M-shaped Genioplasty: New Findings after 10 Years of Experience.

This study aimed to evaluate changes of the M-shaped genioplasty in sagittal and vertical planes in a group of 34 patients and describe other indications, such as the increase of the mentolabial angle, decrease in the depth of the mentolabial fold, and the centering of the chin. Methods: A retrospective analysis was performed on 34 patients between 2010 and 2019. All studies were conducted at T0 (preoperative), T1 (a month after surgery), and T2 (1 year after surgery). The position of the bone pogonion (Pg) was measured vertically and horizontally at T0, T1, and T2; the mentolabial angle and the depth of the mentolabial fold were measured at T0 and T2. Results: The average sagittal advancement at T1 was 6.6 mm and at T2 was 6.4 mm. The inferior movement was an average of 5.6 mm at T1 and T2, showing both movements excellent stability. The mentolabial angle increased at T2 an average of 28.2 degrees (5 degrees per each millimeter of inferior movement), whereas the depth of the mentolabial fold decreased an average of 2.8 mm (decreased 49% from the initial depth and decreased 0.56 mm per each mm of inferior movement). The average increase of the lower third of the face was 5 mm. No complications were observed in any patient. Conclusions: M-shaped genioplasty is an anterior osteotomy of the mandible, which allows the chin to move forward and downward. Additionally, it allows an increase of the mentolabial angle and decreases the mentolabial fold.

A comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions.

INTRODUCTION: Clinical reasoning is a core competence in health professions that impacts the ability to solve patients' health problems. Due to its relevance, it is necessary to identify difficulties arising from different sources that affect clinical reasoning development in students. The aim of this study was to explore a comprehensive approach to identify challenges for clinical reasoning development in undergraduate dental students and their potential solutions. METHODS: Mixed methods were used in four stages: (1) students and clinical teachers focus groups to identify challenges to clinical reasoning development; (2) literature review to explore potential solutions for these challenges; (3) Delphi technique for teacher consensus on pertinence and feasibility of solutions (1-5 scale); and (4) teachers' self-perception of their ability to implement the solutions. RESULTS: Three categories and seven subcategories of challenges were identified: (I) educational context factors influencing the clinical reasoning process; (II) teacher's role in clinical reasoning development; and (III) student factors influencing the clinical reasoning process. From 134 publications identified, 53 were selected for review, resulting in 10 potential solutions. Through two Delphi rounds, teachers rated the potential solutions very highly in terms of relevance (4.50-4.85) and feasibility (3.50-4.29). Finally, a prioritisation ranking of these solutions was generated using their scores for relevance, feasibility, and teachers' self-perception of their ability to implement them. CONCLUSIONS: The present comprehensive approach identified challenges for clinical reasoning development in dental students and their potential solutions, perceived as relevant and feasible by teachers, requiring further research and follow-up actions to address them.

Injerto Óseo Tibial en Cirugía Oral y Maxilofacial: Indicaciones y Descripción de la Técnica, Propósito De Tres Casos

RESUMEN: Uno de los mayores desafíos en cirugía máxilo facial, es la reconstrucción de los defectos óseos maxilares para una posterior rehabilitación funcional del sistema estomatognático. La pérdida del tejido óseo que sufren los huesos maxilares puede ser de origen congénito como las fisuras labio palatinas o adquiridas, ya sea como consecuencia de una neoplasia o lesión intra ósea que provoque algún defecto post quirúrgico, o bien un trauma o el desdentamiento de la zona (Kolerman et al., 2012). El déficit de tejido óseo que sufren los maxilares, a menudo impide o dificulta la rehabilitación dentaria, necesitando acudir a técnicas quirúrgicas que permitan corregir dichos defectos, siendo los injertos óseos la alternativa más utilizada hoy en día (Ramírez-Fernández et al., 2013). Según origen los injertos óseos se clasifican en: aloinjertos, autoinjertos, xenoinjertos y sustitutos óseos (Chappard et al., 2010). Se describen múltiples técnicas de reconstrucción mediante injertos óseos que dependen de la magnitud del defecto, de la disponibilidad de biomaterial es y de las condiciones tanto locales como sistémicas del paciente. A continuación se presenta una serie de 3 casos clínicos que requiriero n de reconstrucción ósea alveolar previo a instalación de implantes para la rehabilitación dentaria. En los tres pacientes se utiliz ó injerto óseo autólogo de tibia, siendo tratados por el equipo de cirugía máxilofacial del Hospital el Carmen Maipú, Santiago Chile. El primer caso correspondía a una paciente mujer de 65 años con una atrofia maxilar severa por pérdida de los dientes 1.4/2.4/2.5, con neumoti zación severa del seno maxilar bilateral. El segundo caso, una mujer de 30 años, portadora de una fisura alveolar unilateral, la cual no recibió injerto óseo alveolar en etapas tempranas. El tercer caso, una paciente mujer de 55 años que presentaba un odontoma compuesto m andibular en relación a las piezas dentarias 4.2 y 4.3. Para los tres casos, se utilizó injerto óseo autólogo tomado de la tibia según la técnica descrita por Catone et al. (1992) con el fin de realizar una posterior rehabilitación con implantes dentales. El objetivo de este reporte fue presentar la técnica quirúrgica utilizada y realizar una revisión breve de sus ventajas, desventajas y complicaciones asociadas.

ABSTRACT: One of the greatest challenges in maxillofacial surgery is the reconstruction of maxillary bone defects for a subsequent functional rehabilitation of the stomatognathic system. The loss of bone tissue suffered by the maxillary bones may be of congenital origin such as palatal lip fissures or acquired, either as a result of a neoplasm or intra-cè˛e injury that causes a post-surgical defect, or trauma or toothlessness of the area (Kolerman et al.). The deficit of bone tissue suffered by the jaws, often prevents or hinders dental rehabilitation, needing to resort to surgical techniques that correct these defects, with bone grafts being the most widely used alternative today (Ramírez-Fernández et al.). According to origin, bone grafts are classified as: allografts, autografts, xenografts and bone substitutes (Chappard et al.). Multiple reconstruction techniques are described using bone grafts that depend on the magnitude of the defect, the availability of biomaterials and the patient's local and systemic conditions. Below is a series of 3 clinical cases that required alveolar bone reconstruction prior to implant installation for dental rehabilitation. Autologous tibia bone graft was used in the three patients, being treated by the maxillofacial surgery team at Hospital el Carmen Maipú, Santiago Chile. The first case corresponds to a 65-year-old female patient with severe maxillary atrophy due to loss of 1.4 / 2.4 / 2.5 teeth, with severe pneumatization of the bilateral maxillary sinus. The second case was a 30-year-old woman with a unilateral alveolar fissure, who did not receive an alveolar bone graft in the early stages. The third case was a 55-year-old female patient who presented a mandibular compound odontoma in relation to teeth 4.2 and 4.3. For all three cases, an autologous bone graft taken from the tibial bone was used according to the technique described by Catone et al. (1992) in order to carry out subsequent rehabilitation with dental implants. The objective of this report is to present the surgical technique used and make a brief review of its advantages, disadvantages and associated complications.

Panoramic radiography for detection of bilateral carotid calcified atheroma: an unusual case report / Radiografía panorámica para la detección de ateroma calcificado carotídeo bilateral: reporte de un caso inusual

Introduction: Atherosclerosis is a progressive inflammatory disease that can trigger serious medical consequences like acute myocardial infarction or stroke. Case Report: The purpose of this study is to report an unusual case of finding calcified atheromatous plaques in the carotid arteries bilaterally using a panoramic radiography (PR). A 75-year-old female with a morbid history, attends the Teaching Dental Clinic of the Pontifical Catholic University with complementary exams. PR showed well-defined radiopaque structures adjacent to C4. Using a Doppler ultrasound, the presence of calcified atheromas in the right and left carotid arteries were confirmed. The patient was informed of these findings and is currently under medical follow-up. Conclusion: PR is a useful complementary resource in the detection of atherosclerotic plaques of the upper carotid region.

Introducción: La aterosclerosis es una enfermedad inflamatoria progresiva que puede desencadenar graves consecuencias médicas como infarto agudo de miocardio o accidente cerebrovascular. Case Report: El propósito de este estudio es reportar un caso inusual de hallazgo de placas ateromatosas calcificadas en las arterias carótidas de forma bilateral mediante una radiografía panorámica. Mujer de 75 años con antecedentes mórbidos, acude a la Clínica Odontológica Docente de la Pontificia Universidad Católica con exámenes complementarios. La radiografía panorámica mostró estructuras radiopacas bien definidas adyacentes a C4. Mediante ecografía Doppler se confirmó la presencia de ateromas calcificados en las arterias carótidas derecha e izquierda. El paciente fue informado de estos hallazgos y actualmente se encuentra en seguimiento médico. Conclusión: La radiografía panorámica es un recurso complementario útil en la detección de placas ateroscleróticas de la región carotídea superior.

Vertical Ridge Augmentation of Fibula Flap in Mandibular Reconstruction: A Comparison between Vertical Distraction, Double-Barrel Flap and Iliac Crest Graft.

Double-barrel flap, vertical distraction and iliac crest graft are used to reconstruct the vertical height of the fibula. Twenty-four patients with fibula flap were reconstructed comparing these techniques (eight patients in each group) in terms of height of bone, bone resorption, implant success rate and the effects of radiotherapy. The increase in vertical bone with vertical distraction, double-barrel flap and iliac crest was 12.5 ± 0.78 mm, 18.5 ± 0.5 mm, and 17.75 ± 0.6 mm, (p < 0.001). The perimplant bone resorption was 2.31 ± 0.12 mm, 1.23 ± 0.09 mm and 1.43 ± 0.042 mm (p < 0.001), respectively. There were significant differences in vertical bone reconstruction and bone resorption between double-barrel flap and vertical distraction and between iliac crest and vertical distraction (p < 0.001). The study did not show significant differences in implant failure (p = 0.346). Radiotherapy did not affect vertical bone reconstruction (p = 0.125) or bone resorption (p = 0.237) but it showed higher implant failure in radiated patients (p = 0.015). The double-barrel flap and iliac crest graft showed better stability in the height of bone and less bone resorption and higher implant success rates compared with vertical distraction. Radiation therapy did not affect the vertical bone reconstruction but resulted in a higher implant failure.

Tratamiento Ortopédico de las Fracturas de Cóndilo Mandibular A Propósito de Tres Casos / Orthopedic Treatment for Mandibular Condyle Fracture: A Three Case Series

RESUMEN: Las fracturas de cóndilo mandibular son frecuentes en el trauma maxilofacial. Pueden tratarse ortopédicamente o en forma quirúrgica, dependiendo principalmente de las características morfológicas y funcionales del caso, y también de la experiencia del cirujano y los recursos disponibles. En los últimos años se ha establecido una corriente proclive al tratamiento quirúrgico, basada en la rápida recuperación del enfermo y la disminución de las secuelas funcionales y estéticas. Sin embargo, el tratamiento ortopédico bien indicado y ejecutado, puede ser una buena alternativa de tratamiento y que debe ser considerada dentro de las propuestas terapéuticas. El Objetivo de este estudio, es presentar una serie de tres casos de pacientes afectados por fracturas de cóndilo mandibular, tratados en forma ortopédica, en el Hospital El Carmen Dr. Luis Valentín Ferrada, Santiago - Chile. Además, se presentará una revisión de las dos tendencias de tratamiento con énfasis en las indicaciones y protocolo adecuado de tratamiento ortopédico.

ABSTRACT: The Mandible condyle fracture, are common in maxillofacial trauma. They can be treated orthopedically or surgically, depending on the characteristics of the case, the available means and the experience of the surgeon. In recent years, a trend has been established that is prone to surgical treatment, based on the patient's rapid recovery and the reduction of aesthetic and functional sequelae. However, orthopedic treatment can be an excellent treatment alternative. This is why today the treatment of mandibular condyle fractures has become a controversy in the specialty. The objective of this report is to present a series of three cases of patients with mandibular condylar fractures, treated orthopedically, at the Carmen Clinical Hospital, Santiago - Chile. In addition with a brief review of the two treatment trends will be presented with emphasis on the indications and appropriate protocol of orthopedic treatment.