Outcomes of permanent canines on the cleft side after secondary alveolar grafting using different materials in complete unilateral cleft lip and palate.

The prevalence of impaction of the permanent canine on the cleft side (PCCS) ranges from 12-35% after alveolar bone grafting (ABG). PCCSs usually develop above other permanent teeth in the alveolar process, gradually becoming vertical until they reach the occlusal plane. The type of cleft, hypodontia of lateral incisor on the cleft side, slower PCCS root development, and genetic factors are predictors of impaction and/or its ectopic eruption. To compare the behavior of PCCS in individuals with complete unilateral cleft lip and palate (UCLP) subjected to secondary alveolar grafting (SAG) with different materials. This retrospective longitudinal study analyzed 120 individuals undergoing SAG with iliac crest bone, rhBMP-2, and mandibular symphysis. The individuals were selected at a single center and equally divided into three groups. Panoramic radiographs were analyzed by the Dolphin Imaging 11.95 software to measure PCCS angulation and PCCS height from the occlusal plane at two different timepoints. No statistical significance was found between grafting materials (P=0.416). At T1, the PCCS height from the occlusal plane was greater for rhBMP-2 and mandibular symphysis compared to iliac crest bone. The lateral incisor on the cleft side was not related to success or lack of eruption of PCCS (P=0.870). Impaction rates of PCCS were similar for the materials studied. Absence of the lateral incisor on the cleft side did not prevent spontaneous eruption of PCCSs.

Outcomes of permanent canines on the cleft side after secondary alveolar grafting using different materials in complete unilateral cleft lip and palate

Abstract The prevalence of impaction of the permanent canine on the cleft side (PCCS) ranges from 12-35% after alveolar bone grafting (ABG). PCCSs usually develop above other permanent teeth in the alveolar process, gradually becoming vertical until they reach the occlusal plane. The type of cleft, hypodontia of lateral incisor on the cleft side, slower PCCS root development, and genetic factors are predictors of impaction and/or its ectopic eruption. Objective: To compare the behavior of PCCS in individuals with complete unilateral cleft lip and palate (UCLP) subjected to secondary alveolar grafting (SAG) with different materials. Methodology: This retrospective longitudinal study analyzed 120 individuals undergoing SAG with iliac crest bone, rhBMP-2, and mandibular symphysis. The individuals were selected at a single center and equally divided into three groups. Panoramic radiographs were analyzed by the Dolphin Imaging 11.95 software to measure PCCS angulation and PCCS height from the occlusal plane at two different timepoints. Results: No statistical significance was found between grafting materials (P=0.416). At T1, the PCCS height from the occlusal plane was greater for rhBMP-2 and mandibular symphysis compared to iliac crest bone. The lateral incisor on the cleft side was not related to success or lack of eruption of PCCS (P=0.870). Conclusion: Impaction rates of PCCS were similar for the materials studied. Absence of the lateral incisor on the cleft side did not prevent spontaneous eruption of PCCSs.

Outcomes of Alveolar Graft With Rhbmp-2 in CLP: Influence of Cleft Type and Width, Canine Eruption, and Surgeon.

OBJECTIVE: To evaluate the influence of cleft type and width, canine eruption stage, and surgeon on the outcomes of alveolar graft with rhBMP-2. DESIGN: Cross-sectional. SETTING: Tertiary craniofacial center. PARTICIPANTS: Ninety individuals submitted to alveolar graft in late mixed or early permanent dentition. INTERVENTIONS: The 90 individuals (mean age: 16.8 years) were submitted to alveolar graft with rhBMP-2. Periapical radiographs were obtained before and 6 months after surgery. Surgeries were performed by 4 experienced maxillofacial surgeons. The alveolar grafts were assigned as success or failure by 3 blinded raters based on the modified Bergland and Chelsea scales. Permanent canines adjacent to the defect were assigned as erupted and not erupted. The greatest cleft width was measured on preoperative periapical radiographs. MAIN OUTCOME MEASURES: The influence of 4 independent variables (cleft type, cleft width, canine eruption phase, and surgeon) on the outcome of alveolar graft was analyzed by multivariate logistic regression ( P < .05). RESULTS: All independent variables presented significant influence on alveolar graft outcome. The subgroup of unerupted maxillary canines demonstrated better outcomes than erupted canines ( P = .001). The group with cleft lip and alveolus (CL/A) demonstrated better outcomes than complete cleft lip and palate (CLP; P < .001). The greater the alveolar cleft width, the less favorable were the graft outcomes ( P = .027). The surgeon also had a significant influence on the surgery success ( P = .003 and .001). CONCLUSION: The type and width of CLP, the eruption of permanent canines, and the surgeon influenced the outcome of alveolar graft surgeries performed with rhBMP-2.

Força de mordida em pacientes com fissura labiopalatina reabilitados proteticamente / Bite force in patients with cleft lip and palate with prosthetic rehabilitation

O objetivo deste trabalho foi comparar a força de mordida máxima entre indivíduos sem fissura labiopalatina e com dentes naturais, indivíduos com fissura labiopalatina reabilitados com prótese parcial fixa sobre implante e indivíduos com fissura labiopalatina reabilitados com prótese parcial fixa convencional, principalmente na região de incisivo lateral e canino. Para isso, os sujeitos da pesquisa foram divididos em 2 grupos experimentais: Prótese Parcial Fixa Sobre Implante (n=6) e Prótese Parcial Fixa Convencional (n=10) e grupo Controle (n=11). As medidas de força de mordida foram realizadas com um gnatodinamômetro, sendo então analisadas estatisticamente por meio do teste de Kruskal-Wallis com nível de significância de 0,05. Quando verificada significância estatística, utilizou-se o método de Dunn em seguida. Na região de molares direitos foi observada significância estatística (p=0,048) entre os grupos Controle e Prótese Parcial Fixa Sobre Implante. Quando a variável incisivos centrais foi examinada, verificou-se diferença estatística (p=0,036) entre o grupo Controle e o grupo Prótese Parcial Fixa Sobre Implante. Na área de incisivo lateral e canino a diferença estatisticamente significativa (p=0,003) foi averiguada apenas nas comparações envolvendo o grupo Controle, não sendo encontrada entre os grupos experimentais. Já nos molares esquerdos não foi observada diferença estatisticamente significativa entre os grupos (p=0,085). Concluiu-se que, apesar da força de mordida máxima mediana ter sido maior para o grupo prótese parcial fixa convencional, não é possível afirmar que a mesma apresenta função mastigatória superior à prótese parcial fixa sobre implante na região de incisivo lateral e canino em pacientes com fissura labiopalatina

The aim of this study was compare the maximal bite force among individuals without cleft lip and palate and with natural teeth, individuals with cleft lip and palate rehabilitated with implant-supported partial fixed prosthesis and individuals with cleft lip and palate rehabilitated with conventional partial fixed prosthesis, especially in the lateral incisor and canine region. For this, the subjects were divided in 2 groups: ImplantSupported Partial Fixed Prosthesis (n= 6) and Conventional Partial Fixed Prosthesis (n=10) and Control group (n=11). The bite force measurements were performed with a gnathodynamometer and statistically analyzed by Kruskal-Wallis test with a 0,05 significance level. When was verified statistical significance, the Dunn’s method was used. In the right molars region was observed statistical significance (p=0,048) between the groups Control and ImplantSupported Partial Fixed Prosthesis. When the central incisors variable was examined, there was a statistical difference (p=0,036) between Control group and Implant-Supported Partial Fixed Prosthesis group. In the lateral incisor and canine area the statistically significant difference (p=0,003) was ascertained only in comparisons involving the Control group, not being found between the experimental groups. Already in the left molars was not observed statistically significant difference between groups (p=0,085). It was concluded that, although the median maximal bite force has been greater for Conventional Partial Fixed Prosthesis group, it’s not possible affirm that it presents higher masticatory function than implant-supported partial fixed prosthesis in the lateral incisor and canine region in patients with cleft lip and palate

Evolution of Postoperative Edema in Alveolar Graft Performed With Bone Morphogenetic Protein (rhBMP-2).

OBJECTIVE: To evaluate the evolution of facial edema in the postoperative period after alveolar graft surgeries performed with collagen membrane soaked with recombinant human bone morphogenetic protein-2 (rhBMP-2) in individuals with cleft lip and palate. DESIGN: Longitudinal prospective. SETTING: Tertiary craniofacial center. PARTICIPANTS: One hundred fifty individuals submitted to alveolar graft. INTERVENTIONS: In the preoperative consultation and 4 days after surgery, the individuals were assessed as to age, professional performing the surgery, duration of the procedure, type of cleft, measurement of facial edema, mouth opening, and global evaluation of the postoperative period. MAIN OUTCOME MEASURES: Statistical analysis was performed to compare the facial edema and different variables, at a significance level of .05. RESULTS: The maximum facial edema occurred between 3 and 4 days postoperatively, was inversely proportional to age and mouth opening, greater for female patients compared with male patients, for incomplete unilateral cleft lip and palate compared with other types of clefts, and for surgeon 1 compared with the other surgeons at some moment postoperatively. The surgeries were longer for complete unilateral and bilateral clefts. The difference was statistically significant for these variables. CONCLUSIONS: The facial edema was influenced by the rhBMP-2 used in alveolar graft, and trismus was proportional to the intensity of facial edema.

Is there a consensus for CBCT use in Orthodontics?

This article aims to discuss current evidence and recommendations for cone-beam computed tomography (CBCT) in Orthodontics. In comparison to conventional radiograph, CBCT has higher radiation doses and, for this reason, is not a standard method of diagnosis in Orthodontics. Routine use of CBCT in substitution to conventional radiograph is considered an unaccepted practice. CBCT should be indicated with criteria only after clinical examination has been performed and when the benefits for diagnosis and treatment planning exceed the risks of a greater radiation dose. It should be requested only when there is a potential to provide new information not demonstrated by conventional scans, when it modifies treatment plan or favors treatment execution. The most frequent indication of CBCT in Orthodontics, with some evidence on its clinical efficacy, includes retained/impacted permanent teeth; severe craniofacial anomalies; severe facial discrepancies with indication of orthodontic-surgical treatment; and bone irregularities or malformation of TMJ accompanied by signs and symptoms. In exceptional cases of adult patients when critical tooth movement are planned in regions with deficient buccolingual thickness of the alveolar ridge, CBCT can be indicated provided that there is a perspective of changes in orthodontic treatment planning.

O presente artigo visa discutir as evidências e recomendações atuais concernentes à indicação da tomografia computadorizada de feixe cônico (TCFC) em Ortodontia. Devido à dose de radiação mais elevada em relação às radiografias, a TCFC não é o método padrão de diagnóstico em Ortodontia. O seu uso rotineiro, em substituição à documentação convencional, é considerado uma prática inaceitável. A TCFC deve ser indicada com muito critério, e somente após uma análise clínica, quando os benefícios para o diagnóstico e tratamento superarem os riscos de uma dose mais elevada de radiação. Deve ser requisitada estritamente quando houver um potencial de prover novas informações não demonstradas em exames radiográficos convencionais, modificando o plano de tratamento ou facilitando a sua execução. As indicações mais frequentes em Ortodontia, que demonstram algum nível de evidência sobre sua eficácia clínica, podem ser resumidas em casos de dentes permanentes retidos; anomalias craniofaciais complexas; discrepâncias faciais severas com indicação de tratamento ortodôntico-cirúrgico; e malformações ou irregularidades ósseas na ATM acompanhadas de sinais e sintomas. Em casos excepcionais, em pacientes adultos em que se planeja movimentos dentários críticos em áreas com espessura óssea vestibulolingual deficiente, a TCFC pode ser indicada, desde que se vislumbre uma perspectiva de alteração no plano de tratamento ortodôntico.

Is there a consensus for CBCT use in Orthodontics?

This article aims to discuss current evidence and recommendations for cone-beam computed tomography (CBCT) in Orthodontics. In comparison to conventional radiograph, CBCT has higher radiation doses and, for this reason, is not a standard method of diagnosis in Orthodontics. Routine use of CBCT in substitution to conventional radiograph is considered an unaccepted practice. CBCT should be indicated with criteria only after clinical examination has been performed and when the benefits for diagnosis and treatment planning exceed the risks of a greater radiation dose. It should be requested only when there is a potential to provide new information not demonstrated by conventional scans, when it modifies treatment plan or favors treatment execution. The most frequent indication of CBCT in Orthodontics, with some evidence on its clinical efficacy, includes retained/impacted permanent teeth; severe craniofacial anomalies; severe facial discrepancies with indication of orthodontic-surgical treatment; and bone irregularities or malformation of TMJ accompanied by signs and symptoms. In exceptional cases of adult patients when critical tooth movement are planned in regions with deficient buccolingual thickness of the alveolar ridge, CBCT can be indicated provided that there is a perspective of changes in orthodontic treatment planning.

Reabilitação de mandíbula severamente reabsorvida com implantes curtos e prótese fixa total parafusada / Rehabilitation of severely resorbed mandible with short dental implants and a total fixed, screw-retained prosthesis

Pacientes com atrofia óssea avançada dos maxilares ainda consistem em um desafio para a reabilitação oral. A literatura sugere várias opções de tratamento e cabe ao profissional escolher qual é a mais indicada conforme as condições psicossomáticas e financeiras do paciente. Este artigo relata e discute, embasado na literatura pertinente, o caso de uma paciente portadora das características ósseas acima, onde o tratamento escolhido foi a confecção de uma prótese total superior convencional e uma prótese fixa inferior suportada por implantes curtos com minipilares angulados devido à perda óssea vertical severa e ao prognatismo mandibular.

Patients with advanced bone jaw atrophy still consist of a challenge for oral rehabilitation. The literature suggests several treatment options, and clinicians must choose which is the most appropriate according to financial and psychological conditions. This article reports and discusses, based on relevant literature, the case of a patient with those characteristics, where the treatment of choice was the construction of a conventional denture and a lower fixed screw-retained, implant-supported prosthesis with short implants and mini-abutments due to the severe vertical bone loss and mandibular prognathism

Integrated treatment to resolve a horizontal root fracture.

Root fractures are defined as those that involve cement, dentin and pulp, comprising from 0.5 to 7% of injuries in permanent dentition. Diagnosis is made through clinical and radiographic exams, the latter frequently being limited by the position of the fracture. Treatment varies according to the displacement and vitality of the fragments. The authors present a clinical case of recurrent trauma of tooth 21 causing a horizontal root fracture in the middle third. After several attempts at endodontic treatment, the option was to remove the apical fragment by surgery. The postoperative period of 4 years shows very satisfactory results with regard to wound repair and tooth mobility, or implantation of the coronal segment.

Controle da ansiedade em cirurgia bucal: revisão de literatura / Control of anxiety on oral surgery: literature review

A ansiedade é um fator importante e significativo durante o atendimento odontológico, principalmente em intervenções cirúrgicas. Nem sempre a verbalização é suficiente na redução dos sinais e sintomas apresentados pelo paciente, sendo necessário o controle medicamentoso da ansiedade. Considerando-se que a incidência de quadros emergenciais, durante procedimentos cirúrgicos, é maior em pacientes com a ansiedade exacerbada, foi propósito deste artigo, revisar, fundamentando-se na literatura, os fármacos mais empregados no controle da ansiedade, suas aplicações e implicações clínicas. Pode-se concluir que: o tratamento cirúrgico odontológico induz a um quadro de ansiedade e apreensão na maioria dos pacientes, que nem sempre é controlado por meios não farmacológicos; o emprego adequado de benzodiazepínicos é um método eficaz e seguro no controle da ansiedade em adultos e crianças e a redução do quadro de ansiedade diminui a ocorrência de situações emergenciais no consultório odontológico

Controle da dor pós-operatória em cirurgia bucal: revisão de literatura / Control of postoperative pain in oral surgery: literature review

A dor é um fenômeno biológico importante para a defesa do organismo, porém, desconfortável para o indivíduo acometido. É inerente a alguns procedimentos odontológicos, principalmente aos cirúrgicos, sendo sua intensidade, quase sempre, relacionada à extensão da cirurgia. Devido à grande quantidade de medicamentos atualmente disponíveis no mercado com a finalidade de controlar a dor, os profissionais da saúde, inclusive os cirurgiões-dentistas, sentem dificuldade para prescrever adequadamente essas drogas. O objetivo deste trabalho foi, através da revisão de literatura, ilustrar os mecanismos envolvidos no desencadeamento da dor pós-operatória e o modo de ação de cada classe medicamentosa nestes eventos. Os autores concluíram que a escolha da droga deve considerar concomitantemente a etiopatogenia da dor pós-operatória, as condições sistêmicas do paciente e o tipo de procedimento realizado; que o momento da prescrição é direcionado pela classe a que o medicamento pertence e pelo seu modo de ação no mecanismo da dor; que a eficácia do controle da dor pós-operatória depende da escolha da droga adequada e do momento correto da prescrição

Estudo comparativo entre as dimensões dos fórceps utyilizados para extração de dentes permanentes e sua compatibilidade com a mão do usuário / Comparative study of the forceps dimensions utlized for permanent teeth extraction and usuary hand compatibility

Os autores estudaram o comprimento das hastes dos fórceps e sua compatibilidade com a mão do usuário. A amostra foi composta por 160 graduandos da Faculdade de Odontologia de Araçatuba - UNESP. A mensuração da largura e comprimento foi realizada e os dados obtidos foram empregados para planificar as dimensões da mão. Os valores foram tratados estatisticamente empregando o teste t-Student e a descrição demonstrativa. O comprimento ideal da haste foi determinado multiplicando-se o comprimento da mão pela raiz quadrada de dois e dividindo esse resultado por dois. Concluiram que: a) existe diferença estatisticamente significante entre o comprimento da mão masculina e feminina; b) aproximadamente 50% dos alunos avaliados apresentam dificuldades para manusear o fórceps com haste com 12 cm de comprimento; c) é necessário adequar o comprimento das hastes dos fórceps para usuários com mãos pequenas