Fratura complexa de teto de órbita associada disjunção traumática do complexo zigomático / Complex Orbit Roof Fracture Associated with Traumatic Disjunction of the Zygomatic Complex / Fractura Compleja del Techo de la Órbita Asociada a Disyunción Traumática del Complejo Cigomático

Objetivo: As fraturas do complexo zigomático-maxilar (CZM) constituem as principais fraturas do terço médio da face. O diagnóstico é complexo, por envolver uma área alternente sensorial e nobre da face. Portanto o tratamento não visa apenas devolver os contornos ósseos, mas também preservar as funções oculares. No presente caso paciente apresentou severo trauma facial associado a TCE com afundamento do frontal e teto de órbita. Relato de caso: Paciente do sexo masculino, 33 anos, vítima de queda da própria altura. No exame físico notou-se FCC extenso em região frontal, se estendendo para a região supra-orbital esquerda, blefaroedema periorbital esquerdo, com oclusão palpebral e distopia ocular. Escoriações em face e afundamento em região fronto parietal esquerda e perda de consciência. O diagnóstico apontou para fratura do complexo zigomático-maxilar associada a afundamento do osso frontal. Paciente submetido à osteossíntese das fraturas com por meio da ferida e complementado com acesso subciliar e caldwel luc. Foi alcançada boa reabilitação estética e funcional. Conclusão: Portanto, a redução aberta com fixação funcional estável com placas e parafusos segue sendo o padrão ouro para o tratamento de fraturas complexas do CZM. Sendo imperativo uma adequada redução e o reestabelecimento do continente orbitário... (AU)

Objective: Fractures of the zygomatic-maxillary complex are the main fractures of the middle third of the face. The diagnosis is complex, as it involves an alternating sensory and noble area of the face. Therefore, the treatment is not only aimed at restoring bone contours but also preserving ocular functions. In the present case, the patient presented severe facial trauma associated with TBI with frontal and orbital sinking. Case Report: Male patient, 33 years old, victim of a fall from standing height. Physical examination revealed extensive CCF in the frontal region, extending to the left supraorbital region, left periorbital blepharoedema, with eyelid occlusion and ocular dystopia. Excoriations on the face and sinking in the left fronto-parietal region and loss of consciousness. The diagnosis pointed to fracture of the zygomatic-maxillary complex associated with frontal bone sinking. Patient undergoing osteosynthesis of fractures through the wound and complemented with subciliary access and caldwell luc. Good aesthetic and functional rehabilitation were achieved. Conclusion: Therefore, open reduction with stable functional fixation with plates and screws remains the gold standard for the treatment of complex ZMC fractures. An adequate reduction and reestablishment of the orbiting continent is imperative... (AU)

Objetivo: Las fracturas del complejo cigomático maxilar son las principales fracturas del tercio medio de la cara. El diagnóstico es complejo, ya que involucra una zona sensorial y noble alternada de la cara. Por lo tanto, el tratamiento no solo está dirigido a restaurar los contornos óseos sino también a preservar las funciones oculares. En el presente caso, el paciente presentó trauma facial severo asociado a TCE con hundimiento frontal y orbitario. Caso Clínico: Paciente masculino, 33 años, víctima de caída desde altura de pie. A la exploración física destacaba FCC extensa en región frontal, con extensión a región supraorbitaria izquierda, blefaroedema periorbitario izquierdo, con oclusión palpebral y distopía ocular. Excoriaciones en la cara y hundimiento en la región fronto-parietal izquierda y pérdida del conocimiento. El diagnóstico apuntó a fractura del complejo cigomático-maxilar asociada a hundimiento del hueso frontal. Paciente con osteosíntesis de fractura a través de herida y complemento acceso subciliar y calwell luc. Se logró una buena rehabilitación estética y funcional. Conclusión: Por lo tanto, la reducción abierta con fijación funcional estable con placas y tornillos sigue siendo el estándar de oro para el tratamiento de fracturas CCM complejas. Es imperativo una adecuada reducción y restablecimiento del continente en órbita... (AU)

Estudo clínico comparando duas técnicas de expansão ortocirúrgica da maxila: avaliação clínica e tomográfica / Clinical study comparing two techniques of surgically assisted rapid maxillary expansion: clinical and tomographic evaluation

O objetivo deste estudo foi comparar duas técnicas de expansão ortocirúrgica da maxila, a osteotomia convencional em 2 segmentos, entre os incisivos centrais superiores, versus a osteotomia em 3 segmentos entre os incisivos laterais e os caninos superiores bilateralmente. Um estudo prospectivo foi realizado com 19 pacientes. Foram divididos em dois grupos: osteotomia convencional em 2 segmentos (dez pacientes) e osteotomia em 3 segmentos (nove pacientes). Na metodologia do presente trabalho foram analizadas medidas dentárias e esqueléticas das imagens de tomografia computadorizada de feixe cônico, pré e pós-operatória. Foi realizada a sondagem periodontal pré e pós-operatória. A percepção estética dos pacientes foi avaliada em uma escala analógica visual colorida. Além disso o tempo decorrido durante a cirurgia foi medido com um cronômetro regular. A homocedasticidade foi confirmada pelo teste de Levene e o teste t das amostras independentes foi utilizado para comparar as médias. No presente estudo a expansão ortocirúrgica da maxila em três segmentos resultou em uma maior expansão transversa, menor inclinação dos dentes molares e menor comprometimento estético. A cirurgia levou mais tempo do que a expansão convencional em 2 segmentos, provavelmente devido à etapas extras e à curva de aprendizado do cirurgião (AU)

The purpose of this study was to compare the two surgically assisted rapid maxillary expansion techniques, the conventional 2-segment osteotomy between maxillary central incisors versus the 3-segment osteotomy between maxillary lateral incisors and canines bilaterally. A prospective study was conducted with 19 patients. they were divided into two groups: conventional 2-segment osteotomy (ten patients) and 3-segment osteotomy (nine patients). Dental and skeletal measurements of the preoperative and postoperative cone beam computed tomography images were analyzed in the present study. Pre and post-operative periodontal probing was performed, patients` cosmetic perception was evaluated in a colored visual analogue scale, and time elapsed during surgery was measured with a regular chronometer. Homoscedaticity was confirmed by the Levene`s test, and independent samples t-test was utilized to compare means. Three segment surgically assisted rapid maxillary expansion in the current study resulted in greater transverse expansion, less molar inclination and less aesthetic compromise. Surgery took longer than conventional 2 segment SARME probably due to extra steps and surgeon's learning curve (AU)

O esportista e a prevalência de trauma bucomaxilofacial: conhecimento e uso de protetor bucal, hábitos e respiração na prática esportiva / The athlete and the prevalence of maxillofacial trauma: knowledge and use of mouth guard, habits and breathing in sports practice

O trauma buco maxilo facial (TBMF) relacionado à prática esportiva tem aumentado nos últimos anos, portanto é fundamental investigar os esportes de maior ocorrência, a saúde bucal dos atletas e a adoção de medidas preventivas. O objetivo neste estudo foi verificar a prevalência de trauma buco-maxilo-facial (BMF) em atletas; a relação com a modalidade esportiva praticada, bem como conhecimento e uso de protetores bucais, hábitos de higiene bucal, hábitos sociais e de hidratação. Trata-se de um estudo transversal, descritivo, envolvendo 647 atletas praticantes de diferentes esportes em um município do Brasil. Os participantes responderam a um questionário que abordava como desfecho primário a ocorrência de trauma na região da cabeça e pescoço durante atividades esportivas e o conhecimento e uso de protetores bucais. As seguintes variáveis também foram investigadas: esporte praticado, região afetada, escovação, uso do fio dental, consumo de refrigerantes, bebidas alcoólicas, tabagismo, hidratação e a respiração durante a prática esportiva. Do total, 148 atletas (22,87%) sofreram TBMF e os esportes de maior ocorrência foram o basquetebol e o futebol. Houve associação significativa entre ocorrência de TBMF e desconhecimento sobre protetores bucais (p=0,0042) e modalidade esportiva (p<0,0001). A boca foi o local mais acometido (30,40%), a cotovelada foi a principal causa (32,54%). O protetor bucal era conhecido por 538 atletas (83,15%), no entanto, apenas 169 (26,12%) utilizavam, sendo 13 (7,69%) deles personalizados. Verificou-se que 313 atletas (48,53%) respiravam pela boca durante a prática esportiva, 381 (58,89%) não ingeriam refrigerantes, 618 (95,52%) não fumavam e 98 (15,15%) consumiam bebidas alcoólicas ao menos duas vezes por semana. A maioria dos atletas (n=554; 85,63%) ingeria apenas água, enquanto 138 (21,33%) consumiam energéticos durante o exercício. O fio dental não era usado por 212 (32,77%) atletas e 606 (93,67%) escovavam os dentes 2 a 3 vezes ao dia. A maioria dos atletas conhecia os protetores bucais, no entanto, poucos faziam uso. Grande parte dos atletas apresentava respiração bucal durante a prática esportiva e embora todos realizassem a escovação dentária, uma parcela considerável não fazia uso de fio dental. O consumo de refrigerante, bebidas alcoólicas e cigarros foi baixo(AU)

Buccomaxillofacial trauma (TBMF) related to sports practice has increased in recent years, so it is essential to investigate the sports with the highest occurrence of TBMF, the oral health of athletes and the adoption of preventive measures. The aim of this study was to verify the prevalence of buccomaxillofacial trauma (BMF) in athletes; the relationship with the sport practiced, as well as knowledge and use of mouthguards, oral hygiene habits, social habits and hydration. This is a cross-sectional, descriptive study, involving 647 athletes practicing different sports in a municipality in Brazil. Participants answered a questionnaire that addressed the occurrence of trauma in the head and neck during sports activities and the knowledge and use of mouthguards as the primary outcome. The following variables were also investigated: sport practiced, affected region, brushing, flossing, consumption of soft drinks, alcoholic beverages, smoking, hydration and breathing during sports practice. Of the total, 148 athletes (22.87%) suffered TBMF and the most frequent sports were basketball and football. There was a significant association between the occurrence of TBMF and lack of knowledge about mouthguards (p=0.0042) and sports (p <0.0001). The mouth was the most affected site (30.40%), the elbow was the main cause (32.54%). The mouthguard was known by 538 athletes (83.15%), however, only 169 (26.12%) used it, 13 (7.69%) of whom were personalized. It was found that 313 athletes (48.53%) breathed through the mouth during sports, 381 (58.89%) did not drink soft drinks, 618 (95.52%) did not smoke and 98 (15.15%) consumed drinks alcoholic at least twice a week. Most athletes (n = 554; 85.63%) drank only water, while 138 (21.33%) consumed energy drinks during exercise. The dental floss was not used by 212 (32.77%) athletes and 606 (93.67%) brushed their teeth 2 to 3 times a day. Most athletes knew about mouthguards, however, few used them. Most of the athletes had mouth breathing during sports practice and although all of them performed tooth brushing, a considerable portion did not use dental floss. The consumption of soft drinks, alcoholic beverages and cigarettes was low(AU)

Prevenção e manejo terapêutico da osteoradionecrose dos maxilares: revisão de literatura / Prevention and therapeutic management of osteoradionecrose of maxilars: literature review

O objetivo desse estudo foi revisar a literatura e enfatizar os aspectos relacionados ao manejo preventivo e terapêutico da osteorradionecrose dos maxilares. Realizou-se revisão bibliográfica não sistemática, descritiva e qualitativa nas plataformas de pesquisa Scielo, Pubmed e Medline, utilizando os descritores, osteoradionecrosis/osteoradionecrose e/ou radiotherapy/radioterapia e/ou jaw/arcada maxilares. Os critérios de inclusão foram: artigos publicados em inglês, espanhol ou português, pesquisas clínicas ou relatos de casos abordando tratamento com radioterapia de cabeça e pescoço e artigos publicados entre 1980-2018, excluindo da pesquisa trabalhos experimentais em animais, artigos publicados na forma de nota técnica ou carta ao editor e artigos baseados em opinião de especialistas. Baseando-se nos critérios de pesquisa, foram selecionados 56 artigos. A radioterapia é eficaz e amplamente utilizada como terapia nas neoplasias malignas de cabeça e pescoço, entretanto produz efeitos colaterais, sendo a osteorradionecrose uma das mais graves. Na maioria dos casos, progride lentamente, tornando-se extensa e dolorosa, suas manifestações tardias compreendem infecção e fratura óssea patológica. Nas últimas décadas, várias opções profiláticas ou terapêuticas foram consideradas no manejo da osteorradionecrose, sendo as mais relatadas: medidas de suporte, antibioticoterapia/antibioticoprofilaxia, pentoxifilina e tocoferol, oxigênio hiperbárico e ressecção cirúrgica com enxerto ósseo. A adequação do meio bucal e cirurgias orais antes de iniciar a radioterapiaainda é o tratamento ideal para prevenir a osteorradionecrose. A antibioticoterapia e/ou antibioticoprofilaxia sistêmica, anti-sépticos locais, pentoxifilina e tocoferol e oxigênio hiperbárico são os tratamentos mais relatados na literatura e que buscam minimizar a incidência da osteorradionecrose após procedimentos cirúrgicos odontológicos em pacientes submetidos a tratamentos de radioterapia(AU)

The purpose of this paper was to review the literature and to emphasize the aspects related to the preventive and therapeutic management of osteorradionecrosis of the jaws. Methods: A nonsystematic, descriptive and qualitative bibliographic review was performed on the Scielo, Pubmed and Medline research platforms, using the descriptors, osteoradionecrosis/osteoradionecrose and/or radiotherapy/radioterapia and/or jaw/maxilares. The inclusion criteria were: articles published in English, Spanish or Portuguese, clinical research or reports of cases approaching of treatment with head and neck radiotherapy and articles published between 1980- 2018, excluding from the research experimental study on animals, articles published in the form of technical note or letter to the editor and articles based on expert opinion. Results: Based on the search criteria, 56 articles were selected. Radiotherapy is effective and widely used as a therapy for malignant head and neck neoplasias, however it produces side effects, being osteoradionecrosis the most severe one. In most cases, it progresses slowly, becoming extensive and painful; its late manifestations comprise infection and pathological bone fracture. In the last decades, several prophylactic or therapeutic options have been considered in the management of osteoradionecrosis, being reported: supportive measures, antibiotic therapy/prophylaxis, pentoxifylline, tocopherol, hyperbaric oxygen and surgical resection with bone graft. Conclusion: The suitability of the oral cavity and oral surgery before starting the radiation therapy is still an ideal treatment to prevent osteoradionecrosis. Antibiotic therapy/prophylaxis, local antiseptics, pentoxifylline, tocopherol and hyperbaric oxygen are the most commonly reported treatments in the literature and seek to minimize the incidence of osteoradionecrosis after dental surgical procedures in patients undergoing radiation therapy(AU)

Dolor crónico del maxilar. presentación de un caso / Chronic pain of the maxilla. presentation of a case

Se presentó el caso de una paciente de 31 años de edad atendida en el Departamento de Patología bucal de la Universidad de San Gregorio de Portoviejo, Ecuador, con historia de dolor de más de dos años de duración en el maxilar derecho luego de una extracción dentaria. Se abordaron aspectos de la semiotecnia diagnóstica y el tratamiento. Se realizó una revisión actualizada de la literatura científica sobre el tema(AU)

It was presented a case of 31-year-old female patient admitted at the Department of Oral Pathology at the University of San Gregorio of Portoviejo, Ecuador, with a history of pain of more than two years in the right maxilla after a tooth extraction. Aspects of diagnostic, semiotic and treatment are exposed. An updated review of the scientific literature on the subject is made

Firearm Projectile in the Maxillary Tuberosity Located by Adjunctive Examination of Wide-Field Optical Fluorescence.

OBJECTIVE: Demonstrate the use of wide-field optical fluorescence as an adjunctive examination in a clinical routine to oral diagnosis. BACKGROUND DATA: Use of wide-field optical fluorescence in the oral cavity has been restricted to topics related to the detection and diagnosis of oral cancer. MATERIALS AND METHODS: In a regular medical appointment, a 58-year-old female patient, without any complaint or oral symptom, underwent the complementary examination by wide-field optical fluorescence. A device with high-power light-emitting diode emitting light centered at a wavelength of (400 ± 10) nm and maximum irradiance of (0.040 ± 0.008) W/cm2 was used for fluorescence visualization. RESULTS: We report the location of a firearm projectile, intraosseous, in the maxillary tuberosity using wide-field optical fluorescence. CONCLUSIONS: It is evidenced that wide-field optical fluorescence, within a clinical routine, can provide relevant images and data, with an immediate result, without the use of ionizing radiation, enabling an efficient oral diagnosis.

Dolor crónico del maxilar. presentación de un caso / Chronic pain of the maxilla. presentation of a case

Se presentó el caso de una paciente de 31 años de edad atendida en el Departamento de Patología bucal de la Universidad de San Gregorio de Portoviejo, Ecuador, con historia de dolor de más de dos años de duración en el maxilar derecho luego de una extracción dentaria. Se abordaron aspectos de la semiotecnia diagnóstica y el tratamiento. Se realizó una revisión actualizada de la literatura científica sobre el tema(AU)

It was presented a case of 31-year-old female patient admitted at the Department of Oral Pathology at the University of San Gregorio of Portoviejo, Ecuador, with a history of pain of more than two years in the right maxilla after a tooth extraction. Aspects of diagnostic, semiotic and treatment are exposed. An updated review of the scientific literature on the subject is made(AU)

Management of an uncomplicated crown fracture by reattaching the fractured fragment-Case report.

Coronal fractures of the anterior teeth are common sequelae of traumatic dental injuries. Reattachment of fractured tooth fragments using dental adhesive techniques offers some advantages, including restoration of the function, esthetics, shape, texture, and brightness of the surface. The present report describes a clinical case of reattachment with a 4-year clinical and radiographic follow up in a permanent maxillary central incisor with an uncomplicated crown fracture. Fragment reattachment is a conservative procedure, preserving esthetics and functionality, and it can provide an immediate positive emotional response from the patient.

Removable Partial Denture After Gunshot Injury: Five Year Follow-Up.

The aim of this study was to report a patient of rehabilitation with removable partial denture retained by implants in-patient who suffered injury after firearm shooting. A 19-year-old man presented to the hospital of the Val Paraíso city after being hit by a bullet in the right on the face, affecting the teeth 12 to 16. The surgery to remove the shards of teeth, and bullet was performed. Surgical team opted for installation of implants without bone grafts; however, due to extensive loss of alveolar bone, only 3 tilted implants (2 Ø3.75 × 8.5 mm and 1 Ø3.75 × 10 mm) were installed. After recovery, the patient was referred to the Araçatuba Dental School-UNESP for the rehabilitation on the affected region. The difficulty of rehabilitation with conventional fixed prostheses was verified during the prosthetic phase. This way, it was opted for rehabilitation with removable partial dentures associated with dental implant. Two attachment system ERA (ERA, Sterngold) were positioned in the bar to make the removable partial denture. After 5 years of follow-up, the authors can conclude that the use of removable partial denture retained by implants is effective for functional and aesthetic rehabilitation, favoring socialization and self-esteem of the patient.

Tratamiento de la mordida cruzada anterior con plano inclinado anterior: efecto sobre los arcos dentales / Tratamiento de la mordida cruzada anterior con plano inclinado anterior: efecto sobre los arcos dentales / Treatment of anterior crossbite with lower inclined bite plane: effect on the dental arches

Objetivo: Evaluar los cambios dimensionales de los arcos dentales primarios tratados con plano inclinado anterior como método de corrección de la mordida cruzada anterior. Métodos: Se trataron 10 pacientes con edades entre 3 y 5 años afectados con mordida cruzada anterior completa, se colocó un plano inclinado anterior elaborado en acrílico, que estuvo en posición en promedio 8.5 semanas. Se obtuvieron modelos de estudio en 3 momentos T0: antes del tratamiento; T1: 6 meses después de iniciado el tratamiento, y T2: al final del primer año de tratamiento y se evaluaron los cambios en las dimensiones de los arcos dentales. Resultados: En el 100% de los pacientes se corrigió la mordida cruzada anterior, se encontraron diferencias estadísticamente significativas para las variables evaluadas con la terapéutica empleada. Conclusiones: El plano inclinado anterior produjo cambios dentales evidentes en un periodo corto de tiempo, sin recidivas y mejorando las dimensiones de los arcos dentales, especialmente el arco superior.

Objetivo: Avaliar as alterações dimensionais dos arcadas dentárias primárias tratados com plano inclinado como método de correção da mordida cruzada anterior. Métodos: 10 pacientes foram tratados com idades entre 3 e 5 sofrimento com mordida cruzada anterior completa, um plano inclinado em acrílico, que estava em posição de, em média, 8,5 semanas foi colocado. Modelos de estudo foram obtidos em 3 vezes T0: antes do tratamento; T1: 6 meses após o início do tratamento, e T2: o final do primeiro ano de tratamento e avaliadas alterações nas dimensões das arcadas dentárias. Resultados: Em 100% dos pacientes a mordida cruzada anterior foi corrigida, foram encontradas diferenças estatisticamente significativas para as variáveis avaliadas com o emprego terapêutico. Conclusões: O plano inclinado gerou alterações dentárias evidentes em pouco tempo, sem recaídas e melhorando as dimensões dos arcos dentários, principalmente da arcada superior.

Objective: To evaluate the dimensional changes of the primary dental arches treated with lower inclined bite plane as a method of correction of the anterior crossbite. Methods: Ten patients aged 3 to 5 years with complete anterior crossbite were treated with a lower inclined bite plane elaborated in acrylic. The average time of the plane position was 8.5 weeks. Dental casts were obtained in 3 moments T0: before treatment; T1: 6 months after starting treatment, and T2: at the end of the first year of treatment and changes in dimensions of dental arches were evaluated. Results: In 100% of patients the anterior crossbite were corrected, statistically significant differences for the variables evaluated with the therapeutic employed were found. Conclusions: The lower inclined bite plane generated evident dental changes in a short time, without relapses and improving the dimensions of the dental arches, especially the upper arch.

Lessons Learned from Delayed Versus Immediate Microsurgical Reconstruction of Complex Maxillectomy and Midfacial Defects: Experience in a Tertiary Center in Mexico.

Microsurgical reconstruction of complex midfacial and maxillectomy defects is among the most challenging procedures in plastic surgery, and it often requires composite flaps to improve functional and aesthetic results. Various factors have been identified as having influence in the outcome of microsurgical reconstruction. In this article, the authors present their experience with immediate and delayed reconstruction of complex maxillectomy defects in a tertiary center in Mexico. The authors present a total of 37 patients with microsurgical reconstruction of a complex maxillectomy defect; 13 patients had immediate and 24 had delayed reconstructions. The authors recommend doing immediate reconstruction when feasible.

Distribution of traumatic injuries after the installation of complete dentures in adult patients

Aim Describe the location of traumatic lesions of the oral mucosa that develop after the installation of complete dentures, as well as to quantify the number of post-operative controls that are required. A descriptive study was conducted by examining 84 patients who attended the dental center of Universidad de Los Andes, San Bernardo, during the period from July 2012 to July 2013. A sample of 120 edentulous patients was obtained. After the fabrication and installation of the complete dentures, at least 3 post-operative controls were performed and the location of oral lesions was recorded. Documentation of the association between the patient's clinical variables and the appearance of oral lesions during the first 3 controls was performed using a logistic regression. Results For maxillary dentures, 5 post-operative visits were made and 6 controls for mandible dentures. In the upper jaw the anatomical areas of higher incidence of traumatic injuries were: canine fossa (23.9%), average bridle (23.1%), and distobuccal sulcus (20.1%). In the lower jaw, the highest number of lesions were recorded on the anterior lingual flank (16.5%), anterior and posterior lingual flank (13.4%), and distobuccal sulcus (12.8%). A significant association was observed between subjects who reported consumption of cholesterol-lowering medications and the development of traumatic lesions of the oral mucosa (OR: 0.25 and 95% CI: 0.055-0.939). The installation of complete dentures does not determine that the treatment has ended. Post-operative controls are needed to assess areas of erythema and ulceration.

Objetivo Describir la ubicación y frecuencia de las lesiones traumáticas de la mucosa oral que se generan después de la instalación de las prótesis dentales completas, y cuantificar el número de controles postoperatorios necesarios. Se realizó un estudio descriptivo, examinando a 84 pacientes que asistieron al centro dental de la Universidad de Los Andes, durante el período comprendido entre de julio de 2012 y julio del de 2013. Se obtuvo una muestra de 120 pacientes edéntulos. Después de la fabricación e instalación de las dentaduras completas se realizaron por lo menos 3 controles postoperatorios y la localización de las lesiones orales fue registrada. La documentación de la asociación entre las variables clínicas de los pacientes y la aparición de lesiones orales durante los 3 primeros controles fue realizado por medio de una regresión logística. Resultados Para prótesis maxilar 5 visitas de controles postoperatorios fueron realizados y 6 para mandibulares. En el maxilar superior las zonas de mayor incidencia de lesiones traumáticas fueron: fosa canina (23,9%), flanco medio (23,1%) y distovestibular del surco (20,1%). En la mandíbula se registraron mayor frecuencia de las lesiones en el flanco lingual anterior (16,5%), anterior y posterior (13,4%) y distovestibular del surco (12,8%). Una asociación significativa se observó entre los sujetos que reportaron consumo de medicamentos reductores del colesterol y el desarrollo de las lesiones traumáticas de la mucosa oral (o: 0,25 e IC: 0,055-0,939). La instalación de las prótesis dentales completas no determina que el tratamiento haya terminado. Los controles postoperatorios son necesarios para evaluar las áreas de eritema y ulceración.

Aspectos epidemiológicos de lesões bucomaxilofaciais registradas em laudos periciais / Epidemiological of maxillofacial injury recorded in expert reports

Os traumas acidentais e intencionais, principalmente as agressões, são preocupações da sociedade contemporânea, não somente pelo dano causado e suas possíveis sequelas, mas também pelo Impacto no serviço de saúde. As regiões mais acometidas são a cabeça e o pescoço. As lesões bucomaxilofaciais têm grande importância, tanto pela incidência, como pelo fato de que, se não forem reparadas de maneira adequada podem evoluir e ter graves sequelas estéticas e funcionais. Objetivou-se neste estudo realizar um levantamento dos aspectos epidemiológicos das lesões corporais que atingiram o complexo bucomaxilofacial, registradas em laudos periciais. Realizou-se i um estudo analítico-descritivo, no Instituto Médico Legal de um município de médio porte do Estado de São Paulo, que atende 30 cidades da região. Foram analisados 14.218 prontuários, referentes aos atendimentos do período de 2011 a 2013 e incluídos na pesquisa 2.196, os quais apresentaram lesões bucomaxilofaciais. Foram verificadas as características sociodemográficas do periciado (gênero, idade e etnia); características da lesão (localização e tipo); motivo da ocorrência (agressão, acidentes de trânsito e acidentes em geral); e observações adicionais contidas na conclusão do laudo pericial. Os dados foram analisados empregando-se teste de qui-quadrado ou por meio de teste de qui-quadrado da razão de verossimilhança (G2), sendo definido o uso do coeficiente V de Cramer para quantificação da associação. Observou-se que a prevalência das lesões (15,45%) foi relevante e proporcionalmente mais elevada nas agressões (75,95%), ocorrendo principalmente em homens (75,83%), adultos (75,82%) e leucodermas (75,86%). Os acidentes de trânsito demonstraram crescente evolução de casos com lesões graves. Houve associação significativa quantificada pelo coeficiente V de Cramer entre motivo da ocorrência e idade (p<0,01), e gênero (p<0,0001). Os casos periciados tiveram prevalência do agente etiológico contundente (87,15%); e foram classificados como leve (84,60%). O perfil epidemiológico das lesões bucomaxilofaciais registradas em laudos periciais revelou que as agressões e os acidentes de trânsito foram os principais causadores. Homens adultos foram envolvidos com maior frequência nos eventos e lesões leves e de tecidos moles foram as mais prevalentes. As ocorrências das lesões provenientes de agressões e acidentes de transito estiveram associadas ao gênero, ao tipo de agente etiológico, ao dano e à resultante. A gravidade das lesões esteve associada ao tipo de agente etiológico(AU)

Accidental and intentional traumas, especially aggression, are the contemporar's society's concerns, not only by the damage caused and its possible consequences, but also for the impact on Health's Service. The most affected are head and neck. Maxillofacial injuries are of great importance, both for its occurrence and for the fact that if not properly repaired it can come to evolve and result in serius esthetic and functional sequelae. This study aimed to perform a survey of Epidemiological aspects of body injuries which reached the maxillofacial complex, recorded in expert reports. It was performed an analytical- descriptive study at the Legal Medical Institute located in an average size country in the state of São Paulo, which serves 30 cities in the region. It had been analyzed 14.218 records; relating calls from 2011 to 2013, and 2196 that showed maxillofacial injuries were included in the survey. Individual's sociodemographic characteristics (such as gender, age and ethnicity); lesion's characteristics (location and type); reason for the occurrence (assault, traffic acidentes and acidentes in general); and additional notes along the expert's report conclusion were verified. Data were analyzed using the chi- square test or chi-square likelihood ratio test medium (G2), being defined the use of the coefficient V Cramer paragraph for the association's quantification. It was noticed that the predominance of trauma was relevant and proportionally higher in agression (75.95%), occuring mostly in men (75.83%); Adults (75.82%) and Caucasian 1 (75.86%). The Traffic Accidents showed increasing evolution in cases presenting critical, injuries. There was a significant association quantified by V Cramer coefficient between j reason for the occurrence and age (p <0.01), and between reason for the occurrence and gender (p <0.0001). The examined cases presented prevalence of blunt etiologic agent (87,15%); and they were classified as mild (84.60%). Epidemiological profile of maxillofacial injuries recorded in expert reports showed that aggression and traffic accidents were the main causes. Adult men were involved more frequently in events and minor injuries and soft tissue were the most prevalent. Occurrences of injuries from aggressions and traffic accidents were associated with gender, type of etiologic agent, the damage and the resultanting. The severity of injuries was associated with the type of etiologic agent(AU)

Long-term clinical and radiographic follow up of subluxated and intruded maxillary primary anterior teeth.

AIMS: This study aimed to determine the kinds of sequelae resulting from intrusive luxation and subluxative injuries in primary anterior teeth as well as the timing of such sequelae. MATERIALS AND METHODS: In this longitudinal retrospective study, data were collected from dental records and radiographs of patients with traumatic dental injury (TDI) treated at the Centre for the Study and Treatment of Dental Trauma in Primary Dentition (Pelotas, RS, Brazil). Fifty-two children, with seventy intruded teeth, and 76 children, with 99 subluxated teeth, met the inclusion criteria. Sequelae, such as crown discoloration, fistula, pulp canal obliteration (PCO), inflammatory root resorption (IRR), and internal root resorption, were investigated. The data on the sequelae were distributed into eight follow-up periods: 0-30 days, 31-90 days, 91-180 days, 181-365 days, 1-2 years, 2-3 years, 3-4 years, and >4 years. RESULTS: The sample comprised 99 subluxation cases and 70 intruded teeth. Crown discoloration was the most prevalent sequelae. Among the subluxated teeth, <50% of IRR, fistula, crown discoloration, and PCO occurred within 180 days after TDI; however, the sequelae were also diagnosed after longer periods. Majority of sequelae of intrusion were diagnosed within the 181-365 days and 1-2 years periods but were also observed after more than 4 years of follow up. CONCLUSIONS: For both intrusion and subluxation, trauma sequelae were diagnosed even after the 3-4 years of follow-up.

Treatment of class II malocclusion with open bite and absence of central maxillary incisor lost by trauma aided by use of orthodontic mini-implants.

The aim of this article is to report the clinical case of non-surgical treatment of a Class II malocclusion with anterior open bite, associated with absence of a maxillary central incisor avulsed due to trauma. Treatment proceeded with the use of orthodontic mini-implants as an anchorage device for intrusion of the maxillary molars and for mesial movement of the lateral incisor to replace the central incisor. Treatment resulted in good occlusion, with anterior and lateral guides, enhancement of the facial profile, and good dental esthetic appearance without the need for prosthetic treatment. The treatment outcome was satisfactory but needs long-term or permanent retention.

A method for the geometric standardization of intraoral radiographs for long-term follow up of replanted teeth: a case report.

The interpretation of the set of radiographs taken during the follow-up period after tooth replantation might pose several difficulties, especially the inability to adequately reproduce the projection geometry of the exposures. This article describes a method for the geometric standardization of intraoral radiographs using a custom-made apparatus comprising a film-holder attached to an occlusal splint for the long-term follow up of dentoalveolar trauma. The method was applied in a patient who suffered an avulsion of the maxillary central incisors and had the teeth replanted after 4 h in saline storage. Endodontic treatment started 7 days after the trauma with changes of a calcium hydroxide intracanal medication every 15 days in the first 2 months and thereafter at 30-day intervals for 8 months. Root canal filling was carried out after this period. The radiographic exposures taken at the follow-up visits were standardized to identify the possible alterations during the repair process, such as root resorptions. A maxillary arch impression was made with alginate, and the model was cast in stone for fabrication of an acetate occlusal splint. The custom-made apparatus used for standardization of the radiographic exposures was fabricated by fixing a Rinn X-C-P film-holder and a 5-mm-long piece of 0.7-mm orthodontic wire to the occlusal splint with autopolymerized acrylic resin. Radiographs were taken at 4-month intervals, starting 10 months after replantation up to 76 months. The images were digitized and analysed using the Digora system. The length of the central incisors was determined to verify the reproduction of the projection geometry of the exposures and the orthodontic wire served to assess accuracy during length estimations in the radiographs. The method described in this article for geometric standardization of intraoral radiographs provided a consistent reproduction of the geometric exposure parameters, being indicated for use in the radiographic follow up of cases of dentoalveolar trauma.

Granuloma piogénico en la edad pediátrica: reporte de un caso / Pyogenic granuloma in children: a case report

Granuloma Piogénico (GP) es una lesión reactiva producida por un crecimiento excesivo del tejido conectivo, es frecuente en la mucosa bucal muy especialmente en el tejido gingival. Se trata de una patología de crecimiento rápido, sangrante y se asocia a la presencia de irritantes locales, microtraumatismos, entre otros factores. Tiene importante predilección por el género femenino entre la segunda y quinta década de la vida. Lesiones como malformaciones vasculares, lesión periférica de células gigantes y sarcoma de Kaposi son sus principales diagnósticos diferenciales y el tratamiento de elección es la escisión quirúrgica. A continuación se presenta un caso clínico poco común debido a las características clínicas de la lesión y la edad del paciente, pues se trata de un infante del género masculino de 5 años de edad, que acudió a la Facultad de Odontología de la UCV, referido por su odontólogo general, debido a la presencia de una lesión tumoral en el sector posterior derecho maxilar, adyacente a la cara distal del 55 de 2.5cm de tamaño. Se realizó la escisión quirúrgica de la lesión posterior a la evaluación de los exámenes preoperatorios y fue analizada histopatológicamente, donde se confirmó el diagnóstico inicial de GP

Pyogenic Granuloma (PG), is a reactive lesion caused by an excessive connective tissue growth and it frequently appears on oral mucosa, especially the gingiva. The PG present fast growth, bleeding propensity and it is associated, among other factors, to local irritation and minor trauma. It has predilection for female patients between second and fifth decade of life. The main differential diagnosis can be made with lesions such as: vascular malformations, peripheral giant-cell lesion and Kaposi's sarcoma. Surgical excision is the treatment of choice. This article presents a case report of an uncommon lesion regarding its rare clinical features and age of the patient. A 5 year old male patient who attended the Facultad de Odontología of Universidad Central de Venezuela, referred by his dental practitioner, presented a tumor-like lesion. The lesion was 2.5 cm in size and located on posterior right maxilla next to distal surface of 55. Surgical excision was performed after full laboratory test evaluation. The histopathology findings confirmed initial diagnose of PG

Fibromixoma odontogénico en el maxilar superior: reporte de un caso clínico y revisión de la literatura / Fibromixoma odontogenic in the maxilla: report of a case and literture review

El Fibromixoma Odontogénico es una variante del Mixoma Odontogénico. Se describe como una lesión intraósea agresiva derivada del tejido conjuntivo embrionario asociada con la odontogénesis1 constituida principalmente por grandes cantidades de tejido fibroso celular maduro. Su origen es controvertido, aparece en el esqueleto facial, afectando con mayor frecuencia a la mandíbula2. A continuación se presenta el caso clínico de un paciente de sexo femenino de 36 años de edad que presentó un aumento de volumen a nivel del ápice de diente 1.6 ,en la que se realizó un curetaje logrando la completa resección de la lesión, el resultado del informe patológico da el diagnóstico de Fibromixoma de origen Odontogénico

The Odontogenic Fibromyxoma is a variant of the Odontogenic Myxoma. It is described as an agressive intraoseous lesion that derives from the embrionary connective tissue associated with the odontogenesis, constituted by great amounts of celular mature fibrous tissue. It has a controverted origin, appears in the facial skeleton affecting more frecuently the mandible. We present a case of a 36 year old female who consulted with an increase of volume in relation to the 1.6 theet where we practiced a curetaje obtaining a complete resection of the lesion, the results of the patologic inform gives the diagnostic of odontogenic fibromyxoma

[Le Fort type I segmentary and nasoorbitalethmoidal fractures. A case report]. / Fractura de Le Fort I segmentaria y nasoorbitoetmoidal. Informe de un caso.

The association of Le Fort fractures and those of the nasoorbito-etmoidal complex represent severe injuries usually associated to traffic accidents or physical violence. The occurrence of such combination of fractures represents a challenge for the maxillofacial surgeon due to the great index of comminuted and displacement fragments. The initial evaluation represents the opportunity to identify and treat possible life-threatening complications such as brain damage or airway compromise; this first evaluation will also allow the establishment of diagnosis and a suitable surgical plan in order to preserve both the aesthetic and functional aspects.

Surgical repositioning of osseointegrated malposed dental implant with segmental osteotomy.

After extensive research, the practice with dental implants has been used on a large scale. With the increase in its indications in various local conditions, more complications have been observed. Among these, one of the most frequent is the installation of the implants in a three-dimensional altered position, making the prosthesis and aesthetics more difficult to achieve. For this reason, techniques such as segmental osteotomy have been developed and adapted to implantology to reestablish the adequate position of these implants with correct aesthetic outcome and function. The present clinical report shows the segmental osteotomy technique in a malposed osseointegrated dental position of the upper central incisor with 1-year follow-up.