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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.

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.

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.

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

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.

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

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 clinical performance of dental implants is strongly defined by biomechanical principles. The aim of this study was to quantify the Vicker's hardness (VHN) and elastic modulus (E) surround bone to dental implant in different regions, and to discuss the parameters of dynamic microindantion test. Ten cylindrical implants with morse taper interface (Titamax CM, Neodent; 3.5 mm diameter and 7 mm a height) were inserted in rabbit tibia. The mechanical properties were analyzed using microhardness dynamic indenter with 200 mN load and 15 s penetration time. Seven continuous indentations were made distancing 0.08 mm between each other perpendicularly to the implant-bone interface towards the external surface, at the limit of low (Lp) and high implant profile (Hp). Data were analyzed by Student's t-test (a=0.05) to compare the E and VHN values obtained on both regions. Mean and standard deviation of E (GPa) were: Lp. 16.6 ± 1.7, Hp. 17.0 ± 2.5 and VHN (N/mm2): Lp. 12.6 ± 40.8, Hp. 120.1 ± 43.7. No statistical difference was found between bone mechanical properties of high and low profile of the surround bone to implant, demonstrating that the bone characterization homogeneously is pertinent. Dynamic microindantion method proved to be highly useful in the characterization of the individual peri-implant bone tissue. O desempenho clínico de implantes dentais é fortemente definido por princípios biomecânicos. Este trabalho objetivou quantificar a Dureza Vickers (VHN) e módulo de elasticidade (E) do osso periimplantar e discutir parâmetros metodológicos de ensaio dinâmico de indentação. Foram utilizados 10 implantes de corpo cilíndrico com interface cone morse, (Titamax CM; Neodent, Curitiba, PR, Brasil), diâmetro de 3.5 mm e altura de 7 mm inseridos em tíbia de coelho recém obtidas após abate dos animais. As propriedades mecânicas foram analisadas usando penetrador dinâmico de microdureza Vickers (CSM Micro-Hardness Tester; CSM Instruments, Peseux, Switzerland) com carga de 200 mN e tempo de penetração de 15s. Foram feitas 7 indentações no osso cortical na base da rosca (Br) e na ponta da rosca (Pr) na direção perpendicular ao implante, com distância entre elas de 0,08 mm perpendicular a interface osso implante em direção a superfície esterna. Os dados foram analisados por meio de teste t-Student (P

Objectives The objective of this histologic study was to determine the effect of three drilling protocols (oversized, intermediate, and undersized) on biologic responses to a single implant type at early healing periods (2 weeks in vivo) in a beagle dog model. Materials and methods Ten beagle dogs were acquired and subjected to surgeries in the tibia 2 weeks before euthanasia. During surgery, each dog received three Unitite implants, 4 mm in diameter by 10 mm in length, in bone sites drilled to 3.5, 3.75, and 4.0 mm in final diameter. The insertion torque was recorded during surgery, and bone-to-implant contact (BIC), and bone area fraction occupied (BAFO) measured from the histology. Each outcome measure was compared between treatment conditions with the Wilcoxon signed-rank test. Bonferroni-corrected statistical significance was set to 95%. Results Insertion torque increased as an inverse function of drilling diameter, as indicated by significant differences in torque levels between each pair of conditions (P = 0.005). BIC and BAFO levels were highest and statistically similar in the recommended and undersized conditions and significantly reduced in the oversized condition (P

Fibrous dysplasia is characterized by excessive proliferation of bone-forming mesenchymal cells. The maxilla is the most commonly affected facial bone, with facial asymmetry being the usual complaint. Surgery is the treatment of choice with two available options: conservative bone shaving or radical excision and reconstruction. We describe two cases of monofocal fibrous dysplasia of the midface causing facial asymmetry and treated by conservative surgery with good esthetic results.

Due to the critical role of monocytes/macrophages (Mϕ) in bone healing, this study evaluated the effects of bio-anodized, acid-etched, and machined titanium surfaces (Ti) on Mϕ behavior. Cells were separated from whole human blood from 10 patients, plated on Ti or polystyrene (control) surfaces, and cultured for 72 h. At 24, 48 and 72 h, cell viability, levels of IL1β, IL10, TNFα, TGFβ1 inflammatory mediators, and nitric oxide (NO) release were analyzed by mitochondrial colorimetric assay (MTT assay) and immunoenzymatic assays, respectively. Real-time PCR was used to verify the expression of TNFα and IL10 at 72 h. The data were subjected to a Kruskal-Wallis analysis. IL1β, TNFα and TGFβ1 release were not significantly different between the Ti surfaces (p>0.05). The presence of NO and IL10 was not detected in the samples. Cell viability did not differ between the samples cultivated on Ti and those cultivated on control surfaces, except at 24 h (p=0.0033). With respect to the mediators evaluated, the surface characteristics did not induce a typical Th1 or Th2 cytokine profile, although the cell morphology and topography were influenced by the Ti surface during the initial period. Devido ao papel crítico dos monócitos / macrófagos (Mϕ) na cicatrização óssea, este estudo avaliou os efeitos de superficies de titânio (Ti) bio-anodizada, ataque ácido e usinada sobre o comportamento Mϕ. As células foram separadas a partir de sangue humano de 10 pacientes, plaqueadas em Ti ou superfícies de poliestireno (controle), e cultivadas durante 72 h. Às 24, 48 e 72 h, a viabilidade celular e IL1β, IL10, TNFα, TGFβ1 e liberação de óxido nítrico foram analisados por ensaio colorimétrico mitocondrial (MTT) e ensaios imunoenzimáticos, respectivamente. PCR em tempo real foi utilizado para verificar a expressão de TNFα e IL-10 às 72 h. Os dados foram submetidos a uma análise de Kruskal-Wallis. IL1β autorização, TNFα e TGFβ1, não foram significativamente diferentes entre as superfícies de Ti (p>0,05). A presença de NO e de IL-10 não foi detectada nas amostras. A viabilidade celular não diferiu entre as amostras cultivadas em Ti e aquelas cultivadas em superfícies de controle, exceto às 24 h (p=0,0033). No que diz respeito aos mediadores avaliados, as características da superfície, não induziu resposta típica de citocinas Th1 ou Th2, embora a morfologia da célula e a topografia foram influenciadas pela superfície de Ti, durante o período inicial.

In this study we investigated whether anodization with calcium phosphate (CaP) incorporation (Vulcano®) enhances growth factors secretion, osteoblast-specific gene expression, and cell viability, when compared to acid etched surfaces (Porous®) and machined surfaces (Screw®) after 3 and 7 days. Results showed significant cell viability for Porous and Vulcano at day 7, when compared with Screw (p=0.005). At the same time point, significant differences regarding runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP) and bone sialoprotein (BSP) expression were found for all surfaces (p0.05). Although no significant correlation was found for growth factors secretion and Runx2 expression, a significant positive correlation between this gene and ALP/BSP expression showed that their strong association is independent on the type of surface. The incorporation of CaP affected the biological parameters evaluated similar to surfaces just acid etched. The results presented here support the observations that roughness also may play an important role in determining cell response.

Nitric oxide has an important effect on host immune response. However, little has been studied in relation to its potential as a possible diagnostic tool in peri-implant disease. The present study analyzed nitrite levels in the peri-implant sulcular fluid (PISF) of implants with mucositis and the correlation of these nitrite levels with clinical parameters using a simplified fluid collection methodology. Twenty-five partially edentulous patients showing peri-implant mucositis were evaluated, and the peri-implant status was determined based on current clinical parameters: probing depth (PD) and bleeding on probing (BOP). The sulcular fluid (SF) around teeth (control) and implants were collected, and the nitrite levels were evaluated using the Griess method. The mean probing depth (mm) was significantly higher (P < .0001) in implants (2.852 ± 0.6484) than in control teeth (1.585 ± 0.3636). The mean total nitrite level (μM) was statistically higher (P = .0069) in implants with mucositis (14.34 ± 11.83) than in control teeth (9.316 ± 5.534). No correlation was observed between the total nitrite levels and the PD mean in the control group (P = .2558, r = −0.2361) or in the implant group (P = .1160, r = −0.3224), as well as the number of faces showing bleeding on probing (P = .8747, r = 0.0332). These results demonstrated that the nitrite levels were higher in inflamed areas. According to the methodology applied and results obtained, the higher nitrite levels in inflamed areas suggest that, in the future, nitrite could be used as a marker of peri-implant mucositis associated with clinical data to monitor the cure or evolution of the disease.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:28:24Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:42:49Z : No. of bitstreams: 1 2-s2.0-84873357563.pdf: 2215055 bytes, checksum: 23b981cc6aa7a826944bb815a34471e8 (MD5) Made available in DSpace on 2014-05-27T11:28:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-11 The surface energy of the implant surface has an impact on osseointegration. In this study, 2 surfaces: nonwashed resorbable blasting media (NWRBM; control) and Ar-based nonthermal plasma 30 days (Plasma 30 days; experimental), were investigated with a focus on the surface energy. The surface energy was characterized by the Owens-Wendt-Rabel-Kaelble method and the chemistry by X-ray photoelectron spectroscopy (XPS). Five adult beagle dogs received 8 implants (n = 2 per surface, per tibia). After 2 weeks, the animals were euthanized, and half of the implants (n = 20) were removal torqued and the other half were histologically processed (n = 20). The bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) were evaluated on the histologic sections. The XPS analysis showed peaks of C, Ca, O, and P for the control and experimental surfaces. While no significant difference was observed for BIC parameter (P > 0.75), a higher level for torque (P < 0.02) and BAFO parameter (P < 0.01) was observed for the experimental group. The surface elemental chemistry was modified by the plasma and lasted for 30 days after treatment resulting in improved biomechanical fixation and bone formation at 2 weeks compared to the control group. © 2013 Fernando P. S. Guastaldi et al. Department of Biomaterials and Biomimetics College of Dentistry New York University, 345 East 24th Street, New York, NY 10010 Department of Surgery and Integrated Clinic São Paulo State University, 16015 Araçatuba, SP Department of Postgraduate Dentistry UNIGRANRIO, 25071 Duque de Caxias, RJ Department of Prosthodontics Faculty of Odontology Malmö University, 205 06 Malmö Department of Oral and Maxillofacial Surgery and Implantology University of Uberlândia, 38408 Uberlândia, MG Department of Surgery and Integrated Clinic São Paulo State University, 16015 Araçatuba, SP

Autogenous bone tissue has regeneration potential; however, this capacity may not be sufficient in larger bone defects. The aim of this study is to histologically evaluate anorganic bovine bone grafts (GenOx Inorg) with or without platelet-rich plasma (PRP). Two bone lesions were created in calvaria of 12 rabbits. The 24 surgical lesions were separated into 3 groups: coagulous, anorganic, and anorganic with PRP. At the 4-week time point, the animals were euthanized and the grafted area removed, fixed in formalin 10% with phosphate buffered saline, 0.1 M, and embedded in paraffin. The histologic parameters analyzed were new bone filling the defect area, presence of giant cells and particles of the graft, and new bone formation associated with the particles. In the coagulous group, defects were filled with fibrous tissue that attached the periosteum and little bone neoformation in the periphery. In anorganic groups with or without PRP, little new bone formation in the periphery of the defect was observed; however, in the center of some defects there was new bone. Moderate presence of giant cells and little new bone formation was associated with the innumerous graft particles. Histologic results revealed no statistically significant differences among the defects new bone fill between the studied groups (P = .64). There was no significant difference in the number of giant cells (P = .60), graft particles (P = .46), and new bone formation around graft particles (P = .26), whether PRP was added or not. Anorganic bone, isolated or mixed with PRP, was biocompatible and osteoconductive, while maintaining bone volume.

Summary Introduction: Repairing large bone defects is a huge challenge that reconstructive surgery currently faces. Objective: The objective of this study was to perform the histological evaluation of bone repair in rabbit calvaria when using bovine bone graft (Gen-ox-organic®) associated with platelet-rich plasma (PRP). Method: 12 rabbits were used and two bone fragments were bilaterally removed from calvaria. Then, 24 surgical sites were randomly divided into 3 groups: coagulum (group I), organic (group II) and PRP-included organic (group III). After four weeks, the animals were sacrificed and the grafted area removed, fixed in 10% formalin with PBS 0.1 M, and embedded in paraffin. Study method: The analyzed histological parameters were: defective area filled with the newly-formed bone, graft's giant cells and particles, as well as the new bone formation associated with the particles. Group I's defects were filled with fibrous tissue attaching the periosteum and revealed a little bone formation peripherally. In both groups II and III, a similar standard was noticed in addition to the absence of graft particles and giant cells. There was no significant difference in the number of giant cells, graft particles and new bone formation around the particles between the grafted material and the PRP-related group. Conclusion: The results achieved indicate that the organic biomaterial neither separately nor jointly with PRP improves bone regeneration.

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

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:02:50Z No. of bitstreams: 1 S0370-44672003000200008.pdf: 871211 bytes, checksum: f7a628209631f57ff6ed884de39f7042 (MD5) Made available in DSpace on 2013-08-22T19:02:50Z (GMT). No. of bitstreams: 1 S0370-44672003000200008.pdf: 871211 bytes, checksum: f7a628209631f57ff6ed884de39f7042 (MD5) Previous issue date: 2003-06-01 Made available in DSpace on 2013-09-30T18:31:35Z (GMT). No. of bitstreams: 2 S0370-44672003000200008.pdf: 871211 bytes, checksum: f7a628209631f57ff6ed884de39f7042 (MD5) S0370-44672003000200008.pdf.txt: 21723 bytes, checksum: 53859e0d97eee215d102051771e0fca5 (MD5) Previous issue date: 2003-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:45:01Z No. of bitstreams: 2 S0370-44672003000200008.pdf: 871211 bytes, checksum: f7a628209631f57ff6ed884de39f7042 (MD5) S0370-44672003000200008.pdf.txt: 21723 bytes, checksum: 53859e0d97eee215d102051771e0fca5 (MD5) Made available in DSpace on 2014-05-20T13:45:01Z (GMT). No. of bitstreams: 2 S0370-44672003000200008.pdf: 871211 bytes, checksum: f7a628209631f57ff6ed884de39f7042 (MD5) S0370-44672003000200008.pdf.txt: 21723 bytes, checksum: 53859e0d97eee215d102051771e0fca5 (MD5) Previous issue date: 2003-06-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Esse artigo tem como objetivo apresentar o projeto, a construção e os resultados obtidos no estudo da osseointegração com um torquímetro de alta precisão. Esse torquímetro, especialmente desenvolvido para este tipo de pesquisa, pode ser usado para desenvolver pesquisas odontológicas da osseointegração de implantes dentários. Os implantes foram feitos em sete coelhos que foram avaliados após 21 e 42 dias. Alguns coelhos sofreram estimulações ultra-sônicas em seus implantes, enquanto outros foram analisados sem se submeterem a estas estimulações. Os resultados mostraram o bom funcionamento do torquímetro e que o torque para remover o implante do coelho é diretamente proporcional ao tempo de osseintegração e que as estimulações ultra-sônicas podem influenciar o torque necessário para remover o implante em alguns casos. This paper has as objective, to present the project, the construction and the results obtained in the study of the osseointegration with a torque gauge of high precision. The torque gage, especially developed for this research type, was used to improvement of odontological research on osseointegration of dental implant. The implants were done in seven rabbits that were available after 21 and 42 days. In some rabbits were made ultra-sonic stimulations at rabbits' implants. The results showed that the torque to remove the implant of the rabbits is directly proportional at the time of osseointegration and that the ultra-sonic stimulations can also influence the torque in some cases. UNESP Departamento de Engenharia Mecânica UNESP Departamento de Engenharia Elétrica UNESP UNESP Faculdade de Odontologia de Araraquara Departamento de Clínica Infantil Universidade de Uberlândia Departamento de Cirurgia UNESP Engenharia Mecânica UNESP Departamento de Engenharia Mecânica UNESP Departamento de Engenharia Elétrica UNESP UNESP Faculdade de Odontologia de Araraquara Departamento de Clínica Infantil UNESP Engenharia Mecânica

Introduction Coconut water (CW) and soy milk (SM) have been proposed as storage media for avulsed teeth because of their nutrients that preserve cell viability. The present study investigated the periodontal healing process of dog teeth replanted after storage in CW, SM, and whole milk (WM) using micro–computed tomographic (μCT) and histologic analyses compared with immediate tooth replantation. Methods Forty roots of 10 adult beagle dogs were extracted and subjected to the following protocols: immediate replantation after extraction (control), stored in CW with an adjusted pH, and SM and WM for 50 minutes before replantation. The animals were euthanized 28 days postoperatively, and the obtained specimens were scanned using a μCT scanner and subjected to routine processing for histometric analyses under an optical microscope. Results CW and SM performed similarly to WM; however, SM showed significantly higher ankylosis than the control group. Conclusions Additionally, this study showed that the combined use of histologic analysis and μCT is a promising method to better identify tooth resorption and the repair process and to evaluate the total extension of the periodontium. CW as a storage medium is a promising transport media for avulsed teeth.

Surgical reconstruction of mandibular bone defects is a routine procedure for rehabilitation of patients with deformities caused by trauma, infection or tumor resection. The mandible plays a major role in masticatory and phonetic functions, supporting the teeth and defining the contour of the lower third of the face. Therefore, mandibular discontinuity produces se‐ vere cosmetic and functional deformities, including loss of support for suprahyoid muscles and subsequent airway reduction. Reconstruction of these severe defects is mandatory for restoring the patient’s quality of life. Surgical techniques have improved considerably in the last decade, but reconstruction of large bone defects of the mandible still pose a great chal‐ lenge in maxillofacial rehabilitation. Several things can be done to optimize the surgery; the use of prototyping modeling for instance provides a better assessment of the bone defect and pre-contouring of the fixation plates, reducing operating time. The choice of the most suitable titanium plate system is critical to the success of the procedure. Mandibular defects with loss of continuity require more robust (load bearing) systems supporting mandibular function. Many studies consider the use of plates and screws temporary treatment due to the large number of complications such as fracture of plates and screws, plate exposure and infection. Thus, the use of grafts both in the first operation or in a two-stage procedure en‐ sures a more predictable result.

The success of autogenous bone graft is related to the graft cell viability. In bone-grafting procedures, harvested grafts are often maintained in extraoral media while the recipient site is prepared. The aim of this study was to evaluate in vivo the effect of storage media over autogenous bone grafts during the transsurgical time. Two grafts were removed bilaterally from the calvaria of 18 rabbits. One graft was immediately fixed in the mandibular angle (control group), and the other was maintained in air exposure (dry group), 0.9% NaCl solution (saline group), or platelet-poor plasma (PPP group) during 30 minutes and stabilized in the symmetrical location of control grafts. After 28 days, the animals were euthanized and the bone fragments were removed, demineralized, and embedded in paraffin. Histological evaluation was performed under light microscope. Empty lacunae and bone graft area quantification were carried out for the sections. The histomorphometrical analysis revealed reduction of the graft area and increase of empty lacunae in the dry group when compared with control. No significant differences were found in the number of empty lacunae or bone graft area between the saline group and its control and also between the PPP group and its control. The dry group showed more empty lacunae and less graft area than the saline and PPP groups. In accordance with the results, PPP and physiologic solution demonstrated osteocyte preservation and bone graft area maintenance, being satisfactory storage media for autogenous bone grafts during the transsurgical period.

To evaluate the bone healing of defects filled with particulate bone graft in combination with platelet-rich plasma (PRP), added with a mixture of calcium chloride and thrombin or just calcium chloride. Two 5-mm bone defects were created in the calvaria of 24 rabbits. Each defect was filled with particulate bone graft and PRP. In one defect the PRP was activated by a mixture of calcium chloride and thrombin; in the other, PRP was activated by calcium chloride only. The animals were euthanized 1, 2, 4, and 8 weeks after the surgeries, and the calvaria was submitted to histologic processing for histomorphometric analysis. The qualitative analysis has shown that both defects presented the same histologic characteristics so that a better organized, more mature, and well-vascularized bone tissue was noticed in the eighth week. A good bone repair was achieved using either the mixture of calcium chloride and thrombin or the calcium chloride alone as a restarting agent of the coagulation process.

O objetivo do trabalho foi avaliar a influência da dor e ansiedade sobre a freqüência cardíaca (FC) e pressão arterial (PA) de 275 voluntários em situações de urgências endodônticas, selecionados de forma aleatória, entre os pacientes que procuraram o serviço do Pronto Socorro Odontológico da Faculdade de Odontologia da Universidade Federal de Uberlândia (FOUFU). Os voluntários responderam a ficha de anamnese e a Escala de Ansiedade Dental de Corah ainda na sala de espera. A Escala de 11 Pontos em Caixa foi usada para avaliar a sensação dolorosa dos voluntários, em dois momentos: antes do atendimento, para determinar a dor com que chegaram para atendimento e, após o tratamento, para determinar se houve alteração na sensação dolorosa. A PA e FC foram avaliadas através de esfingnomanômetro com coluna de mercúrio, também em dois momentos; inicialmente, com o paciente na sala de espera e, imediatamente ao término do atendimento, com o objetivo de correlacionar o controle eficaz da dor com a variação dos parâmetros cardiovasculares avaliados. De acordo com os resultados obtidos concluímos que a dor e a ansiedade não foram capazes de alterar significativamente a pressão arterial e freqüência cardíaca.

Este estudo avaliou comparativamente o período de latência e duração do cloridrato de levobupivacaína 0,5% sem vasoconstritor e com epinefrina 1:200.000 (NOVABUPI®), após anestesia terminal infiltrativa na maxila. As injeções foram realizadas no canino superior, escolhido previamente pelo voluntário de forma aleatória em um estudo triplo-cego, onde o mesmo dente foi anestesiado com as duas soluções, com intervalo de no mínimo 48 horas. O período de latência e duração da anestesia pulpar, foram analisados através do teste de sensibilidade elétrico (Analytic Technology) e o tempo de duração em tecidos moles foi relatado pelo voluntário. Os resultados obtidos revelaram diferenças estatisticamente significantes (p< 0,05) em relação à adição do vasoconstritor, quanto à duração da anestesia pulpar (p= 0,0004) e a duração em tecidos moles (p= 0,0019), porém com relação ao período de latência não houve diferença estatisticamente significante (p= 0,6547). Concluiu-se que ambas as soluções foram eficazes na perda da sensibilidade dos tecidos duros e moles e a adição de epinefrina 1:200.000 prolongou o tempo de duração do cloridrato de levobupivacaína 0,5%. The purpose of this study was to comparatively evaluate the time of latency and duration of two types of levobupivacaine 0,5%: plain and with epinephrine 1:200.000, in maxillary infiltrative anesthesia. The infiltration anesthesias were perfomed in the vestibule in the upper caninine chosen at random by the voluntee in a triple-blind study. The chosen tooth was anesthetized with both anesthetic solution in two sessions with a minimum interval of 48 hours. The time of latency and duration of pulpar anesthesia were analysed by eletric pulp tester (Analytic Technology) and the soft tissue duration was noted by the volunteer. The results showed statistical significant difference (p< 0,05) when there was vasoconstrictor addition in time of pulpar (p= 0,0004) and soft tissue (p= 0,0019) anesthesia; however, no significanct difference was obtained in latency period (p=0,6547). it was concluded that both Solutions were effective in obtaining anesthesia for hard and soft tlssues and the addition of 1:200.000 epinephrine prolonged the duration of anesthesia. Dissertação (Mestrado)

The aim of this study was to investigate the potential use of salivary IL1β in early-stage diagnostics of peri-implant inflammation in partially and totally edentulous patients rehabilitated with dental implants. Patients were classified according to peri-implant probing depth and bleeding upon probing in groups of healthy individuals or in groups of individuals with peri-implant inflammation. Data on plaque index, clinical attachment loss, suppuration, and mobility were also assessed. Saliva was collected without stimulation, and the levels of IL-1β were determined by ELISA. Healthy groups demonstrated significantly lower levels of IL-1β compared with the inflammation groups. No difference in IL-1β levels was observed between partially edentulous or totally edentulous patients. Salivary IL-1β may be useful for the diagnosis and monitoring of early peri-implant inflammation, particularly in edentulous patients.

Made available in DSpace on 2022-04-29T08:42:24Z (GMT). No. of bitstreams: 0 Previous issue date: 1990-01-01 Abstract ATP solution seems to increase calcium absorption when applied both to dentin and to the pulp before the application of calcium hydroxide. In this study, the effects of a brief storage of teeth in ATP or saline solution before replantation were compared. The right maxillary incisors of 80 male albino rats were extracted and immersed, either directly or after 25 min air‐drying, in ATP or saline solution and then replanted. Eight animals in each group were killed 5, 10, 30, 60 and 90 d after replantation and the teeth were examined histologically. The histometric analysis revealed significant differences between the saline‐ and ATP‐treated group. More new cementum or cementum‐like tissue was deposited over the radicular surface in the ATP‐treated teeth. More root surface area was resorbed and not repaired by new cementum in the saline group and more total root surface was not resorbed or resorbed and repaired in the ATP‐treated group. Based on these findings, it seems reasonable to conclude that brief storage of teeth in ATP solution before replantation may have improved the healing of replanted teeth in rats. Copyright © 1990, Wiley Blackwell. All rights reserved Department of Oral and Maxillofacial Surgery University Hospital Department of Clinical and Restorative Dentistry Uberlândia Federal University, Uberlâdia, Minas Gerais Department of Diagnostic and Oral Surgery Araçatuba School of Dentistry, Säo Paulo, Araçatuba

Introduction: Osseointegrated dental implants have been routinely used in oral rehabilitation. Patients with dysplastic bone diseases represent a particular challenge for oral rehabilitation with dental implants. Nevertheless, the installation of implants in patients with cemento-osseous dysplasia (COD) has been reported with apparent success. Objective: In this paper, we present a case of a patient with COD in which a dental implant had been installed and lost six months later. In this regard, we analyzed pertinent aspects of the indications for dental implants in patients with COD considering the pathogenesis, dysplastic nature, and behavior of the disease. Conclusion: The present case report illustrates that COD can be considered a limiting factor in the recommendation for a dental implant. Because of this, it is imperative to inform the patient about the risks of surgically manipulating the diseased bone.

The head and neck are commonly affected in gunshot injuries and this can cause functional and esthetic defects in the maxillofacial region. Mandibular discontinuity is an important esthetic and functional problem and its reconstruction represents a huge challenge. The opening, closing, lateral and protrusive movements of the mouth are diminished and malocclusion can occur. The purpose is to report a clinical case of a 44 years man who had an immediate loaded implant-supported prosthesis after six months of mandibular reconstruction with free iliac bone grafting of a greatmandibular defect caused by gun shot. Autogenous bone grafting is the most predictable treatment from the available reconstruction options for mandibular bone defects. Reconstructed patients can achieve good results with dental implants and implant-supported prostheses with immediate loading. This treatment can promote better masticatory function, improving the nutrition capacity, facial symmetry, muscular equilibrium, better diction and quality of life.

INTRODUCTION: Extraction of third molars can rarely provoke post-operative complications, such as temporomandibular joint disorders (TMDs). OBJECTIVE: Although the literature presents a series of discussions of the clinical evidence related to this subject, in this report, we present an uncommon case of a patient submitted for the extraction of third molars who presented, in postoperative monitoring, with recurrent bilateral condylar luxation. CONCLUSION: Due to this critical condition, the patient was successfully treated by bilateral eminectomy.

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.