Biomechanical comparison of four mandibular angle fracture fixation techniques.

The aim of this study was to make a comparison of the biomechanical behavior of four different internal fixation systems for mandibular angle fractures. A total of 40 polyurethane mandible replicas were employed with different fixation methods: group 1SP, one 2.0-mm four-hole miniplate; group 2PPL, two 2.0-mm four-hole parallel miniplates; group 3DP, one 3D 2.0-mm four-hole miniplate; and group 3DPP, one 3D 2.0-mm eight-hole miniplate. Each group was subjected to incisal or homolateral molar region loading. The load resistance values were measured at load application causing tip displacement of 1, 3, and 5 mm, and at the time at which the system achieves its maximum strength (MS). Means and standard deviations were compared among groups using analysis of variance and the Tukey test. Group 2PPL showed higher strength for all the displacements. For incisal loading, no statistically significant differences were found between groups 1SP, 3DP, and 3DPP. For molar loading, group 1SP and 3DPP showed statistically significant differences. For MS testing, group 1SP and 2PPL showed statistically significant differences in incisal loading; group 1SP and 3DP showed no statistically significant differences; and group 3DPP showed lower values of strength. Two parallel miniplates provide the most favorable mechanical behavior under the conditions tested.

Etiology, treatment, and complications of mandibular fractures.

The objective of this retrospective study was to evaluate some epidemiological characteristics, surgical treatment methods, and complications of cases involving mandibular fractures. Records from 119 patients treated for mandibular fractures between January 2006 and December 2011 were analyzed. We find mandibular fractures mostly affect Caucasian (72.2%) men (80.7%). The mean age of the patients was 28.1 years. Road traffic accidents (RTA) caused the most fractures (49.5%), followed by physical violence, including gunshot wounds (21%). Motorcycle accidents were the most common cause of RTA (76.2%). The most affected mandibular regions were the parasymphysis (26.9%) and the mandible angle (25.1%). Both surgical and nonsurgical treatments were applied (90.4% and 9.6%, respectively). The most common surgical approach was the intraoral (64.9%), using the 2.0-mm fixation system (88.0%). Complications such as postoperative infections, malocclusion, and paresthesia occurred in 36 patients (30.2%). This research revealed interesting features about the etiology of mandibular fractures that were mostly associated with RTA. Severity of the trauma and noncompliance of the patients were factors that contributed to the development of postoperative complications.

Implantes extrabucales para la rehabilitación craneofacial / Extraoral fixation for craniofacial rehabilitation

Las prótesis maxilofaciales retenidas en implantes extrabucales o fijaciones cr neofaciales son herramientas claves en la rehabilitaci¢n de pacientes con alteraciones faciales debido a resecciones asociada con enfermedades, traumas graves, malformaciones y otros. El uso de implantes craneofaciales se caracteriza, principalmente, por ser procedimientos quir£rgicos r pidos, efectuados con anestesia general o local, con poca morbilidad y gran versatilidad para tratar diferentes  reas cr neofaciales como la regi¢n orbitaria, auricular y nasal, entre otras. Sin embargo, a£n existen dudas respecto a los protocolos e indicaciones de tratamientos asi como en otros t¢picos de relevancia. La siguiente revisi¢n bibliogr fica tiene como objetivo recolectar la informaci¢n cient¡fica disponible respecto de las fijaciones cr neofaciales abordando diferentes elementos de la evoluci¢n y procedimientos quir£rgicos para la instalaci¢n de estos dispositivos.

Maxillofacial prosthesis retained in extraoral implants or craneofacial attachments are key tools in the rehabilitation of patients withfacial abnormalities due to associated diseases, severe trauma, malformations and others. The use of craniofacial implants is mainlycharacterized by rapid surgical procedures performed under general or local anesthesia, with little morbidity and versatility to treatdifferent facial skull and the orbital region, auricular, nasal, among other areas. However, there are still doubts about protocols andtreatment indications as well as other relevant topics. The aim of this literature review was to collect the scientific information availablerelated to craniofacial fixations addressing different elements of evolution and surgical procedures for the installation of these devices.

Análisis químico y topográfico de la superfície de implantes dentarios mediante espectroscopia de fotoelectrones y microscopía electrónica de barrido: estudio preliminar / Chemical and topographic analysis of dental implant surfaces using photoelectron spectroscopy and scanning electron microscopy: preliminary study

El objetivo de este estudio fue analizar la composición química y la topografía superficial de implantes de titanio comercialmente puro, obtenidos de 3 marcas comerciales utilizadas actualmente en odontología. Fueron analizados 6 implantes de titanio de los siguientes sistemas: SIN, P-I philosophy y Neodent. Este material fue dividido en 3 grupos de 3 implantes cada uno. Para determinar la composición química de la superficie fue utilizada la técnica de Espectroscopia de Fotoelectrones Excitada por rayos-X (XPS), mientras que para caracterizar la topografía superficial fue utilizada Microscopia electrónica de barrido. Titanio, Carbono Silicio y Oxigeno fueron identificados en todas las muestras analizadas. Otros elementos contaminantes identificados fueron Silicio, Aluminio, azufre, plomo, Fósforo, Calcio, Sodio, Nitrógeno y Carbono. Fueron identificadas impurezas en la superficie de todos los implantes analizados. Consideramos necesarios otros estudios que relacionen permanentemente la presencia y concentración de estos elementos con el proceso de oseointegración...

The aim of this study was to analyze the chemical composition and surface topography of commercially pure titanium implants, obtained from 03 trademarks frequently used in dentistry. There were 9 titanium implants of the following systems: SIN, P-I philosophy and Neodent. These materials were divided into 3 groups, with 3 implants in each group. Photoelectron Spectroscopy Excited by X-ray (XPS) was used to determine the chemical composition, while to characterize the surface topography we used Scanning Electron Microscopy (SEM). Titanium, carbon silicon and oxygen were identified in all samples analyzed. Other contaminants were: silicon, aluminum, sulfur, lead, phosphorus, calcium, sodium, nitrogen and carbon. We identified impurities on the surface of all implants analyzed. We consider necessary to development more studies relating the presence and concentration of these elements with the osseointegration process...

Pattern and treatment of facial trauma in pediatric and adolescent patients.

Pediatric maxillofacial trauma is a challenge for surgeons. There are no completely defined protocols, and sometimes, the initial management could be complex. The aim of this research was to perform a retrospective study to analyze the pattern and treatment of maxillofacial fractures in pediatric and adolescent patients. We reviewed the clinical records of 2986 patients treated at the Oral and Maxillofacial Surgery Division of Piracicaba Dental School between 1999 and 2008. Seven hundred fifty-seven patients were younger than 18 years and were divided into 3 groups according to age; the age and sex of the patients, etiology, fractures and associated injury, treatment, and complications were evaluated. Five hundred thirty boys (70.01%) and 227 girls (29.99%) were treated for injuries with major prevalence in adolescents. The most common injury causes were bicycle accidents (29.06%) and falls (28.40%). The mandible was the most fractured bone (44.8%); associated injuries were lacerations of the soft tissue and dental trauma. Surgical treatment was performed in 75 cases (30%) with minor complications (10% of surgical patients). We conclude that maxillofacial trauma in child is associated to fall and bicycle accidents; the mandible is more affected than other maxillofacial structures, and frequently, nonsurgical treatment is performed.

Tratamiento quirúrgico de caninos mandibulares bilaterales transmigrados / Surgical treatment of bilateral mandibular transmigrated canine

La migración de caninos inferiores es un fenómeno poco común. Su incidencia es menor que incluidos maxilares y son frecuentemente encontrados en jóvenes. Solamente caninos, segundos premolares y terceros molares incluidos migran a lugares ectópicos en su desarrollo y dientes incluidos ectópicos son, en la mayoría de los casos, asintomáticos. La etiología es compleja y poco descrita en la literatura. Un canino es considerado un diente migrado cuando, horizontalmente, más de la mitad del diente atraviesa la línea mediana. Este artículo reporta un caso clínico, con tratamiento quirúrgico de exodoncia de caninos bilaterales incluidos, horizontalmente en la región de la sínfisis. Se observó que la exodoncia es la conducta operatoria más frecuente, presentando en este caso buenos resultados.

Migration of canine mandibles is a very uncommon phenomenon. Their incidence is less frequent than maxillary canines and present frequently in young people. Only canines, second bicuspid and third molars can migrate to ectopic areas in their development and ectopic embedded teeth are, for the most part asymptomatic. The etiology is complex and with poor information. A canine is considered a migrating tooth when it penetrates horizontally the middle line of the mandible. This paper reports a case with surgical treatment of dental extraction, including horizontal bilateral canines in the symphysis region. It was observed that dental extraction is a more frequent treatment and presented with good results in this case.

Treating oral histoplasmosis in an immunocompetent patient.

BACKGROUND: Histoplasmosis is a deep fungus infection that occurs worldwide and is caused by Histoplasma capsulatum. Oral histoplasmosis has been of considerable importance in recent years because it occurs frequently in immunosuppressed patients, more often in those who test positive for the human immunodeficiency virus (HIV). However, the literature contains reports of histoplasmosis in immunocompetent patients, especially in endemic areas. CASE DESCRIPTION: The authors describe a case of an HIV-negative, immunocompetent 60-year-old man with ulcerative and painful oral lesions. The clinician included squamous cell carcinoma and systemic mycosis in the differential diagnosis. After the patient underwent a biopsy and a definitive diagnosis was reached, his initial treatment regimen included itraconazole (200 milligrams per day for one month), nystatin and chlorhexidine mouthrinse (0.12 percent, 10 milliliters, two times a day). The itraconazole treatment was continued for three more months (100 mg daily) until the lesions had resolved completely. CLINICAL IMPLICATIONS: Clinicians need to conduct a careful clinical evaluation and make an accurate diagnosis of ulcerated oral lesions. Knowledge of the oral manifestations of histoplasmosis may enable clinicians to reach a diagnosis earlier and initiate therapy more quickly.

Consideraciones actuales en hiperplasia fibrosa inflamatoria / Current considerations in inflammatory fibrous hyperplasia

El objetivo de esta investigación es evaluar los aspectos clínicos, histológicos y las posibilidades de tratamiento de la hiperplasia fibrosa inflamatoria (HFI). Esta lesión se origina frecuentemente a partir de prótesis totales o parcial mal adaptadas, las cuales generan un traumatismo crónico de baja intensidad. Se han descrito lesiones en mandíbula y maxila, no existiendo predilección por ninguna de las arcadas dentales. Lesiones pequeñas pueden ser tratadas de manera conservadora, con remoción del agente causal o mediante atrofia por presión con nuevas prótesis, mientras que lesiones extensas y de larga evolución necesitarán de escisión quirúrgica. Si el tratamiento quirúrgico es considerado, éste debe incluir la remoción total de la lesión, usando diversas técnicas como bisturí “frío” (lámina), láser o electrocirugía.La remoción quirúrgica es necesaria, pues restaura el contorno normal del tejido y la adaptación protética. Algunos autores han reportado alteraciones displásicas en la HFI, pero la posibilidad de que ésta sufra una transformación maligna aún es muy discutida.

The objective of this research is an evaluate of clinical and histologic aspects of fibrous inflammatory hyperplasia and the possibilities of its treatment. This lesion is frequently originated for using total or partial prosthesis which are inadequate adapted generating a chronic traumatism of low intensity. Clinical cases in jaw and maxila have been reported, not existing predilection for any dental arches. Small lesions can be treated by the conservative way that means removing the causal agent or atrophying by putting pressure with a new prosthesis, whereas extensive lesions of large evolution need surgical excision. If the surgical treatment is considered, this should include the total removal of the lesion, using varieties of techniques such as “cold” scalpel, laser or electrosurgical techniques. The surgical removal is necessary because recover the normal contour of tissue and the prosthetic adaptation. reports exist about dysplasic alterations related to fibrous inflammatory hyperplasia, but the possibility of a malignant transformation is actually controversial.

El área cervical de implantes dentales presenta mayor formación ósea que el área apical en diferentes condiciones de diseño y carga: resultados preliminares / The cervical area of dental implants present more osseous formation than apical area in different load and design condition: preliminary results

Los implantes dentales han evolucionado de forma sustancial en los últimos 40 años; sin embargo, dudas sobre las características de la reparación ósea continúan toda vez que nuevos diseños y nuevos métodos quirúrgicos son aplicados. El objetivo de esta investigación es evidenciar la presencia de tejido mineralizado en diferentes regiones del implante. Se elaboró un estudio basado en un modelo de restauración inmediata, aplicado en la mandíbula de 7 canes machos. Se realizaron las exodontias de los premolares mandibulares y, después de 3 meses de recuperación, se instalaron 2 implantes endóseos bilaterales, siendo uno de tipo cónico y otro de tipo cilíndrico. Después de dos periodos de sacrificio se realizo una evaluación histomorfométrica en los cortes seleccionados. Los resultados se presentan de forma porcentual estableciendo comparaciones entre las áreas cervical, media y apical. Los implantes de morfología cónica sometidos al modelo de restauración inmediata, presentaron mayor formación ósea en todos los niveles evaluados. En todas las condiciones de trabajo el área cervical presentó mayor presencia de tejido mineralizado que el área apical. Concluimos que el modelo de restauración inmediata no es un obstáculo para la instalación de la secuencia apropiada de reparación ósea y que diferentes factores deben estar asociados a la mayor formación ósea presente en el área cervical de los implantes dentales.

Dental implants have evolved of substantial form in the last 40 years; however, doubt about osseous repair characteristic are maintained because new design and surgical method are applied. The aim of this research is show the mineralized tissue in different areas of the implant. Was done a study based to a immediate load model applied in 7 male dogs mandible. Was realized the dental extractions of de bilateral mandibles bicusp and after to 3 month of recuperations was installed two bilaterally implants, been conical and cylindered shape. After of two sacrifices period was realized a histomorphometric analysis in the selection cut. The results are present with perceptual form, establishing cervical, meddle and apical comparison. Conical implants with immediate restoration model were present more osseous formations in all evaluated level. For all conditions of work, cervical area presented more mineralized tissue than apical area. We conclude that immediately restoration model it is not an obstacle for the installation of the appropriate sequence for the osseous reparation and that different factors have been associated to the more osseous formation in the cervical area of the dental implants.