Search

BackgroundAnorganic bovine bone (Bio-Oss®) has been extensively used for reconstruction of posterior area of maxilla in sinus lift procedure; however, a new graft material (Lumina-Bone Porous®), that has a different manufacturing process, has not been yet compared in clinical and histological terms. The manufacturing process of bovine bone graft is related to size and porosity of the particles, and this can change osteoconductive property of the material and bone formation. The use of Lumina-Porus® could improve bone formation, reduce the remaining particles of the biomaterial using a low-cost material. The aim of this research was to compare the clinical, radiological, and histomorphometrical results from maxillary sinus lift with two different anorganic bovine bone substitutes Bio-Oss® (control) and Lumina-Bone Porous® (test).ResultsA split-mouth study was performed with 13 volunteers. The mean bone ridge height in the deepest portion of maxillary sinuses floor was 3.11 ± 0.83 mm in the Bio-Oss® and 2.38 ± 0.75 mm in the Lumina-Bone Porous®. After sinus lift, the Bio-Oss® group shows bone ridge height of 11.56 ± 2.03 mm and Lumina-Bone® of 10.62 ± 1.93 mm. The increase in alveolar bone height scores was significant between pre-augmentation and 6 months after SL in both groups (p< 0.001). No statistical significant difference in newly formed bone in the Bio-Oss® group (20.4 ± 5.4%), and Lumina-Bone Porous® (22.8 ± 8.5%) was histomorphological observed (p> 0.05). On the other hand, the residual graft particles showed significant difference between the Bio-Oss® group (19.9 ± 8.6%) and Lumina-Bone Porous® (14.6 ± 5.6%) (p< 0.05). The survival rate of dental implants for augmented area with Lumina Bone Porous® was 88.88%, while for Bio-Oss® group was 100%.ConclusionBoth materials Bio-Oss® and Lumina-Bone Porous® can be used in the maxillary sinus floor augmentation with good predictability in clinical, radiographical, and histological point of view.

INTRODUCTION: The extraction of the upper third molar is a simple and common procedure in Oral and Maxillofacial Surgery daily practice. Infection, facial swelling, trismus, wound dehiscence, root fracture, oroantral fistula, iatrogenic displacement, fracture of the maxillary tuberosity are some of the complications that can occur during third molar extraction.CASE DESCRIPTION: In this article, an unusual fracture of the pterygoid process during upper third molar extraction and a minimally invasive technique for treatment are described.CONCLUSION: It is important to recognize the fracture and not remove the fragment before a complementary image exam, it will guide the type of treatment that should be use. *Fratura de processo pterigóide durante extracção dental – uma complicação incomum*INTRODUÇÃO: A extração do terceiro molar superior é um procedimento simples e comum na prática diária da cirurgia buco-maxilo-facial. Infecção, inchaço facial, trismo, deiscência de feridas, fratura de raiz, fístula oroantral, deslocamento iatrogênico, fratura da tuberosidade maxilar são algumas das complicações que podem ocorrer durante a extração do terceiro molar.DESCRIÇÃO DO CASO: Neste artigo, Descreve-se uma fratura incomum do processo pterigóide ocorrida durante a extração do terceiro molar superior e uma técnica minimamente invasiva para o tratamento.CONCLUSÃO: É importante reconhecer a fratura e não remover o fragmento antes de um exame de imagem complementar, ele irá orientar o tipo de tratamento que deve ser usado.

Background The installation of dental implants in the posterior maxilla is often faced with resorbed alveolar processes, resulting from a combination of pneumatization of the maxillary sinus, the effects of periodontal disease, and physiological bone resorption. The sinus lift surgery has been practiced since 1980 with the aim to increase bone height in this region for an implant supported prosthetic rehabilitation, and various filling materials have been used for such. Objectives This study aimed to clinically, radiographically, and histologically evaluate a preparation of calcium phosphate cement (Bone Source®, BS) used as filling material in maxillary sinus elevation surgery. Methods Ten patients were operated requiring maxillary sinus graft for future placement of osseointegrated implants. After a period ranging from 9 to 16 months, a clinical evaluation and biopsy of the grafted area in the region adjacent to the axis of the implant to be inserted were performed. Results Clinically and radiographically, no evidence of resorption/substitution of BS was noticed. Although no patients have had postoperative complications and the material presented fully biocompatible characteristics with woven bone in intimate contact with BS, it was not possible to place any implants due to minimal bone formation and friability of the material. Conclusion It was concluded that despite the osteoconductive capacity of BS, this conventional calcium phosphate preparation does not support sufficient amount of new bone formation that could allow its use as filling material for maxillary sinus floor lift and subsequent dental implant placement.

Purpose The literature does not present any consensus on a uniform treatment plan for odontogenic keratocysts (OKCs) and does not provide adequate evidence for determining which modality is most effective in lowering morbidity or preventing recurrence. The purpose of this study was to compare the effectiveness of surgical treatment based on a 1- versus 2-step protocol. Materials and Methods The authors designed and implemented a retrospective cohort study and enrolled a sample of patients diagnosed with OKC from 1991 through 2018. The medical records of all cases were retrieved from files of the Oral and Maxillofacial Surgery Division of the Piracicaba Dental School (Piracicaba, Brazil). The predictor variable was treatment group (1- vs 2-step protocol). Statistical analysis was performed using Kaplan-Meier analysis, Mantel-Cox log-rank test, and proportional hazard regression analysis. Results The sample was composed of 72 patients (38 male) with a mean age of 40.72 years. Thirteen patients received 1-step treatment and 59 received 2-step treatment. The complex composed of the body, angle, and mandibular ramus was the site most frequently affected. In the individual Kaplan-Meier analysis for each presented variable only involved tooth was significant (P = .0128 by log-rank test), with the risk of relapse 4.23 times higher for the involved tooth than for the non-involved tooth. Conclusion The 1- and 2-step protocols for treatment of OKCs are safe and appropriate as the first treatment option, offering a conservative and effective option with low morbidity. Treatment protocols associated with systematic monitoring promote a better quality of life for patients with low potential for complications.

The presence of asymptomatic third molars can represent a potential problem in the mandible when these teeth are retained and the patient has lost all normally erupted teeth. Once the mandibular first and second molars are removed, the mandibular body becomes weaker with time, increasing the complexity, morbidity and incidence of complication in the surgical procedure to remove the retained third molar. This paper reports a case where the mandibular third molars retained in a severely resorbed mandible were removed in a 54-year-old female patient. The treatment plan was based on the safe surgical removal of the teeth and prosthetic rehabilitation with an implant-supported milled bar overdenture and a bone-mucous-supported complete denture in the mandibular and maxillary arch, respectively. If the removal of a retained third molar is indicated in a severely resorbed edentulous mandible, the treatment plan must involve not only preventive measures in order to avoid mandible fracture during or after tooth removal, but also alternatives that allow an adequate mandibular rehabilitation. A presença de terceiros molares inclusos assintomáticos pode representar um grande problema quando estes dentes encontram-se inclusos em um paciente desdentado total. Uma vez que os primeiros e segundos molares foram extraídos, o corpo mandibular torna-se mais frágil com o passar do tempo, o que aumenta a complexidade, a morbidade e a incidência de complicações nas cirurgias de remoção de terceiros molares inclusos. Neste artigo é apresentado um caso de uma paciente de 54 anos de idade com severa reabsorção do osso mandibular onde os terceiros molares mandibulares encontravam-se inclusos e com necessidade de extração. O plano de tratamento objetivou a extração segura dos dentes e a reabilitação mandibular com o uso de uma prótese implanto-suportada. Se a extração dos terceiros molares inclusos é indicada em pacientes que apresentam mandíbula atrófica, o plano de tratamento deve incluir não apenas as medidas preventivas com o intuito de prevenir a fratura da mandíbula durante ou após a remoção dos dentes, mas também alternativas de tratamento que possibilitem uma adequada reabilitação.

It has been a matter of debate as to whether dental implant therapies are suitable for patients subjected to long-term use of bisphosphonates (BPs). This report presents a case of a 76-year-old woman who developed BPs-related osteonecrosis of the jaw (BRONJ) in the left hemimandible after dental implant exposure. The implants and the necrotic crestal bone were removed, and postoperatively, a delay in tissue healing with bone exposure was noticed. The histologic analysis of the block biopsies revealed a lamellar bone tissue exhibiting necrotic areas and bacterial colonies associated with the bone outer surface. The bone-implant interface showed viable lamellar bone with enlarged vascular spaces in the areas between the implant threads. The possible mechanisms for the loss of implants in BRONJ patients are discussed, and the potential protocols for dental implant rehabilitation for patients under BP therapies are presented.

Purpose: To report on the clinical outcome of 129 zygomatic implants placed in 37 patients with severely resorbed partially or completely edentulous maxillae. Materials and Methods: Patients who received zygomatic implants between 2007 and 2014 were included in this retrospective analysis. All patients were treated using the same surgical protocol, the sinus slot technique. The following data were recorded: sex, age, race, medical history, etiology, addictions, degree of bone atrophy, type and size of zygomatic implants, number of implants placed, type of prosthesis, survival rate, and success of implants and complications. Follow-up included standardized clinical and tomography examinations. Results: Thirty-seven consecutive patients (25 women, 12 men; mean age 55.64 years [range 40 to 77 years]) were treated. All were in need of oral reconstruction and had maxillary atrophy that warranted zygomatic implant placement. One hundred twenty nine zygomatic implants were placed in these 37 patients. Two of the implants failed, resulting in a cumulative survival rate of 98.44%. Maxillary sinusitis was the most common complication found (21.62%); however, neither of the implant failures was related to sinusitis or smoking. Conclusion: The zygomatic implant is a reliable option for treatment of the severely resorbed maxilla.

The objective of this study was to evaluate the bone repair along a mandibular body osteotomy after using a 2.0 miniplate system. Nine adult mongrel dogs were subjected to unilateral continuous defect through an osteotomy between the mandibular 3rd and 4th premolars. Two four-hole miniplates were placed in accordance with the Arbeitgeimeinschaft fur Osteosynthesefragen Manual. Miniplates adapted to the alveolar processes were fixed monocortically with 6.0-mm-length titanium alloy self-tapping screws, whereas miniplates placed near the mandible bases were fixed bicortically. At 2, 6 and 12 weeks, three dogs were sacrificed per period, and the osteotomy sites were removed, divided into three thirds (Tension Third, TT; Intermediary Third, IT; Compression Third, CT) and prepared for conventional and polarized light microscopy. At 6 weeks, while the CT repaired faster and showed bone union by woven bone formation, the TT and IT exhibited a ligament-like fibrous connective tissue inserted in, and connecting, newly formed woven bone overlying the parent lamellar bone edges. At 12 weeks, bone repair took place at all thirds. Histometrically, proportions of newly formed bone did not alter at TT, IT and CT, whereas significantly enhanced bone formation was observed for the 12-week group, irrespective of the third. The results demonstrated that although the method used to stabilize the mandibular osteotomy allowed bone repair to occur, differences in the dynamics of bone healing may take place along the osteotomy site, depending on the action of tension and compression forces generated by masticatory muscles.

The aim of the study was to evaluate histologically and histometrically the bone repair at the mandibular body osteotomy and at the bone-screw interface after using a biodegradable 2.0-mm internal fixation system. Six dogs were subjected to an osteotomy in the mandibular body, which was stabilized by applying a fixation device manufactured with poly-L-DL-lactic acid (70:30). The dogs were euthanized at 2 and 18 weeks. Each screw was sectioned along its long axis, and the osteotomy sites were divided into 3 parts: the upper part was labeled the tension third (TT); the lower part, compression third (CT); and the part between the TT and CT, intermediary third (IT). Histologic analysis showed areas of direct contact between the screw surface and the parent lamellar bone at 2 weeks. At 18 weeks, 3 microscopically distinct layers at the bone-screw interface were noted. At the osteotomy sites, union between the bone fragments was observed at 18 weeks. Statistically significant differences in the newly formed bone among TT, IT, and CT (P = 0.019) were observed. In conclusion, the biomechanical environment created by the biodegradable IF system used in this study facilitated bone repair at the osteotomy site.

An unusual case of an impacted right maxillary third molar that was accidentally displaced into the maxillary sinus during exodontia and was surgically retrieved almost 2 years later is described. The tooth was removed under general anesthesia, after maxillary sinus exposure through Caldwell-Luc approach. Postoperative recovery was uneventful. Six months after the retrieval surgery, the maxillary sinus was completely healed and the patient did not present any complaint. Este artigo descreve um caso raro de um terceiro molar superior direito impactado que foi deslocado acidentalmente para o interior do seio maxilar durante exodontia e foi removido cirurgicamente após quase dois anos. O dente foi removido sob anestesia geral, após exposição do seio maxilar pela técnica de Caldwell-Luc. O pós-operatório transcorreu sem complicações. Seis meses após a cirurgia, houve completa recuperação do seio maxilar e a paciente não apresentou qualquer queixa.

AIM: To evaluate medical records from patients who had maxillofacial infections between August 2002 and May 2010. METHODS: Analysis of 157 patients' data looking for epidemiology, causes of the infection, type of treatment established and complications. RESULTS: 113 patients had odontogenic infections and 44 had non-odontogenic infections. The white ethnicity was the most affected (64.33%), prevailing the men (53.5%). The odontogenic infections occurred mostly at the mandible (55.74%), involving the posterior teeth (82%). Dental decay was the main etiology (90.90%). The most affected facial anatomic region was the submandibular (42.85%). Surgical treatment was required in 76% of the cases. CONCLUSIONS: Maxillofacial infections should be treated as soon as possible. Even without culture and antibiogram results, it was possible to treat the infection and to reestablish tissue function.

Patients wearing complete dentures for a long time usually exhibit lack of bone and keratinized mucosa in the bearing area due to bone resorption. The patients suffering from this phenomenon usually have unstable and non-retentive complete denture, which result in constant trauma to the mucosa, pain, functional limitations and worsening of facial esthetics. An innovative technique has been described in which a novel surgical approach using osseointegrated dental implants as "tent poles" was applied concomitant with particulate autogenous bone graft. The authors claim that the control and maintenance of the surgically expanded soft tissue volume should prevent graft resorption in the long term. Nevertheless, resorption of the bone graft is usually more significant where the bone mass is poorer, in the mandibular body. This paper describes a case of severely resorbed edentulous mandible in which the "tent pole" technique was applied with some modifications. Use of the titanium mesh "shelters" and two additional implants was effective in "protecting" the bone graft in the posterior portion of the mandibular body increasing bone mass volume in this area. Furthermore, we believe that this kind of graft "protection" on the whole residual alveolar ridge can increase the width of bone mass gain optimizing the "tent pole" technique. Pacientes portadores de próteses totais por um longo período geralmente apresentam perda significativa de osso do processo alveolar e de mucosa ceratinizada na área chapeável devido ao processo de reabsorção óssea associada com a perda de função. Estes pacientes geralmente possuem próteses totais sem retenção e estabilidade, o que resulta em trauma crônico à mucosa, limitações funcionais e piora da estética facial. Uma técnica cirúrgica inovadora foi descrita na qual implantes osseointegráveis são posicionados em forma de "pilares" conjuntamente com enxerto ósseo autógeno particulado. Os autores afirmam que o controle e manutenção do volume tecidual obtido cirurgicamente diminui a perda em volume do enxerto ósseo utilizado. Entretanto esta reabsorção geralmente ocorre com maior intensidade onde a massa óssea é mais pobre, ou seja, em corpo mandibular. Este artigo descreve um caso onde uma mandíbula severamente reabsorvida foi reconstruída utilizando-se a técnica de "tent pole" com algumas modificações propostas pelos autores. O uso da malha de titânio em forma de "cabana" e dois implantes dentários osseointegráveis adicionais contribuíram para "proteger" o enxerto ósseo autógeno na região posterior do corpo mandibular aumentando o volume ósseo na região. Adicionalmente, nós acreditamos que o uso deste tipo de proteção em todo rebordo alveolar residual pode melhorar o ganho de massa óssea otimizando, portanto, a técnica original de "tent pole".

The investigation of titanium (Ti) surface modifications aiming to increase implant osseointegration is one of the most active research areas in dental implantology. This study was carried out to evaluate the benefits of coating Ti with type I collagen on the osseointegration of dental implants. Acid etched Ti implants (AETi), either untreated or coated with type I collagen (ColTi), were placed in dog mandibles for three and eight weeks for histomorphometric, cellular and molecular evaluations of bone tissue response. While the histological aspects were essentially the same with both implants being surrounded by lamellar bone trabeculae, histomorphometric analysis showed more abundant bone formation in ColTi, mainly at three weeks. Cellular evaluation showed that cells harvested from bone fragments in close contact with ColTi display lower proliferative capacity and higher alkaline phosphatase activity, phenotypic features associated with more differentiated osteoblasts. Confirming these findings, molecular analyses showed that ColTi implants up-regulates the expression of a panel of genes well known as osteoblast markers. Our results present a set of evidences that coating AETi with collagen fastens the osseointegration by stimulating bone formation at the cellular and molecular levels, making this combination of morphological and biochemical modification a promising approach to treat Ti surfaces.

The prosthetic rehabilitation of an atrophic mandible is usually unsatisfactory due to the lack of support tissues, mainly bone and keratinized mucosa for treatment with osseointegrated implants or even conventional prosthesis. The prosthetic instability leads to social and functional limitations and chronic physical trauma decreasing the patient's quality of life. A 53-year-old female patient sought care at our surgical service complaining of impairment of her masticatory function associated with the instability of the lower total prosthetic denture. The clinical and complementary exams revealed edentulism in both arches, while the mandibular arch presented severe reabsorption resulting in denture instability and chronic trauma to the oral mucosa. The proposed treatment plan consisted in the mandibular rehabilitation with osseointegrated implants and fixed Brånemark's protocol prosthesis after mandibular reconstruction applying the modified visor osteotomy technique. The proposed technique offered predictable results for reconstruction of the severely resorbed edentulous mandible and posterior rehabilitation with osseointegrated implants. A reabilitação protética de mandíbulas edêntulas muitas vezes torna-se insatisfatória em função da falta de tecido de suporte para reabilitação com implantes osseointegrágeis ou mesmo próteses totais convencionais. A falta de estabilidade protética ocasiona perda de qualidade de vida, pois geralmente resulta em limitação funcional e transtornos sociais. Este artigo descreve um caso clínico de uma paciente de 53 anos que procurou atendimento em nosso serviço queixando-se de dificuldade em mastigação e instabilidade da prótese total inferior, e apresentando atrofia severa de mandíbula. A reabilitação mandibular foi realizada com prótese fixa do tipo protocolo Brånemark, após cirurgia pré-protética reconstrutora com a utilização da osteotomia em "viseira modificada" e enxerto ósseo autógeno. A técnica proposta ofereceu resultados previsíveis para a reconstrução de mandíbulas severamente reabsorvidas para posterior reabilitação com implantes osseointegráveis.

The surgical removal of impacted maxillary third molars is a procedure routinely carried out by dentists and oral surgeons, and it is usually associated with low rates of complications and morbidity. 1,2 These complications frequently include fracture of the tuberosity, tooth root fracture, perforation of the maxillary sinus, prolapse of the buccal fat pad, and displacement of the roots or tooth into the maxillary sinus, all of which may be easily managed. 2,3 Although the displacement of an entire tooth into the infratemporal fossa was once considered a rare complication, 3 it has been reported more frequently in the literature in the last 4 decades. 1,2,4-11 This case report describes the location and surgical removal of a left maxillary third molar displaced into the infratemporal fossa during an unsuccessful surgical removal by the patient's dental clinician. The diagnostic and treatment problems and the causes of this complication are also discussed.

Purpose The purpose of this study was to assess tobacco use as a risk factor for early implant failure. Materials and Methods To address the research aim, a retrospective study design was used, and a study sample was derived from among patients who had 1 or more implants inserted between July 1996 and July 2004. The main predictor variable was the frequency of tobacco use. The major outcome variable was early implant failure. Appropriate descriptive, bivariate, and multivariate statistics were computed. Results The study sample was composed of 650 patients who had 1,628 implants inserted and were selected for analysis. The early implant loss rates found in the nonsmoking group and the smoking group were 3.32% and 2.81%, respectively. Univariate and bivariate analyses showed no statistical significance for early implant losses associated with the frequency of tobacco use. Conclusions The results of this study suggest that tobacco use alone cannot be considered as a factor for risk related to early implant failures. Prospective studies are needed to assess the risk of early implant failure in conjunction with smoking.