Bone Density of the Midpalatal Suture After Surgically Assisted Rapid Maxillary Expansion: A Retrospective Cohort Study.

OBJECTIVES: To evaluate the bone density in the midpalatal suture after 10 months of surgically assisted rapid maxillary expansion (SARME) with the separation of the maxilla into 2 segments. METHODS: Sixty multislice computed tomography (MCT) from 20 patients undergoing SARME were analyzed in 3 periods of time (1 MCT per patient on each occasion): (1) 1 week before surgery, (2) postsurgery immediately after completing the expander activation, and (3) 10 months after the expander activation. On all occasions, the bone density was measured in Hounsfield units on MCT scans in axial and coronal sections, in the anterior (A1), middle (A2), and posterior (A3) regions of the midpalatal suture. RESULTS: The mean percentage values of bone density in Hounsfield units, from the 10-month postactivation period to preoperative in the A1, A2, and A3 regions were 68.38%, 38.21%, and 55.90%, respectively, in the axial norm, and 64.06%, 36.81%, and 55.50% in coronal norm (A1 = A3>A2), with no significant difference in the tomographic cuts (P >0.05). There was no correlation between patient age or amount of expansion in the expander and bone density. CONCLUSIONS: The bone density in the midpalatal suture 10 months after SARME is lower than preexpansion. A denser new bone formation along the suture concentrates closer to the extremities rather than in the central region. Although the maturation of the new bone formation in the midpalatal suture is lower 10 months after SARME, it appears to be sufficient for satisfactory clinical results, regardless of patient age or the amount of expansion in the expander.

Randomized clinical trial of surgically assisted rapid maxillary expansion with two and three segments for nasal breathing.

OBJECTIVES: To evaluate surgically assisted rapid maxillary expansion (SARME), with osteotomies separating the maxilla into two segments (SARME-2S) and three segments (SARME-3S), on obstruction symptoms and nasal cavity dimensions in patients with maxillary transverse skeletal deficiency (MTSD). MATERIALS AND METHODS: Sixteen patients with MTSD of 7 mm or above were evaluated in each group, for a total of 32 patients. All patients were evaluated pre- and postoperatively up to 10 months after the expander activations. The minimum cross-sectional area (MCA) and the volume of the nasal cavities were identified by acoustic rhinometry. The Nasal Obstruction Symptom Evaluation (NOSE) scale questionnaire was applied. The palate surface area (PSA) was measured, via digitized maxillary models, as a criterion for comparison with the other variables studied. RESULTS: There was no difference between the groups (p = 0.370) and was verified a significant increase in PSA postoperatively. MCA showed a small increase without statistical significance, and together with the volume of the nasal cavities remained constant during the study. NOSE scale scores decreased significantly in the postoperative periods, implying a decrease in nasal obstruction symptoms in both groups. CONCLUSIONS: SARME with two and three segments show similar results, and both may improve nasal obstruction symptoms when present in patients with MTSD. CLINICAL RELEVANCE: SARME, regardless of the chosen surgical technique, should follow the recommendation to correct just the MTSD. While an improvement in nasal breathing is expected, this must be understood as likely, but not certain.

The effectiveness of hydroxyapatite-beta tricalcium phosphate incorporated into stem cells from human exfoliated deciduous teeth for reconstruction of rat calvarial bone defects.

OBJECTIVE: To investigate the effects of stem cells from the pulp of human exfoliated deciduous teeth (SHED) on biphasic calcium phosphate granules (BCP) to repair rat calvarial defects as compared to autogenous bone grafting. MATERIALS AND METHODS: A defect with a 6-mm diameter was produced on the calvaria of 50 rats. BCP granules were incorporated into SHED cultures grown for 7 days in conventional (CM) or osteogenic (OM) culture media. The animals were allocated into 5 groups of 10, namely: clot, autogenous bone, BCP, BCP+SHED in CM (BCP-CM), and BCP+SHED in OM (BCP-OM). The presence of newly formed bone and residual biomaterial particles was assessed by histometric analysis after 4 and 8 weeks. RESULTS: The autogenous group showed the largest newly formed bone area at week 8 and in the entire experimental period, with a significant difference in relation to the other groups (P < 0.05). At week 8, BCP-CM and BCP-OM groups showed homogeneous new bone formation (P = 0.13). When considering the entire experimental period, the BCP group had the highest percentage of residual particle area, with no significant difference from the BCP-CM group (P = 0.06) and with a significant difference from the BCP-OM group (P = 0.01). BCP-CM and BCP-OM groups were homogeneous throughout the experimental period (P = 0.59). CONCLUSIONS: BCP incorporated into SHED cultures showed promising outcomes, albeit less pronounced than autogenous grafting, for the repair of rat calvarial defects. CLINICAL RELEVANCE: BCP incorporated into SHED cultures showed to be an alternative in view of the disadvantages to obtain autogenous bone graft.

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.

Controvérsias em cirurgia ortognática / Controversies in orthognathic surgery

A correção ortodôntica é uma requisição cada vez mais freqüente dos pacientes adultos. Algumas vezes somente o tratamento ortodôntico não irá proporcionar ao paciente o melhor resultado. Saber reconhecer um paciente com má-oclusão associada com uma deformidade esquelética é importante para a correta indicação de um tratamento ortodôntico-cirúrgico, possibilitando resultados funcionais (oclusão e respiração) e estéticos (harmonia facial) adequados. Este trabalho, com base na apresentação de casos clínicos, tem como objetivo discutir as principais controvérsias ligadas à cirurgia ortognática como: idade mínima para sua realização; camuflagem ortodôntica ou tratamento ortodôntico-cirúrgico; operar a maxila, a mandíbula ou ambos; e a importância da relação multidisciplinar que envolve o tratamento de pacientes portadores de deformidades dentofaciais

Zygomatic and orbitozygomatic fractures

Zygomatic fractures may cause major inconveniences for patients both functionally and esthetically. Orbitozygomatic fractures are characterized chiefly by involvement of the orbit, and they often lead to some ocular dysfunction. Zygomatic fractures, on the other hand, correspond chiefly to damage to the zygoma with anatomic involvement of the orbit. With the objective of rationalizing the treatment of zygomatic fractures, this paper suggests a classification based on the experience of treating and following-up 148 cases for at least three months in the Instituto da Face, in São Paulo, Brazil. Etiology of the trauma, gender, age,direction of the vector, time after the fracture and the presence of functional changes were taken into consideration. Fractures were classified as type I (51 cases or 34 percent), type II (59 cases or 40 percent) and type III (38 cases or 26 percent). Type I fractures were treated with transcutaneous reduction, and 48 cases (94 percent) evolved with good projection of the zygoma. Fractures types II and III underwent direct reduction with visualization of the fracture line, and 55 cases (92 percent) and 34 cases (89,5 percent) evolved, respectively, with good projection of the zygoma.

Respiraçäo bucal e alteraçöes dentofaciais / Mouth breathing and dentofacial alterations

Muitas säo as dúvidas quanto à influência da respiraçäo bucal no crescimento dentofacial. Há autores que aceitam a respiraçäo bucal como provável fator etiológico da maloclusäo, enquanto outros sustentam que a respiraçäo bucal por si só näo é fator suficiente para a interferência no crescimento dentofacial. Neste estudo, foram avaliadas 30 crianças, sendo 15 respiradoras bucais e 15 respiradoras nasais, com idade entre 7 e 11 anos. Foi verificado que as crianças respiradoras bucais têm muitas alteraçöes musculares e estäo mais propensas ao desenvolvimento de face longa e retroposiçäo mandibular

Correção cirúrgica da hipertrofia de masseter / Surgical correction of masseter muscle hypertrophy

A hipertrofia de masseter é uma entidade benigna que pode apresentar envolvimento uni ou bilateral, sendo comumente assintomática. A etiologia ainda é desconhecida, porém, fatores como bruxismo, apertamento dental, desordens internas da articulação temporo-mandibular e trauma são considerados como possíveis agentes etiológicos. O diagnóstico é basicamente clínico, sendo que exames radiográficos contribuem para a identificação de envolvimento ósseo ao nível de ângulo mandibular. O tratamento pode ser cirúrgico ou conservador. O presente trabalho tem como objetivo relatar 41 casos de hipertrofia de masseter em 22 pacientes operados no Setor de Cirurgia e Traumatologia Buco-Maxilo-Facial do Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo, no período correspondente entre março de 1998 a setembro de 2000. Dentre os pacientes operados não foi diagnosticado nenhum caso de infecção e apenas três pacientes evoluíram com assimetria no pós-operatório tardio, sendo que a correção cirúrgica de masseter foi considerada um procedimento viável e adequado para o tratamento desta entidade

Reconstruction of the mandibular condyle using a costochondral graft after osteosynthesis in fracture dislocations / Reconstrução de côndilo mandibular com enxerto costocondral após osteossíntese para fratura com deslocamento

The treatment of mandibular condylar fractures is a controversial issue among surgeons. Complete resorption of the condylar process after a fracture treated using internal fixation has been described in the literature. The present study of a 14 years-old female patient aims to describe a case of resorption of the mandibular condyle due to a condylar fracture with displacement, which had been previously treated by surgical reduction and osteosynthesis with steel sutures. Treatment consisted of a costochondral graft fixed with two 2.0mm diameter screws that provided adequate long-term functional and aesthetic results.

Racionalizaçäo da antibioticoterapia para cirurgias de terceiros molares inferiores retidos / Rationalization of the antibiotic therapy for retained third molars surgeries

Os autores avaliaram o índice de infecçäo na reumoçäo de terceiros molares inferiores retidos em pacientes hígidos que fizeram ou näo o uso da antibioticoterapia, relacionando os resultados ao tempo cirúrgico, osteotomia e odontosecçäo

Enxerto ósseo autógeno associado a regeneração tecidual guiada no auxílio a terapia ortodôntica: revisão da literatura e relato de um caso clínico / Autogeous bone graft associated to guided tissue regeneration in the aid to the orthodontic therapy: review of the literature and report of a case

Os autores discutem o emprego de enxerto ósseo autógeno proveniente da sínfise mandibular na região maxilofacial, bem como o auxílio desta prática junto ao tratamento ortodôntico quando o volume ósseo da arcada é insuficiente

A mandíbula como área doadora de enxertos em cirurgia buco-maxilo-facial / The mandible as a donor area of grafts oral and maxillofacial surgery

Os autores discutem a utilizaçäo de enxerto ósseo autógeno proveniente da mandíbula na regiäo buco-maxilo-facial, analisando a facilidade e viabilidade de sua obtençäo. Discutem também as vantagens de reduzir o tempo cirúrgico, evitar uma cicatriz cutânea e ser um procedimento mais aceitável pelo paciente em diferentes tipos de defeitos ósseos, como: áreas de osteotomias, cavidades remanescentes após enucleaçäo de cistos, rebordo alveolar residual atrófico (nos casos de reabilitaçäo oral com implantes osseointegrados) e nos casos de reconstruçäo mandibular