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Transmigração é a definição do movimento de caninos permanentes não irrompidos em direção à linha média dos maxilares, ultrapassando-a. Já a transposição dentária é uma anomalia ocasionada pela inversão na posição de dois dentes adjacentes. São duas raras anomalias de desenvolvimento. O prognóstico do tratamento destas anormalidades depende do diagnóstico precoce e do estágio de irrupção dos dentes envolvidos. O presente relato de caso descreve um caso incomum de transposição e transmigração de caninos mandibulares, no mesmo paciente, enfatizando aspectos relevantes para o manejo cirúrgico dessas alterações. A escolha de tratamento foi a exodontia dos caninos mandibulares, permitindo a correção ortodôntica das alterações oclusais e boa condição mastigatória. Após 12 meses de acompanhamento, paciente apresenta-se sem queixas e com adequado alinhamento e nivelamento das arcadas.

Objective The aim of this study was to compare the outcomes of 2 surgical treatment options: one for correction of class II malocclusion skeletal deformity and one for pre-existing temporomandibular joint (TMJ) disorders requiring orthognathic surgery (OS) for correction of dentofacial deformity. Study Design This retrospective study evaluated patients who underwent OS with maxillomandibular advancement (MMA) with or without concomitant TMJ surgery for articular disk repositioning (ADR). Patients were divided into 2 groups: group I (MMA) was treated with OS only (18 patients); and group II (MMA-ADR) was treated with OS and concomitant ADR (19 patients). The sample consisted of 74 TMJs (mean patient age 29.86 years). Results In group I, 38.5% of the disks that were originally in normal position became displaced after OS, and 33.3% of displaced disks with reduction became nonreducing after OS. In group II, 78.9% of disks exhibited normal position in the final evaluation, and 97.3% of patients showed improved disk position after surgery. There was significant symptom improvement in all patients in group II, but no significant improvement in group I. Conclusions OS with ADR appears to produce stable and beneficial results in improving symptoms in patients with displaced disk and TMJ pain.

The conventional or multicystic solid ameloblastoma is the most common type with the majority of cases affecting the posterior region of the mandible and occurring between the third and fourth decades of life. The present study aims to report a case of multicystic ameloblastoma in which treatment by means of curettage was chosen and no evidence of recurrence was noted over 7 years of follow-up. Although the literature indicates aggressive surgical therapy as the best form of treatment for multicystic ameloblastoma, factors such as the clinical, radiographic and histopathological aspects of the lesion, patient age, postoperative morbidity, possibilities for aesthetic and functional changes must be evaluated together during treatment planning. In some cases, as in the report presented, conservative therapies such as aggressive curettage of the lesion can be effective in the long term, with no recurrence of the lesion and providing quality of life to the patient.

Introdução: As soluções anestésicas têm características próprias em relação a propriedades como latência, potência e tempo de ação. Muitos autores demonstraram a superioridade da difusão de soluções de articaína a 4%, embora haja controvérsias na literatura científica sobre essa questão. Objetivo: O objetivo do presente estudo foi comparar a capacidade de induzir a anestesia da mucosa palatina e a eficácia anestésica após o bloqueio do nervo alveolar superior posterior de duas soluções anestésicas: articaína a 4% com epinefrina 1:100.000 e lidocaína a 2% com epinefrina 1:100.000. Mé- todos: Esse experimento original foi um estudo transversal, duplo-cego, randomizado, com dezoito voluntários saudáveis, com idades entre 14 e 26 anos, com indicação de extração de terceiro molar superior impactado. A capacidade de difusão e a eficácia das soluções anestésicas foram verificadas pela Escala de 11 Pontos em Caixa, e o grau de ansiedade foi avaliado pela Escala de Ansiedade Dental de Corah. Resultados: Os resultados mostraram que, em pacientes saudáveis, ambas as soluções anestésicas tiveram a mesma difusão para a mucosa palatina e apresentaram comportamento clínico semelhante. Conclusão: ambas as soluções testadas apresentaram capacidade de difusão e eficácia anestésica semelhantes, mostrando-se igualmente adequadas para uso em cirurgias de extração de terceiros molares superiores impactados.

The minimum number of implants to support fixed complete dentures is still unclear.The purpose of this retrospective clinical study was to evaluate the survival rate of fixed complete dentures supported by 3 immediately loaded implants opposing maxillary complete dentures.A retrospective study of edentulous patients rehabilitated with complete dentures opposing mandibular metal-resin implant-supported fixed complete dentures supported by 3 immediately loaded implants was conducted in a 48-hour protocol. Fifty-one machined and 99 rough-surface implants were evaluated from 2.2 up to 8 years. Implant loss, peri-implant outcomes, and mechanical complications were assessed by considering the influence of age, sex, health status, smoking, excessive alcohol consumption, educational level, and socioeconomic status. The presence of comorbidities in relation to the implant surface or the cantilever lengths was also evaluated.Four machined and 6 rough-surface implants failed, a 6.7% failure rate. The cantilever length varied from 3.3 to 22.9 mm. Mechanical complications were abutment screw loosening (3.0%), prosthetic screw loosening (17%), screw fracture (1%), superstructure detachment and fractures (16%), metal framework fracture (2%), maxillary denture fractures (6%), and mandibular prosthesis loss (4%). Peri-implant mucositis was found in 27% of participants. The cumulative implant and mandibular prosthesis survival rates were 93.3% and 96%, respectively. None of the variables evaluated, including demographic data and health status, were found to influence clinical failures and/or mechanical complications.Mandibular fixed complete dentures supported by 3 implants can be considered a successful treatment with reduced costs compared with those of other fixed options for application in public health.

Snakebite is an important public health problem because of its incidence, morbidity, and mortality. It may be related to climatic factors and rural habits. Snakes of the genus Bothrops are responsible for most snakebites in Brazil. The venom of these snakes has peculiar characteristics, with important proteolytic, coagulant, and hemorrhagic actions, leading to local and systemic alterations. Initial manifestations include local tissue injury, pain, swelling, bleeding, and bullous lesions that can progress to abscesses or tissue necrosis. Systemic manifestations should be carefully evaluated especially for the probability of hemorrhagic events such as epistaxis, gingivorrhagia, hematuria, and hemoptysis. Knowing the clinical manifestations of snakebites, as well as the adequate treatment, is essential. Efficient and rapid diagnosis can minimize victims’ injuries and the probability of death. The present study reports the clinical case of bleeding at a distant site from the initial site of venom inoculation after bite by a Bothrops snake, emphasizing the therapeutic approach and differential diagnosis in these cases. Los accidents de ofidios son un importante problema de salud pública, por su incidencia, morbilidad y mortalidad. Estos accidents pueden estar relacionados con factores climáticos y habitos rurales. La serpiente del género Bothrops es responsible de la maayoría de las mordeduras de serpientes que ocurrieon en Brasil. El veneno de esta serpiente tiene características peculiares, con importentes acciones proteolíticas, coagulantes y hemorrágicas, que provocam cambios locales y sistémicos. Las manifestaciones iniciales incluyen daño tisular local con dolor, edema, sangrado y lesiones ampollosas que pueden progresar a abscesos o necrosis tisular. Sin embargo, las manifestaciones sistémicas deben evaluarse cuidadosamente, especialmente por la probabilidad de eventos hemorrágicos como epistaxis, gingivorragia, hematia y hemoptysis. El conocimiento de las manifestaciones clínicas y un abordaje adecuado en la búsqueda de un diagnóstico rápido y eficiente es fundamental, minimizando así el daño a la víctima y la probabilidad de muerte. Elpresente artículo científico reporta el caso clínico de hemorragia a distancia del sitio de inoculacion inicial del veneno que ocurrío luego de un de un accidente tipo serpiente conla serpiente Bothrops, enfatizzando así el abordaje terapéutico para estos casos además del diagnóstico diferencial en este tipo de ocurrencia. O acidente ofídico é um importante problema de saúde pública, em virtude de sua incidência, morbidade e mortalidade. Tais acidentes podem estar relacionados à fatores climáticos e hábitos rurais. A serpente do gênero Bothrops é a responsável pela maioria dos acidentes ofídicos ocorridos no Brasil. O veneno desta serpente possui características peculiares, com importantes ações proteolítica, coagulante e hemorrágica, levando a alterações locais e sistêmicas. As manifestações iniciais incluem lesão tecidual local com dor, edema, sangramento e lesões bolhosas que podem evoluir para abscessos ou necrose tecidual. Porém, as manifestações sistêmicas devem ser cuidadosamente avaliadas em especial pela probabilidade de eventos hemorrágicos como epistaxe, gengivorragia, hematria e hemoptise. Torna-se imprescindível o conhecimento de manifestações clínicas e abordagem adequada na busca do diagnóstico eficiente e rápido, minimizando assim danos a vítima e a probabilidade de óbito. O presente artigo científico relata o caso clínico de hemorragia a distância do sítio inicial de inoculação da peçonha ocorrido após acidente ofídico com serpente do gênero Bothrops, enfatizando assim a abordagem terapêutica para esses casos além do diagnóstico diferencial neste tipo de ocorrência.

Introducao: As cirurgias ortognaticas sao procedimentos indicados para correcao de deformidades dento esqueleticas. Os sistemas de fixacao das osteotomias permitiram a obtencao de melhores resultados cirurgicos. As placas customizadas representam uma das tecnologias mais recente. Objetivo: Realizar uma revisao sistematica para avaliar a precisao da cirurgia ortognatica com placas de titânio customizadas em relacao ao planejamento virtual. Metodologia: Este trabalho apresentou protocolo registrado na base de dado PROSPERO, e seguiu o guideline PRISMA e recomendacoes Cochrane. Seis bases de dados (Embase, LILACS, PubMed, SciELO, Scopus, Web of Science) foram utilizadas como fonte primaria de busca. E duas bases (OpenThesis e OpenGrey) para capturar parte da “literatura cinzenta”. Foram incluidos estudos clinicos descritivos que realizaram cirurgia ortognatica com o uso de placas de titânio customizadas, sem restricao de ano e idioma. Dos 11.916 estudos identificados, somente sete preencheram os criterios de elegibilidade e foram incluidos. Discussao: A amostra total incluiu 74 pacientes, com 63 cirurgias bimaxilares, e 11 cirurgias unimaxilares. que todos os estudos mostraram precisao aceitavel dentro de parâmetros clinicos previamente estabelecidos. Conclusao: A utilizacao de placas de titânio customizadas em cirurgia ortognatica apresenta alta precisao em relacao ao planejamento virtual.

A assimetria facial pode ser decorrente de inúmeros tipos de doenças, tais como: traumatismos (edema, enfisema, hematomas) e processos infecciosos graves que geram aumentos volumétricos em face de forma rápida e notória. Já o desenvolvimento de cistos e tumores, alterações de desenvolvimento/crescimento tanto de tecidos duros, quanto partes moles, são processos mais lentos e consequentemente percebidos quando há uma alteração significativa. O osteocondroma (OC), uma das lesões intraósseas pode ser definida como uma protusão de cartilagem óssea que surge a partir da superfície mais externa do osso afetado. O objetivo do trabalho é descrever uma metodologia de tratamento complexa, porém estável e satisfatória com boa estabilidade e resultados estéticos-funcionais satisfatórios. A discussão diretamente relacionada com modalidade terapêutica, custo-benefício do tratamento localizado comparado com o tratamento combinado, riscos, benefícios e afins. Os resultados evidenciam imagens que possibilitam a verificação da precisão e aplicabilidade do planejamento virtual na correção de deformidades associadas a expertise de cirurgiões com grande experiência em tratamentos cirúrgicos, finalizando em com um resultado satisfatório para a paciente e equipe.

Ameloblastoma is a benign odontogenic tumor of epithelial origin with slow, asymptomatic, rare growth and is associated with a high rate of recurrence, being responsible for 1% of mandibular tumors. There are several variations of these tumors, with solid / multicystic and unicystic types being the most recurrent. The signs are discrete and rarely noticed by the patient in the early stages. In the imaging examination, it presents itself as a well-delimited radiolucent image, which may be associated with the crown of an unerupted tooth, resorption of adjacent roots and vestibular-lingual medullary expansion. In the literature, the most appropriate treatment for the management of such pathology is still controversial, since there are conservative philosophies such as curettage, marsupialization (decompression) and defending currents of the radical surgical approach through resection with a safety margin. This study aims to report a case of curettage of follicular unicystic ameloblastoma with a single incidence of recurrence and treated again by means of a conservative surgical approach and continuing with a 19-year clinical preservation, without any clinical or imaging signs of recurrence. El ameloblastoma es un tumor odontogénico benigno de origen epitelial de crecimiento lento, asintomático, raro y se asocia a una alta tasa de recidiva, siendo responsable del 1% de los tumores mandibulares. Hay varias variaciones de estos tumores, siendo los tipos sólido / multiquístico y uniquístico los más recurrentes. Los signos son discretos y el paciente rara vez los nota en las primeras etapas. En el examen de imagen se presenta como una imagen radiolúcida bien delimitada, que puede estar asociada a la corona de un diente no erupcionado, reabsorción de raíces adyacentes y expansión medular vestibular-lingual. En la literatura, el tratamiento más adecuado para el manejo de dicha patología sigue siendo controvertido, ya que existen filosofías conservadoras como el curetaje, marsupialización (descompresión) y corrientes de defensa del abordaje quirúrgico radical mediante resección con margen de seguridad. Este estudio tiene como objetivo reportar un caso de legrado de ameloblastoma folicular uniquístico con una sola incidencia de recidiva y tratado nuevamente mediante abordaje quirúrgico conservador y continuando con una preservación clínica de 19 años, sin ningún signo clínico o imagenológico de recurrencia. O ameloblastoma é um tumor odontogênico benigno de origem epitelial com crescimento lento, assintomático, raro e está associado a alto índice de recorrência, sendo responsável por 1% dos tumores mandibulares. Existem várias variações desses tumores, sendo os tipos sólido / multicístico e unicístico os mais recorrentes. Os sinais são discretos e raramente percebidos pelo paciente nos estágios iniciais. No exame de imagem, apresenta-se como uma imagem radiolúcida bem delimitada, que pode estar associada à coroa de um dente não irrompido, reabsorção de raízes adjacentes e expansão medular vestíbulo-lingual. Na literatura, o tratamento mais adequado para o manejo dessa patologia ainda é controverso, visto que existem filosofias conservadoras como a curetagem, a marsupialização (descompressão) e as correntes de defesa da abordagem cirúrgica radical por ressecção com margem de segurança. O objetivo deste trabalho é relatar um caso de curetagem de ameloblastoma folicular unicístico com incidência única de recidiva e tratado novamente por meio de abordagem cirúrgica conservadora e continuando com preservação clínica de 19 anos, sem quaisquer sinais clínicos ou de imagem de recidiva.

A ancoragem sempre foi uma das limitações da ortodontia e em quase toda terapia ortodôntica há necessidade de obtê-la. Com a descoberta da ósteo integração surgiu um novo modelo de ancoragem, a esquelética. Numa ancoragem esquelética extra alveolar o posicionamento mais oblíquo dos miniparafusos pode aumentar os riscos de deformação. O objetivo deste trabalho foi analisar, num estudo in vitro, o desempenho mecânico nos torques de inserção e remoção e observar se o tipo de liga e as angulações de inserção influenciam na utilização destes miniparafusos em posições extra alveolares. Foram utilizados 40 miniparafusos de diâmetro e comprimento semelhantes (2,0x12mm), porém de ligas diferentes (20 de aço e 20 de titânio), todos inseridos por um torquímetro digital em cortical óssea sintética de poliuretano (40PCF). As inserções foram feitas em duas angulações, uma a 30º e outra de 60º para 30º. Após obtenção dos dados, os mesmos foram submetidos à análise estatística de variância, Equações de Estimativas Generalizadas, com grau de confiança de 95% e nível de significância de 5%. Diferenças estatísticas foram observadas nos fatores analisados. Dentre os fatores analisados, tipo de liga e angulação de inserção, e com os dados obtidos podemos concluir que independente da liga, a angulação é um fator essencial no aumento dos torques.

The risk of fracture or strain in mini-screws is higher if diameter, length, type of alloy or insertion angle is selected inappropriately. The aims of this study were to test the structural resistance of two types of orthodontic mini-screws -one made of stainless steel and another of titanium- from an international brand and to evaluate the efficacy of two other titanium miniscrews of Brazilian origin, during an extra-alveolar anchorage procedure. The mini-screws analyzed were: Bomei stainless steel and Bomei titanium / Taiwan, Morelli titanium and Neodent titanium/ Brazil. Experiments were conducted on pig mandibles to simulate the process of extra-alveolar anchorage. Two insertion processes were used: Direct at 30º, and Indirect, starting at 60º and ending at 30º with gradual continuous movement. Strain was evaluated using Optical and Scanning Electron Microscopy. Data were evaluated using Kruskal-Wallis non-parametric statistical analysis and post hoc Tamhane test. Significant statistical differences in strain were observed among the mini-screws used in the extra-alveolar insertions, both for the direct and indirect procedures. In the indirect insertion tests, both stainless steel and titanium mini-screws suffered deformation, showing that angling can be an important factor in mini-screw failure rates. The change in angle during the insertion movement increased deformation rates independently of alloy type, increasing the risk of failure. These results could help orthodontists in choosing mini-screws for extra-alveolar anchorage, which can be performed with direct or indirect insertion. In vivo studies should be conducted to confirm the findings of this study.O risco de fratura ou tensão nos mini-parafusos é maior se o diâmetro, comprimento, tipo de liga ou ângulo de inserção for selecionado de forma inadequada. Os objetivos deste estudo foram testar a resistência estrutural de dois tipos de miniaparafusos ortodônticos –um feito de aço inoxidável e outro de titânio– de uma marca internacional e avaliar a eficácia de dois outros mini-parafusos de titânio de origem brasileira, durante um procedimento de ancoragem extra-alveolar. Os miniaparafusos analisados foram: Bomei aço inoxidável e Bomei titânio / Taiwan, Morelli titânio e Neodent titânio / Brasil. Foram realizadas experiências em mandíbulas de porcos para simular o processo de ancoragem extra-alveolar. Foram utilizados dois processos de inserção (Direta a 30º, e Indireta, começando a 60º e terminando a 30º com movimento gradual contínuo). A deformação foi avaliada utilizando Microscopia Óptica e Microscopia Eletrônica de Varredura. Os dados foram avaliados utilizando análise estatística não paramétrica Kruskal-Wallis e teste post-hoc Tamhane. Diferenças estatísticas significativas na deformação foram observadas entre os miniparafusos utilizados nas inserções extra-alveolares, tanto para os procedimentos diretos como indiretos. Nos testes de inserção indireta, tanto os mini-parafusos de aço inoxidável como os de titânio sofreram deformação, mostrando que a angulação pode ser um fator importante nas taxas de falha dos mini-parafusos. A mudança no ângulo durante o movimento de inserção aumentou as taxas de deformação independentemente do tipo de liga, aumentando o risco de falha. Estes resultados podem ajudar os ortodontistas na escolha de mini-parafusos para ancoragem extra-alveolar, que pode ser realizada com inserção direta ou indireta. Estudos in vivo devem ser conduzidos para confirmar os resultados deste estudo.

Objective: This study analyzed the effect of ionizing radiation on bone microarchitecture and biomechanical properties in the bone tissue surrounding a dental implant. Methodology: Twenty rabbits received three dental morse taper junction implants: one in the left tibia and two in the right tibia. The animals were randomized into two groups: the nonirradiated group (control group) and the irradiated group, which received 30 Gy in a single dose 2 weeks after the implant procedure. Four weeks after the implant procedure, the animals were sacrificed, and the implant/bone specimens were used for each experiment. The specimens (n=10) of the right tibia were examined by microcomputed tomography to measure the cortical volume (CtV, mm3), cortical thickness (CtTh, mm) and porosity (CtPo, %). The other specimens (n=10) were examined by dynamic indentation to measure the elastic modulus (E, GPa) and Vickers hardness (VHN, N/mm2) in the bone. The specimens of the left tibia (n=10) were subjected to pull-out tests to calculate the failure load (N), displacement (mm) up to the failure point and interface stiffness (N/mm). In the irradiated group, two measurements were performed: close, at 1 mm surrounding the implant surface, and distant, at 2.5 mm from the external limit of the first measurement. Data were analyzed using one-way ANOVA, Tukey’s test and Student’s t-test (α=0.05). Results: The irradiated bone closer to the implant surface had lower elastic modulus (E), Vickers hardness (VHN), Ct.Th, and Ct.V values and a higher Ct.Po value than the bone distant to the implant (P

OBJECTIVES: This study aimed to evaluate the effects of radiotherapy on biomechanical, histomorphometric, and microstructural characteristics of bone, in diverse periods, compared with intact bone tissue.MATERIALS AND METHODS: Eighteen adult male New Zealand rabbits were treated with a single radiation dose of 30 Gy. The animals were randomly divided into six groups: NoIr, control group, no radiation, and five irradiated groups sacrificed after 24 h (Ir24h), 7 (Ir7d), 14 (Ir14d), 21 (Ir21d), and 28 (Ir28d) days. After these periods, the animals were sacrificed and their tibias (n = 6) evaluated using three-point bending test to calculate the ultimate force, work to failure, and bone stiffness. Dynamic indentation test was used to quantify Vickers hardness and elasticity modulus of bone tissue. Micro-CT was used to analyze the cortical volume (CtV), cortical thickness (CtTh), and porosity (Ct.Po). Histomorphometric assessment was based on the lacunarity of bone tissue. Data were analyzed using one-way ANOVA and Kruskal-Wallis tests followed by Tukey, Dunnet, and Dunn's post-tests (P RESULTS: The ultimate force, work to failure, stiffness, elastic modulus, and Vickers hardness values of irradiated bone were significantly lower that non-irradiated bone. Irradiated bone showed significantly lower CtTh and CtV values and higher CtPo than non-irradiated bone. No significant difference was found for lacunarity between non-irradiated bone and irradiated bone.CONCLUSIONS: Ionizing radiation decreases normal anisotropy on microarchitecture of cortical bone, and increases bone fragility compared with non-irradiated bone. Further, these changes were seen after longer periods (e.g., 14 and 21 days), and not immediately after radiation therapy.CLINICAL RELEVANCE: The radiotherapy reduces bone mechanical properties and the normal structure of organic and inorganic bone matrix. For studying the protocols to protect the radiotherapy effect using rabbit model, the use of the sacrificing period between 14 and 21 days is recommended.

PURPOSE The purpose of this study was to evaluate the effect of surface functionalization with bioactive glass BSF18 on the osseointegration of sandblasted and dual acid-etched surface (AE) implants. METHODS AND MATERIALS Forty Morse taper implants with an AE surface as controls (C) or with an AE surface functionalized with BSF18 (BF) were placed in the mandibles of 10 beagles. Implants were analyzed after 2 and 4 weeks of healing. Implant stability quotient (ISQ) values were registered immediately after installation and prior to sacrifice. Samples were analyzed for bone-to-implant contact (BIC) and bone density (BD). The characterization of BF implants included surface roughness analysis with atomic force microscopy and contact angle (CA) analysis to evaluate wettability. Data were analyzed using two-way ANOVA followed by Tukey's test (p

The aim of this study was to evaluate the effect of different storage media on angiogenesis and maintaining autogenous bone graft volume in rabbits.Two grafts were removed bilaterally from the calvaria of 18 rabbits. One graft was removed and immediately fixed in the right mandibular angle (control group). The other graft was stored for 30 minutes in 1 of the following storage media (n = 6): saline solution (saline group), air exposure (dry group), or platelet-poor plasma (PPP group) and then retained by a screw in the right mandibular angle in the same animal. Four weeks later the animals were euthanized, and the grafted areas were harvested, fixed in 10% phosphate buffered formaldehyde solution, and embedded in paraffin. The 5-μm semi-serial sections were stained in hematoxylin and eosin and Mallory trichrome.Histologic analysis of all groups showed the bone graft was vascularized and well incorporated into the recipient site. The number of blood vessels decreased in the saline and dry groups compared with the control group (P .03); in contrast, the number of blood vessels increased in the PPP group (P .05). There were fewer osteoclasts in the saline group compared with the control group (P .05). Furthermore, the saline group showed larger numbers of blood vessels than the dry group (P .01). The PPP group showed larger bone graft volumes compared with the dry and saline groups (P .01). In addition, the saline group showed larger bone graft volumes than the dry group (P .01).PPP improved angiogenesis, maintained the volume of the autogenous bone graft, and was a better storage medium during the trans-surgical period than the dry and saline media.

Statement of problem Consensus is lacking regarding the influence of the maxillary dentition on the survival rate of a mandibular metal-resin implant-supported fixed complete denture (MRISFCD) with distal cantilevers. Purpose The purpose of this systematic review was to identify whether an opposing natural dentition influences the survival rate of mandibular MRISFCDs. Material and methods A literature search was performed up to February 2018 from MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, BBO/LILACS databases and also in the non–peer-reviewed literature through Open Grey. Clinical studies regarding natural (ND), removable prostheses (RP), and complete fixed maxillary implant dentitions (ID) with at least a year of follow-up were included. The quality of the included studies was analyzed, and the risk of bias was reported. A meta-analysis comparing the survival rate of ND with RP and ND with ID was performed with a confidence interval (CI) of 95%, and heterogeneity was tested by an I2 index. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to determine the certainty of the evidence. Results From a total of 112 ND, 69 ID, and 204 RP in the maxillary dentition, the overall prevalence of failures was 5.4% (6/112; 95% CI [2.3 to 10.76]) for ND, 13.99% (20/69; 95% CI [0.77 to 39.41]) for ID, and 4.9% (10/204; 95% CI [0.69 to 12.18]) for RP. No statistical differences were detected in the success rates between ND and RP (risk difference = 0.00 [−0.06, 0.06]; P=.93; I2=27%) or between ND and ID (risk difference=0.00 [−0.06, 0.07]; P=.97; I2=0%), both with moderate evidence. Conclusion With a moderate certainty of evidence, it is suggested that natural maxillary dentitions do not affect the survival rate of mandibular MRISFCDs differently from other prosthetic designs.

The deleterious effects of ionizing radiation on the growth plate continue to be cause for concern. This study evaluated the ionizing radiation effects on bone development and growth plate in the tibia of rats. All animals were submitted to ionizing radiation on the left leg. The animals were divided into two groups and euthanized 30 and 60 days after radiation. The tibiae were removed and separated into groups: control 30 days, irradiated 30 days, control 60 days and irradiated 60 days. Animals in each group (n = 7) were used for macroscopic and histological analysis. The irradiated tibiae showed arrested growth, angular deformity and limb length discrepancy when compared with nonirradiated tibiae. There was statistical difference between control and radiation groups in all the parameters analyzed, except in the lateral-medial thickness of the distal epiphysis. Histological analysis showed evident changes in the growth plate, which was thicker in the Groups irradiated for 30 days, and irradiated for 60 days, compared with their respective controls. The growth plate showed wide areas with disorganized zones of chondrocytes and severely reduced calcification zone. It was concluded that ionizing radiation damaged the growth plate, compromised the endochondral ossification process, and resulted in complete arrest of bone development.

O presente estudo teve como objetivo avaliar os efeitos da HBO no reparo ósseo após radiação ionizante, por meio da histomorfometria, tomografia computadorizada e microscopia de polarização. Vinte ratos Wistar machos foram usados. Uma dose de radiação (30 Gy) foi administrada na perna esquerda em todos os animais, e após 30 dias, defeitos ósseos foram criados em ambos os fêmures. Em seguida, 10 animais receberam sessões diárias de HBO (2,5 ATA por 90 minutos), e todos os animais foram sacrificados 5 ou 7 dias após a cirurgia. Os fêmures foram separados em 4 grupos (n = 5) para cada intervalo de tempo de eutanásia: Controle (fêmur direito: não irradiado e não HBO), RXT (fêmur esquerdo: irradiado e não HBO), HBO (fêmur direito: não-irradiado com HBO), RXT + HBO (fémur esquerdo: irradiado com HBO). A cortical óssea e os defeitos foram avaliados. Os dados foram analisados por meio dos testes de Kolmogorov-Smirnov, teste t não pareado e ANOVA com correção de Bonferroni. Valores maiores de HU e neoformação óssea foram observados nos grupos Controle e HBO, com melhora do reparo. O grupo HBO apresentou birrefringência de colágeno predominantemente amarela/laranja/vermelha na área do defeito. A HBO melhorou a reparação óssea em condições fisiológicas, com aumento dos vasos sanguíneos e formação óssea. No entanto, não foi eficiente em melhorar o reparo e a orientação do colágeno no osso após altas doses de radiação ionizante.

The monostotic fibrous dysplasia is a benign fibro-osseous lesion of bone development, usually asymptomatic, which affects only 1 bone and is characterized by the substitution of the normal bone by an excessive proliferation of the fibrous connective tissue. In almost all cases there are deformities that cause aesthetic and functional disorders. The diagnosis is based on clinical, radiographic, and histologic characteristics. The facial asymmetry is the main clinical change, which is radiographically observed as a radiopaque appearance with frosted glass appearance, and histologically it is verified by the excessive proliferation of bone-forming mesenchymal cells. The objective of the present study is to report a case of a monostotic fibrous dysplasia in the middle third of the face, causing facial asymmetry and treated by a conservative surgery with good aesthetic results.

The calcifying cystic odontogenic tumor (CCOT) is a benign neoplasm that originates from the remnant of the odontogenic epithelium. It is usually of central occurrence, but it may also occur peripherally. The defects resulting from surgical treatments of these tumors cause significant sequels in patients, so restoration of mandibular defects is a challenge for the surgeon. The association between the autogenous graft and the oxygen therapy seems to be a good option in cases of restoration of mandibular defects. This work describes an immediate mandibular restoration of a CCOT associated to a hyperbaric oxygenation of a 63-year-old patient submitted to a segmental resection of the mandible and primary restoration with autogenous, nonvascularized iliac crest excision. Knowing the characteristics of the lesion is fundamental for choosing the best treatment and prognosis.

Oral surgery to remove pyogenic granuloma in a high-risk patient is reported. A 47-year-old man with gastroesophageal reflux disease, diabetes mellitus II, dyslipidemia, and chronic coronary insufficiency (myocardial infarction within 2 years) with episodes of unstable angina was submitted to an excisional biopsy of hemorrhagic lesion in the lingual right mandibular gingiva. During dental treatment, the arterial blood pressure, oxygen saturation, heart rate, and electrocardiogram were monitored. Local anesthesia was performed with 0.45 ml of 3% prilocaine with 0.03 IU/ml felypressin. The anticoagulant therapy was not interrupted. No local or systemic complications were noticed during or after the surgery.

Background The high survival clinical success rates of osseointegration are requisites for establishing a long-term biomechanical fixation and load-bearing potential of endosseous oral implants. The objective of this preclinical animal study was to evaluate the effect of surface microtopography and chemistry on the early stages of biomechanical rigidity with a sandblasted, dual acid-etched surface, with or without an additional chemical modification (SAE-HD and SAE, respectively), in the tibia of Beagle dogs. Methods Two pairs of implants, with the same macrogeometry but different surface technology ((a) dual acid-etched surface treatment with hydrochloric and sulfuric acid followed by microwave treatment and insertion in isotonic saline solution to increase hydrophilicity (SAE-HD) (test, n = 12) and (b) dual acid-etched surface (SAE) (control, n = 12)), were installed bilaterally in the proximal tibia of six Beagle dogs. In order to determine the effect of surface modification on biomechanical fixation, a test protocol was established to assess the torque and a complete set of intrinsic properties. Maximum removal torque (in N cm) was the primary outcome measure, while connection stiffness (N cm/rad) and removal energy (× 10−2J) were the secondary outcome measures and were assessed after 2 and 4 weeks in vivo. A general linear statistical model was used and performed for significant differences with the one-way ANOVA followed by Tukey post hoc test (P

Our aim was to assess the influence of internal fixation in skeletal stability on patients who had had counterclockwise rotation of the maxillomandibular complex and mandibular advancement procedures. We studied 60 records of 20 patients (14 female, 6 male), mean (range) age at operation 29 (16-50) years. The mean (range) postoperative follow-up was 15 (8-24) months. Sixty standard lateral cephalometric radiographs were randomly traced and digitised by one senior radiologist to estimate surgical and postoperative changes. Patients were divided into two groups, the first group (n=10) of which had fixation with only 2.0 system plates (2 plates with monocortical screws alone) and the second (n=10) of which had hybrid fixation (1 plate with monocortical screws and 2 or 3 bicortical bone screws). During operation the change in the mean occlusal plane with counterclockwise rotation was 9.4° (range -17.3 to -2.5mm). The maxilla moved forward and upward. All the anterior mandibular measurements had advanced horizontally, the mean (range) being 17 (6.4 to 9.9) mm for the pogonion, and 17.6 (6.0 to 30.7) mm for the menton. At the longest follow-up period, there were significant long-term changes, but these were clinically acceptable (

ObjectiveEvaluate the biological performance of titanium alloys grade IV under different surface treatments: sandblasting and double etching (Experimental surface 1; Exp1, NEODENT); surface with wettability increase (Experimental surface 2; Exp2, NEODENT) on response of preliminary differentiation and cell maturation.Material and methodImmortalized osteoblast cells were plated on Exp1 and Exp2 titanium discs. The polystyrene plate surface without disc was used as control group (C). Cell viability was assessed by measuring mitochondrial activity (MTT) at 4 and 24 h (n = 5), cell attachment was performed using trypan blue exclusion within 4 hours (n = 5), serum total protein and alkaline phosphatase normalization was performed at 4, 7 and 14 days (n = 5). Data were analyzed using one-way ANOVA and Tukey test.ResultThe values of cell viability were: 4h: C– 0.32±0.01A; Exp1– 0.34±0.08A; Exp2– 0.29±0.03A. 24h: C– 0.43±0.02A; Exp1– 0.39±0.01A; Exp2– 0.37±0.03A. The cell adhesion counting was: C– 85±10A; Exp1- 35±5B; Exp2– 20±2B. The amounts of serum total protein were 4d: C– 40±2B; Exp1– 120±10A; Exp2– 130±20A. 7d: C– 38±2B; Exp1– 75±4A; Exp2– 70±6A. 14 d: C– 100±3A; Exp1– 130±5A; Exp2– 137±9A. The values of alkaline phosphatase normalization were: 4d: C– 2.0±0.1C; Exp1– 5.1±0.8B; Exp2– 9.8±2.0A. 7d: C– 1.0±0.01C; Exp1– 5.3±0.5A; Exp2– 3.0±0.3B. 14 d: C– 4.1±0.3A; Exp1– 4.4±0.8A; Exp2– 2.2±0.2B. Different letters related to statistical differences.ConclusionThe surfaces tested exhibit different behavior at dosage of alkaline phosphatase normalization showing that the Exp2 is more associated with induction of cell differentiation process and that Exp1 is more related to the mineralization process.

Background: This study histologically evaluated two implant designs: a classic thread design versus another specifically designed for healing chamber formation placed with two drilling protocols. Material and Methods: Forty dental implants (4.1 mm diameter) with two different macrogeometries were inserted in the tibia of 10 Beagle dogs, and maximum insertion torque was recorded. Drilling techniques were: until 3.75 mm (regular-group); and until 4.0 mm diameter (overdrilling-group) for both implant designs. At 2 and 4 weeks, samples were retrieved and processed for histomorphometric analysis. For torque and BIC (bone-to-implant contact) and BAFO (bone area fraction occupied), a general-linear model was employed including instrumentation technique and time in vivo as independent. Results: The insertion torque recorded for each implant design and drilling group significantly decreased as a function of increasing drilling diameter for both implant designs ( p 0.18). A significant increase in BIC was observed from 2 to 4 weeks for both implants placed with the overdrilling technique ( p 0.32). Conclusions: Despite the differences between implant designs and drilling technique an intramembranous-like healing mode with newly formed woven bone prevailed

The aim of this preclinical in vivo study was to compare histologically and histomorphometrically osseointegration of dual acid-etched vs. hydrophilic implants.Two pairs of implants (Neodent, Curitiba, Brazil), with same macrogeometry but different surface technology (i) dual acid-etched surface (SAE) treatment with hydrochloric and sulfuric acid followed by microwave treatment and insertion in isotonic saline solution to increase hydrophilicity (SAE-HD) (test, n = 12); (ii) dual SAE (control, n = 12) were installed bilaterally in the proximal tibia of six beagle dogs. Histologic and histomorphometric evaluation was performed after 2 and 4 weeks in vivo, on non-decalcified sections. Percentages of bone-to-implant contact (BIC) and bone density (BD) were estimated and tested for significant differences with the Wilcoxon signed-rank test for paired samples (P 0.05).In general, new bone formation along and in contact with the implant surface could be observed irrespective of the experimental group and observation period. Most of the bone was woven but small quantities of lamellar bone, mainly in close proximity to the cortex could also be observed. BIC at 2 weeks was 19.57 ± 13.57 and 20.33 ± 7.99 (P = 0.75), and at 4 weeks was 42.80 ± 14.48 and 40.25 ± 9.45 (P = 0.65) for SAE-HD and SAE implants respectively. BD at 2 weeks was 24.85 ± 16.31 and 25.66 ± 8.59 (P = 0.35) and at 4 weeks 44.13 ± 6.46 and 40.13 ± 6.46 (P = 0.25) for SAE-HD and SAE implants respectively.Bone-to-implant contact and BD increased with time in both SAE-HD and SAE implants. No significant differences were observed between the two different implant surfaces for any of the evaluated parameters and at any observation time-point.

The aim of this study was to evaluate the stability and osseointegration of implant with different wettability using resonance frequency analysis (RFA) and histomorphometric analysis (bone implant contact, BIC; and bone area fraction occupied, BAFO) after 2 and 4 weeks in rabbit tibiae. Thirty-two Morse taper implants (length 7 mm, diameter 3.5 mm) were divided according to surface characteristics (n=8): Neo, sandblasted and dual acid-etched; and Aq, sandblasted followed by dual acid-etched and maintained in an isotonic solution of 0.9% sodium chloride. Sixteen New Zealand rabbits were used. Two implants of each group were installed in the right and left tibiae according to the experimental periods. The RFA (Ostell(r)) was obtained immediately and after the sacrifice (2 and 4 weeks). The bone/implant blocks were processed for histomorphometric analysis. Data were analyzed using two-way ANOVA followed by Tukey's test and Pearson's correlation for ISQ, BIC and BAFO parameters (p=0.05). No significant effect of implant, period of evaluation or interaction between implant and period of evaluation was found for BIC and BAFO values (p>0.05). Only period of evaluation had significant effect for RFA values at 4 weeks (p=0.001), and at 2 weeks (p

Objective The objective of this study was to evaluate, in a rat model, the effect of hyperbaric oxygen (HBO) on the healing of normal bone on day 7. Study Design Forty male rats were used, equally divided into two groups based on treatment and time of sacrifice: the control group had bone defects created; and the HBO group had bone defects and received HBO. HBO sessions were conducted daily, at 2.5 atmosphere absolute for 90 minutes, and the animals were euthanized after 1, 3, 5, or 7 days. Bone density, bone neoformation, and expression of Runt-related transcription factor 2 (Runx2) and tartrate-resistant acid phosphatase were evaluated. Results Computed tomography analysis revealed significant differences only at 3 days ( P = .01) between the control and HBO groups. HBO treatment accelerated the initial events of bone repair, resulting in improved bone neoformation. Increased expression of Runx2 was observed, especially on days 5 and 7 in the HBO group, although not significantly. There was no significant difference ( P = .74) in the number of tartrate-resistant acid phosphatase–positive osteoclasts between the control and HBO groups on day 7. Conclusions These results suggest that exposure to HBO enhances bone anabolism, reduces inflammation, and accelerates bone healing, with positive results in bone neoformation. Therefore, the aim of this study was to evaluate the effect of HBO on the healing of experimental defects created in normal bone, on the first 7 days, in a rat model.

Objective The aim of this study was to assess changes in the superior airway space (SAS) in Class II patients undergoing orthognathic surgery with counterclockwise rotation of the maxillomandibular complex (MMC). Study Design A total of 23 patients (15 females and 8 males; mean age, 33 years) with symptoms of respiratory disease (mouth breathing) were studied. The patients were subjected to computed tomography analyses at two time intervals: T1 (preoperatively) and T2 (postoperative minimum of 6 months). The computed tomography images were exported to Dolphin Imaging 11.5 software to measure the surface area, minimum axial area, and volume of the SAS. Results The surgery (including a median mandibular advancement of 14 mm with an average rotation of 8 degrees) significantly increased the static SAS, with mean postoperative increases of 178 mm 2 in SA, 76.67 mm 2 in minimum axial area, and 10118.5 mm 3 in volume. A significant increase was also observed in the three-dimensional airspace following orthognathic surgery, which provided a greater permeability of the SAS in Class II patients. Conclusions This confirmed the efficacy of this technique in the treatment of respiratory disorders.

O propósito deste estudo foi avaliar o efeito adjuvante da terapia probiótica no tratamento de indivíduos com mucosite peri-implantar. Em um estudo clínico aleatorizado, duplo-cego e placebo-controle, 36 indivíduos com mucosite peri-implantar foram tratados com o uso de probiótico multiespécies associado ao debridamento mecânico (Grupo Teste) ou apenas debridamento mecânico (Grupo Controle). No Grupo Teste, a sessão de tratamento foi concluída com uma aplicação tópica profissional de gel de carboximeticelulose contendo 109 unidades formadoras de colônias (UFCs) de Bifidobacterium animalis subsp. lactis HN019TM, Lactobacillus rhamnosus HN001TM e Lactobacillus paracasei Lpc-37®. Os indivíduos receberam, então, cápsulas contendo 109 UFCs dos 3 microrganismos probióticos e foram instruídos a dissolverem o conteúdo das cápsulas em 20 mL de água para realizarem bochechos de 30 a 60 segundos, seguidos por deglutição, duas vezes ao dia, durante 12 semanas. O grupo Controle recebeu os mesmos procedimentos de debridamento mecânico e foi tratado com gel e pastilhas placebo. Parâmetros clínicos periodontais (Índice de placa modificado - IPM; Índice de Sangramento Sulcular Modificado - ISSm; Profundidade de Sondagem - PS e Sangramento à Sondagem - SS) foram avaliados no baseline (período pré-intervenção) e em 12 e 24 semanas após o debridamento mecânico inicial. Os dados obtidos foram estatisticamente analisados (p < 0,05). Não houve diferença, ao longo do tempo, para o percentual de IPM no grupo Teste. No grupo Controle, houve aumento significativo no percentual de IPM - escore 0, tanto nas comparações entre o baseline e 12 semanas como entre o baseline e 24 semanas (p < 0,05). Não foram observadas diferenças significativas nas comparações entre os grupos para os valores de IPM. No grupo Teste, o percentual de ISSm - escore 0 aumentou significativamente nas comparações entre o baseline e 12 semanas e entre o baseline e 24 semanas (p < 0,05). O percentual de ISSm - escore 1 diminuiu de forma significativa nas comparações entre o baseline e 24 semanas no grupo Teste. Nenhuma outra mudança significativa ao longo do tempo (comparações intragrupos) foi observada nos grupos Teste e Controle. Nas comparações entre os grupos, observa-se que a há maior percentual de ISSm - escore 0 no grupo Teste do que no grupo Controle em 24 semanas (p < 0,05). Ainda, há maior percentual de ISSm - escore 1 (24 semanas) e ISSm - escore 2 (12 semanas) no grupo Controle do que no grupo Teste (p < 0,05). Nos grupos Teste Controle, comparando os valores obtidos no baseline com aqueles de 24 semanas, a PS diminuiu significativamente, sendo que no grupo Controle esta diferença também foi observada nas comparações entre os valores de 12 semanas e àqueles do baseline (p < 0,05). Não foram observadas diferenças significativas nas comparações entre os grupos para os valores de PS em qualquer tempo experimental. Os valores de SS apresentaram diminuição significativa nas avaliações intragrupos, em ambos os tempos avaliados quando comparados ao baseline, tanto no grupo Teste como no grupo Controle (p < 0,05). Em 12 e 24 semanas, os valores de SS foram menores no grupo Teste quando comparado ao grupo Controle (p < 0,05). Em 24 semanas, 13 de 18 indivíduos do grupo Teste e apenas 6 de 18 indivíduos do grupo Controle apresentaram menos de 10% de SS (p < 0,05). Pode-se concluir que a utilização da terapia probiótica como recurso adjuvante ao debridamento mecânico promove benefícios clínicos adicionais no tratamento de indivíduos com mucosite peri-implantar. The aim of this study was to assess the adjuvant effect of probiotic therapy on the treatment of patients with peri-implant mucositis. In a double-blind, placebo-controlled, randomized clinical trial, 36 patients with peri-implant mucositis were treated with multispecies probiotic in association with mechanical debridement (test group) or with mechanical debridement only (control group). In the test group, the treatment session was concluded with a topical application of carboxymethyl cellulose gel containing 109 colony-forming units (CFUs) of Bifidobacterium animalis subsp. lactis HN019TM, Lactobacillus rhamnosus HN001TM, and Lactobacillus paracasei Lpc-37®. The patients received capsules containing 109 CFUs of the three probiotic microorganisms and were instructed to dissolve the capsule contents in 20 mL of water for mouth rinses during 30 to 60 seconds, followed by swallowing, twice a day, for 12 weeks. The control group was subjected to the same mechanical debridement procedures and treated with placebo gel and lozenges. Periodontal clinical parameters (modified plaque index - mPlI; modified sulcus bleeding index - mSBI; probing depth - PD, and bleeding on probing - BOP) were assessed at baseline (pre-intervention period) and at 12 and 24 weeks after the initial mechanical debridement. The data were statistically analyzed (p < 0.05). There was no difference over time in mPlI in the test group. There was a significant increase in mPlI in the control group - score 0, both in the comparisons between baseline and 12 weeks and between baseline and 24 weeks (p < 0.05). No significant differences in mPlI were observed in the comparisons between the groups. In the test group, mSBI - score 0 increased significantly in the comparisons between baseline and 12 weeks and between baseline and 24 weeks (p < 0.05). Also in the test group, mSBI - score 1 decreased significantly in the comparisons between baseline and 24 weeks. No other significant change was observed over time (within-group comparisons) in the test and control groups. In the between-group comparisons, there was a higher mSBI - score 0 in the test group than in the control group at 24 weeks (p < 0.05). Also, there was a higher mSBI - score 1 (at 24 weeks) and mSBI - score 2 (at 12 weeks) in the control group than in the test group (p < 0.05). In the test and control groups, when comparing the baseline values with those obtained at 24 weeks, PD decreased significantly, and this difference was also observed in the control group between baseline values and those at 12 weeks (p < 0.05). No significant differences were noted in the comparisons between the groups regarding PD in any time period. BOP decreased significantly in the within-group comparisons in both time periods assessed when compared with baseline, both in the test and control groups (p < 0.05). At 12 and 24 weeks, BOP was lower in the test group than in the control group (p < 0.05). At 24 weeks, 13 out of 18 patients from the test group and only 6 out of 18 patients from the control group had less than 10% of BOP (p < 0.05). It may be concluded that the use of probiotic therapy as an adjuvant in mechanical debridement provides additional clinical benefits in the treatment of patients with peri-implant mucositis.