Taxa de sobrevivência de implantes instalados em área de levantamento de seio maxilar em pacientes com fissura labiopalatinas / Survival rate of implants installed at maxillary sinus lifting areas in cleft lip and palate patients

O objetivo deste estudo foi avaliar a taxa de sobrevivência de implantes instalados em áreas previamente submetidas à cirurgia de levantamento de seio maxilar (LSM) em pacientes com fissura labiopalatina do Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). Uma busca eletrônica retrospectiva foi realizada em 60.000 prontuários de pacientes do HRAC de 1998 a 2007. Essa busca resultou em 58 pacientes (15 masculinos e 43 femininos, média de idade de 36 anos) que foram submetidos a procedimentos cirúrgicos de enxerto ósseo no seio maxilar e tiveram implantes osseointegráveis instalados nesta área, compreendendo 83 procedimentos de LSM e 161 implantes instalados (38 do sexo masculino e 123 do feminino). As informações clínicas destes pacientes foram registradas em prontuários com exames radiográficos. Foi tomada análise descritiva e as porcentagens de sobrevivência e falha foram obtidas. Visava-se reduzir as falhas nas reabilitações de pacientes edêntulos totais ou parciais e ganhar experiência nesta área. Como resultados, foi constatado que técnicas de implantes imediatos mostraram taxa de sobrevivência de 94,94%, enquanto a técnica cirúrgica de implantes em segunda instância apresentou taxa de sobrevivência de 93,9%. Baseados nos resultados obtidos e considerando os limites da metodologia deste estudo, concluiu-se que o LSM é uma opção de tratamento excelente, desde que sua indicação seja corretamente seguida (AU).

The aim of this study was to evaluate the survival rate of implants installed in areas where maxillary sinus lifting surgeries had been previously performed in clef lip and palate patients of Hospital for Rehabilitation of Craniofacial Anomalies - São Paulo University (HRAC-USP). A retrospective electronic search was performed in 60,000 files of HRCA patients from 1998 to 2007. This search resulted in 58 patients (15 male and 43 female, mean age of 36 years old) who had been submitted to maxillary sinus bone grafting procedures and had osseointegrated implants installed in those areas, comprising 83 maxillary sinus lifting (MSL) procedures and 161 implants installed (38 male and 123 female). The clinical information concerning those patients was registered in dental records with radiographic examinations. A descriptive analysis was performed and the percentage of survival and failure rates were obtained. The main objective was to reduce the rehabilitation failures of completely or partially edentulous patients and to gain experience in this field. As results immediate implants technique showed a survival rate of 94.94%, while second stage implants surgery technique presented a survival rate of 93.9%. Therefore, based on the results obtained and considering the study methodology limitations, it can be concluded that maxillary sinus lifting (MSL) procedure is an excellent treatment option, as long as its indications are correctly followed (AU).

Sucesso de enxertos ósseos complementares em fissuras labiopalatinas e sobrevivência de implantes dentários / Success of compementary bone grafts in patients with cleft lip and palate and survival of dental implants

Este estudo teve por objetivo monitorar a eficácia de implantes dentais inseridos em áreas receptoras de re-enxerto autógeno (enxerto em bloco intraoral) e identificar os fatores de risco relevantes para o prognóstico em pacientes com fissuras labiopalatinas. Foi realizado um levantamento retrospectivo das informações clínicas registradas nos prontuários dos pacientes do Hospital de Reabilitação de Anomalias Craniofaciais (USP), de 1999 até os casos finalizados em abril de 2009. Foram avaliados os prontuários de 161 pacientes, de ambos os sexos, submetidos à cirurgia de enxerto ósseo em bloco para complementação óssea em volume e/ou altura para posterior instalação de implante, na região da fissura ou fora dela. Os enxertos foram obtidos de ramo mandibular ou mento. Em 161 pacientes foram realizados 211 enxertos ósseos intraorais autógenos, sendo 2% destes realizados com finalidade de auxiliar a movimentação ortodôntica. Foram instalados 160 implantes nessas áreas, em 76% dos blocos, visto que 22% dos enxertos ósseos autógenos falharam antes mesmo da instalação de implantes. Considerando a sobrevivência dos implantes instalados nas áreas enxertadas, 15% dos implantes foram removidos por falta de osteointegração, resultando em uma taxa de sobrevivência equivalente a 85% nos blocos bem-sucedidos. Embora a sobrevivência dos implantes em áreas de re-enxerto seja compatível com outros relatos na literatura, tais implantes apresentaram maiores falhas do que implantes instalados em áreas de fissura que receberam apenas enxerto ósseo alveolar secundário (AU).

This study aimed to monitor dental implants efficacy inserted in regrafted areas with autogenous bone (intra-oral block grafts) and to identify relevant risk factors for cleft lip and palate patients prognosis. A retrospective research collected clinical information registered in the medical records of Craniofacial Anomalies Rehabilitation Hospital - São Paulo University (HRAC-USP) from 1999 up to the April 2009. A hundred and sixty-one patient's records were evaluated, of both sexes, submitted to block bone graft surgery for bone complementation in volume and/or height for further implant installation, in the cleft region or out of it. Grafts were taken either from mandibular branch or chin. Two hundred and eleven intraoral autogenous block bone grafts were done in a hundred and sixty-one patients, 2% of these with the aim of orthodontic movement support. A hundred and sixty implants were installed in these areas, in 76% of the blocks as 22% of the autogenous bone grafts failed before implant installation. Considering implant survival rates in grafted areas, 15% of the implants were removed due to lack of osseointegration, resulting in a successful survival rate of 85% for successful bone blocks. Although implant survival rates in regrafted areas are compatible with other literature records, these implants had greater failure rates if compared to those of cleft areas that received only secondary alveolar bone grafting (AU).

Immunohistochemical evaluation of MMP-2, MMP-9 and CD31/microvascular density in squamous cell carcinomas of the floor of the mouth.

The aim of this study was to evaluate the immunoexpression of MMP-2, MMP-9 and CD31/microvascular density in squamous cell carcinomas of the floor of the mouth and to correlate the results with demographic, survival, clinical (TNM staging) and histopathological variables (tumor grade, perineural invasion, embolization and bone invasion). Data from medical records and diagnoses of 41 patients were reviewed. Histological sections were subjected to immunostaining using primary antibodies for human MMP-2, MMP-9 and CD31 and streptavidin-biotin-immunoperoxidase system. Histomorphometric analyses quantified positivity for MMPs (20 fields per slide, 100 points grade, ×200) and for CD31 (microvessels <50 µm in the area of the highest vascularization, 5 fields per slide, 100 points grade, ×400). Statistical design was composed by non-parametric Mann-Whitney U test (investigating the association between numerical variables and immunostainings), chi-square frequency test (in contingency tables), Fisher's exact test (when at least one expected frequency was less than 5 in 2×2 tables), Kaplan-Meier method (estimated probabilities of overall survival) and Iogrank test (comparison of survival curves), all with a significance level of 5%. There was a statistically significant correlation between immunostaining for MMP-2 and lymph node metastasis. Factors associated negatively with survival were N stage, histopathological grade, perineural invasion and immunostaining for MMP-9. There was no significant association between immunoexpression of CD31 and the other variables. The intensity of immunostaining for MMP-2 can be indicative of metastasis in lymph nodes and for MMP-9 of a lower probability of survival.

Immunohistochemical evaluation of MMP-2, MMP-9 and CD31/microvascular density in squamous cell carcinomas of the floor of the mouth

The aim of this study was to evaluate the immunoexpression of MMP-2, MMP-9 and CD31/microvascular density in squamous cell carcinomas of the floor of the mouth and to correlate the results with demographic, survival, clinical (TNM staging) and histopathological variables (tumor grade, perineural invasion, embolization and bone invasion). Data from medical records and diagnoses of 41 patients were reviewed. Histological sections were subjected to immunostaining using primary antibodies for human MMP-2, MMP-9 and CD31 and streptavidin-biotin-immunoperoxidase system. Histomorphometric analyses quantified positivity for MMPs (20 fields per slide, 100 points grade, ×200) and for CD31 (microvessels <50 µm in the area of the highest vascularization, 5 fields per slide, 100 points grade, ×400). Statistical design was composed by non-parametric Mann-Whitney U test (investigating the association between numerical variables and immunostainings), chi-square frequency test (in contingency tables), Fisher's exact test (when at least one expected frequency was less than 5 in 2×2 tables), Kaplan-Meier method (estimated probabilities of overall survival) and Iogrank test (comparison of survival curves), all with a significance level of 5%. There was a statistically significant correlation between immunostaining for MMP-2 and lymph node metastasis. Factors associated negatively with survival were N stage, histopathological grade, perineural invasion and immunostaining for MMP-9. There was no significant association between immunoexpression of CD31 and the other variables. The intensity of immunostaining for MMP-2 can be indicative of metastasis in lymph nodes and for MMP-9 of a lower probability of survival.

O objetivo deste estudo foi avaliar a imunoexpressão de MMP-2, MMP-9 e CD31/densidade microvascular em carcinomas espinocelulares de soalho bucal e correlacionar os resultados com variáveis demográficas, de sobrevida, clínicas (estadiamento TNM) e histopatológicas (grau de diferenciação tumoral, invasão perineural, embolização e invasão óssea). Dados de prontuários e de diagnósticos de 41 pacientes foram revisados. Cortes histológicos foram submetidos à imunomarcação usando anticorpos primários para MMP-2, MMP-9 e CD31 humanos e sistema streptoavidina-biotina-imunoperoxidase. Análise histomorfométrica quantificou a positividade para MMPs (20 campos, grade de 100 pontos por lâmina, ×200) e para CD31 (microvasos <50 µm na área de maior vascularização, 5 campos, grade de 100 pontos por lâmina, ×400). O planejamento estatístico foi composto pelo teste não paramétrico U de Mann-Whitney (verificação da associação entre variáveis numéricas e imunomarcações), teste de frequências do qui-quadrado (em tabelas de contingência), teste exato de Fisher (quando pelo menos uma frequência esperada foi menor do que 5 em tabelas 2×2), método de Kaplan-Meier (estimativa de probabilidades de sobrevida global) e teste de Iogrank (comparação das curvas de sobrevida), todos com nível de significância de 5%. Houve correlação estatisticamente significante entre imunomarcação para MMP-2 e metástase em linfonodo. Os fatores relacionados negativamente com a sobrevida foram estadiamento N, gradação histopatológica, invasão perineural e imunomarcação de MMP-9. Não houve associação significativa entre imunoexpressão de CD31 e as demais variáveis. A intensidade de imunomarcação para MMP-2 pode ser indicativa de metástase em linfonodo e para MMP-9 de uma menor probabilidade de sobrevida.

O uso de implantes, enxerto ósseo e condicionamento do tecido gengival perimplantar na reabilitação estética de área anterior de maxila / The use of dental implants, bone graft and peri-implant gingival tissue modeling in the esthetic rehabilitation of the maxillary anterior area

A reabilitação protética implanto-suportada de espaços edêntulos na região anterior da maxila é um desafio para o cirurgião-dentista. Um adequado posicionamento dos implantes e sua relação harmoniosa com os tecidos duros e moles são fundamentais para uma alta demanda estética. Esse caso relata a correção de um severo defeito estético no qual foi necessário associar vários procedimentos, como a realização de enxerto ósseo prévio, a instalação de implantes osseointegráveis, a manipulação dos tecidos peri-implantares e a escolha de componentes protéticos estéticos, para se alcançar um resultado estético satisfatório.

Implant-supported prosthetic rehabilitation of anterior edentulous spaces is a challenge to the dentist performing the implant surgery. Proper positioning of the implant and its harmonious relationship with the hard and soft tissues are fundamental for a high aesthetic demand. This case report a correction of a serious esthetic defect in that was necessary associate some procedures, like a previous bone graft, installation of osseointegrated implants, soft tissue manipulation and the use of esthetic prosthetic components to reach a satisfactory result.

Congenital granular cell lesion: clinical, microscopic and immunohistochemical aspects in a case of multiple lesions.

Congenital granular cell lesion of the newborn, also known as congenital epulis, is a rare benign oral cavity tumor presenting at birth. Usually, it appears as a solitary mass arising in the mouth and originates from the anterior alveolar ridge. The objective of the present article is to report a case of congenital granular cell lesion in an 8-day-old female newborn. The patient presented four intraoral pedunculated lesions. Diagnosis, treatment, microscopic and immunohistochemical characteristics are also discussed.

Peri-implantite: alternativas de tratamento / Peri-implantitis: treatment alternatives: a literature review

A peri-implantite é um processo inflamatório que ocorre nos tecidos adjacentes aos implantes osseointegrados e pode resultar em perda de suporte ósseo e consequentemente na perda do implante. O tratamento da peri-implantite visa eliminar a causa e restabelecer a condição original de saúde dos tecidos peri-implantares. Diversas terapias têm sido propostas com esta finalidade, dentre as quais se incluem debridamento mecânico, uso de antimicrobianos tópicos e/ou sistêmicos, terapias cirúrgicas, além de diferentes tipos de laser. A seleção da terapia a ser aplicada depende do tipo e do tamanho do defeito ósseo apresentado. No entanto, em virtude da variedade de morfologia, extensão e severidade das lesões peri-implantares, nenhuma terapia foi estabelecida, ainda, como alternativa totalmente segura e eficaz. Ainda que não haja um consenso de tratamento a ser estabelecido, todas as modalidades terapêuticas se mostram benéficas no tratamento da peri-implantite, dentro de suas limitações. Portanto, utilizadas de forma individual ou associadas, as terapias podem ser aplicadas visando o sucesso no tratamento das lesões peri-implantares. Diante disso, este trabalho teve como objetivo revisar na literatura as diversas alternativas utilizadas para o tratamento da peri-implantite.

Peri-implantitis is an inflammatory process in the adjacent tissues of osseointegrated dental implants, which can result in bone loss support and consequently in implant failure. The treatment for peri-implantitis aims to eliminate the cause and to reestablish the original health condition. Several therapies have been proposed to restore peri-implant tissues, among these mechanical debridement, conditioning with chemical agents, flap surgery, bone regeneration procedures, use of antiseptic agents, as well as topic and antibiotic systemic therapy, besides different laser therapies. The selection of the therapeutic technique to be employed depends on bone defect type and size. Due to the variety of peri-implant lesion morphology, measurement, and severity, none of these therapies have been established as totally safe and efficient. The aim of this study was to review the literature on the several alternatives used for peri-implantitis treatment. Although there has not been a treatment consensus established, all therapeutic modalities showed benefits for peri-implantitis treatment within the limitations of each study. Therefore, either individually or associated, therapies could be applied aiming the treatment success of peri-implant lesions.

Evaluation of halitosis and sialometry in patients submitted to head and neck radiotherapy

Objectives: The aim of this study was to investigate the parameters of halitosis and sialometry in patients who had undergone head and neck radiotherapy, correlating oral concentration of volatile sulfur compounds (VSC) with the presence of tongue coating, salivary flow rate and BANA test.Material and Methods: 35 patients allocated in two groups were examined: group I (control) - patients with systemic and oral health; group II - patients submitted to head and neck radiotherapy. All volunteers were submitted to halitosis measurements through a sulphide monitor, evaluation of tongue coating weight, non-stimulated sialometry and BANA test.Results: The results were analyzed through analysis of variance, Pearson’s correlation and Student’s t-test, showing that there was statistically significant difference in halimetry between the groups, where the irradiated patients showed halitosis. There was a relation between the presence of tongue coating and the levels of VSCs in both groups and it was also noted that the irradiated patients showed a decreased salivary flow rate compared to healthy patients.Conclusion: On the conditions of the present research, it was concluded that halitosis can be considered an adverseeffect of radiotherapy, connected to hiposalivation and poor oral health (AU)

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Particulate inlay nasal graft with immediate dental implant placement in a patient with repaired alveolar cleft: case report.

Primary bone grafts in congenital cleft alveolus do not always provide sufficient bulk or height of bone for ideal placement of endosseous implants. Thus, maxillary sinus or nasal floor elevation and inlay bone grafts in previously grafted areas are not exceptions in the daily routine. This case report stresses the need of a detailed treatment plan and careful surgical management of nasal floor elevation with particulate autogenous bone graft to successfully provide the patient with osseointegrated prostheses.

Evaluation of oral and nasal halitosis parameters in patients with repaired cleft lip and/or palate.

OBJECTIVE: The objective of this study was to investigate the relationship between halitosis parameters in patients with and without cleft lip and/or palate. STUDY DESIGN: Forty-two subjects were examined. They were divided into group I, postgraduate students of Bauru Dental School (FOB); and group II, individuals with repaired cleft lip and/or palate. The concentration of volatile sulfur compounds (VSC) was assessed with a portable sulfide monitor and the values were correlated to the salivary flow rate and weight of tongue coating. RESULTS: There was a relationship between the presence of tongue coating and VSC levels, as well as between salivary flow rate and VSC levels in group II. The same group also revealed a significant correlation between weight of tongue coating and salivary flow rate. There were no significant differences between groups as regards the Halimeter oral measurement. CONCLUSIONS: Individuals with repaired cleft lip and/or palate can have the same VSC levels as subjects without clefts.

Evaluation of oral and nasal odor in patients with and without cleft lip and palate: preliminary report.

OBJECTIVE: To evaluate oral and nasal halitosis parameters in patients with and without clefts. DESIGN: Randomized and prospective study. Patients with and without clefts were evaluated as to oral and nasal halitosis. SETTING: University of São Paulo, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, Brazil. PATIENTS: Twelve patients with clefts and 12 without clefts were evaluated, and no exclusion criteria were followed. INTERVENTIONS: Nasal and oral halitosis were measured with the use of a portable sulfide monitor during a single visit. RESULTS: One hundred percent of the patients with clefts had altered values for volatile sulfur compounds. Only 33.3% of the patients without clefts had at least one strong value for nasal halimeter measurements, and 58.3% of these patients showed alteration in the nasal values. Statistical evaluation, made using the Mann-Whitney U test, classifying the nasal halimeter values as normal, weak, and strong, showing a statistical significant group difference (p = .003). There was no significant difference in the oral halimeter values between the two groups. CONCLUSIONS: Patients with cleft lip and palate had a tendency to present higher values for the nasal halimeter measurements, when compared with patients without clefts.