Titanium Mesh Exposure After Bone Grafting: Treatment Approaches-A Systematic Review.

Study Design: A systematic review according to PRISMA statement has been designed to answer the preliminary question: "In titanium mesh exposures, is there a treatment alternative which leads to an increased graft maintenance?" and fill the PICO assessment out. Objective: To review studies published in the past 20 years (1999-2019) in which mesh exposure has occurred, detecting the suitable approaches to treat exposure allowing the graft maintenance. Methods: Initial search on PUBMED, SCOPUS, and COCHRANE databases resulted in 777 articles, and hand-searching identified 6 articles. After removing duplicates and unrelated articles, eligibility criteria were applied, and 31 studies were selected (randomized clinical trials, retrospective/prospective clinical trials, and case series). Results: A total of 677 surgical sites and 225 cases of mesh exposure were identified. Eleven treatments have been identified. Chlorhexidine was the primary approach in 46% of cases, followed by oral hygiene instructions and follow-up with 22.5% of occurrences. In 21% of clinical situations, titanium mesh removal was the treatment of choice, associated with other measures (i.e., antibiotic prescription). There seems to be a consensus in cases of infection. When this complication was associated with tissue dehiscence, the primary treatment was mesh removal. The same does not occur when the site needs to be cleaned for long-term periods. Conclusion: In 2 decades of use of titanium meshes, the available treatments do not seem to have evolved, and there is not enough data to establish a guideline.

Nasal Septal Deviation After Surgically Assisted Rapid Maxillary Expansion.

Background and Aim: Surgically assisted rapid maxillary expansion (SARME) is a surgical technique widely used to correct deficiency of the transverse maxillary dimension. Although some studies investigated the effect of SARME on nasal and facial alterations, there is no evidence that correlates nasal septal deviation (NSD) to SARME as a possible postoperative sequel. The aim of this study is to address and quantify possible variations in the position of the nasal bony septum after SARME and identify any NSD as a postoperative outcome of this surgical technique. Patients and Methods: This is a retrospective study, conducted at the Department of Oral and Maxillofacial Surgery of the University Hospital of Araraquara (Unesp, faculty of dentistry), SP, Brazil. Twenty-nine patients who underwent SARME were studied; every patient was evaluated by cone-beam computerized tomography (CBCT) before (T0) and six months after surgery (T1), and we collected the variation of nasal septal position by measuring the distance between the bony septum and the nasal lateral wall. Our measurements were carried out at the level of the head, midpoint and tail of the inferior turbinate. Results: A mean NSD ranging from 0.4 to 1.2 mm was measured, and it is more pronounced at the anterior part of the bony septum. Twenty-seven patients (93.1%) presented minor changes in bony septum position; in 2 cases (6.8%), a significant NSD was found (p < 0.05). Conclusion: A variation of bony nasal septum position can be expected in any direction after SARME, and it is more pronounced at anterior portion.

Bone formation after surgically assisted rapid maxillary expansion: comparison of 2 distraction osteogenesis protocols.

OBJECTIVE: The aim of this study was to compare bone formation between 2 distraction osteogenesis protocols by analyzing cone beam computed tomography (CBCT) scan data. STUDY DESIGN: In this retrospective study, the efficacy of 2 different surgically assisted rapid maxillary expansion protocols (group 1 [G1], 3 × 0.25 mm/d; group 2 [G2], 1 mm start followed by 2 × 0.25 mm/d) was analyzed using CBCT scans obtained at 3 time points: preoperatively (T0), immediately after surgery (T1), and 6 months after surgery (T2). Bone formation at T0, T1, and T2 was analyzed using the Dolphin Imaging 11 program. RESULTS: At T1, both groups had significantly higher bone volume than at T0 (G1, 135.6 vs 124.65 mm3, respectively; G2, 153.49 vs 118.9 mm3, respectively), with no significant difference between groups (P = .6). Moreover, bone density measured in the region of interest was similar between groups at all 3 time points; however, in both groups, bone density was significantly lower at T1 and T2 than at T0 (P < .01), with no difference between T1 and T2. CONCLUSIONS: Bone density between the incisors decreased with progressive distraction (i.e., increasing volume), regardless of the distraction protocol used; thus, both protocols can be used safely in clinical practice. Nevertheless, our results indicate that stress should not be applied to the incisors within 6 months of surgery, regardless of the protocol used. Surgeons and orthodontists should therefore consider immature bone formation and avoid using excessive force to close a diastema.

Atrophic Maxilla Reconstruction With Autogenous Iliac Graft and Guided Dental Implants.

Oral rehabilitation with osseointegrated implants is frequently the best alternative for replacement of lost teeth. Several techniques and materials allow achievement of excellent function and esthetics. In the case of maxillary or mandibular atrophy, extensive grafting may be necessary before implants can be properly placed. This is a case of maxillary reconstruction with autogenous iliac crest bone grafts, followed by placement of guided implants. After integration of the grafts, planning and insertion of implants allowed installation of an implant-supported prosthesis, recovering the morphology, function, and esthetics.

The relevance of dental surgeon on Gorlin-Goltz syndrome.

Multiple odontogenic keratocysts could be linked to different conditions. Then, to achieve the correct diagnosis whether their presence is associated to a syndrome, some criteria must be followed. The present study aims to report a case of a 21 years-old male patient whose was referred with several radiolucent lesion on the maxilla-mandibular complex. The lesions were biopsied and the diagnosis of the histological exam hypothesized as odontogenic keratocyst. After complete evaluation, others abnormalities were also found such as calcification of falx cerebri, palmar and plantar pits, and multiple basal cell on feet. The patient was diagnosed with Gorlin-Goltz syndrome and was referred to other medical specialties to adequate follow-up. Dental surgeon represents an important role on correct diagnosis of the Gorlin-Goltz syndrome and could avoid further complications.

Reconstruction of orbital floor defects assisted by transantral endoscopy.

PURPOSE: The goal of orbital reconstruction is to restore anatomy, volume, and function. In extensive orbital floor defects, the visualization of the posterior area is limited through inferior eyelid incisions. The use of endoscope may improve the treatment; however, it is a high-sensitivity technique. The aim of this case series is to describe the combination of inferior eyelid incision with transantral endoscopy for treatment of extensive orbital floor defects. METHODS: Three patients were submitted to orbital reconstruction, and the postoperative CT scans were evaluated to analyze the orbital volume and anteroposterior globe position. Surgical treatment was performed using subciliary inferior palpebral approach to explore the orbital floor and placement of the titanium mesh and an intraoral antrostomy for endoscopy to magnification of the surgical field and adaptation of the mesh. RESULTS: Postoperative CT scan analysis shows that all treatments restored orbital volume and globe position without compression or damage of the optical nerve. CONCLUSION: The use of endoscope allowed the precise visualization of the posterior region of the orbit and adaptation of the titanium mesh.

The Importance of Early Diagnosis of Retrobulbar Hemorrhage.

Midface fractures usually affect the orbital cavity. This trauma may result in severe and rare consequences such as retrobulbar hemorrhage. This condition requires immediate diagnosis and early intervention to avoid blindness. The treatment usually requires evaluation of an oral and maxillofacial surgeon. This patient report aims to describe a facial trauma resulting in blindness after 4 days. An 83-year-old woman fell and hit her face on the floor. The initial evaluation only found a contusion on her left orbit, and an ophthalmologic examination was not made. After 72 hours, the patient searched for the oral and maxillofacial surgeon, showing blindness of her left eye. Despite the treatment, the vision was not recovered. Blindness can become irreversible 90 minutes after trauma, and this condition must be treated as an emergency.

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.

Pathologic Mandibular Fracture as First Sign of Multiple Myeloma.

Multiple myeloma (MM) is a neoplasia characterized by the proliferation of plasmacytoid cells, which produce abnormal immunoglobulins. It frequently creates local and systemic complications such as pathologic fractures and renal disease. This article reports the case of a 70-year-old man presenting a pathologic fracture of the right mandibular angle secondary to a plasmocytoma. He had a history of a previous pathologic fracture of the left mandibular angle 13 years before that was treated elsewhere, but no documentation was available. Investigation revealed the disease to be a MM and evolution led to renal failure and death. Differential diagnosis is necessary for this kind of pathologic presentation because MM presents a survival rate of 5.7% in 5 years and mandibular involvement happens in the advanced stage of the disease.

Implant-supported rehabilitation after treatment of atrophic mandibular fractures: report of two cases.

OBJECTIVE: The objective of this article is to present options of rehabilitation with dental implants in two cases of severely atrophic mandibles (<10 mm) after rigid internal fixation of fractures. PATIENTS AND METHOD: Two patients who sustained fractures in severely atrophic mandibles with less than 10 mm of bone height were treated by open reduction and internal fixation through a transcervical access. Internal fixation was obtained with 2.4-mm locking reconstruction plates. The first patient presented satisfactory bone height at the area between the mental foramens and after 2 years, received flapless guided implants in the anterior mandible and an immediate protocol prosthesis. The second patient received a tent pole iliac crest autogenous graft after 2 years of fracture treatment and immediate implants. After 5 months, a protocol prosthesis was installed in the second patient. RESULTS: In both cases, the internal fixation followed AO principles for load-bearing osteosynthesis. Both prosthetic devices were Branemark protocol prosthesis. The mandibular reconstruction plates were not removed. Both patients are rehabilitated without complications and satisfied with esthetic and functional results. CONCLUSION: With the current techniques of internal fixation, grafting, and guided implants, the treatment of atrophic mandible fractures can achieve very good results, which were previously not possible.

Frequência de ressonância e sondagem Peri-Implantar em implantes curtos sob carga imediata com prótese totalfica em cantileverna arcada mandibular: Acompanhamento de um ano

Nas situações clínicas em que ocorre severa reabsorção óssea após perdas dentárias, as opções de tratamento descritas na literatura incluem a utilização de técnicas para aumento da disponibilidade óssea, implantes transmandibulares e a utilização de implantes curtos. Entretanto, os enxertos ósseos para ganho em altura não apresentam boa previsibilidade. As técnicas de distração osteogênica também estão associadas à grande desconforto e maiores custos ao paciente. E os implantes transmandibulares apresentam altos índices de insucesso. Já os implantes curtos apresentam índices de sucesso similares aos implantes convencionais, tornando-os uma excelente alternativa de tratamento para os casos de atrofia óssea vertical. O enfoque atual é a redução do período de tratamento e a diminuição dos custos ao paciente, com isso, vários estudos têm avaliado a taxa de sucesso dos implantes curtos submetidos ao protocolo de carga imediata. A proposta desse trabalho foi relatar um caso de atrofia mandibular, tratada, com sucesso, por meio da instalação de quatro implantes 3 curtos entre os forames mentuais para reabilitação com prótese implanto-suportada tipo protocolo hibrido submetido à carga imediata. Atualmente a paciente encontra-se em pós-operatório de 13 meses apresentando valor médio de profundidade de sondagem Peri-implantar de 1,87 mm e de 78,56 ISQ da freqüência de ressonância.

Estudo comparativo da inclinação do plano oclusal de modelos para cirurgia ortognática montados em dois tipos de articuladores semiajustáveis / Comparative study of occlusal plane angulation of dental casts for orthognathic surgery mounted in two types of semi-adjustable articulators

Objetivo: este estudo busca comparar a inclinação do plano oclusal obtida em dois tipos diferentes de articuladores semiajustáveis com aquela obtida na telerradiografia em norma lateral. Metodologia: 20 pacientes a serem submetidos à cirurgia ortognática tiveram seus modelos de gesso montados em 2 diferentes articuladores semiajustáveis por meio da transferência com arcos faciais da posição da maxila e registro oclusal para a mandíbula. Após montagem, à inclinação do plano oclusal nos articuladores foi mensurada e comparada com a inclinação mensurada nas telerradiografias cefalométricas laterais e entre os articuladores entre si. Os resultados obtidos foram submetidos a análise estatística pertinente. Resultados: os valores médios dos ângulos obtidos nos articuladores Bio Art (7,55º) e Kavo (-5,70º) diferem entre si em 13,25º, sendo essa diferença estatisticamente significante (p=0,00). Quando comparados individualmente à telerradiografia (5,075º), o articulador Bio Art apresentou valor mais próximo, com uma diferença de 2,475º, enquanto que o articulador Kavo apresentou uma diferença de 10,775º. Conclusão: os dois modelos de articuladores semiajustáveis testados não reproduzem, com fidelidade, a inclinação do plano oclusal maxilar de pacientes portadores de deformidades dentofaciais; a diferença encontrada entre o articulador Bio Art e a telerradiografia foi menor do que aquela encontrada entre o articulador Kavo e a telerradiografia.

Purpose: The aim of this study was to compare occlusal plane angulation measured in two different types of semi-adjustable articulators with that obtained on the lateral cephalometric radiograph. Materials and Methods: 20 patients due to undergo orthognathic surgery had dental casts mounted in two different types of semi-adjustable articulators through face bow transfer from the position of the maxilla and occlusal recording to the mandible. After mounting, the inclination of the occlusal plane in the articulators was measured and compared with the inclination measured at on both articulators and compared with the inclination measured on the lateral cephalometric radiographs and between the articulators themselves. The results obtained werestatistically analyzed. Results: Mean angulation values for the Bio Art (7.55º) and Kavo (-5.70º) articulators differ by 13.25º, which is statistically significant (p=0.00). When individually compared to the lateral cephalometric radiograph (5.075º), the Bio Art articulator showed more similar angulation values, with a difference of 2.475º, while the Kavo articulator presented a difference of 10.775º. Conclusion: Neither of the models of semi-adjustable articulators accurately reproduced the inclination of the maxillary occlusal plane of patients with dentofacial deformities; the difference between the two articulators tested and the lateral cephalometric radiograph was lower for the Bio Art than for the Kavo articulator.

Tratamiento de la deformidad facial causada por la hiperplasia condilar: relato de caso / Treatment of facial deformity caused by condylar hyperplasia: case report

La hiperplasia condilar es una anomalía de desarrollo adquirida, rara, caracterizada por el crecimiento excesivo y progresivo, afectando el cuello, la cabeza condilar, el cuerpo y la rama mandibular, provocando importante asimetría facial. En el artículo, se presenta un caso clínico de paciente del género masculino, 22 años de edad, quejándose de sintomatología dolorosa en la región de la articulación temporomandibular y asimetría facial severa. Fue instituido un tratamiento ortodóntico- quirúrgico por medio de cirugía ortognática combinada y condilectomía alta. Después de seis años de control postoperatorio, el paciente se presenta en buen estado, sin recidiva de la asimetría facial o de la hiperplasia condilar

The condylar hyperplasia is an acquired development anomaly, rare, characterized by an excessive and progressive growing, affecting neck, condilar head, body and the mandible bough, provoking an important facial asymmetry. In the article we present a case of male patient, 22-years-old, reclaiming of painful sintomatology in the region of temporomandibular joint and severe facial asymmetry. It was instituted an orthodontic-surgical treatment by means of orthognathic combined surgery and high condilectomy. After six years of post-surgical controlling, the patient is now in a good shape, without recurrence of facial asymmetry and condylar hyperplasia

Extenso lipoma em mucosa jugal. Caso clínico / Wide cheek's lipoma. Case report

Os autores fazem uma breve revisäo de literatura sobre os lipomas localizados na cavidade oral e face, apresentando um caso clínico de um homem de 52 anos de idade que se apresentou com um extenso lipoma em regiäo de bochecha