Rare and Multiple Hypodontia in Van der Woude Syndrome: Case Report.

Van der Woude syndrome (VWS) is a rare syndrome of genetic etiology, commonly occasioned by mutations in the IRF6 gene and that causes disorders in craniofacial development. VWS is characterized by the presence of paramedian fistulas in the lower lip and cleft lip and / or cleft palate. Although some dental phenotypes have been reported in this syndrome, multiple and rare hypodontias were not described. Through this case report, we present a case of Van der Woude Syndrome (VWS) with rare and multiple hypodontia in which clinical data and radiographic exams were evaluated. The patient presented hypodontia of eight permanent teeth (lateral incisors, second premolars and second molars). So, when the dentist recognizes multiple and/or rare hypodontias, for an accurate diagnosis, detailed examination of the lower lip is indicated, as well as a survey of the family history and referral for genetic counseling, since the syndrome presents high penetrance. The patient is expected to be rehabilitated to have a good quality of life. Rehabilitation in these cases requires alveolar bone graft, orthodontics and prosthesis to replace missing teeth.

Estudo comparativo da distorção radiográfica de implantes osseointegráveis radiografados pela técnica periapical da bissetriz / Comparative study of radiographic distortion of osseointegrated implants radiographed by bisecting-angle periapical technique

Objetivou-se verificar a ocorrência de distorção em imagens obtidas por meio de radiografias periapicais pela técnica da bissetriz. Foram utilizadas 64 radiografias periapicais, padronizadas e digitalizadas, obtidas pela técnica periapical da bissetriz de pacientes submetidos à colocação de implantes. Após a obtenção das imagens, os implantes foram mensurados pelo método de medida digital por meio do programa ImageJ, em seu comprimento e em 3 medidas transversais ao longo de seu eixo. Os dados foram tabulados e analisados estatisticamente pelo teste T pareado. Evidenciou-se distorção de ampliação nas imagens obtidas, sendo maior na arcada superior do que na inferior. As maiores ampliações foram observadas no comprimento do implante, seguido pelo diâmetro da plataforma, diâmetro do corpo e diâmetro apical, respectivamente. Concluiu-se que há distorção importante nas imagens radiográficas obtidas pela técnica periapical da bissetriz, devendo existir o devido cuidado com tal técnica, já que essa discrepância de medida afeta o planejamento, o que pode ocasionar lesão de estruturas anatômicas importantes ou gerar engano na quantidade de possíveis perdas ósseas verticais e horizontais após a instalação do implante (AU).

This study aimed to verify the occurrence of distortion in images obtained by bisecting-angle periapical radiography. We used 64 periapical radiographs, standardized and digitalized, obtained by bisecting-angle periapical technique of patients undergoing implants insertion. After images obtainment, the implants were measured by digital measurement method through ImageJ program, in length and in three cross-cuting measures along its axis. The data were organized and statistically analyzed by paired T test. It was shown distortion of magnification in obtained images, being higher in superior arcade than in inferior. The higher magnifications were observed in length of the implant, followed by the platform diameter, body diameter, and apical diameter, respectively. It was concluded that the significant distortion in the radiographic images was taken by the bisecting-angle periapical technique and there should be proper care of such technique, since this discrepancy of measure affects the planning, which can cause injury to anatomical structures or generate major mistake in the amount of possible vertical and horizontal bone loss after installation of the implant (AU).

Comparative dimensional tomographic study of the mandibular condyle of individuals with transverse maxillary deficiency

Transverse maxillary deficiency is characterized by posterior uni or bilateral crossbite, crowded and rotated teeth, as well as high palate. Its treatment in adult individuals is surgically assisted rapid palatal expansion. The aim of this study was to verify the occurrence of dimensional alterations in the mandibular condyles of patients with TMD submitted to surgically assisted maxillary expansion. Measurements of the mandibular condyles using the DISTANCE tool in cone beam computed tomography iCat software were performed. The values obtained were submitted to statistical analysis by the paired t-test and the results showed statistically significant dimensional reduction in the axial posterior-anterior lateral (-0.74mm), axial posterior-anterior lateral left (-0.90mm) and coronal medium right (-1.24mm) dimensions. The coronal inferior (1.13mm), coronal inferior left (1.78mm) and coronal superior-inferior right (0.76mm) measurements showed statistically significant dimensional increase. The results allowed us to conclude that dimensional alterations occurred in the mandibular condyles in individuals with maxillary transversal deficiency that underwent surgically assisted rapid palatal expansion (SAPE), which can be understood by remodeling, since they are characterized by dimensional increase or reduction, depending on the location where the measurement was performed (AU)

Estudo comparativo dimensional tomográfico do côndilo mandibular de indivíduos com deficiência transversal de maxila / Comparative dimensional tomographic study of the mandibular condyle of individuals with transversal maxillary deficiency

A deficiência transversal de maxila, caracteriza-se por mordida cruzada posterior uni ou bilateral, dentes apinhados e ou rotacionados, e pelo formato ogival do palato. O tratamento em indivíduos adultos tem sido realizado a partir da expansão de maxila cirurgicamente assistida (EMCA), que resulta em efeitos esqueléticos e dentários no arco superior, com expectativa de efeitos no arco inferior. Neste estudo nos propusemos avaliar a ocorrência de alterações dimensionais nos côndilos mandibulares, de pacientes com deficiência transversal de maxila, e submetidos a expansão cirurgicamente assistida em imagens obtidas por tomografias computadorizadas de feixe cônico (TCFC) de catorze indivíduos com deficiência transversal de maxila, sendo cinco homens e nove mulheres, com idades entre 24 e 28 anos. Na reformatação axial as medidas foram obtidas no sentido, látero-medial, póstero-anterior lateral, póstero-anterior central e pósteroanterior medial da superfície articular. Nas reformatações coronais, mensurou-se os sentidos látero-medial superior, látero-medial inferior, látero-medial médio e súperoinferior. Dentre as medidas obtidas e submetidas à análise estatística pelo teste t pareado, somente as medidas axial póstero-anterior lateral esquerda (-0,90mm), coronal médio direita (-1,24mm), coronal inferior esquerda (1,78mm), coronal súpero-inferior direita (0,76mm), axial póstero-anterior lateral (-0,74mm) e coronal inferior (-1,13mm) foram estatisticamente significativas. Os resultados obtidos na amostra estudada nos permitiram concluir que: em indivíduos com deficiência transversal de maxila e submetidos a EMCA, ocorreram alterações dimensionais nos côndilos mandibulares, que puderam ser entendidas por remodelação, uma vez que caracterizaram-se por aumento e redução, dependendo da localização da medida realizada.

Transverse maxillary deficiency is characterized by posterior uni or bilateral crossbite, crowded and rotated teeth, as well as high palate. Its treatment in adult individuals is surgically assisted rapid palatal expansion (SARPE). This procedure not only has skeletal and dental effects in the upper arch, but also expresses effects in the lower arch. The objective of this study was to verify the occurrence of dimensional alterations in the mandibular condyles of patients with transversal maxillary deficiency submitted to surgically assisted maxillary expansion. Measurements by cone beam computed tomography (CBCT) of the mandibular condyles, axial plains, lateromedial sizes, posterior-anterior lateral, posterior anterior central, and posterior-anterior medial of the articular surface were performed. In the coronal reformats, the superior lateral medial, inferior lateral medial, medium lateral medial, and superior inferior sizes were measured. CBCT images of fourteen individuals with transversal maxillary deficiency were used, five male and nine female with an average age of 24.28 years. Among the values obtained and submitted to statistical analysis by the paired t-test, only the left posterior-lateral anterior axial measurements (-0.90mm), right middle coronal (-1.24mm), left inferior coronal (1.78mm), right superior-inferior coronal (0.76mm), axial anterior-posterior lateral (-0.74mm) and inferior coronal (-1.13mm) were statistically significant. It was concluded that in individuals with maxillary transversal deficiency that underwent surgically assisted rapid palatal expansion (SARPE), dimensional alterations occurred in the mandibular condyles, which can be understood by remodeling, once they are characterized by an increase and reduction, depending on the location where the measurement was performed.

Computerized cephalometric study of the pharyngeal airway space in patients submitted to orthognathic surgery.

INTRODUCTION: Pharynx is a muscular organ with is sustained by craniofacial bones. It is divided into nasal, oral and hipopharynx, and can be considered as a tube that serves both respiratory and digestive systems. Its anatomical morphology permits that factors facilitate its obstruction, leading to the sleep apnea syndrome. One of the treatment consists of surgical mandibular advancement, increasing pharyngeal dimensions. The aim of this study was evaluate the cephalometric changes in the pharyngeal airway space after orthognathic surgery procedures for correction of mandibular prognathism. MATERIALS AND METHODS: Pre and post-operative cephalometric analysis was performed on 19 patients submitted to mandibular setback by mandibular bilateral sagittal split osteotomy associated with maxillary advancement by Le Fort I osteotomy, using the Dolphin Imaging 10.0 software. RESULTS: Results did not reveal statistically significant changes in the upper (nasopharyngeal), middle (oropharyngeal) and lower (hypopharyngeal) airway spaces, but showed increase in the nasal pharynx due the maxillary advancement and a lower position of the hyoid bone due the mandibular setback. DISCUSSION: Maxillomandibular orthognathic surgery for correction of mandibular prognathism does not seem to statistically significantly change the pharyngeal airway space, but it increases the maxillary airway. CONCLUSION: It seems to be important to consider the double jaw surgery in cases of mandibular prognathism, aiming prevention of a possible reduction of whole upper airway.

Complicações após expansão de maxila cirurgicamente assistida / Complications following surgically assisted maxillary expansion

Introdução: O tratamento da deficiência transversal de maxila, em adultos, exige a expansão de maxila cirurgicamente assistida. Diversas técnicas cirúrgicas são conhecidas para a realização desse procedimento, porém estas relacionam-se com complicações. Objetivo: Avaliar a incidência de complicações associadas ao procedimento de expansão de maxila cirurgicamente assistida. Material e Método: Trinta e três indivíduos com deficiência transversal de maxila foram submetidos ao procedimento de expansão pela técnica da osteotomia Le Fort I subtotal com degrau no pilar zigomático-maxilar, disjunção ptérigo-maxilar e osteotomia da sutura intermaxilar. Durante os períodos trans e pós-operatório, as complicações relacionadas ao procedimento e as distâncias interdentais foram registradas. Resultado: Doze homens e 21 mulheres, com idade média de 24,64 anos, submeteram-se ao procedimento. As mensurações das distâncias interdentais evidenciaram aumento das mesmas entre os períodos pré-operatório e pós-operatório de 2 meses. As complicações prevalentes foram sinusite (6%) e deslocamento associado à inclinação dental (6%). Conclusão: A expansão de maxila cirurgicamente assistida é um procedimento eficaz e de baixa morbidade para o tratamento da deficiência transversal de maxila em indivíduos adultos.

Introduction: The treatment of adult transverse maxillary deficiency is the surgically assisted maxillary expansion. Several surgical techniques have been described for this and complications have been related to these procedures. Objective: the aim of this study was evaluate the incidence of complications associated with surgically assisted maxillary expansion. Material and Method: 33 individuals undergone surgically assisted maxillary expansion by subtotal Le Fort I osteotomy with a step in the zygomatic-maxillary buttress and associated to pterigomaxillary disjunction and osteotomy of intermaxillary suture. Operative complications, post-operative complications and the distance between the upper teeth were recorded. Result: 12 men and 21 women with an average age of 24.64 years undergone the procedure. The interdental distances increased from preoperative to 2 months post-operative time. The prevalent complications were sinusitis (6%) and teeth displacement and inclination (6%). Conclusion: Surgically assisted maxillary expansion is an effective and low morbidity procedure to treat transverse maxillary deficiency in adults.

Agenesia dentária reabilitada por meio de implante de superfície SLActive: relato de caso / Dental agenesis treated with SLActive implant: case report

Agenesia dentária é uma anomalia genética que caracteriza-se pela ausência total de um ou mais dentes. Ocorre em de 6% da população brasileira, geralmente no segundo pré-molar inferior e representa um desafio para a reabilitação, pois leva a alterações funcionais e estéticas. Nesse contexto, os implantes osseointegráveis ocupam lugar de destaque, dentre eles, os implantes de superfície SLActive®, que promovem aceleração no período de osseointegração, reduzindo esse tempo para 21 dias, além de melhor qualidade do osso neoformado ao redor dos implantes. Com altos índices de sucesso, mesmo quando submetidos a carga oclusal precoce ou imediata, tais implantes têm revolucionado a implantodontia moderna. O objetivo desse trabalho é relatar caso de agenesia dentária do segundo pré-molar inferior, reabilitado por meio de implante de superfície SLActive® e instalação da coroa protética definitiva na quinta semana pós-operatória.

Dental agenesis is a genetic abnormality characterized by total absence of one or more teeth. It affects about 6% of the population, affects preferably the second mandibular premolar and represents a challenge for rehabilitation because it leads to functional and esthetic problems. Currently, dental implants play a prominent role in rehabilitation, and the SLActive® implants stand out because they accelerate osseointegration, shorten it to 21 days, and ensure better quality of new bone around the implant. With high rates of success even when immediate or early loading is used, these implants have revolutionized modern Implantology. This report describes a case of dental agenesis of the second mandibular premolar treated using a SLActive® implant and a final prosthetic crown installed on the fifth postoperative week.

Importância do diagnóstico radiográfico de patologias dos maxilares em pacientes ortodônticos / Importance of radiographic diagnosis of pathologies of the jaws in orthodontic patients

Introdução: a Ortodontia como uma especialidade odontológica tem mostrado para a sociedade a sua grande relevância e seu impacto na promoção da saúde da população. Enquanto ciência, os avanços para tratamento e reabilitação de pacientes são incontestáveis,desde situações mais simples às mais complexas, proporcionando saúde e bem-estar a um número cada vez maior de pessoas. Por outro lado, o grande número de profissionais tem gerado preocupações e inquietações à medida que tratamentos podem ser conduzidos deforma inadequada. Objetivo: neste artigo será abordada a importância do diagnóstico de patologias dos maxilares por meio da descrição de quatro situações clínicas, nas quais pacientes sob tratamento ortodôntico, portadores de lesões visíveis ao exame radiográfico panorâmico,tiveram o diagnóstico destas lesões negligenciado ou desconsiderado.Conclusão: a radiografia panorâmica constitui importante meio de diagnóstico de patologias assintomáticas dos maxilares, devendo ser criteriosamente avaliada antes do início da terapia ortodôntica.A parceria com outras especialidades da Odontologia é fortemente aconselhada na rotina do ortodontista.

Introduction: orthodontics as a dental specialty has shown its relevance to society and a great impact on the promotion of public health. The advances in the treatment and rehabilitation of orthodontic patients, from mild to severe cases, provide health and wellness to a growing number of people. On the other hand, the growing number of orthodontic professionals has raised concems,as treatments can be conducted improperly Objective: in this articlewe discuss the importance of diagnosis of pathological changes of the jaws through the description of four clinical situations in which patients under went orthodontic treatment. Lesions which were visible on panoramic radiographs were overlooked or disregarded for these patients. Conclusion: the panoramic radiograph is an important modality of diagnosis of asymptomatic pathological changes of the jaws. The panoramic image must be carefully evaluated before the beginning of orthodontic treatment. Collaboration with other specialties of dentistry is strongly recommended for the orthodontist.

Peripheral osteoma of the maxillary sinus: a case report.

BACKGROUND: Paranasal sinus osteomas are rare benign tumors. Although various theories such as trauma and infection have been proposed, it is difficult to establish the pathogenesis of osteoma. Osteomas may be detected with routine radiographic examination or the tumors may enlarge and cause symptoms. Osteomas most frequently occur in the frontal and ethmoid sinuses, and are rare in the maxillary sinus. CASE REPORT: In the present study, we report a case of an 18-year-old woman with a maxillary sinus osteoma. Radiographically, the tumor was characterized as a radiopaque, well-delimited lesion in the periapical region of teeth 27 and 28 that had positive sensitivity test. After computed tomographic scanning and complete removal of the tumor, the histopathological diagnosis was osteoma. After 1 year of follow-up, the patient shows no signs of recurrence.