Three-dimensional assessment of the maxilla after modified surgically assisted rapid expansion: a retrospective study.

OBJECTIVE: This retrospective study aims to assess the three-dimensional dentoskeletal effects and median palatal suture opening pattern in patients undergoing modified surgically assisted maxillary rapid expansion (SARME) without pterygoid plate detachment. METHODS: Twenty-eight patients submitted to modified SARME between 2009 and 2016 were retrospectively evaluated through cone-beam computed tomography (CBCT). Dental and skeletal measurements were taken at three different operative periods (before the expansion - T0; at the end of the activation of the Hyrax device - T1; and six months after the immobilization of the device - T2). Statistical analyses, including ANOVA and Pearson's correlation coefficient, were performed using SPSS software. RESULTS: SARME demonstrated significant transverse maxillary expansion (with an average of 6.05 mm) with a greater impact in the anterior region. Dental measurements, including canine and molar distances, exhibited significant changes over the operative periods. Bone measurements (ANS and PNS) presented small but significant alterations, including a slight inferior displacement of ANS during device activation. The nasal floor width increased, followed by a width reduction after immobilization. The median palatal suture predominantly exhibited a Type II (V-shaped) opening. CONCLUSION: The modified SARME presented a transversal direction increase and a super-lower skeletal displacement, with the anterior region being more affected than the posterior region. There was no change in the anteroposterior direction of the maxilla. Additionally, there was an increase in the linear dental measurements and a decrease in the angular measurement, with a positive correlation between the amount of posterior bone expansion and molar expansion as a result of the treatment in the analyzed period.

Epidemiological Study of Frontal Sinus Fractures: Evaluation of 16 Years of Care at the Faculty of Dentistry of Ribeirão Preto/Brazil.

Purpose: Aiming to evaluate and study the epidemiological profile of frontal sinus fractures treated in the region of Ribeirão Preto-Brazil. Methods: Sixteen years of activity in the Oral and Maxillofacial service of the Faculty of Dentistry of Ribeirão Preto/SP (FORP/USP), totaling 9,736 consultations, 4,524 with facial fractures, those diagnosed with frontal sinus fracture (113) were evaluated and selected for the study. Results: Frontal sinus fractures accounted for 2.5% of facial fractures, the majority occurring in men (89.4%), concentrated in the age group 21-30 years old, with 52.2% of cases being caused by road traffic accidents (RTA). Associations with other facial fractures are common and appeared in 75.2% of cases. Treatment was followed either surgically, by open reduction internal fixation (52.2%) or conservatively (35.4%). Analyzing only the 28 isolated frontal sinus fractures, the most common treatment was conservative (46.4%). surgical treatment dropped to 25%. The most common postoperative complications were temporal branch paralysis and supraorbital nerve paresthesia, both occurring in 30.5% of surgical cases. Conclusion: The frequency of frontal sinus fractures may be decreasing, but the pattern of occurrence in young men due to road traffic accidents does not seem to change, fortunately the appearance of serious complications is not common and it is usually associated with more severe trauma.

Pseudocarcinomatous Squamous Hyperplasia After Surgical Management Of Pediatric Ameloblastoma: An Immunohistochemical Study.

Pseudocarcinomatous squamous hyperplasia (PSH) affecting the jaws is uncommon. The mandible is the most common location, usually as a complication associated with osteomyelitis, medication-related osteonecrosis or osteoradionecrosis. Herein, we report an 8-year-old male patient presenting a solid ameloblastoma, plexiform type, who was treated by segmental mandibulectomy with bone grafting. Three months later, on the underlying graft, a sinus tract was observed, and a small bone fragment was resected which was diagnosed as bone sequestration associated with PSH. After 7-year follow-up, the patient is well, without alterations. To our knowledge, for the first time, we report in detail the immunohistochemical features of PSH which, in addition to epithelial component profile and chronic inflammatory cells, revealed a diffuse infiltration by dendritic cells, suggesting that epithelial cell-immune cell interactions in PSH pathogenesis should also be considered.

Retrospective analysis of the predictability of using three-dimensional models for preoperative planning of the length of zygomatic implants.

PURPOSE: This present study aimed to retrospectively evaluate the predictability of using three-dimensional models (TDMs) to plan the preoperative lengths of zygomatic implants (ZIs). METHODS: The records of all patients that received such implants between March 2007 and March 2019 were evaluated. The ZI lengths predicted on the TDMs were compared to the lengths of the implants the patients received. RESULTS: In total, the records of 74 patients were evaluated, of which 37 records met the criteria of inclusion, and were included in the study. Twenty-seven (73%) of the patients were female and 10 (27%) were male, ranging from 34 to 80 years of age, with the average age being 55.7 years. Seventeen (43.2%) of these patients were classified as ASA I and 21 (56.8%) as ASA II. A total of 142 ZIs were planned and installed in the time frame mentioned. Without distinguishing the region of the maxilla, the implants used were, on average, 1.1 mm larger in length than those initially planned. CONCLUSION: Overall, the data indicates moderate agreement between the planned and surgical lengths of the ZIs and indicates that using TDMs is a predictable and reliable preoperative planning technique of the length of posterior ZIs.

Laboratorial Comparative Study of the Accuracy Between Virtual Planning and Erickson's Platform.

Purpose: The goal was to perform an orthognathic surgery laboratorial study to evaluate the reproducibility of the resulting movements from virtual surgical planning (VSP), by comparing the measurements obtained from VSP to those obtained from Erickson's platform using the 3D printed surgical guide. Methods: Eight patients who had undergone orthognathic surgery were screened and grouped according to maxillary movement and the patient's dentofacial deformity. Three-D virtual surgery simulations were performed, and surgical guides were obtained using Dolphin Imaging 11.9® software. In a semi-adjustable articulator (SAA), the maxilla model was separated from the SAA mounting platform, and the surgical guide was used to reassemble it. Then, the maxilla model was fixed and transferred to Erickson's platform to verify the planned movement. The data were submitted for statistical analysis. Results: The agreement between the methods was excellent, regardless of direction, landmark analyzed, or the amount of movement. The most considerable variation was 0.42 mm in the movement amplitude of 6 mm, and the highest mean was 0.07 mm in the region of the superior right first molar (16). Conclusion: Therefore, regardless the movement of the maxilla, no statistically significant difference was observed between the measurements obtained through VSP and Erickson's platform, demonstrating that both methods are equally accurate and reliable.

Alveolar defects before and after surgically assisted rapid palatal expansion (SARPE): a CBCT assessment.

INTRODUCTION: Surgically Assisted Rapid Palatal Expansion (SARPE) promote maxillary expansion in skeletally mature patients. This technique is effective; however, some side effects are still unknown. OBJECTIVES: evaluate the presence of alveolar defects (dehiscences and fenestrations) in patients submitted to the SARPE. The null hypothesis tested was: SARPE does not influence the number of dehiscences and fenestrationss. METHODS: A retrospective quasi-experiment study of a convenience sample of 279 maxillary teeth, in 29 patients evaluated with Cone Beam Computed Tomography (CBCT) at T1 (before SARPE), T2 (after expansion) and T3 (after retention), was performed. The examined teeth were: canines, first and second premolars, first and second molars. in axial, coronal, and cross-sectional views. The evaluations involved viewing slices from mesial to distal of the buccal roots. RESULTS: All statistical analyses were performed using SAS 9.3 and SUDAAN softwares. Alpha used in the study was 0.05. Alveolar defects increased statistically from T1 (69.0%) to T2 (96.5%) and T3 (100%). Dehiscences increased 195% (Relative Risk 2.95) at the end of expansion (T2). After retention (T3), individuals were on average 4.34 times more likely to develop dehiscences (334% increase). Fenestrations did not increase from T1 to T2 (p = 0.0162, 7.9%) and decreased from T2 to T3 (p = 0.0259, 4.3%). Presence of fenestrations at T1 was a significant predictor for the development of dehiscences in T2 and T3. Dehiscences increased significantly in all teeth, except second molars. CONCLUSION: The null hypothesis was rejected. After SARPE the number of dehiscences increased and fenestrations decreased. Previous alveolar defects were predictor for dehiscences after SARPE.

Does the type of sagittal split ramus osteotomy influence fixation strength? Evaluation of the mechanical behavior of two types of fixation used in three types of sagittal split ramus osteotomy.

PURPOSE: This study compared the mechanical behavior of two fixation techniques used in three sections representing the sagittal split ramus osteotomy (SSRO) in polyurethane replicas that were divided into groups, according to type of section, and sub-groups according to type of fixation, simulating 11-mm advancement and 6º clockwise mandibular rotation. METHODS: Loads were applied in two regions, aiming at progressive application and consequent strength value, measured in kilogram-force in displacements of 1, 3, 5, and 7 mm, from the load application tip. Shapiro-Wilk test was performed, followed by two-way analysis of variance (ANOVA-2 way), and Bonferroni's multiple comparison. RESULTS: The results showed no statistically significant difference in the type of section and type of fixation used when load was applied to the inter-incisor region. However, when load was applied to the first molar region, statistically significant difference was observed in 1-mm displacement, in which section described by Epker with two modifications showed greater strength, regardless of type of fixation used (p = 0.007). CONCLUSION: In the application of load in the inter-incisor region, there was no statistical difference between the type of osteotomy and the type of fixation used. When applying loads to molars, there was a difference for the type of osteotomy, where the Epker osteotomy with 2 modifications presented greater resistance, regardless of the type of fixation used.

Surgically assisted rapid palatal expansion (SARPE): three-dimensional superimposition on cranial base.

OBJECTIVES: To evaluate dental and skeletal changes caused by surgically assisted rapid palatal expansion (SARPE) using the superimposition of three-dimensional cone-beam computed tomography (CBCT) images on the cranial base. MATERIAL AND METHODS: This is a retrospective quasi-experiment before-and-after study using a convenience sample. Twenty-four adult patients (13 male and 11 female) were evaluated before SARPE (T0), immediately after expansion (T1), and after 6 months of retention (T2). CBCT scans were superimposed on the anterior cranial base using voxel-based registration. Measurements from different reference points were used for comparisons between times. RESULTS: At T1, all teeth had significant buccal tipping. At T2, most teeth remained in the same position as at T1, except the first premolar and the first molar, whose buccal roots moved slightly. The amount of bony expansion was 65 to 70% of the amount of tooth movement. The A point and maxillary incisors moved anteriorly from T0 to T1 and T2 (p < 0.0001). Inter-nasal distance had increased significantly at T1 (p < 0.0001) and remained stable at T2 (p = 0.478). No expansion was achieved at the zygomatic arch (p = 0.114). CONCLUSION: SARPE promoted substantial buccal tipping of posterior teeth and some bone displacement; it also moved the maxilla and teeth forward and increased nasal width. CLINICAL RELEVANCE: No other clinical studies have evaluated dental and skeletal changes caused by SARPE using superimposition of 3D CBCT images on the cranial base. This study findings may help clinical dentists plan treatments using safe and reliable information.

Effect of vomer position following surgically assisted rapid palatal expansion.

PURPOSE: To evaluate the effect of vomer position and prevalence of periodontal dehiscence in patients who underwent surgically assisted rapid palatal expansion (SARPE). The null hypotheses were the following: (1) vomer position in the coronal plane does not influence the degree of skeletal and dental expansion; and (2) there is no association between expansion, periodontal dehiscence and vomer position. METHODS: Twenty-one patients were evaluated before treatment (T0) and immediately after SARPE expansion (T1). After SARPE, the vomer was in the right side in 11 patients and in the left in 10 patients. Skeletal and dental effects were evaluated using CBCT, landmarks and measurements. RESULTS: The maxilla and the nasal cavity expanded asymmetrically. The side containing the vomer had less skeletal expansion but more dental tipping. Dehiscence increased significantly from T0 to T1 and was associated with the amount of skeletal displacement, especially when greater than 3.20 mm. In the first premolars region, there was more than 2 mm of asymmetric expansion observed in 38.5% of the patients. CONCLUSION: The null hypotheses were rejected. The side containing the vomer had less skeletal expansion of the maxilla and nasal cavity but more dental tipping. Dehiscence increased after expansion, but there were no differences between sides.

Alveolar defects before and after surgically assisted rapid palatal expansion (SARPE): a CBCT assessment

ABSTRACT Introduction: Surgically Assisted Rapid Palatal Expansion (SARPE) promote maxillary expansion in skeletally mature patients. This technique is effective; however, some side effects are still unknown. Objectives: evaluate the presence of alveolar defects (dehiscences and fenestrations) in patients submitted to the SARPE. The null hypothesis tested was: SARPE does not influence the number of dehiscences and fenestrationss. Methods: A retrospective quasi-experiment study of a convenience sample of 279 maxillary teeth, in 29 patients evaluated with Cone Beam Computed Tomography (CBCT) at T1 (before SARPE), T2 (after expansion) and T3 (after retention), was performed. The examined teeth were: canines, first and second premolars, first and second molars. in axial, coronal, and cross-sectional views. The evaluations involved viewing slices from mesial to distal of the buccal roots. Results: All statistical analyses were performed using SAS 9.3 and SUDAAN softwares. Alpha used in the study was 0.05. Alveolar defects increased statistically from T1 (69.0%) to T2 (96.5%) and T3 (100%). Dehiscences increased 195% (Relative Risk 2.95) at the end of expansion (T2). After retention (T3), individuals were on average 4.34 times more likely to develop dehiscences (334% increase). Fenestrations did not increase from T1 to T2 (p = 0.0162, 7.9%) and decreased from T2 to T3 (p = 0.0259, 4.3%). Presence of fenestrations at T1 was a significant predictor for the development of dehiscences in T2 and T3. Dehiscences increased significantly in all teeth, except second molars. Conclusion: The null hypothesis was rejected. After SARPE the number of dehiscences increased and fenestrations decreased. Previous alveolar defects were predictor for dehiscences after SARPE.

RESUMO Introdução: A expansão rápida da maxila assistida cirurgicamente (ERMAC) promove expansão em pacientes esqueleticamente maduros. Essa técnica é efetiva; entretanto, alguns efeitos colaterais ainda são desconhecidos. Objetivos: Avaliar a presença de defeitos alveolares (deiscência e fenestração) em pacientes submetidos à ERMAC. A hipótese nula testada foi que a ERMAC não influenciaria o número de deiscências e fenestrações. Métodos: Foi realizado um estudo quase-experimental de uma amostra de conveniência de 279 dentes superiores, de 29 pacientes que foram avaliados por meio de tomografia computadorizada de feixe cônico (TCFC) em T1 (antes da ERMAC), T2 (após expansão) e T3 (após contenção). Caninos, primeiros e segundos pré-molares, primeiros e segundos molares foram examinados em cortes axiais, coronais e sagitais. As raízes vestibulares desses dentes foram avaliadas da face mesial até a distal. Resultados: Todas as análises estatísticas foram realizadas usando os softwares SAS 9.3 e SUDAAN. O alfa usado no estudo foi de 0,05. Os defeitos alveolares aumentaram significativamente de T1 (69,0%) para T2 (96,5%) e T3 (100%). Deiscências aumentaram 195% (risco relativo de 2,95%) no final da expansão (T2). Após contenção (T3), os pacientes tiveram, em média, 4,34 vezes mais chance de desenvolver deiscência (334% de aumento). As fenestrações não aumentaram de T1 para T2 (p= 0.0162, 7.9%) e diminuíram de T2 para T3 (p = 0.0259, 4,3%). A presença de fenestrações em T1 foi um preditor significativo para o desenvolvimento de deiscências em T2 e T3. Deiscências aumentaram significativamente em todos os dentes, exceto nos segundos molares. Conclusão: A hipótese nula foi rejeitada. Após a ERMAC, o número de deiscências aumentou e o de fenestrações diminuiu. Defeitos alveolares prévios foram preditores de deiscências após a ERMAC.

Complex odontoma restricting mouth opening: an unusual clinical presentation and surgical management.

Odontomas are common benign odontogenic tumors, being often detected on routine radiographs during the first two decades of life. Rarely, odontoma can interfere with jaw movements, causing mouth opening limitation. A 28-year-old male patient was referred complaining of restriction of mouth opening and mandibular movements, which started 6 months ago. Clinical examination revealed a painless increase of volume on the right maxilla, which interfered the mandibular movements, being associated with pain in these attempts. A well-defined, oval radiopaque lesion in close relationship with the impacted maxillary right third molar was detected in tomographic reconstructions. A surgical excision of the lesion was performed, and microscopy revealed complex odontoma. After 4 months of follow-up, the patient achieved adequate mouth opening and recovered mandibular movements. In the current case, the lesion was placed in a difficult access site, which directly interfered with the displacement of coronoid process. Odontoma should be included in the differential diagnosis when assessing causes of restricted mouth opening.

Body postural realignment in the first 2 months after orthognathic surgery.

INTRODUCTION: This study aimed to assess the static posture in patients with Angle Class II and III malocclusions in the first 2 months after orthognathic surgery. METHODS: This was a longitudinal observational study. Eligible participants were adult patients who had an indication of orthognathic surgery (bilateral sagittal split osteotomy of the maxilla and/or mandible, can be associated or not with genioplasty). Thirty-five patients were evaluated from the orthognathic surgery group (OSG) and control group (CG). Measurements in OSG were performed at 3 time points: preoperative orthognathic surgery (P0), first postoperative month (P1), and second postoperative month (P2). Static posture was evaluated using the PostureScreen Mobile (PostureCo Inc, Trinity, Fla) application in 4 views. RESULTS: Patients with Angle Class II malocclusion in the OSG evidenced a tendency to a left hip translation at P1 with a significant difference at P2 in the anterior view (P = 0.052). In the right lateral view, patients with Angle Class II malocclusion in the OSG at P1 presented an accentuated anterior shoulder translation when compared with CG (P <0.001). At P1, patients with Angle Class II malocclusion in the OSG showed a significant anterior knee translation compared with the CG and OSG at P0 and P2 (P <0.001 for all). Patients in the OSG with Angle Class III malocclusion presented an average posterior head translation in the right lateral view at P1 when compared with those in the CG and OSG at P0, who presented an anterior translation (P = 0.0008). CONCLUSIONS: These findings suggest a realignment of static posture in the first 2 months after orthognathic surgery.

Which type of method shows the best mechanical behavior for internal fixation of bilateral sagittal split osteotomy in major advancements with clockwise rotation? Comparison of four methods.

PURPOSE: The aim of the present study was to evaluate the four methods for bilateral sagittal osteotomy fixation. METHODS: In this study, 56 replicas of whole mandibles made of rigid polyurethane were used. After simulation of major advancement (11 mm) with clockwise rotation of the mandible (6o) in relation to the occlusal plane, the bone segments were fixed with plates and screws of the 2.0-mm system on both the right and left sides: group I, double "H" plate; group II, two mini-plates; group III, "hybrid technique"; and group IV, three bicortical screws in the "inverted L" pattern. The mandibles were submitted to load on the central incisors and right first molar. RESULTS: The mean value of group I was higher than those of groups IV and II in the displacement of 1 mm (F = 4.705; p = 0.010) with load on the incisor. The mean value of group III was higher than those of groups I and II in the displacement of 1 mm (F = 5.166; p = 0.007) and 3 mm (F = 5.166; p = 0.007). The mean value of group IV was higher than that of group II (F = 3.142; p = 0.044) with load on the molar. CONCLUSION: Therefore, after the analyses, the hybrid technique was the one that showed the best results.

Linear analysis of the nasal septum in patients treated with surgically assisted rapid maxillary expansion.

INTRODUCTION: Surgically assisted rapid maxillary expansion is a widely used surgical procedure for resolving transverse maxillary occlusal changes in patients with bone maturity. However, few studies about the postoperative morphologic alterations in the nasal cavity in its inferior portion and the nasal septum positioning exist. METHODS: The linear nasal septum measurements of 26 adult patients treated with surgically assisted rapid maxillary expansion from 2009 to 2013 were assessed through a retrospective analysis of cone-beam computed tomographies, in Digital Imaging and Communications in Medicine files, through the Dolphin Imaging program (Dolphin Imaging and Management Solutions, Chatsworth, Calif), aimed to identify significant changes during 3 time periods of the treatment: preoperative, immediately after the palatal expansion device locking (immediate postoperative), and 6-months postoperative (late postoperative). The analyses were performed in the inferior third of the nasal septum, from 4 equidistant points in anteroposterior position and height, using fixed cranial references for lateral measures of displacement. RESULTS: No significant difference was found between preoperative, immediate postoperative, and late postoperative measurements in the 4 fixed nasal septum measurements, applying the analysis of variance test with a significance level of 5%. Comparing the surgical times alone, we found no statistically significant difference between the right and left sides applying the Student t test, which also showed symmetry in the nasal septum. CONCLUSIONS: The measurements of the nasal septum did not change in the different surgical times throughout their inferior extension, and they remained symmetrical throughout patients' follow-up period.

Primary intraosseous CD9-positive B-cell lymphoblastic lymphoma of the maxilla affecting a pediatric patient: Immunohistochemical and in situ hybridization analysis.

Lymphoblastic lymphoma (LBL) is a clinically aggressive disease, representing approximately 2% of all non-Hodgkin lymphoma cases. In the oral and maxillofacial (OMF) region, approximately 39 cases, diagnosed as LBL, acute lymphoblastic leukemia (ALL) or ALL/LBL, have been reported to date. Noteworthy, the CD9 expression, which indicates a poor outcome in ALL, has not been reported in LBL and lymphoblastic neoplasms of the OMF region. Herein, we report an additional maxillary intraosseous B-cell LBL, affecting a 14-year-old girl, which also showed positivity for CD9, Bcl-6 and MUM1/IRF4. Aiming at diagnostic and prognostic criteria, further studies focusing CD9 expression in LBL is recommended.

Migration and surgical retrieval of a broken dental needle: a literature review and case report.

Although the incidence of broken needles in dental practice is minimal, needle breakage can occur as a result of manufacturing defects, inadequate patient management, or poor practitioner technique. Retrieval of a broken needle is justified not only because of the potential for needle migration but also because of psychological and medicolegal considerations. This case report describes the surgical removal of a dental needle that fractured during an attempt at local anesthesia. Identifying the precise location of the broken needle fragment and its relationship with the surrounding bones, vessels, and nerves is essential to designing an adequate treatment plan. If surgical retrieval is indicated, it should be performed immediately, especially in cases in which the needle fragment has not been bent or deformed. In the present case, the use of C-arm fluoroscopy aided the surgical removal while saving time and reducing the cost of treatment.

Gingival carcinoma cuniculatum mimicking a reactive/inflammatory process / Carcinoma cuniculado gengival mimetizando um processo inflamatório/reativo

ABSTRACT Carcinoma cuniculatum (CC), a rare variant of oral squamous cell carcinoma, presents well-differentiated neoplastic epithelial cells infiltrating the underlying submucosal or bone tissues, forming the so-called "rabbit burrows" filled with keratin. A 67-year-old female patient was referred complaining of a painless tumoral mass in the left mandibular body, with several months of evolution. Previous history indicated extraction of the teeth #37 and #38 and diagnosis of chronic suppurative osteomyelitis. A deep incisional biopsy revealed CC. Due to its microscopic features, suggesting an inflammatory or reactive process, strict clinicopathological correlation is necessary for the correct diagnosis of CC.

RESUMEN El carcinoma cuniculatum (CC), una variante del carcinoma de células escamosas oral, presenta células epiteliales neoplásicas bien diferenciadas que se infiltran en la submucosa o en el tejido óseo subyacente, formando la llamada "madriguera de conejo", rellenada con queratina. Reportamos el caso de una paciente de 67 años con quejas de una masa tumoral asintomática en el cuerpo mandibular izquierdo con varios meses de evolución. La historia previa apuntó exodoncia de los dientes 37 y 38 y diagnóstico de osteomielitis supurativa crónica. Una biopsia incisional profunda reveló CC. Debido a las características microscópicas, que sugirieron un proceso inflamatorio o reactivo, es necesaria una estrecha correlación clinicopatológica para el diagnóstico correcto del CC.

RESUMO O carcinoma cuniculado (CC), uma rara variante do carcinoma espinocelular oral, apresenta células epiteliais neoplásicas bem diferenciadas que se infiltram na submucosa ou no tecido ósseo subjacente, formando a chamada "toca de coelho", preenchida por queratina. Relatamos o caso de uma paciente de 67 anos que foi encaminhada apresentando uma massa tumoral assintomática no corpo mandibular esquerdo com vários meses de evolução. A história prévia indicou exodontia dos dentes 37 e 38 e diagnóstico de osteomielite supurativa crônica. Uma biópsia incisional profunda revelou CC. Devido às características microscópicas, as quais sugeriram um processo inflamatório ou reativo, é necessário estrita correlação clinicopatológica para o correto diagnóstico do CC.

Removal of Implant and New Rehabilitation for Better Esthetics.

Tooth loss can result in loss of facial esthetics, in addition to its effect on mastication, swallowing, and speech. Adequate planning is required in order for the prosthetic treatment of the teeth and implants to be successful. Here, we present a clinical case demonstrating that improper positioning of an implant can make prosthetic rehabilitation unfeasible, necessitating new surgical and rehabilitation planning to achieve the desired esthetics. The patient had a missing right lateral incisor and cuspid, and a buccally directed implant. The preferred treatment regimen involved the removal of this implant and placement of another one more properly positioned distally and three dimensionally. The repositioning of the implant made rehabilitation treatment with a mesial cantilever possible. Due to esthetic considerations, gingival conditioning in the cantilever region was performed in the temporary prosthesis phase. The changes adopted in planning the surgery and rehabilitation resulted in good esthetics as well as functional outcomes.

Resistance of four fixation techniques used to treat subcondylar fractures.

OBJECTIVE: This study aimed to evaluate the resistance of four fixation techniques used to treat subcondylar fractures. The following techniques were evaluated: fixation with one 4-hole single straight plate; fixation with one 2-mm 4-hole system plate and one 1.5-mm 3-hole system plate; fixation with two 2-mm plates with a 3-hole anterior plate; and fixation with two 2-mm plates with four holes each. STUDY DESIGN: Each fixation technique was subjected to a resistance test. The load values were measured when displacement of 1, 2, and 5 mm was reached. Load values were compared for statistically significant differences using analysis of variance (ANOVA; p < 0.5) and Tukey's test. RESULTS: Statistically significant differences were observed, when the load was applied to the first molar on the side of the fracture. The group treated with a 4-hole, 2-mm, one plate system showed resistance to lower load values than the groups treated with two plates in any combination. CONCLUSIONS: When the fracture was fixed using two plates, regardless of the kind of plates used, no statistically significant difference between the groups was observed. However, two plate systems showed better resistance than one plate systems.