Clear aligners combined with orthognathic surgery: a case series.

The goal of this study was to describe a series of orthognathic surgery cases in which a clear aligner system was used for orthodontic treatment. A total of 16 cases were undertaken. A majority of the patients were female (68.75%), and the mean age of the patients was 26.78 years (SD 10.85 years). The most frequent malocclusion was Class II (56.25%), mainly caused by mandibular retrognathism (80.00%). Most of the patients were treated with single-jaw surgeries (56.15%). Orthodontic buttons and elastics were used for maxillomandibular fixation in 81.25% of the patients. The mean (SD) treatment period was 19.00 (1.11) months, and the postsurgical follow-up varied from 6 months to 10 years. Good results were achieved with orthognathic surgery and the adjunctive use of clear aligners, and no damage was noted during the orthosurgical treatment. Since clear aligners provide an esthetic, removable appliance and may be more acceptable to patients than conventional orthodontic appliances, the use of clear aligners in orthognathic surgery is a promising alternative to traditional orthodontics.

Evaluation of Alveolar Bone Quality: Correlation Between Histomorphometric Analysis and Lekholm and Zarb Classification.

OBJECTIVES: This study evaluated the bone quality of the maxilla and mandible by using the classification proposed by Lekholm and Zarb (L & Z) and histomorphometry. METHODS: Sixty edentulous areas were evaluated. The classification by L & Z was obtained through the evaluation of periapical and panoramic radiographs associated with the surgeon's tactile perception during milling and implant installation. Before implant installation, bone biopsies of standardized sizes were performed for histological evaluation. RESULTS: Type III bone quality was more frequent in the posterior (73.33%) and anterior (73.33%) maxilla, whereas type II bone quality was more frequent in the posterior (53.33%) and anterior (60.00%) mandible. Through histometry, statistical difference was observed for the amount of bone tissue of the posterior region of the maxilla in relation to the anterior and posterior regions of the mandible (P ≤ 0.043). However, there was no difference in osteocyte counts between alveolar regions (P = 0.2946). In the female gender, the age showed a low positive correlation with the L & Z classification (rho = 0.398; P = 0.006) and in the male gender, a moderate negative correlation was observed (rho = -0.650, P = 0.016). CONCLUSIONS: Both methods detected differences in the bone quality of the alveolar regions of the maxilla/mandible and that the classification by L & Z is a reliable method, since it was consistent with histomorphometry, considered the "gold standard" method for the evaluation of bone quality and greater bone density was observed in older men.

Modified coronectomy procedure for mandibular third molar: association of platelet-rich fibrin / Técnica de coronectomia de terceiro molar inferior modificada: associação de plasma rico em fibrina

ABSTRACT The present case report describes a modified technique of coronectomy for mandibular third molar with association of Platelet-Rich Fibrin Graft (PRF). The panoramic radiograph showed proximity of the roots of the vertical positioned 48 tooth with the superior wall of the mandibular canal, since the erasure of the superior cortical of the mandibular canal was observed. Due to the risk of injury to the inferior alveolar nerve, the technique of coronectomy was chosen. After the realized the coronectomy, in order to promote the regeneration of soft and hard tissues and also to prevent pulp changes that could lead to pain, pulp necrosis and infection, the PRF graft was used to fill the surgical defect formed by removal of the crown. Good healing evolution was observed and after 12 months of clinical and radiographic follow-up there was complete bone formation in the area where the crown was removed and no complications were observed.

RESUMO O presente caso clínico descreve uma técnica modificada de coronectomia de um terceiro molar inferior com a associação de Plasma Rico em Fibrina (PRF). A radiografia panorâmica mostrou proximidade das raízes do dente 48 posicionado verticalmente com a cortical superior do canal mandibular, The panoramic radiograph showed proximity of the roots of the vertical positioned 48 with the superior wall of the mandibular canal, ma vez que, observou-se o desaparecimento da cortical superior do canal. Devido ao risco de lesão ao nervo alveolar inferior, a técnica de coronectomia foi empregada. Depois de realizada a coronectomia, com o objetivo de favorecer a regeneração dos tecidos moles e duros e também de prevenir alterações pulpares que poderiam causar dor, necrose pulpar e infecção, o enxerto de PRF foi usado para preencher o defeito formado pela remoção da coroa. Boa evolução cicatricial foi observada 12 meses pós-operatórios, o acompanhamento clínico e radiográfico mostrou completa formação óssea na área onde a coroa foi removida e não foram observadas complicações.

Radiographic Evaluation in the Diagnosis of Alveolar Bone Quality in Implant Rehabilitation.

This study evaluated the optical bone density of the maxilla and mandible and correlate with the classification of bone quality of the Lekholm and Zarb (L & Z). Sixty edentulous areas were evaluated. Panoramic and periapical radiographs were performed with an aluminum scale to evaluate the optical bone density. L & Z classification was also applied. By using periapical radiographs, a statistically significant difference was observed in the optical bone density of the posterior maxilla (2.38 ±â€Š1.06) and the posterior mandible (3.84 ±â€Š0.68), when compared to the other regions (P ≤ 0.015). However, with panoramic radiographs, no differences were observed in the optical bone density (P = 0.6322). A negative correlation was observed between the L & Z classification and the optical bone density obtained by the periapical radiographs (rho = -0.463; P < 0.001), that is, the worse the bone quality, the lower the bone density. However, there was no significant correlation with the bone density obtained by panoramic radiographs (rho = -0.009; P = 0.948). As for gender, a correlation between aging and the presence of medullary bone was observed in females, assessed by the L & Z classification (rho = 0.398; P = 0.006). However, there was a correlation between aging and a denser and less medullary presence in males, both assessed by the L & Z classification (rho = -650; P = 0.016), as well as the optical density assessed by periapical (rho = 0.621; P = 0.023) and panoramic (rho = 0.588; P = 0.035) radiographs. These results suggest that gender and age interfere with the bone quality and periapical radiographs are an acceptable method for evaluating bone density. However, a panoramic radiograph was not found to be a reliable method.

Orthodontic-surgical treatment of a patient with Marfan Syndrome and Obstructive Sleep Apnea Syndrome: a case report with a 9-year follow-up / Tratamento ortodôntico-cirúrgico de um paciente com Síndrome de Marfan e Síndrome da Apnéia Obstrutiva do Sono: relato de caso com 9 anos de acompanhamento

ABSTRACT Marfan's (MFS) syndrome is characterized by a defect in the connective tissue, which affects multiple organic systems. Therefore, the management of these patients requires a multidisciplinary approach. This case reports the orthodontic-surgical treatment of a patient who presented both Marfan's and obstructive sleep apnea syndrome. Patient had malocclusion, TMJ clicking, vertical maxillary excess, mandibular retrognathia, severe esthetic compromise, signs and symptoms of obstructive sleep apnea syndrome, as well as alterationsin joints, cardiovascular and respiratory systems. He was treated with bimaxillary surgery aimed to enhance esthetics, occlusion and address the obstructive sleep apnea syndrome. The clinical results show that a desirable functional occlusion was achieved and both patient's facial esthetics and quality of life were significantly improved. After a 9-year follow-up period, these pleasing features were maintained. The diagnosis and management of Marfan's patients is challenging and require multidisciplinary follow-up.

RESUMO A síndrome de Marfan (SMF) é caracterizada por um defeito no tecido conjuntivo que afeta múltiplos sistemas orgânicos. Portanto, o manejo desses pacientes requer uma abordagem multidisciplinar. Este artigo relata o tratamento ortodôntico-cirúrgico de um paciente com síndrome de Marfan e síndrome da apneia obstrutiva do sono (SAOS). Ele manifestava má oclusão, estalidos na ATM, excessovertical de maxila, retrognatismo mandibular, comprometimento estético severo, sinais e sintomas de síndrome da apneia obstrutiva do sono, além de alterações nas articulações, nos sistemas cardiovascular e respiratório. O tratamento incluiu cirurgia bimaxilar com o objetivo de melhorar a estética, a oclusão e tratar sua apneia obstrutiva do sono. Os resultados clínicos mostram que uma oclusãofuncional desejável foi alcançada e tanto a estética facial quanto a qualidade de vida do paciente foram significativamente melhoradas. Após um período de 9 anos de acompanhamento, essas características agradáveis foram mantidas. O diagnóstico e tratamento de pacientes com síndrome de Marfan é desafiador e requer acompanhamento multidisciplinar.

Dental self-perception and clinical dental description of participants in the Open University programme for elderly people / Autopercepção e características clínico-odontológicas dos participantes da Universidade aberta a terceira idade

ABSTRACT Objective: This study verified both the self-perception and oral characteristics of a group of elderly participants of the Open University for the Elderly (UNATI). Methods: The sample consisted of a cross-sectional epidemiological study with elderly subjects (50 years of age or older), who attended the UNATI-UNIFAL/MG program. Data collection was carried out using a semi-structured questionnaire consisting of open- and closed-ended questions regarding oral health, its interference with self-esteem and nutrition, among other features. In addition, an application form based on the proposals by the Oral Health Survey 2010, was used. Univariate and multivariate descriptive analyses were performed. Results: The study sample consisted of 106 subjects (mean age of 62.4 years), of whom 59.4% had attended a dental appointment in the last year for routine and/or aesthetic examinations (38.7%). The clinical conditions showed that only 19.8% of the subjects were completely edentulous, an average DMFT of 26.1, and 37.7% used some kind of complete upper dentures, complete lower dentures, or both. Regarding self-perception of oral conditions, 34.9% considered it a regular perception, however in the applied statistics the presence of pain demonstrated a worse perception which was not correlated with teeth loss, presence of dentures and/or restored teeth. Conclusion: The self-perception of oral conditions is regular and the clinical and odontological characteristics evaluated revealed partial edentulous subjects with high DMFT. By evaluating the odontological aspects, it was observed that the majority of the subjects did not have difficulties to look for a dentist, they attended dental appointments in the last year and the preventive treatment had been the most required.

RESUMO Objetivo: Este estudo verificou a autopercepção, as características bucais e os aspectos odontológicos dos participantes da Universidade Aberta a Terceira Idade (UNATI). Métodos: Refere-se a um estudo epidemiológico transversal com indivíduos a partir de 50 anos de idade que frequentam o programa UNATI-UNIFAL/MG. O instrumento de coleta de dados consistiu em um questionário semiestruturado, composto por perguntas referentes à saúde bucal, interferência da mesma na autoestima e alimentação, entre outros. Além disso, foi utilizada uma ficha clínica baseada nas propostas do Levantamento em Saúde Bucal 2010. Foram realizadas análises descritivas, uni e multivariadas. Resultados: A amostra foi composta por 106 indivíduos, com idade média de 62,4 anos, dentre os quais 59,4% visitaram o cirurgião-dentista no último ano para exames de rotina e/ou estética (38,7%). As condições clínicas evidenciaram que apenas 19,8% dos indivíduos eram desdentados totais, o CPOD médio de 26,1 e 37,7% usava algum tipo de prótese total superior, inferior ou ambas. Quanto a autopercepção das condições bucais, 34,9% se refere regular, contudo, na estatística aplicada a presença de dor determinou uma pior percepção e não esteve correlacionada com a perda de dentes, presença de próteses e/ou dentes restaurados. Conclusão: A autopercepção das condições bucais é regular e as características clínico-odontológicas avaliadas revelaram indivíduos desdentados parciais com elevado CPOD. Ao avaliar os aspectos odontológicos a maioria não apresentou dificuldades ao procurar o cirurgião-dentista, visitaram esse profissional no último ano e o tratamento mais procurado por eles foi o preventivo.

Postoperative Complications Associated With Different Fixation Methods of Isolated Mandibular Angle Fractures.

The objective of this study was to review the medical records of patients with a history of mandibular angle fracture who were attended at the Service of Oral and Maxillofacial Surgery and Traumatology of FOAr/UNESP in the last 5 years. The data collected were subjected to chi-squared test (significance level of 5%). The authors reviewed 19 medical records. The main cause was physical aggression (58.00%), but with no statistical difference in relation to the other etiologies (P > 0.05). Regarding the type of fixation, one 2.0-mm system plate associated with one 2.4-mm system plate and the fixation using only two 2.0-mm system plates were used in 7 patients each. The fixation method with a monocortical plate at the upper border was used in 5 patients. However, there was no statistically significant difference in the frequency of complications among the 3 fixation methods used (P > 0.05). In 52.64% of the patients, the third molar was removed intraoperatively. Despite this, there was no statistically significant difference in the frequency of complications when the third molar was in the fracture line or when it was removed postoperatively (P > 0.05). The complications observed were dehiscence associated with pain (44.44%), trismus (22.22%), infection (22.22%), and presence of bone spicules (11.11%). However, no statistical differences were observed between the frequency of different types of complications (P = 0.779). In the sample studied, there were no differences in the frequency of complications among the fixation methods applied.

Immediate loading over lower prosthesis in edentulous mandibles: comparison between two types of prosthetic connection / Carga imediata sobre protocolos inferiores: comparação entre dois tipos de conexões protéticas

ABSTRACT Objective: This study evaluated two implant-abutment connection systems under immediate loading of lower prosthesis in edentulous mandibles. Methods: Seventy-two implants placed in 18 patients were analyzed. The parameters evaluated included probing depth, stability of implants and perimplant bone loss, which were measured immediately when installing the prosthesis and after 3 and 6 months. All data underwent statistical analysis (T-Test and ANOVA, 5% significance level). Results: Implants with Morse cone connections showed smaller, statistically significant probing depth values for all periods (0.68/1.19/1.31), when compared to the external hexagon connections (1.08/1.52/1.64). A statistically significant difference was observed between baseline, 3 months (p<0.01 for Morse cone; p<0.001 for external hexagon) and 6 months (p<0.001 for both connections). When periods were considered there was a statistically significant difference in Implant Stability Quotient ISQ values between baseline and 6 months for both prosthetic connections. Conclusion: Immediate loading of the lower prosthesis is a viable option for the treatment of edentulous mandibles and that the external hexagon or Morse cone connections do not interfere with the success of the implants in a short-term evaluation.

RESUMO Objetivo: Avaliar dois sistemas de conexões protéticas sobre carga imediata em próteses tipo protocolo em mandíbulas edêntulas. Métodos: Setenta e dois implantes instalados em 18 pacientes foram analisados. Os parâmetros avaliados incluíram: profundidade de sondagem, estabilidade dos implantes e perda óssea periimplantar, os quais foram mensurados imediatamente após a instalação das próteses e depois de 3 e 6 meses pós-operatórios. Todos os dados foram submetidos à análise estatística (Teste T e ANOVA, ao nível de 5% de significância). Resultados: Implantes com conexão cone Morse mostraram profundidade de sondagem estatisticamente menor em todos os períodos (0,68/1,19/1,31), quando comparado com a conexão hexágono externo (1,08/1,52/1,64). Diferença estatisticamente significante foi observada entre o pré-operatório imediato, 3 meses (p<0,01 para cone Morse; p<0,001 para hexágono externo) e 6 meses (p<0,001 para ambas as conexões). Quando os períodos foram considerados houve uma diferença estatisticamente significante no quociente de estabilidade do implante (ISQ) entre o pré-operatório imediata e de 6 meses para ambas as conexões protéticas. Conclusão: A carga imediata sobre protocolos inferiores é uma opção viável para o tratamento de mandíbulas edêntulas e a conexão hexágono externo ou cone Morse não interferiram no sucesso dos implantes em um período curto de avaliação.

Remoção de terceiro molar superior deslocado para o espaço bucal / Removal of upper third molar displaced to the buccal space

Os autores descrevem um caso clínico de deslocamento de germe dentário de terceiro molar superior esquerdo para o espaço bucal em um paciente de 13 anos de idade. A localização do dente em posição profunda com envolvimento do corpo adiposo do bucinador dificultou a sua localização, ainda não descrita, nas condições em questão, na literatura. Com a Tomografia Computadorizada de Feixe Cônico (TCFC), foi possível localizar o dente deslocado e planejar a sua remoção. Os riscos e benefícios das extrações de germes de terceiros molares precisam ser avaliados devido ao grande risco de deslocamentos... (AU)

The authors describe a case of displacement of left upper third molar tooth germ to the buccal space in a patient 13 years old. The deep position of the tooth with involvement of the fat body of the buccinator made it difficult its location, still not described, under the concerned conditions, in the literature. With the cone beam computed tomography (CBCT), it was possible determine the location of the tooth and plan his removal. The risks and benefits of third molar tooth germ extraction should be evaluated because there is a greater chance of displacement... (AU)

Aggressive Osteoblastoma in the Maxilla: Unusual Lesion in the Craniofacial Skeleton.

Osteoblastomas are benign bone tumors, which are unusual in the craniofacial skeleton, being most often observed in the axial skeleton and long bones. The most common site in the maxillofacial region is the mandible and the involvement of the maxilla and paranasal sinuses is extremely rare. Although it is a benign lesion, the aggressive variant raises concerns due to its huge local destructive potential and tendency to relapse. In this clinical case, an aggressive osteoblastoma is described in a 7-year-old patient. The lesion was large and fully involved the left maxilla, including the maxillary sinus and the nasal cavity. Recurrent volume increase was observed 2 months following enucleation of the lesion and en bloc resection of the maxillary segment was performed. Histological and immunohistochemical evaluation associated with clinical and imaging findings allowed to define the tumor as an aggressive variant of osteoblastoma and not osteosarcoma, despite the aggressive behavior. The patient recovered well and no relapses were observed after 12 months following maxillary resection.

Bone grafting for alveolar ridge reconstruction. Review of 166 cases.

OBJECTIVE:: to investigate the predictive factors of failure in bone grafts for alveolar ridge augmentation and implant surgery. METHODS:: we reviewed the charts of 166 patients operated between 1995 and 2014. A total of 248 grafting procedures were performed. We submitted the data to the binomial test at 5% significance. RESULTS:: grafts to gain width of the alveolar ridge (65.32%) were more frequent than sinus lifting (p<0.0001) and the number of grafts to the posterior maxilla (48.8%) was greater than in other regions (p<0.01); 6.04% of the grafts were lost. The losses in anterior (p<0.0309) and posterior (p<0.0132) maxilla were higher than in the mandible. There were 269 ​​implants installed in the grafted areas, of which only 4.83% were lost. The number of implants lost (4.51%) in areas of onlay grafts was not statistically higher than those placed after sinus lifting (2.63%, p<0.2424). Losses were greater in the anterior (53.85%) and posterior (38.46%) maxilla than in the mandible (p<0.031). Regarding patients' age, 76.92% of the lost grafts (p<0.006) and 80% of the lost implants (p<0.001) were installed in patients over 40 years. CONCLUSION:: failure rate was higher both for grafts and dental implants in the maxilla and in patients over 40 years of age. OBJETIVO:: investigar os fatores preditivos de falhas em enxertos ósseos para aumento do rebordo alveolar e cirurgia de implantes. MÉTODOS:: os prontuários de 166 pacientes, operados entre 1995 e 2014, foram revistos. Um total de 248 enxertos foi realizado. Os dados foram submetidos ao teste binomial a 5% de significância. RESULTADOS:: os enxertos para ganho em espessura do rebordo alveolar (65,32%) foram mais frequentes do que levantamentos de seio maxilar (p<0,0001) e o número de enxertos para a região posterior da maxila (48,8%) foi maior do que em outras regiões (p<0,01). Foram perdidos 6,04% dos enxertos. As perdas em maxila anterior (p<0,0132) e posterior (p<0,0309) foram maiores do que na mandíbula. Foram instalados 269 implantes nas áreas enxertadas e apenas 4,83% perdidos. O número de implantes perdidos (4,51%) em áreas de enxertos em bloco não foi estatisticamente maior do que na área de seios maxilares enxertados (2,63%) (p<0,2424). As perdas foram maiores na região anterior (53,85%) e posterior (38,46%) da maxila em relação a mandíbula (p<0,031) e, 76,92% dos enxertos (p<0,006) e 80% dos implantes perdidos (p<0,001), foram instalados em pacientes com mais de 40 anos de idade. CONCLUSÃO:: maior taxa de falhas foi observada para enxertos e implantes dentários realizados em maxila e em pacientes com mais de 40 anos de idade.

Bone grafting for alveolar ridge reconstruction. Review of 166 cases. / Enxerto ósseo para reconstrução óssea alveolar. Revisão de 166 casos

ABSTRACT Objective: to investigate the predictive factors of failure in bone grafts for alveolar ridge augmentation and implant surgery. Methods: we reviewed the charts of 166 patients operated between 1995 and 2014. A total of 248 grafting procedures were performed. We submitted the data to the binomial test at 5% significance. Results: grafts to gain width of the alveolar ridge (65.32%) were more frequent than sinus lifting (p<0.0001) and the number of grafts to the posterior maxilla (48.8%) was greater than in other regions (p<0.01); 6.04% of the grafts were lost. The losses in anterior (p<0.0309) and posterior (p<0.0132) maxilla were higher than in the mandible. There were 269 ​​implants installed in the grafted areas, of which only 4.83% were lost. The number of implants lost (4.51%) in areas of onlay grafts was not statistically higher than those placed after sinus lifting (2.63%, p<0.2424). Losses were greater in the anterior (53.85%) and posterior (38.46%) maxilla than in the mandible (p<0.031). Regarding patients' age, 76.92% of the lost grafts (p<0.006) and 80% of the lost implants (p<0.001) were installed in patients over 40 years. Conclusion: failure rate was higher both for grafts and dental implants in the maxilla and in patients over 40 years of age.

RESUMO Objetivo: investigar os fatores preditivos de falhas em enxertos ósseos para aumento do rebordo alveolar e cirurgia de implantes. Métodos: os prontuários de 166 pacientes, operados entre 1995 e 2014, foram revistos. Um total de 248 enxertos foi realizado. Os dados foram submetidos ao teste binomial a 5% de significância. Resultados: os enxertos para ganho em espessura do rebordo alveolar (65,32%) foram mais frequentes do que levantamentos de seio maxilar (p<0,0001) e o número de enxertos para a região posterior da maxila (48,8%) foi maior do que em outras regiões (p<0,01). Foram perdidos 6,04% dos enxertos. As perdas em maxila anterior (p<0,0132) e posterior (p<0,0309) foram maiores do que na mandíbula. Foram instalados 269 implantes nas áreas enxertadas e apenas 4,83% perdidos. O número de implantes perdidos (4,51%) em áreas de enxertos em bloco não foi estatisticamente maior do que na área de seios maxilares enxertados (2,63%) (p<0,2424). As perdas foram maiores na região anterior (53,85%) e posterior (38,46%) da maxila em relação a mandíbula (p<0,031) e, 76,92% dos enxertos (p<0,006) e 80% dos implantes perdidos (p<0,001), foram instalados em pacientes com mais de 40 anos de idade. Conclusão: maior taxa de falhas foi observada para enxertos e implantes dentários realizados em maxila e em pacientes com mais de 40 anos de idade.

Off-Label Use of Bone Morphogenetic Protein 2 in the Reconstructions of Mandibular Continuity Defects.

This paper describes 3 patients of off-label use of bone morphogenetic protein 2 (rhBMP-2) in the reconstruction of mandibular continuity defects. In the first patient, rhBMP-2 was associated with iliac crest bone graft for late mandibular reconstruction after resection of osteosarcoma. In the 2 other patients, rhBMP-2 was used alone. In 1 patient the mandibular continuity defect was due to resection for treatment of osteomyelitis and in the other patient a continuity defect was created by unsuccessful osteogenic distraction for correction of mandibular hypoplasia. Despite the good results in those patients, the off-label use of rhBMP-2 is associated with increased rate of complications, so more studies are needed to assess the predictability of the use of rhBMP-2 in mandibular continuity defects. Therefore, at the moment the off-label use of rhBMP-2 should be restricted to complicated bone defects in which the conventional alternatives of reconstruction were unsuccessful.

Pathological Mandibular Fracture Associated With Diffuse Large B-Cell Lymphoma in HIV-Positive Patient.

This article describes the occurrence of diffuse large B-cell lymphoma in a 39-year-old human immunodeficiency virus-positive patient. The patient sought medical care complaining of increased volume in the right mandibular angle and imaging tests showed an extensive radiolucency with undefined boundaries compromising the mandibular border. After the incisional biopsy, the patient had a pathological fracture in the region, which was properly treated in a second surgical procedure using a 2.4-mm reconstruction plate. Immunohistochemical analysis revealed positive marking for CD3, CD79a, Ki67, and Epstein-Barr virus-encoded RNA. The treatment consisted of concurrent antiretroviral therapy with chemotherapy with rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone. Examinations of images (2 years postoperatively) revealed complete bone repair and absence of injury recurrence. This work is important because it describes an unusual location of diffuse large B-cell lymphoma and shows the importance of diagnosis and treatment of the injury at an early stage in order to promote the prognosis and survival of patients.

Third molar extractions: a retrospective study of 1178 cases / Exodontias de terceiros molares: estudo retrospectivo de 1178 casos

ABSTRACT Objective: This study aims to investigate the demographics, patient health status, position of the teeth, pericoronitis incidence, surgical complications, use of antibiotics to third molar removal and correlate those findings. Methods: Based on panoramic radiographs, the teeth were classified as proposed by Pell and Gregory and Winter. The binomial test for proportions with a significance level of 5% was applied. Results: Records of 337 patients submitted 1178 third molar extractions in the period from 1993 to 2011 were reviewed. Most upper teeth were vertically positioned, (84.2%) (p<0.0001), class I (49.55%) (p<0.0001), position C (58.88%) (p<0.0001) and most inferiors were mesioangulated (42.03%) (p<0.0122), class II (60.22%) (p<0.0001), position A (48.15%) (p<0.0001). Complications occurred in 2.88% of the procedures (p<0.0006), mainly in women (69.7%) (p<0.0014) and more frequently in patients who did not receive antibiotics (71.43%) (p<0.0027). Complications were more frequent after extraction of inferior third molars (75.75%) (p<0.0001). The most common complication was alveolitis (52.51%) (p<0.0006). Conclusion: In this study, the complication rates were low. They were more frequent in women who did not receive antibiotics. The most common complication was alveolitis.

RESUMO Objetivo: Este estudo objetivou descrever os dados demográficos dos pacientes, posicionamento dos terceiros molares, complicações cirúrgicas, condição sistêmica, histórico de pericoronarite e antibioticoterapia e correlacionar esses achados. Métodos: Com base em radiografias panorâmicas os dentes foram classificados conforme proposto por Pell e Gregory e Winter. Foi utilizado o teste Binomial para proporções a 5% de significância. Resultados: Foram revisados os prontuários de 337 pacientes submetidos a 1178 exodontias durante o perído de 1993 a 2011. Os dentes superiores apresentaram-se predominantemente verticais (84,2%) (p<0,0001), classe I (49,55%) (p<0,0001), posição C (58,88%) (p<0,0001) e os inferiores mesioangulados (42,03%) (p<0,0122), classe II (60,22%) (p<0,0001), posição A (48,15%) (p<0,0001). As complicações ocorreram em apenas 2,88% das cirurgias, foram mais comuns em mulheres (69,7%) (p<0,0014) e em pacientes que não fizeram uso de antibióticos (71,43%) (p<0,0027). A maioria das complicações ocorreu após extrações de dentes inferiores (75,75%) (p<0,0001). A complicação mais comum foi a alveolite (52.51%) (p<0.0006). Conclusão: Neste estudo, as complicações não foram frequentes e acometeram mais mulheres e pacientes que não fizeram uso de antibióticos, sendo a alveolite a mais comumente observada.

Gardner Syndrome With Unusual Maxillofacial Manifestation.

Gardner syndrome is a rare autosomal-dominant condition characterized by the presence of intestinal polyposis, multiple osteomas, and tumors of the hard and soft tissues. This paper describes a patient of Gardner syndrome with unusual maxillofacial manifestation with presence of fibromyxomatous injury in jaw, coronoid hyperplasia, and multiple osteomas diffusely distributed in the craniomaxillofacial skeleton. Imaging examinations have identified craniofacial manifestations and the patient was referred to the gastroenterologist who confirmed the diagnosis of Gardner syndrome. The early diagnosis of this syndrome is important since intestinal polyps have high potential for malignant transformation. It is therefore essential that dentists are familiar with the maxillofacial features of this condition, since they precede the intestinal polyposis and encourage early diagnosis. In addition to classic maxillofacial signs of this syndrome, one must consider that, although it is rare, other injuries may be present such as those described in this clinical patient.

Papillary mucinous cystadenocarcinoma: rare malignant tumor in minor salivary gland / Cistadenocarcinoma papilar mucinoso: tumor maligno raro em glândula salivar menor

ABSTRACT Clinical case description of a papillary mucinous cystadenocarcinoma, extremely rare malignant tumor in the salivary gland and difficult to diagnose, in geriatric patient. Patient with 86 years old was referred for treatment with nodular lesion on the inner side of left lower lip extending to the bucal mucosa, without any clinical appearances of malignancy. The lesion was asymptomatic, had flabby consistency and slow growth. Despite the favorable clinical features, after surgical removal, was diagnosed as papillary mucinous papillary mucinous cystadenocarcinoma. Nonetheless, the cellular atypia found was considered to be mild and immunohistochemical evaluation the reaction to Ki-67 was low, indicating a low rate of proliferation of the tumor. Medical evaluation confirmed the absence of systemic disorders or distant metastases. Although it is a malignant lesion, due to low degree of proliferation of lesion and the careful follow-up carried out, there was a favorable evolution after conservative treatment in a follow-up period of 11 years and six months.

RESUMO Descrição do caso clínico de um cistadenocarcinoma papilar mucinoso, tumor maligno extremamente raro em glândula salivar e de difícil diagnóstico, em um paciente geriátrico. Paciente com 86 anos foi encaminhado para tratamento com lesão nodular na parte interna do lábio inferior do lado esquerdo estendendo-se para a mucosa jugal sem qualquer aspecto clínico de malignidade. A lesão era assintomática, apresentava consistência flácida e crescimento lento. Apesar das características clínicas favoráveis, após a remoção cirúrgica, o diagnóstico foi de cistadenocarcinoma papilar mucinoso. Entretanto, a atipia celular encontrada foi considerada leve e a reação imunohistoquímica para o Ki67 baixa, indicando uma baixa taxa de proliferação do tumor. A avaliação médica confirmou a ausência de transtornos sistêmicos e de metástases a distância. Apesar de se tratar de uma lesão maligna, devido ao baixo grau de proliferação do tumor e o acompanhamento cuidadosos realizado houve uma evolução favorável após o tratamento conservador após um período de acompanhamento de 11 anos e 6 meses.

Unusual Adenomatoid Odontogenic Tumor.

The adenomatoid odontogenic tumor is a rare benign neoplasm. It can, however, have locally aggressive behavior. This is a case of an adenomatoid odontogenic tumor of unusual location and behavior in a 15-year-old female patient. A panoramic radiograph revealed a large radiolucent lesion involving the retained tooth 33. Teeth involved in this lesion were displaced and with apparent root resorption. A prototype of the mandible showed a marked expansion of cortical bone, fenestration points in the lingual cortex, and fragility of the base of the mandible. Therefore, because of the risk of postoperative pathologic fracture the placement of a 2.4-mm reconstruction plate was indicated. Total enucleation of the lesion, as well as placement of a reconstruction plate were performed. Despite the large bone destruction, with the correct surgical procedure and the use of the reconstruction plate the patient recovered without incidents and a 24-month postoperative radiography showed satisfactory bone formation.

Effect of topical application of chlorhexidine and metronidazole on the tissue repair of palatal wounds of rats: a clinical and histomorphometric study.

OBJECTIVE: This study investigated the effect of topical application of 2% chlorhexidine (GCl) and metronidazole (Gme) pastes for the repair of palatal wounds in rats. STUDY DESIGN: A 4-mm diameter wound was created on the palates of 27 rats separated randomly into 3 groups of 9 animals each, according to the treatment received: GNa (Control: natrosol), GCl, and GMe. The animals were euthanized after 3, 6, and 10 days, and wound closure was clinically and histomorphometrically assessed. RESULTS: Clinical evaluation showed a statistically significant difference in tissue repair with GCl and GMe compared with GNa. In histomorphometric analysis, the highest values in the areas of the epithelium and keratin were observed for GCl and GMe; however, compared with Gna, no statistically significant differences were observed. CONCLUSIONS: GCl and GMe pastes showed promising results with regard to tissue repair from a clinical point of view. Histologically, premature closure of wounds was noted in most specimens on day 6. Although no statistically significant differences were observed among the experimental groups with regard to histometry of the epithelium and keratin, the highest means were observed for GCl.

Tissue engineering: using collagen type I matrix for bone healing of bone defects.

Among the many tissues in the human body, bone has been considered as a powerful marker for regeneration and its formation serves as a prototype model for tissue engineering based on morphogenesis. Therefore, collagen type I is one of the most useful biomaterials used in tissue engineering as extracellular matrix components capable to promote bone healing. The literature reveals excellent biocompatibility and safety due to its biological characteristics, such as biodegradability and weak antigenicity, making collagen type I the primary resource in medical applications. Thus, it was also used for tissue engineering including skin replacement, bone substitutes, and artificial blood vessels and valves. The authors describe the treatment of an abscessed apical periodontal cyst and show good outcomes of bone healing, using tissue engineering, as collagen type I matrix.