Does Combined Temporomandibular Joint Reconstruction With Patient Fitted Total Joint Prosthesis and Orthognathic Surgery Reduce Symptoms in Juvenile Idiopathic Arthritis Patients?

PURPOSE: Patients with juvenile idiopathic arthritis (JIA) and TMJ involvement may have major dentofacial deformities, pain, and jaw dysfunction. The aim of this study was to evaluate surgical outcomes for JIA patients relative to TMJ pain, headache, jaw function, diet, disability, and quality-of-life (QOL) after TMJ reconstruction with patient-fitted total joint prostheses (TJP) and concomitant orthognathic surgery. METHODS: A retrospective cohort study was conducted on a JIA patient group (JIAG) with significant dentofacial deformity, reconstructed with TJP and concomitant orthognathic surgery, and was compared to a control group (CG) of non-JIA patients that received the same surgical protocol with similar surgical movements. Primary predictors were the 2 groups: JIAG and CG. Data were evaluated and compared presurgery and at longest follow-up using Likert analog scales for the primary variables: TMJ pain, headache, jaw function, diet, and disability. Maximum interincisal opening (MIO) was measured in mm. QOL was rated in JIAG as improved, same, or worse. Comparative data were tested for significance (α = 0.05) using Wilcoxon signed rank and paired T-tests. RESULTS: Forty JIAG patients (8 males, 32 females) met the inclusion criteria, median age 17.5 years, median follow-up 26.5 months, and 26 CG patients (1 male, 25 females), median age 35.5 years, follow-up 24 months. Significant improvements (P ≤ .05) occurred postsurgery for TMJ pain, headache, jaw function, diet, and disability for both groups. Mean increase MIO for JIAG was 36.4 to 43.3 mm, for CG was 35.2 to 37.8 mm. Thirty-eight JIA patients (95%) improved in QOL, 2 had no change, and none were worse. CONCLUSIONS: This study suggests that patient-fitted TJP for TMJ reconstruction in conjunction with orthognathic surgery for the JIA patient provides long-term improvement relative to TMJ pain, headache, jaw function, diet, disability, MIO, and QOL.

Mini-Anchors to Surgically Treat the Chronic Mandibular Dislocation.

PURPOSE: Evaluate the feasibility of using mini-anchors for the treatment of chronic mandibular dislocation and to identify the variables that affect the success of this approach. PATIENTS AND METHODS: A retrospective cohort study evaluated 9 patients with bilateral recurrent dislocation of the mandible (18 operated joints), treated by a mandibular translation control system using the mini-anchor technique. Data was collected using a Visual Analog Scale (VAS) for subjective parameters and measurements for objective parameters prior to surgery (T1) and at the longest available follow-up (T2) with a minimum of a 12 months interval. Patients subjectively rated their facial pain/headache, jaw function, disability, temporomandibular joint (TMJ) pain and diet. Objective functional changes were determined by measuring the interincisal opening and lateral excursions at T1 and T2. RESULTS: Significant subjective improvements in pain and dysfunction (89 to 94%) were observed (P < .01) from T1 to T2 in all parameters. The comfortable and guarded interincisal opening without mandibular dislocation increased by 41%, the maximum interincisal opening reduced 12 mm, and lateral excursions improved by 43%. CONCLUSIONS: Patients with recurrent mandibular dislocations with or without disc dislocation can be treated effectively by the mini-anchor translation control system.

"All-on-4": Passo a passo para carga imediata em maxilares atróficos / All-on-4: Step by step for immediate loading in atrophic jaws

A técnica "All-on-4" consiste na instalação de quatro implantes na melhor distribuição anteroposterior possível no rebordo ósseo maxilar remanescente, sendo os dois posteriores inclinados para distal, tangenciando a cortical da extensão anterior do seio maxilar ou do forame mentoniano, e os outros dois implantes instalados na região anterior do maxilar, propiciando condições biomecânicas para suportar uma reabilitação total sobre quatro implantes em carga imediata. Será feita uma revisão de literatura sobre o assunto incluindo os artigos históricos e enfatizando aqueles autores que contribuíram com os conceitos do estado da arte atual, para a elaboração de um passo a passo da técnica. Foi apresentada uma classificação dos maxilares atróficos para a aplicação do "All-on-4", assim como os tipos de acesso, aspectos anatômicos a serem identificados no transoperatório, customização da guia cirúrgica, inclinação dos implantes, critérios para a carga imediata e para a escolha dos componentes inclinados, detalhes das suturas e da rotina pós-operatória. A técnica "All-on-4" simplificou a carga imediata para a grande maioria dos maxilares atróficos desdentados totais, reduzindo o tempo de tratamento, custos, riscos, morbidade e limitando a indicação de enxertos ósseos apenas para os casos de extrema atrofia maxilar (AU).

The "All-on-4" technique is performed with four implants installed in the best possible anteroposterior distribution on the remaining jaw bone, with the two posterior implants angulated to distal, tangential to the cortical of the anterior extension of the maxillary sinus or the mental foramen, and the other two implants installed in the anterior region of the jaw, providing biomechanical conditions to support a total rehabilitation over four implants in immediate loading. A literature review will be performed on the subject including historical articles and emphasizing those authors who contributed with the concepts to the current state of the art, for elaboration of a step by step of All-on-4 technique. Atrophic jaws classification was presented for technique application, as well as the types of access, anatomical aspects to be trans surgically identified, surgical guide customization, implant angulation, criteria for immediate loading and choice of angulated abutments, details of the sutures and postoperative routine. All-on-4 technique simplified immediate loading for the vast majority of total edentulous atrophic jaws, reducing treatment time, costs, risks, morbidity and limiting bone grafts indication only for cases of extremely atrophic jaws (AU).

Uso de dentina autógena como material complementar em enxertos ósseos para implantes dentários ­ relato de caso / Use of autogenous dentin as complementary material in bone grafts for dental implants ­ case report

Nas últimas décadas, diversos materiais e técnicas têm sido utilizados para o aumento de rebordo alveolar visando a reabilitação através de implantes em maxilas e mandíbulas parcial ou completamente edêntulas. Na busca de um material alternativo que apresentasse as características ideais de um substituto ósseo, diversos autores observaram as semelhanças entre osso e dentina. A literatura mostra que muitas são as vantagens da dentina para este fim, principalmente quando se considera a sua biocompatibilidade (é autógena) associada ao seu potencial osteoindutor e osteocondutor, além do baixo custo. Outro fator que encoraja seu uso seria a menor morbidade da área doadora quando comparada ao enxerto com osso autógeno. Além disso, a dentina autógena não oferece risco de transmissão de doenças quando comparada aos enxertos alógenos. O objetivo deste trabalho foi realizar um relato de caso clínico de uma cirurgia para ganho de estrutura óssea na região anterior de maxila, utilizando- -se dentina autógena associada a Bio-Oss®, osso autógeno e fibrina rica em plaquetas (PRF), com posterior instalação de implantes na região (AU).

In the last few decades, a great amount of materials and techniques have been used for alveolar ridge augmentation aiming the rehabilitation of partial or totally edentulous jaws with dental implants. Searching an alternative material that had the ideal features of a bone substitute and could be used as bone substitute, several authors observed the similarities between bone and dentin. The literature has highlighted the advantages of dentin as bone graft material, especially when considering its biocompatibility (autogenous), associated to its osteoinductive and osteoconductive potential and low-cost treatment, different from alloplastic materials, known for their high prices, and the reduced morbidity related to donor sites when compared to autogenous bone graft, associated with their osteoconductive issues. Another factor that encourages its use would be lower morbidity of the donor area when compared to the graft with autogenous bone. Furthermore autogenous dentin does not present risk of disease transmission when compared to allogeneic grafts. The purpose of this study was to present a clinical case report of a graft surgery in the maxilla anterior region, using autogenous dentin associated with Bio-Oss®, autogenous bone and platelet rich fibrin to allow dental implants installation in the region (AU).

Surgical and prosthetic considerations to rehabilitate an ocular defect using extraoral implants: a clinical report.

This clinical report shows the use of extraoral implants to rehabilitate an ocular defect, focusing the surgical and prosthetic procedures. Using local anesthesia and a surgical template obtained from the diagnostic wax ocular pattern, two cylinder dental implants were strategically placed in the lateral aspect of the right infraorbital region. Four months later, an acrylic framework including two spherical magnets was made using plastic UCLA abutments. After casting laboratory steps, a customized silicon prosthetic appliance was fabricated from the diagnostic wax ocular pattern and attached to the Co-Cr framework, observing its profile and seating aspects. The patient was satisfied with the treatment result, due to the retention, esthetics, and adhesive-free method to anchor his ocular prostheses.

Hiperplasia condilar associada à recidiva de deformidade dentofacial / Condylar hyperplasia associated with relapse of a dentofacial deformity

O diagnóstico prévio de patologias envolvendo a articulação temporomandibular é de extrema importancia para o planejamento das cirurgias ortognáticas. Em caso de patologias da articulação temporomandibular que não sejam diagnosticadas ou sejam ignoradas, é esperada a piora do quadro clínico de disfunção temporomandibular ou a recidiva da deformidade dentoesquelética após a cirurgia ortognática. A hiperplasia condilar causa o aumento do tamanho do côndilo mandibular, que se repercute por toda a mandíbula, com consequente deformidade dentofacial. O tratamento da hiperplasia condilar consiste na remoção da área do côndito, responsável por este crescimento excessivo e posterior correção da deformidade facial remanescente. O objetivo deste trabalho é o de relatar um caso clínico de recidiva da assimetria facial devido à falha no diagnóstico e ao tratamento da hiperplasia condilar, ressaltando a importância da articulação temporomandibular na cirurgia ortognática.

The prior diagnosis of pathological conditions of the temporomandibular joint is extremely important for the planning of orthognathic surgery. If such conditions are ignored or not diagnosed, the worsening of the clinical features or postoperative relapse of the dentofacial deformity are to be expected. Condylar dsyplasia leads to an increase in the size of the mandibular condyle with repercussions for the entire jaw and resulting dentofacial deformity. The treatment of condylar hyperplasia consists in the resection of the area of the condyle responsible for this excessive growth and subsequent correction of the remainig facial deformity. The aim of this paper is to report a clinical case of relapse of facial asymmetry due to a failure to diagnose and treat condylar hyperplasia, emphasizing the importance of the temporomandibular joint in orthognathc surgery.

The role of polymerization cycle and post-pressing time on tooth movement in complete dentures.

This study analyzed the influence of polymerization cycle and post-pressing time on tooth movement in complete dentures. Forty maxillary complete dentures were fabricated and randomly assigned to 8 groups (n = 5); the polymerization cycle (conventional long cycle in water bath, fast cycle in boiling water, and by microwave energy) and the post-pressing time (immediate and 6 hours) were varied. Metal reference pins were placed on the incisal border of the central incisors (RI and LI), on the buccal cusp of the first premolars (RP and LP), and on the mesiobuccal cusp of the second molars (RM and LM). Two transverse and 2 anteroposterior distances were measured with a linear optical microscope (Olympus Optical Co., Tokyo, Japan) with an accuracy of .0005 mm, before and after processing the complete dentures. The data collected were submitted to analysis of variance (ANOVA) and the Tukey Test at a significance level of 5%. When Clássico, a conventional heat-polymerizable acrylic resin, was polymerized by microwave energy, tooth movement was statistically significant for 2 distances, with the highest value being observed for the 6-hour post-pressing time. Onda-Cryl microwave acrylic resin processed by microwave energy presented the lowest tooth movement for 2 distances, considering the 6-hour post-pressing time. QC-20 acrylic resin presented no statistically significant change considering both post-pressing times in each distance evaluated. Tooth movement showed an asymmetric behavior, so the mastering of the processing method is essential to the precise execution of all laboratory steps, irrespective of the polymerization cycle and post-pressing time used.

The role of polymerization cycle and post-pressing time on tooth movement in complete dentures

This study analyzed the influence of polymerization cycle and post-pressing time on tooth movement in complete dentures. Forty maxillary complete dentures were fabricated and randomly assigned to 8 groups (n = 5); the polymerization cycle (conventional long cycle in water bath, fast cycle in boiling water, and by microwave energy) and the post-pressing time (immediate and 6 hours) were varied. Metal reference pins were placed on the incisal border of the central incisors (RI and LI), on the buccal cusp of the first premolars (RP and LP), and on the mesiobuccal cusp of the second molars (RM and LM). Two transverse and 2 anteroposterior distances were measured with a linear optical microscope (Olympus Optical Co., Tokyo, Japan) with an accuracy of .0005 mm, before and after processing the complete dentures. The data collected were submitted to analysis of variance (ANOVA) and the Tukey Test at a significance level of 5 percent. When Clássico, a conventional heat-polymerizable acrylic resin, was polymerized by microwave energy, tooth movement was statistically significant for 2 distances, with the highest value being observed for the 6-hour post-pressing time. Onda-Cryl microwave acrylic resin processed by microwave energy presented the lowest tooth movement for 2 distances, considering the 6-hour post-pressing time. QC-20 acrylic resin presented no statistically significant change considering both post-pressing times in each distance evaluated. Tooth movement showed an asymmetric behavior, so the mastering of the processing method is essential to the precise execution of all laboratory steps, irrespective of the polymerization cycle and post-pressing time used.

Highly aggressive brown tumor in the jaw associated with tertiary hyperparathyroidism.

The purpose of this paper is to describe the case of a 12-year-old patient with end-stage chronic renal failure. The patient presented with an osteolytic lesion in the mandible with expansion of the buccal, lingual, and occlusal cortical bone, as well as dislocation of the teeth in the area. The calcium, creatinine, and parathormone (PTH) contents of the blood were elevated. A histopathological examination of the jaw lesion revealed the presence of a brown tumor lesion, which is associated with hyperparathyroidism (HPT). An adenoma was found in the upper left parathyroid, a finding compatible with the diagnosis of tertiary HPT. In spite of the continuous ambulatory peritoneal dialysis instituted, the osteolytic lesion kept on growing. A conservative treatment employing an association of intralesional corticosteroid and salmon calcitonin (inhaled) was carried out. After 14 months of therapy, a reduction in size and complete calcification of the lesion were achieved. Aesthetic osteoplasty of the jaw was then performed.

Avaliação da precisão do reposicionamento da maxila pela osteotomia le fort / Evaluation of the precision of the maxilla repositioning by the le fort osteotomy

Durante o transoperatório da cirurgia ortognática, o cirurgião-bucomaxilofacial tem como principal objetivo reproduzir no paciente o que planejou no traçado predictivo e na cirurgia dos modelos. A proposição desse trabalho foi avaliar a precisão do reposicionamento da maxila pela osteotomia Le Fort I utilizando-se um protocolo de precisão nas etapas pré e transoperatórias da cirurgia ortognática. A amostra foi constituída de 22 pacientes que foram submetidos à osteotomia le Fort I pelo mesmo cirurgião. As telerradiografias pós-operatórias foram comparadas com seus correspondentes traçados predictivos por meio de uma análise computadorizada específica. As posições vertical e horizontal da borda incisal do incisivo central superior e da ponta da cúspide mésio-vestibular do primeiro molar superior foram utilizadas como referência para a aferição das alterações do plano palatino. Considerando as referências da maxila como um grupo, não foram observadas diferenças estatisticamente significantes entre os reposicionamentos planejados e os realizados na maxila por meio da osteotomia le Fort I.

Mentoplastia: do planejamento à técnica cirúrgica / Genioplasty: from treatment planning to surgical technique

Por meio das mentoplastias, algumas deformidades isoladas do terço inferior da face podem ser corrigidas, modificando-se a forma e o tamanho da sínfise mandibular, melhorando o suporte dos tecidos moles e o perfil do paciente. Neste artigo serão descritos importantes aspectos do planejamento e tratamento cirúrgico das deformidades da região mentoniana e o relato de um caso clínico de osteotomia horizontal deslizante para a reposição anterior do mento em uma paciente com padrão facial tipo II.

Reconstrução de maxila atrófica com enxerto de tíbia para posterior reabilitação com implantes osseointegrados: relato de caso clínico / Atroffic maxilla reconstruction with tibial bone graft for a future rehabilitation through osseointegrated implants: case report

Vários autores têm apontado a tíbia como área doadora extrabucal com vantagens supeirores à crista ilíaca, como acesso cirúrgico mais simples, menores complicações pós-operatórias, bem como uma recuperação mais confortável para o paciente, Este artigo realiza uma revista da literatura sobre enxertos ósseos autógenos obtidos da tíbia e apresenta um caso clínico, desde a reconstrução total da maxila atrófica com enxerto da tíbia até a reabilitação da paciente com a prótese total fixa implantossuportada

Avaliação histológica do processo de reparo ósseo na presença da proteína morfogenética óssea (Gen-Pro) associada com uma membrana biológica (Gen-Derm) / Histological evaluation of bone repair in the presence of bone morphogenetic protein (Gen-Pro) associated with a barrier membrane

Os autores avaliaram, histologicamente, o processo de reparo ósseo na presença da proteína morfogenética óssea bovina (Gen-Pro-Genius-Baumer-proteína morfogenética óssea bovina, cedida pelo Departamento de Bioquímica da FOB-USP) associada com uma membrana biológica (Gen-Derm-Genius-Baumer-membrana de cortical óssea bovina liofilizada, cedida pelo Departamento de Bioquímica da FOB-USP). Os resultados revelaram que a fase inicial do processo de reparo ósseo foi retardada na presença de tal associação de biomateriais, porém, à medida em que estes foram absorvidos com o passar do tempo, o processo de reparo ósseo desenvolveu-se rapidamente.

Regeneração óssea guiada de alvéolos de extração dentária. Porquê fazê-la / Guided bone regeneration of socket of tooth extraccion. Why do it

Realizou-se avaliação clínica, radiográfica e histológica da regeneração óssea guiada de alvéolos de extração dentária em humanos. Foi comparado intraindividualmente o processo de reparo de um alvéolo preenchido com uma mistura entre pool de Proteína Morfogenética Ossea* e Matriz Orgânica de Osso Bovino Liofilizada** coberta por membrana absorvível de cortical óssea bovina liofilizada***com o processo de reparo fisiológico de outro alvéolo de extração dentária preenchido apenas com o coágulo sangüíneo natural. Os resultados evidenciaram a otimização tanto quantitativa quanto qualitativa do processo de reparo do alvéolo enxertado