Forced Esthetic Position: A Diagnostic Strategy for Anteroposterior Repositioning in Orthognathic Surgeries.

Considering the esthetic goals involved in orthognathic surgeries, one of the challenges is to define the horizontal projection of the jaws. Most of the cephalometric analyses are focused on the position of the upper incisor and upper lip. Planning the correction of a mandibular retrognathism can be simplified by clinical simulation asking the patient to project their mandible. A forced esthetic position protocol is presented as a starting point for the planning in orthognathic cases.

Esthetic Considerations In Minimally Invasive Orthognathic Surgery.

Orthognathic surgery has long been successfully utilized to correct dentofacial deformities to help facilitate improved oral function and facial esthetics. The treatment, however, has been associated with a high degree of complexity and severe postoperative morbidity. More recently, minimally invasive orthognathic surgical procedures have emerged that offer potential long-term benefits such as less morbidity, a lower inflammation response, improved postoperative comfort, and better esthetic outcomes. This article examines the concept of minimally invasive orthognathic surgery (MIOS), discussing differences from traditional maxillary Le Fort I osteotomy, bilateral sagittal split osteotomy, and genioplasty procedures. MIOS protocols are described for various aspects of both the maxilla and mandible.

A novel guide for minimally invasive genioplasty.

Mentoplasty or genioplasty is a simple procedure to enhance facial aesthetics. While usually considered simple, it might present certain difficulties during execution, especially when a minimally invasive approach is preferred. Drilling and cutting guides are a valuable tool to overcome such challenges but usually require larger incision and dissection to allow adequate positioning and bone rigid fixation. In this article, we describe a novel guide design that permits adequate bone repositioning while preserving minimally invasive protocols.

Coronectomia em terceiro molar superior: relato de caso / Maxillary third upper molar coronectomy: case report

Introdução: A extração de terceiros molares é um dos procedimentos mais realizados em cirurgias orais. As indicações para esse procedimento estão ligadas à doença cárie, doença periodontal, pericoronite, entre outras. Objetivo: O objetivo deste artigo é apresentar um relato de caso e discussão com a técnica aplicada a um terceiro molar superior com risco de comunicação oroantral, demonstrando os benefícios deste procedimento. Relato de Caso: Paciente sexo masculino, 49 anos, ausência de comorbidades, encaminhado para remoção de terceiro molar superior por dificuldade de higienização e acúmulo de placa bacteriana, ao exame tomográfico, apresentou proximidades das raízes com o seio maxilar, onde foi optado pela contra indicação de extração devido a grande chance de comunicação oroantral e sugerido coronectomia para resolução do caso. Conclusão: A coronectomia é uma técnica bastante difundida nos casos em que o terceiro molar está intimamente relacionado ao nervo alveolar inferior, com chances de parestesia. Não há relatos na literatura dessa técnica aplicada ao terceiro molar superior... (AU)

Introduction: Extraction of third molars is one of the most commonly performed procedures in oral surgeries. The indications for this procedure are linked to caries disease, periodontal disease, pericoronitis, among others. Case Report: Male patient, 49 years old, absent from comorbidities, referred for removal of the upper third molar due to difficulty in cleaning and bacterial plaque accumulation, on tomographic examination, proximity of the roots to the maxillary sinus, where it was opted for the contraindication of extraction due to great chance of oroantral communication and suggested coronectomy to resolve the case. Objective: The purpose of this article is to present a case report and discussion with the technique applied to a maxillary third molar at risk of oroantral communication, demonstrating the benefits of this procedure. Conclusion: Coronectomy is a widespread technique in cases where the third molar is closely related to the lower alveolar nerve, with chances of paresthesia. There are no reports in the literature of this technique applied to the upper third molar... (AU)

In-House Hybrid Technique for Customization of Guides and Miniplates in Orthognathic Surgery.

The use of customized plates in Orthognathic surgery offers precision in the repositioning of the jaws, according to the virtual planning performed, with the great advantage of avoiding the need for intermediate occlusal splints. However, the conventional customization process takes time to manufacture, present high cost and still involve legal issues with insurance companies. Moreover, a technical disadvantage is that the systems available for customized plates require large incisions, with large detachment of soft tissues for insertion of the guides and plates. The objective of this paper is to present the in-house hybrid technique for customization of guides and miniplates in orthognathic surgery using minimally invasive approaches.

Treatment of odontogenic myxoma: a multidisciplinary approach-6-year follow-up case.

The most aggressive diseases that affect the oral environment are considered tumors of the jaw. The surgical treatment is preferably done by surgical resection of the lesion, resulting in a great loss of tissue and esthetics. Multidisciplinary planning is required for the rehabilitation of these cases. Autogenous grafting techniques or vascularized flaps allow ridge reconstruction for implant placement, restoring function, and esthetics. This paper reports a 6-year follow-up case of an odontogenic myxoma treated with wide resection and mandibular bone reconstruction for posterior rehabilitation with dental implants.

Cell block technique as a complementary method in the clinical diagnosis of cyst-like lesions of the jaw.

OBJECTIVE: To evaluate the applicability of the cell block technique as a complementary method for presumptive diagnosis in the analysis of cyst-like aspirates from jaw lesions prior to histopathological diagnosis. MATERIAL AND METHODS: The sample was made up of 17 cyst-like jaw lesions. After puncture, the aspirates were centrifuged, fixed in formalin, embedded in paraffin and processed. All lesions were biopsied and submitted to histopathological examination. RESULTS: In 9 cases, the cytopathological analysis using the cell block method showed a predominant presence of erythrocytes, inflammatory cells and few epithelial cells. In the other 8 cases, the cell block technique demonstrated the presence of parakeratin, whose histopathological analysis confirmed the occurrence of keratocystic odontogenic tumors (KOTs). CONCLUSIONS: According to the studied cases, the cell block method was proven to be a simple, fast and low-cost technique to effectively differentiate KOTs from other lesions with similar clinical and radiographic features. The cell block technique comprises cellular preparations useful to determine a clinical diagnosis and help to develop a therapeutic plan for those lesions.

Cell block technique as a complementary method in the clinical diagnosis of cyst-like lesions of the jaw

OBJECTIVE: To evaluate the applicability of the cell block technique as a complementary method for presumptive diagnosis in the analysis of cyst-like aspirates from jaw lesions prior to histopathological diagnosis. MATERIAL AND METHODS: The sample was made up of 17 cyst-like jaw lesions. After puncture, the aspirates were centrifuged, fixed in formalin, embedded in paraffin and processed. All lesions were biopsied and submitted to histopathological examination. RESULTS: In 9 cases, the cytopathological analysis using the cell block method showed a predominant presence of erythrocytes, inflammatory cells and few epithelial cells. In the other 8 cases, the cell block technique demonstrated the presence of parakeratin, whose histopathological analysis confirmed the occurrence of keratocystic odontogenic tumors (KOTs). CONCLUSIONS: According to the studied cases, the cell block method was proven to be a simple, fast and low-cost technique to effectively differentiate KOTs from other lesions with similar clinical and radiographic features. The cell block technique comprises cellular preparations useful to determine a clinical diagnosis and help to develop a therapeutic plan for those lesions.

Medial canthal region as an external reference point in orthognathic surgery.

PURPOSE: The aim of this investigation was to evaluate the effectiveness of using the medial canthal region (MCR) as an external reference point to determine the vertical dimension during maxillary repositioning as planned in model surgery and predictive tracing. MATERIALS AND METHODS: The analyzed group consisted of 43 consecutive patients who underwent maxillary or bimaxillary orthognathic surgery. Before downfracture, the vertical height was established from the distance of the MCR to the incisal edge of the right upper central incisor (UCI). The vertical dimension was obtained with frequent measurements by use of calipers as desired during cephalometric tracing and model surgery. After rigid fixation, the vertical height was verified again. The UCI was traced from the postoperative cephalogram and predictive tracing onto a preoperative tracing. Repositioning of the maxilla and postsurgical movements of the UCI were registered at the horizontal and vertical planes. Comparison was made between the predicted maxillary position on the cephalometric tracing and the actual position, as well as between the planned maxillary position in model surgery and the actual position. RESULTS: The mean difference between the planned UCI position on predictive tracing and postsurgical position was 0.30 mm (SD, 0.21 mm; P > .05) in the vertical plane. The variation between the planned maxillary position in model surgery and the actual position was 0.37 mm (SD, 0.31 mm; P > .05) in the vertical plane. CONCLUSIONS: Good surgical accuracy in positioning the mobilized maxilla can be achieved by use of the MCR as an external reference point.

Acesso transnasal para marsupialização de cisto naso-labial: relato de caso / Transnasal Approach to Marsupialization of the Nasolabial Cyst: Report of Case

O cisto naso-labial é cisto não odontogênico raro e de evolução lenta que, dependendo do tamanho, pode causar assimetria facial. O tratamento do cisto naso-labial comumente, e com sucesso, se dá por enucleação cística com acesso intra-oral. Existe um potencial risco de formação de uma fístula oro-nasal na enucleação cística por acesso intra-oral, devido à proximidade desse cisto com a mucosa nasal. A marsupialização por via nasal pode ser uma opção no tratamento do cisto naso-labial com menor risco de formação de fístula oro-nasal. O presente artigo relata um caso de cisto naso-labial tratado por marsupialização com acesso via transnasal

The nasolabial cyst is a rare nonodontogenic cyst of slow progression which, depending on its size, can cause facial asymmetry. It is commonly and successfully treated by enucleation, using an intra-oral approach. There is a potential risk of an oronasal fistula when this modality of treatment is employed, owing to the proximity of the cyst to the nasal mucosa. Transnasal marsupialization can be an option in the treatment of the nasolabial cyst as there is a lower risk of formation of an oronasal fistula. The present paper reports a case of nasolabial cyst treated by marsupialization, using a transnasal approach

Manejo gengival em maxilas totalmente reconstruídas por enxertos e implantes / Gingival management in totally reconstructed maxilla by grafts and implants-case report

Os tecidos moles desempenham um importante papel para o resultado das cirurgias com implantes. Várias técnicas estão reportadas na literatura para aumentar a quantidade de gengiva ceratinizada ao redor dos implantes. Este artigo apresenta uma técnica de avanço do retalho palatal realizada durante a cirurgia de reabertura dos implantes em maxilas totalmente edêntulas reconstruídas com blocos de crista ilíaca.

Avaliação histológica de osso bovino inorgânico em seio maxilar: relato de caso / Histological evaluation of inorganic bovine bone graft in maxillary sinus: a case report

Este artigo revisa as bases científicas para a utilização do enxerto ósseo bovino inorgânico associado ao plasma rico em plaquetas (PRP) e relata o uso desta combinação no levantamento de seio maxilar para permitir a posterior colocação de implante. O enxerto xenógeno foi realizado e, após seis meses, ocorreu a colocação de um implante e a coleta do tecido para análise histológica.

Protocolo cirúrgico para extração de germes de terceiros molares inferiores / Surgical protocol for extraction of lower third molar germs

A remoção de terceiros molares é uma intervenção cirúrgica comum em cirurgia bucomaxilofacial e, como qualquer procedimento, é passível de complicações. A criação e a permanência de um defeito periodontal no segundo molar adjacente podem causar a perda desse dente a longo prazo, portanto, novas técnicas de incisão e osteotomia devem ser avaliadas para minimizar ou mesmo evitar essa complicação. Este artigo propõe um protocolo de conduta para a remoção de terceiros molares capaz de facilitar a técnica e reduzir o tempo de cirurgia. Além disso, a técnica reduz o risco de formação de defeitos na região dos segundos molares, devido à modificação na incisão e na remoção óssea reduzida na distal do segundo molar.

Reconstrução de mandíbula severamente reabsorvida usando a técnica da tenda de tecido mole – Relato de caso / Severely atrophic mandible reconstruction using the soft tissue matrix technique - Case report

As técnicas de reconstrução óssea na mandíbula são muito usadas para permitir a reabilitação com implantes. A mandíbula severamente reabsorvida (6 mm ou menos) ainda permanece como um desafio em razão das taxas de insucesso e risco de fratura mandibular. Os autores apresentam um caso de reconstrução de mandíbula severamente reabsorvida usando a técnica da tenda de tecido mole com a colocação simultânea de implantes na região anterior de mandíbula.

Enxerto interposicional. Uma alternativa para as deficiências verticais na região posterior da mandíbula – Descrição da técnica e de dois casos clínicos / Interposicional graft. An alternative to vertical deficiencies in the posterior mandible

A disponibilidade óssea na Implantodontia pode ser decisiva em relação à estabilidade e estética dos implantes em longo prazo. Com muita freqüência, técnicas para o aumento do rebordo ósseo se fazem necessárias para uma maior previsibilidade dos resultados. Os autores descrevem a técnica de enxerto interposicional para ganho de tecido ósseo em altura na região posterior de mandíbula, apresentando dois casos clínicos solucionados com a técnica relatada.