range 10 to 77). At the longest follow-up interval, all 15 patients had had a statistically significant reduction in the incidence and severity of TMJ pain and headaches. The average maximal interincisal opening increased after surgery, but the difference was not statistically significant. Lateral excursions decreased significantly after surgery. Dietary restrictions and disability were significantly improved, and TMJ crepitus had reduced significantly. The average advancement at point B was 21.7 mm (range 14 to 28), and the postoperative change at the longest follow-up interval was 0.1 mm (range 0 to 1). The average pogonion advancement was 29.2 mm (range 19.5 to 38), with a postoperative change of 0.2 mm (range 0 to 1). The average gonion vertical lengthening was 20.7 mm (range 10.5 to 29) with a postoperative change of 1.4 mm (range 0 to 4.5). The average occlusal plane angle change was a decrease of 20.7 degrees (range 16 degrees to 26 degrees), with a postoperative change of 0.4 degrees (range 0 degrees to 2 degrees). Of the 15 patients, 10 had undergone maxillary orthognathic surgery performed at the same operation. The average advancement of these 10 patients at point A was 3 mm (range 2 to 7), and the postoperative change was 0.5 mm (range 0 to 1). CONCLUSIONS: Surgical correction of rheumatoid-associated TMJ disease and the resulting dentofacial deformity can successfully be performed in a single operation using custom-made TMJ total joint prostheses to reconstruct the TMJs and advance the mandible, with maxillary orthognathic surgery and genioplasty performed at the same operation when indicated. The significant reduction in TMJ dysfunction symptoms and the long-term stability of the orthognathic surgery movements show the benefits and predictability of treating these complex patients with this treatment protocol.

Orthognathic surgery in the young cleft patient: preliminary study on subsequent facial growth.

PURPOSE: This study evaluated the long-term effects of orthognathic surgery on subsequent growth of the maxillomandibular complex in the young cleft patient. PATIENTS AND METHODS: We evaluated 12 young cleft patients (9 male and 3 female patients), with a mean age of 12 years 6 months (range, 9 years 8 months to 15 years 4 months), who underwent Le Fort I osteotomies, with maxillary advancement, expansion, and/or downgrafting, by use of autogenous bone or hydroxyapatite grafts, when indicated, for maxillary stabilization. Five patients had concomitant osteotomies of the mandibular ramus. All patients had presurgical and postsurgical orthodontic treatment to control the occlusion. Radiographs taken at initial evaluation (T1) and presurgery (T2) were compared to establish the facial growth vector before surgery, whereas radiographs taken immediately postsurgery (T3) and at longest follow-up (T4) were used to determine postsurgical growth. Each patient's lateral cephalograms were traced, and 16 landmarks were identified and used to compute 11 measurements describing presurgical and postsurgical growth. RESULTS: Before surgery, all patients had relatively normal growth. After surgery, cephalograms showed statistically significant growth changes from T3 to T4, with the maxillary depth decreasing by -3.3 degrees +/- 1.8 degrees , Sella-nasion-point A by -3.3 degrees +/- 1.8 degrees, and point A-nasion-point B by -3.6 degrees +/- 2.8 degrees. The angulation of the maxillary incisors increased by 9.2 degrees +/- 11.7 degrees. Of 12 patients, 11 showed disproportionate postsurgical jaw growth. Maxillary growth occurred predominantly in a vertical vector with no anteroposterior growth, even though most patients had shown anteroposterior growth before surgery. The distance increased in the linear measurement from nasion to gnathion by 10.3 +/- 7.9 mm. Four of 5 patients operated on during the mixed dentition phase had teeth that erupted through the cleft area. A variable impairment of postoperative growth was seen with the 2 types of grafting material used. No significant difference was noted in the effect on growth in patients with unilateral clefts versus those with bilateral clefts. The presence of a pharyngeal flap was noted to adversely affect growth, whereas simultaneous mandibular surgery did not. After surgery, 11 of 12 patients tended toward a Class III end-on occlusal relation. CONCLUSIONS: Orthognathic surgery may be performed on growing cleft patients when mandated by psychological and/or functional concerns. The surgeon must be cognizant of the adverse postsurgical growth outcomes when performing orthognathic surgery on growing cleft patients with the possibility for further surgery requirements. Performing maxillary osteotomies on cleft patients would be more predictable after completion of facial growth.

Autologous fat grafts placed around temporomandibular joint total joint prostheses to prevent heterotopic bone formation.

This study evaluated 1) the efficacy of packing autologous fat grafts around temporomandibular joint (TMJ) total joint prosthetic reconstructions to prevent fibrosis and heterotopic bone formation and 2) the effects on postsurgical joint mobility and jaw function. One hundred fifteen patients (5 males and 110 females) underwent TMJ reconstruction with total joint prostheses and simultaneous fat grafts (88 bilateral and 27 unilateral) for a total of 203 joints. The abdominal fat grafts were packed around the articulating portion of the joint prostheses after the fossa and mandibular components were stabilized. Patients were divided into two groups: group 1 (n = 76 joints) received Christensen total joint prostheses, and group 2 (n = 127 joints) received TMJ Concepts total joint prostheses. Clinical and radiographic assessments were performed before surgery, immediately after surgery, and at long-term follow-up. In group 1, maximal incisal opening (MIO) increased 3.5 mm, lateral excursions (LE) decreased 0.2 mm, and jaw function improved 1.9 levels. In group 2, MIO increased 6.8 mm, LE decreased 1.4 mm, and jaw function improved 2.4 levels. The improvement for MIO and patient perception of jaw function in both groups was statistically significant; no significant difference was found for LE. There was no radiographic or clinical evidence of heterotopic calcifications or limitation of mobility secondary to fibrosis in either group. Twenty-five Christensen prostheses (33%) were removed because of device failure and/or metal hypersensitivity; no fibrosis or heterotopic bone formation was seen at surgical removal. Four TMJ Concepts prostheses (3%) were removed because of metal hypersensitivity. In all instances, removal of the prostheses was unrelated to the autologous fat grafting. Ten patients (8.7%) developed complications involving the fat donor site: two patients (1.8%) developed abdominal cysts requiring surgery, and eight patients (6.9%) developed seroma formation requiring aspiration. Autologous fat transplantation is a useful adjunct to prosthetic TMJ reconstruction to minimize the occurrence of excessive joint fibrosis and heterotopic calcification, consequently providing improved range of motion and jaw function.

Postsurgical stability of counterclockwise maxillomandibular advancement surgery: affect of articular disc repositioning.

PURPOSE: This study evaluated the affect of disc displacement and articular disc repositioning on stability after surgical counterclockwise rotation and advancement of the maxillomandibular complex. PATIENTS AND METHODS: A total of 72 patients (59 females, 13 males), with an average age of 30 years (range, 15 to 60 years) were evaluated. The patients were divided into 3 groups. Group 1 (G1; n = 21), with healthy temporomandibular joints (TMJs), underwent double-jaw surgery only. Group 2 (G2; n = 35), with articular disc dislocation, underwent articular disc repositioning using the Mitek anchor (Mitek Surgical Products, Westwood, MA) technique concomitantly with orthognathic surgery. Group 3 (G3; n = 16), with articular disc dislocation, underwent orthognathic surgery only. Average postsurgical follow-up was 31 months. Each patient's lateral cephalograms were traced, digitized twice, and averaged to estimate surgical changes and postsurgical stability. RESULTS: After surgery, the occlusal plane angle was decreased significantly in all 3 groups: by -6.3 +/- 5.0 degrees in G1, by -9.6 +/- 4.8 degrees in G2, and by -7.1 +/- 4.8 degrees in G3. The maxillomandibular complex was advanced and rotated counterclockwise similarly in all 3 groups, with advancement at the menton of 12.4 +/- 5.5 mm in G1, 13.5 +/- 4.3 mm in G2, and 13.6 +/- 5.0 mm in G3; advancement at the B point of 9.5 +/- 4.9 mm in G1, 10.2 +/- 3.7 mm in G2, and 10.8 +/- 3.7 mm in G3; and advancement at the lower incisor edge of 7.1 +/- 4.6 mm in G1, 6.6 +/- 3.2 mm in G2, and 7.9 +/- 3.0 mm in G3. Postsurgery, the occlusal plane angle increased in G3 (2.6 +/- 3.8 degrees ; 37% relapse rate) but remained stable in G1 and G2. Postsurgical mandibular changes in the horizontal direction demonstrated a significant relapse in G3 at the menton (-3.8 +/- 4.1 mm; 28%), the B point (-3.0 +/- 3.4 mm; 28%), and the lower incisor edge (-2.3 +/- 2.1 mm; 34%) but remained stable in G1 and G2. CONCLUSIONS: Maxillomandibular advancement with counterclockwise rotation of the occlusal plane is a stable procedure for patients with healthy TMJs and for patients undergoing simultaneous TMJ disc repositioning using the Mitek anchor technique. Those patients with preoperative TMJ articular disc displacement who underwent double-jaw surgery and no TMJ intervention experienced significant relapse.

Queratocisto odontogênico em um paciente ortodôntico / Odontogenic keratocyst in an orthodontic patient

A interpretação radiográfica durante o tratamento ortodôntico, avaliando a forma dentária, posição, seqüência de erupção, a presença de espaço e outros fatores, é uma prática rotineira entre os ortodontistas. Porém, quando alterações ósseas de pequena dimensão passam despercebidas, sua evolução pode dificultar o tratamento e oferecer maiores riscos para pacientes. O presente trabalho tem como objetivo o relato de caso de um queracisto odontogênico diagnosticado tardiamente em um paciente ortodôntico, analisando seus aspectos clínicos, histopatológicos e radiográficos. A lesão era totalmente assintomática e na imagem radiográfica inicial observa-se área radiolúcida unilocular com limites nítidos representado por um halo fino e radiopaco na região do dente 38. A abordagem cirúrgica constou de biópsia incisional com marsupialização da lesão para adequada descompressão, seguida de enucleação e extração dos dentes acometidos. O diagnóstico definitivo foi estabelecido após o exame histopatológico, fundamental para a determinação precisa das variantes histológicas e dos índices de recorrência e agressividade da lesão. A proservação de 1 ano mostrou adequada reparação óssea na área cirúrgica, denunciando o sucesso da técnica realizada. A minunciosa análise radiográfica, avaliação de laudos e um adequado encaminhamento pelo ortodontista, são de extrema importância para procedimentos menos invasivos em lesões ósseas diagnosticadas precocemente.

Prevalência da parede superior do canal da mandíbula em radiografias panorâmicas de pacientes desdentados de ambos os gêneros / Prevalence of superior wall of mandibular canal, in panoramic radiographs, in edentulous patients of both genders

A precisa localização do canal da mandíbula e do forame mentual tornou-se uma necessidade aos implantodontistas devido às possibilidades de injúria ao feixe neurovascular. O objetivo deste trabalho foi avaliar a prevalência da presença da parede superior do canal da mandíbula, segundo os lados direito e esquerdo, em radiografias panorâmicas de pacientes desdentados totais de ambos os gêneros. Duzentos e cinqüenta e duas radiografias foram interpretadas por um examinador em duas situações. Estimativas de concordância intra-examinador, por ponto, para os lados direito e esquerdo foram de, respectivamente, k=0,8017 e k=0,8048, semelhantes entre si. As prevalências da presença da parede superior do canal da mandíbula, para os gêneros masculino e feminino, foram de respectivamente 42,31 por cento e 36,78 por cento, sendo de 38,49 por cento para a amostra total. A faixa etária de 21 a 49 anos apresentou prevalência de 39,51 por cento, semelhante à verificada para a de 50 anos e mais (38,01 por cento). Concluindo, a prevalência foi semelhante para os dois gêneros e segundo a faixa etária. a reprodutibilidade intra-examinador na detecção da parede superior do canal da mandíbula para os lados direito e esquerdo foi considerada boa, não havendo diferença significativa segundo lado

Mercado de trabalho: avaliaçäo da relaçäo habitante/cirurgiäo-dentista no estado do Paraná / Work market: estimation of the resident/dentist relation from the Paraná State

O perfil da Odontologia brasileira atual torna necessária, por parte do cirurgiäo-dentista (CD), a procurapor cidades onde a proporçäo Habitante/CD seja favorável, associado ao nível sócioeconômico da área, observando características favoráveis à instalaçäo desses profissionais. Diante desse fato, este trabalho tem por objetivo analisar a relaçäo habitante/CD e habitante/especialista nos diferentes municípios do estado do Paraná, além de avaliar a distribuiçäo das entidades da área odontológica nos diferentes municípios, ano ano 2000. Para este estudo, foram utilizados cadastros do CFO (Conselho Federal de Odontologia) referentes ao CRO (Conselho Regional de Odontologia) do Paraná e dados do IBGE, além de informaçöes presentes em sites sobre o Estado. Mediante metodologia aplicada, pôde-se concluir que o Paraná é um Estado atrativo para o mercado odontológico; a maioria dos CDs é clínica geral; o município mais promissor é Säo José dos Pinhais; os municípios com menor relaçäo Habitante/CD säo os mais populosos e conhecidos no Estado (Curitiba, Londrina e Maringá); a elevada relaçäo Habitante/CD nem sempre indica que a área seja propícia para a instalaçäo do CD, pois áreas com essa característica, na maioria dos casos, säo de economia agrária e infra-estrutura precária; 81 por cento dos municípios apresentam relaçäo Habitante/CD superior a 1/1.500