ABSTRACT
Objective: To report three cases of neural injuries during dental implant placement. Material and methods: In 2014, three female patients aged 59 (A); 60 (B); and 70 (C) years old were referred for legal investigation of malpractice during implant placement. Seven implants were placed in patient A; three implants were placed in patient B; and seven implants were placed in patient C. Postoperative computed tomography of the patients revealed injury signs of the inferior alveolar nerve. Clinically, the patients referred lack of sensitivity in the soft tissue adjacent to the surgical site. Results: All the presented cases culminated in legal suits. Consequently, the dentists involved with patients A and B are awaiting respective trials, while the dentist involved with patient C was already condemned. Conclusion: The present study highlights the need for optimal preoperative planning; careful transoperative performance; and adequate postoperative follow-up. Based on that, oral and maxillofacial injuries and legal consequences may be avoided in Implantology.
Objetivo: Relatar três casos clínicos envolvendo danos neurológicos decorrentes da instalação de implantes dentários. Materiais e métodos: Em 2014, três pacientes do sexo feminino de 59 (A); 60 (B); e 70 (C) anos de idade foram encaminhadas para exame pericial odontológico tendo como objetivo a investigação de dano neurológico decorrente da falha na instalação de implantes. Sete implantes foram instalados na paciente A; três implantes foram instalados na paciente B; e sete implantes foram instalados na paciente C. Clinicamente, todas as pacientes referiram perda de sensibilidade nas regiões adjacentes aos sítios cirúrgicos. Todos os pacientes foram submetidos à tomografia computadorizada pós-operatória, revelando sinais de invasão de espaço do canal mandibular. Resultados: Todos os casos resultaram em ações judiciais demandadas contra os profissionais. Consequentemente, houve a condenação do profissional envolvido no tratamento da paciente C, enquanto os profissionais envolvidos nos demais casos aguardam julgamento. Conclusão: O presente estudo ressaltou a importância do correto planejamento pré-operatório; dos cuidados técnicos transoperatórios; e dos corretos acompanhamentos clínico e radiográfico pós-operatório. Assim, danos orais e maxilofaciais poderão ser potencialmente evitados na rotina cirúrgica dos profissionais de Implantodontia.
ABSTRACT
Mitochondrial DNA (mtDNA) analysis has proved useful for forensic identification especially in cases where nuclear DNA is not available, such as with hair evidence. Heteroplasmy, the presence of more than one type of mtDNA in one individual, is a common situation often reported in the first and second mtDNA hypervariable regions (HV1/HV2), particularly in hair samples. However, there is no data about heteroplasmy frequency in the third mtDNA hypervariable region (HV3). To investigate possible heteroplasmy hotspots, HV3 from hair and blood samples of 100 individuals were sequenced and compared. No point heteroplasmy was observed, but length heteroplasmy was, both in C-stretch and CA repeat. To observe which CA "alleles" were present in each tissue, PCR products were cloned and re-sequenced. However, no variation among CA alleles was observed. Regarding forensic practice, we conclude that point heteroplasmy in HV3 is not as frequent as in the HV1/HV2.
Subject(s)
Blood , Complementarity Determining Regions/genetics , DNA, Mitochondrial/genetics , Hair , Electrophoresis , Forensic Genetics , Humans , Polymerase Chain Reaction , Sequence Analysis, DNAABSTRACT
The analysis of mitochondrial DNA (mtDNA) is a useful tool in forensic cases when sample contents too little or degraded nuclear DNA to genotype by autosomal short tandem repeat (STR) loci, but it is especially useful when the only forensic evidence is a hair shaft. Several authors have related differences in mtDNA from different tissues within the same individual, with high frequency of heteroplasmic variants in hair, as also in some other tissues. Is still a matter of debate how the differences influence the interpretation forensic protocols. One difference between two samples supposed to be originated from the same individual are related to an inconclusive result, but depending on the tissue and the position of the difference it should have a different interpretation, based on mutation-rate heterogeneity of mtDNA. In order to investigate it differences in the mtDNA control region from hair shafts and blood in our population, sequences from the hypervariable regions 1 and 2 (HV1 and HV2) from 100 Brazilian unrelated individuals were compared. The frequency of point heteroplasmy observed in hair was 10.5% by sequencing. Our study confirms the results related by other authors that concluded that small differences within tissues should be interpreted with caution especially when analyzing hair samples.
