Reconstrução de defeitos craniofaciais com uso de material aloplástico de titânio / Craniofacial defects reconstruction with the use of titanium alloplastic material

Introdução: A reconstrução óssea de defeitos craniofaciais é um processo desafiador. Diferentes técnicas operatórias e materiais reconstrutores são utilizados para reestabelecer a forma ideal do crânio. Materiais aloplásticos vem ganhando popularidade nas reconstruções orbitárias devido à sua facilidade de uso, com grande variedade de formas e tamanhos disponíveis. O objetivo deste estudo foi avaliar as reconstruções dos defeitos ósseos orbitários após traumatismos craniofaciais. Metodologia: Trata-se de um estudo observacional, que avaliou pacientes vítimas de traumatismo crânioencefálico com envolvimento orbitário e necessidade de reconstrução por meio de material aloplástico de titânio, atendidos no período de março de 2015 a junho de 2016, no Hospital da Cidade de Passo Fundo, Rio Grande do Sul,Brasil.Resultados: 13 pacientes foram incluídos no estudo e analisados de acordo com idade, gênero, etiologia do trauma,tipos de fratura que envolveram os defeitos craniofaciais e o material utilizado na reconstrução. O exame clínico avaliou a estabilidade da reconstrução, o resultado estético e funcional e a ocorrência de infecção pós-operatória. Tomografias Fan-Beam foram tomadas no pré e pós-operatório. Conclusões:Os resultados obtidos mostram que a escolha do material aloplástico de titânio é segura, e oferece excelente taxa de sucesso estético e funcional, corroborando com a literatura existente... (AU)

Introduction: Bone reconstruction of craniofacial defects is a challenging process. Different surgical techniques and reconstructing materials are used to reestablish the ideal shape of the skull. Alloplastic materials have been gaining popularity in orbital reconstructions due to their ease of use, with a wide variety of shapes and sizes available. The aim of this study was to evaluate the reconstruction of orbital bone defects after craniofacial trauma. Methodology: This is an observational study that evaluated patients who were victims of traumatic brain injury with orbital involvement and the need for reconstruction by means of titanium alloplastic material, treated from March 2015 to June 2016, at the Hospital da Cidade de Passo Fundo, Rio Grande do Sul, Brazil. Results: 13 patients were included in the study and analyzed according to age, gender, trauma etiology, types of fracture involving craniofacial defects and the material used in reconstruction. The clinical examination evaluated the stability of the reconstruction, the aesthetic and functional result and the occurrence of postoperative infection. Fan-Beam tomography were taken before and after surgery. Conclusions: The results obtained show that the choice of titanium alloplastic material is safe and offers an excellent rate of aesthetic and functional success, corroborating the existing literature... (AU)

Uso do hormônio do crescimento associado à fibrina rica em plaquetas e leucócitos injetável (I-PRF) / Use of the growth hormone associated with injectable platelet-rich fibrin (I-PRF)

Objetivo: demonstrar, por meio de uma revisão de literatura, a utilização do hormônio do crescimento (GH) e concentrados plaquetários e sugerir técnica de associação de uso para odontologia em processos de preservação de osso alveolar. Revisão de literatura: enxertos ósseos são uma necessidade na área da saúde, por diversas razões. A utilização de osso autógeno apresenta grande desvantagem em ter um segundo sítio cirúrgico, entretanto, os substitutos ósseos não possuem as características ideais. Assim, existe a busca por alternativas que otimizem a cicatrização e a incorporação dos substitutos ósseos, dentre elas os concentrados sanguíneos, ricos em fatores de crescimento derivados das plaquetas e o hormônio do crescimento. É possível encontrar uma vasta literatura utilizando os concentrados sanguíneos, inclusive utilizando esses como veículos para outras substâncias. Os concentrados sanguíneos são ricos em fatores de crescimento derivados das plaquetas, como fator de crescimento semelhante à insulina (IGF), Fator de crescimento derivado de plaquetas (PDGF) e outros. Além disso, também é possível encontrar, na literatura, o uso tópico de hormônio do crescimento em enxertos ósseos, fraturas e implantes dentários. Entretanto, o GH possui uma meia-vida de 20 minutos, assim, quando utilizado em conjunto com a I-PRF, espera-se um aumento no tempo de ação local. Considerações finais: é possível otimizar os enxertos ósseos utilizando-se L-PRF/I-PRF e hormônio do crescimento. Porém, são necessárias mais pesquisas.(AU)

Objective: this study aims to show through a literature review the use of the growth hormone and platelet concentrates and to suggest an association technique for dentistry use in alveolar bone preservation processes. Literature review: bone grafts are a health requirement for a number of reasons. The use of autogenous bone has the main disadvantage of a second surgical site, while bone substitutes do not present optimal characteristics. Thus, there is a search for alternatives that optimize the healing and incorporation of bone substitutes, which include blood concentrates that are rich in platelet-derived growth factors and the growth hormone. A vast literature can be found on blood concentrates, including their use as vehicles to other substances. Blood concentrates are rich in platelet-derived growth factors such as IGF, PDGF, and others. Moreover, the literature also shows the topical use of the growth hormone in bone grafts, fractures, and dental implants. However, the growth hormone presents a half-life of 20 minutes; therefore, when combined with I-PRF, an increased time in local action is expected. Final considerations: it is possible to optimize bone grafts by using L-PRF/I-PRF and the growth hormone. However, further research is required.(AU)

Elderly patients with facial trauma: a 10 year review / Trauma facial em idosos: uma análise retrospectiva de 10 anos

Abstract Objective: to analyze the epidemiological profile of geriatric patients with facial trauma treated at a Maxillofacial Surgery Department in southern Brazil over a period of 10 years. Methods: a retrospective analysis of the medical records of patients aged over 60 years treated for facial trauma in the period from January 2001 to December 2010 was performed. Result: of a total of 1,385 analyzed medical records of patients with facial trauma, 86 (6.2%) belonged to the group aged 60-89 years. The male gender was the most affected and the age group 60-69 years was the most frequently involved. The middle third was the most affected, and the zygomatic bone was the most commonly fractured. Conclusion: special attention should be given to the 60-69 age group, as while such patients present physiological changes inherent to aging, they remain active in society and exposed to risk factors for facial trauma. AU

Resumo Objetivo: Analisar o perfil epidemiológico dos pacientes geriátricos com trauma facial atendidos em um Serviço de Cirurgia Bucomaxilofacial do Sul do Brasil em um período de 10 anos. Método: Análise retrospectiva dos prontuários dos pacientes com idade superior há 60 anos atendidos com trauma facial no período de 01 de janeiro de 2001 há 31 de dezembro de 2010. Resultados: Num total de 1.385 prontuários analisados de pacientes com traumatismo facial, 86 (6,2%) pertenciam ao grupo na faixa etária de 60-89 anos. O gênero masculino foi o mais acometido e a faixa etária entre 60-69 anos a mais frequentemente envolvida, sendo que o terço médio foi o mais acometido e o osso mais comumente fraturado foi o zigomático. Conclusão: Atenção especial deve ser dirigida a faixa etária entre 60-69 anos, pois ao mesmo tempo que seus pacientes apresentam alterações fisiológicas inerentes ao avanço da idade, os mesmos continuam ativos em nossa sociedade e expostos a fatores de risco para o trauma facial. AU

Influence of chlorhexidine application time on the bond strength between fiber posts and dentin.

INTRODUCTION: The aim of this study was to investigate the effects of chlorhexidine (CHX) application time on the bond strength and durability of the adhesion of fiber posts relined with resin composite to the root dentin. METHODS: Eighty bovine incisor roots were divided into 4 groups after root preparation: control group (irrigation with physiological solution) and experimental groups, CHX for 30 seconds, CHX for 60 seconds, and CHX for 120 seconds. Fiber posts relined with resin composite were cemented with RelyX ARC. The Scotchbond Multi-Purpose total-etching adhesive system was used in half of the samples of each group, and the Clearfil SE Bond self-etching adhesive system was used in the other half. The samples were randomly divided into 2 subgroups, 24 hours of storage and 12 months of storage. All roots were sectioned transversely, and push-out tests were performed. Bond strength means were analyzed by analysis of variance and Tukey test (α = 0.05). Failure mode was determined by examining specimen's surfaces under scanning electron microscope, and its distribution was evaluated by using χ(2) test (α = 0.05). RESULTS: CHX pretreatment resulted in homogeneous bond strength values at 24 hours and 12 months of storage, irrespective of the CHX application time and adhesive system (P < .05). A significant bond strength decrease was noticed after 12 months of storage when irrigation was performed with physiological solution in the control groups (P > .05). Significant differences were observed for fracture patterns (P < .001). CONCLUSIONS: The use of CHX pretreatment could preserve the bond strength of the fiber post relined with resin composite to root dentin for 12 months, irrespective of the CHX application time and adhesive system used.

Effect of chlorhexidine and ethanol on push-out bond strength of fiber posts under cyclic loading.

PURPOSE: To investigate the effects of pretreatment with 2% chlorhexidine in a gel base (CHX) and 100% ethanol (EtOH) on the bond strength between fiber posts relined with resin composite and root dentin under cyclic loading. MATERIALS AND METHODS: Forty bovine incisor roots were divided into four groups after phosphoric acid etching: group 1 (control), irrigation with physiological saline solution; group 2, 5 min pretreatment with CHX; group 3, 1 min pretreatment with EtOH; group 4, 5 min pretreatment with CHX followed by 1 min with EtOH. Fiber posts relined with resin composite were cemented with RelyX ARC and the etch-and-rinse adhesive system Scotchbond Multi-Purpose. Each group was randomly divided into two subgroups: 24 h of storage (immediate groups) and cyclic loading (loading groups) with 250,000 cycles in a controlled chewing simulator. All roots were sectioned transversely and push-out tests were performed. Failure modes were observed and the bond strength means were analyzed using ANOVA and Tukey's test (a = 0.05). RESULTS: The mean values for the bond strength test (MPa) in immediate groups were: group 1, 5.44 ± 1.48; group 2, 5.57 ± 1.41; group 3, 5.49 ± 1.48; group 4, 5.57 ± 1.42. Immediate groups showed similar bond strength values (p > 0.05). In the cyclic loading groups, the bond strength values were: group 1, 2.80 ± 0.79; group 2, 4.02 (1.30); group 3, 4.50 ± 1.67; group 4, 4.97 ± 2.00. After cyclic loading, a significant decrease in the control group was observed (p < 0.05), while CHX pretreatment resulted in intermediate values (p < 0.05) and EtOH alone or associated with CHX preserved the bond strength values (p > 0.05). CONCLUSION: Chlorhexidine and/or ethanol pretreatment preserved the bond strength of the fiber post after cyclic loading.