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The position of dental implants is generally verified through imaging exams, even though its use exposes patients to radiation. Intraoral scanning (IOS) may be a suitable alternative to using radiographic imaging to verify implant position. Using polyurethane jaw models, the purpose of this in-vitro study was to measure and compare implant positions determined by IOS and cone-bean computed tomography (CBCT).One hundred twenty implants were installed in 30 edentulous polyurethane jaws, 4 dental implants in each prototype. Four scanbodies were attached to the implants, and a scanning of each mandible was acquired using an intraoral scanner (CS 3600). All prototypes were also submitted to CBCT. Then, the 3D scan files in STL (Standard Tessellation Language) format were superimposed on the DICOM (Digital Imaging and Communications in Medicine) images of the tomographic mandibles. The accuracy of IOS was evaluated by the metric analyses of deviations between the position of the implants projected by the IOS versus the detected tomographically, in which CBCT served as the gold standard, using a free software for digital planning (Bluesky 4 - Grayslake, IL, USA). The following measures were analyzed: radial deviations at the shoulder (Xc) and at the apex of the implants (Xa), height deviation (Xh) and axial deviation. Bland-Altman and a paired t-test were applied to verify the reproducibility between measurements and a t-test for a mean was applied to compare the measurements with zero value.The results showed Xc and Xa deviation means of 0.14 ± 0.09 mm and 0.12 ± 0.12 mm, respectively. The Xh mean was 0.2 ± 0.12 mm and the axial deviation mean was 0.71° ± 0.66°. T-test showed a statistically significant difference when the 4 means were compared to zero value, represented by the CBCT (P .0001).There was a statistically significant difference of the scanned measures compared to CBCT as the standard, but the differences may not be clinically significant. Also, the IOS utilization to evaluate the position of dental implants is a radiation-free and reproducible method, with the advantage of not generating metal artifacts. Further clinical studies are needed to validate this new method of postoperative evaluation.

Introduction:An idiopathic bone cavity of the jaw is a rare pseudocyst with unclear etiology and is most commonly found in the body of the mandible. This lesion is generally asymptomatic and incidentally discovered on dental radiographs. Objetives:The aim of this study is to report the case of a 15-year-old male with surgical treatment of this lesion involving the mandibular symphysis, but the vitality pulp was positive. Conclusion: Although there is a non-surgical or surgical option for the treatment of this lesion, the latter is most indicated due to the possibility of a definitive diagnosis and improving bone repair.

Delayed mandible reconstruction is a challenged situation in Oral and Maxillofacial surgery, due to great quantity of fibrous tissue and quality of covering soft tissue. The virtual surgical planning not only assists in previewing results, it assists in adjust the size and format of bone grafts by means of cutting surgical guides according to the anatomy of regional donor area too. We reported a clinical case a 20-years-old male patient attended to our service presented with segmented mandibular defect. Aiming to perform the procedure with more predictability, accuracy and less morbidity, we planned to remove the anterior portion of the iliac crest bone using a cutting guide computer aided design/computer aided manufacturing which was in accordance with the curvature and the size mandible bone defect.

Made available in DSpace on 2021-06-26T01:23:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 The presence of a tooth in the nasal cavity is a rare condition. There is an even more rare association, which is the presence with the mineral's deposition and formation of rhinoliths. This report shows a case of rare nasal tooth associated with rhinolithiasis and describes its surgical treatment based on an algorithm. The diagnosis was made by endoscopy with the aid of computed tomography, followed by surgical endoscopy excision. The algorithm and the proposed treatment was successful in its execution and the patient presents no complaints or complications at 3 years after surgery. Sao Paulo State Univ, Aracatuba Sch Dent, Dept Diag & Surg, St Jose Bonifacio 1193, BR-16015050 Aracatuba, SP, Brazil Campinas Univ, Campinas Dent Sch, Piracicaba, Brazil Paraiba Fed Univ, Dept Surg, Joao Pessoa, Paraiba, Brazil Sao Paulo State Univ, Aracatuba Sch Dent, Dept Diag & Surg, St Jose Bonifacio 1193, BR-16015050 Aracatuba, SP, Brazil

Introduction Surgically assisted rapid maxillary expansion is a widely used surgical procedure for resolving transverse maxillary occlusal changes in patients with bone maturity. However, few studies about the postoperative morphologic alterations in the nasal cavity in its inferior portion and the nasal septum positioning exist. Methods The linear nasal septum measurements of 26 adult patients treated with surgically assisted rapid maxillary expansion from 2009 to 2013 were assessed through a retrospective analysis of cone-beam computed tomographies, in Digital Imaging and Communications in Medicine files, through the Dolphin Imaging program (Dolphin Imaging and Management Solutions, Chatsworth, Calif), aimed to identify significant changes during 3 time periods of the treatment: preoperative, immediately after the palatal expansion device locking (immediate postoperative), and 6-months postoperative (late postoperative). The analyses were performed in the inferior third of the nasal septum, from 4 equidistant points in anteroposterior position and height, using fixed cranial references for lateral measures of displacement. Results No significant difference was found between preoperative, immediate postoperative, and late postoperative measurements in the 4 fixed nasal septum measurements, applying the analysis of variance test with a significance level of 5%. Comparing the surgical times alone, we found no statistically significant difference between the right and left sides applying the Student t test, which also showed symmetry in the nasal septum. Conclusions The measurements of the nasal septum did not change in the different surgical times throughout their inferior extension, and they remained symmetrical throughout patients’ follow-up period.

SUMMARY: Facial harmony is the consequence of a proper balance between all facial structures. The identification and classification of morphologic characteristics that detract from facial harmony is most effectively accomplished by clinical examination. The maintenance of the ratios between the facial thirds, correct spatial bone position and soft tissues accommodation are all factors that directly contribute in a balanced facial profile. The chin, likewise, contributes significantly in facial balance, mainly in the profile view. Expressive changes on chin position are associated with the perception of strong or delicate characters. Thus, over the years, a series of studies has been constructed focusing on mandibular osteotomies techniques that enable changes in chin position: advances, setback, extrusion, intrusion, widening, narrowing and asymmetry. This study aims to address historical and technical aspects of genioplasty; associating patient's condition with the surgical techniques that can be applied for correction of chin deformities.

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.

PURPOSE: The goal was to perform an orthognathic surgery laboratorial study to evaluate the reproducibility of the resulting movements from virtual surgical planning (VSP), by comparing the measurements obtained from VSP to those obtained from Erickson’s platform using the 3D printed surgical guide. METHODS: Eight patients who had undergone orthognathic surgery were screened and grouped according to maxillary movement and the patient’s dentofacial deformity. Three-D virtual surgery simulations were performed, and surgical guides were obtained using Dolphin Imaging 11.9® software. In a semi-adjustable articulator (SAA), the maxilla model was separated from the SAA mounting platform, and the surgical guide was used to reassemble it. Then, the maxilla model was fixed and transferred to Erickson’s platform to verify the planned movement. The data were submitted for statistical analysis. RESULTS: The agreement between the methods was excellent, regardless of direction, landmark analyzed, or the amount of movement. The most considerable variation was 0.42 mm in the movement amplitude of 6 mm, and the highest mean was 0.07 mm in the region of the superior right first molar (16). CONCLUSION: Therefore, regardless the movement of the maxilla, no statistically significant difference was observed between the measurements obtained through VSP and Erickson’s platform, demonstrating that both methods are equally accurate and reliable.

This present study aimed to retrospectively evaluate the predictability of using three-dimensional models (TDMs) to plan the preoperative lengths of zygomatic implants (ZIs).The records of all patients that received such implants between March 2007 and March 2019 were evaluated. The ZI lengths predicted on the TDMs were compared to the lengths of the implants the patients received.In total, the records of 74 patients were evaluated, of which 37 records met the criteria of inclusion, and were included in the study. Twenty-seven (73%) of the patients were female and 10 (27%) were male, ranging from 34 to 80 years of age, with the average age being 55.7 years. Seventeen (43.2%) of these patients were classified as ASA I and 21 (56.8%) as ASA II. A total of 142 ZIs were planned and installed in the time frame mentioned. Without distinguishing the region of the maxilla, the implants used were, on average, 1.1 mm larger in length than those initially planned.Overall, the data indicates moderate agreement between the planned and surgical lengths of the ZIs and indicates that using TDMs is a predictable and reliable preoperative planning technique of the length of posterior ZIs.

Le Fort I osteotomy is the technique most applied worldwide in the treatment of dentoskeletal deformity involving the maxilla. Even though it is considered a very safe technique with good intra- and postoperative results, many complications have been described. This paper presents a case of carotid jugular fistula developed in a 22-year-old white male submitted to Le Fort I osteotomy for the treatment of anteroposterior maxillary deficiency, and discusses the possible aetiology and management of this serious complication.

The purpose of this retrospective study was to determine postoperative volume differences associated with orthognathic surgery after controlling for time, gender, age, and side of face. Three-dimensional (3D) photographs of 10 patients submitted to simultaneous Le Fort I + Bilateral Sagittal Split osteotomies were analyzed. The images were obtained using a Vectra® M3 device (Canfield, NJ, USA) and were captured postoperatively, at 1 week (1S), 1 month (1M), 2 months (2M), 6 months, (6M) and 1 year (1A). The photo taken at 1A was used as the basis of comparison for the other photos (1S, 1M, 2M, and 6M). Greatest facial volume was observed at 1 week after surgery (42.54 cm3, SD = 29.71 cm3), with men in this period showing higher values (60.20 cm3, SD = 36.75 cm3) than women (30.76 cm3, SD = 19.04 cm3). The most extensive facial volume reduction occurred between the first week and the first month; postoperatively (52.1%). No significant difference was found between age and side groups.

Melanotic neuroectodermal tumor of infancy is a rare and fast-growing neoplasm. In this study, we describe the case of a 6-month-old female patient, who presented swelling in the anterior maxilla. Tomographic reconstruction showed an unilocular hypodense and expansive area associated with the upper right central primary incisor. The presumptive diagnoses were dentigerous cyst, adenomatoid odontogenic tumor, melanotic neuroectodermal tumor of infancy and rhabdomyosarcoma, and an incisional biopsy was performed. Microscopically, the lesion revealed a biphasic cell population, consisting of small, ovoid, neuroblastic-like cells and epithelioid cells containing melanin. Immunohistochemically, the melanocyte-like component was strongly and diffusely positive for HMB-45 and Melan-A, but weakly positive for S100. Based on these findings, definitive diagnosis of melanotic neuroectodermal tumor of infancy was established. Then, enucleation of the lesion was performed by careful curettage. After 2 year follow-up, no clinical or radiographical evidence of recurrence was verified. The present case highlights the importance of early diagnosis and therapeutic intervention at the appropriate time to achieve a favorable outcome for the patient.

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.

Objective: To report an unusual case of oral hyaline ring granuloma (HRG) that caused an extensive osteolytic lesion. Clinical Presentation and Intervention: A 22-year-old female was referred to our hospital with a large expansile cystic lesion in the left mandibular ramus associated with a clinically visible, partially erupted third molar. A diagnosis of paradental cyst was made. After marsupialization of the lesion, histopathological analysis of the surgical specimen showed an unusual exuberant HRG reaction supported by scarce fibrous stroma. Conclusion: This was a case of exuberant HRG reaction that caused extensive bone destruction.

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.

ResumoRecém-nascidos com Sequência de Robin frequentemente apresentam sérias obstruções respiratórias que podem representar riscos à vida resultante de malformações anatómicas (micrognatia, glossoptose e potenciais fendas palatinas). Esses pacientes precisam de medidas terapêuticas imediatas e efectivas. Dessa forma, o objectivo desse trabalho foi fazer uma revisão de literatura sobre a etiopatogenia, principais características e as actuais formas de tratamento empregadas para os portadores dessas alterações estruturais.AbstractNewborns with Pierre-Robin sequence often suffer from serious or even life-threatening obstructions in the respiratory tract resulting from anatomic malformations (micrognathia, glossoptosis and potentially a median cleft palate). Such babies require immediate effective therapeutic measures. Based on these facts, the aim of this article was to make a review of the literature about the etiopathogenesis, clinical characteristics and the current treatments for theses structural alterations.

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.

Frey's syndrome is the occurrence of hyperesthesia, flushing and warmth or sweating over the distribution of the auriculotemporal nerve and/or greater auricular nerve while eating foods that produce a strong salivary stimulus. Frey's syndrome is also known as auriculotemporal syndrome and gustatory sweating. We present a case of Frey's syndrome after a condylar fracture and its treatment by internal rigid fixation. A review of the literature is provided along with mention of a simple test (Minor's test) that can help in the diagnosis of this syndrome. A Síndrome de Frey é compreendida como a ocorrência de hiperestesia, aumento de temperatura e suor na região da distribuição do nervo auriculotemporal e/ou nervo auricular maior, desencadeado pelo simples ato de se alimentar quando existe um grande estímulo salivatório. É também conhecida como Síndrome Auriculotemporal e Suor Gustatório. Esse artigo identifica um caso de Síndrome de Frey após fratura de côndilo mandibular que foi tratada com fixação interna rígida. Adicionalmente esta revisão da literatura detalha um teste simples (teste de Minor) que pode auxiliar no diagnostico desta síndrome.

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.

A myriad of titanium (Ti) surface modifications has been proposed to hasten the osseointegration. In this context, the aim of this study was to perform histomorphometric, cellular, and molecular analyses of the bone tissue grown in close contact with Ti implants treated by anodic spark deposition (ASD-AK). Acid-etched (AE) Ti implants either untreated or submitted to ASD-AK were placed into dog mandibles and retrieved at 3 and 8 weeks. It was noticed that both implants, AE and ASD-AK, were osseointegrated at 3 and 8 weeks. Histomorphometric analysis showed differences between treatments only for bone-to-implant contact, being higher on AE implants. Although not backed by histomorphometric results, gene expression of key bone markers was higher for bone grown in close contact with ASD-AK and for cells harvested from these fragments and cultured until subconfluence. Cell proliferation at days 7 and 10 and alkaline phosphatase activity at day 10 was higher on AE surfaces. No statistical significant difference was noticed for extracellular matrix mineralization at 17 days. Our results have shown that the Ti fixtures treated by ASD-AK allowed in vivo osseointegration and induced higher expression of key markers of osteoblast phenotype, suggesting that this surface treatment could be considered to produce implants for clinical applications.

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.

Systemic lupus erythematosus (SLE) is a disease of unknown origin that can affect organs and cause severe damage. Lupus is diagnosed through biopsies and laboratory examinations; however, certain clinical characteristics and the presence of lesions can help with early diagnosis and improve the disease prognosis. SLE patients generally receive immunosuppressants that may cause systemic implications---such as suture dehiscence, increased risk of infection, and delayed healing--that deserve specific attention during dental treatment. This article presents a case of a SLE patient with oral manifestations: ulcerative lesions in the mouth and development of lupus nephritis. This article seeks to emphasize the importance of recognizing the lesions related to SLE, which may help the dentist to establish an early diagnosis.

Orientador: Roger William Fernandes Moreira Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba Resumo: A instalação de implantes na região posterior da maxila várias vezes é confrontada com processos alveolares reabsorvidos, resultantes de uma combinação da pneumatização do seio maxilar, dos efeitos da doença periodontal, e do processo de reabsorção óssea fisiológica resultante da falta de estímulo funcional que sucede as exodontias. A elevação do assoalho do seio maxilar vem sendo praticada desde 1980 com o objetivo de aumentar a altura óssea nessa região para uma reabilitação protética suportada por implantes, e para tal vem sendo utilizados vários materiais de preenchimento. O presente estudo teve como objetivo avaliar clinica e radiograficamente o comportamento do Cimento de Fosfato de Cálcio (CFC) utilizado como material de preenchimento em cirurgias de elevação de seio maxilar. Foram operados 10 pacientes não-fumantes e sem alterações sistêmicas, que necessitavam de enxerto em seio maxilar para futura colocação de implantes osseointegráveis. Após um período que variou de 9 a 16 meses, foi realizada avaliação clínica da área enxertada e biópsia com broca trefina de 2mm de diâmetro, em região adjacente ao eixo do implante a ser inserido. Clinicamente, pôde-se observar que não houve reabsorção/substituição do material por osso, o material ainda encontrava-se presente e bem compacto, porém com extremamente friável. Foi possível na macroscopia visualizar no espécime o osso nascente e sua interface com o material. Apesar de nenhum paciente ter tido complicações pós-operatórias e o material ter apresentado características totalmente biocompatíveis, não foi possível a colocação de nenhum implante nos sítios com o material, devido a não formação óssea e sua facilidade em sofrer friabilidade. Foi possível concluir que o cimento de fosfato de cálcio não promove neoformação ósseas quando utilizado como material de preenchimento para elevações de assoalho de seio maxilar visando à reabilitação com implantes dentários e que a radiografia panorâmica não é um método confiável para avaliar o possível ganho ósseo com o emprego do biomaterial. Abstract: Implant placement in the posterior maxilla is frequently challenged by resorbed alveolar processes due to a combination of maxillary sinus pneumatization, the effects of periodontal disease and the physiological bone resorption following tooth extractions. The sinus floor augmentation surgery has been performed since 1980 with the purpose of increasing bone height in this region, allowing implant-supported prosthetic rehabilitation. In the literature a various materials are used for fulfilling in the maxillary sinus litf. The present study aimed evaluate radiography and clinically the calcium phosphate cement (CFC) used as material of fulfilling in sinus lift surgery. Ten non-smoking and systemically healthy patients who needed maxillary sinus grafting for the placement of dental implants were operated. In a second surgical intervention, After a period that various of 9 the 16 months, the implant placement was preceded by clinical evaluation and biopsy of the lateral sinus wall using with a 2 mm diameter trefine bur, in the region of the bone wall created in the sinus lift procedure. Clinically, it could be observed that substitution/resorbable of the material for bone did not have, the material still met present and well compact. It was possible to visualize clearly in the specimen the native bone and its interface with the material. Although no patient to have had postoperative complications and the material to have presented biocompatible characteristics, was not possible the placement of the dental implants, which had not the new bone formation. According the methodology applied was possible to conclude that the calcium phosphate cement does not promote new bone formation when used as material of fulfilling sinus lift surgeries aiming the placement of dental implant rehabilitation and that the panoramic x-ray is not a greatest method to evaluate the possible osseous grow with the biomaterial. Doutorado Cirurgia e Traumatologia Buco-Maxilo-Faciais Doutor em Clínica Odontológica

A Síndrome da Apnéia Obstrutiva do Sono (SAOS) é uma doença incapacitante associada a altos índices de morbidade. O problema afeta 2 a 3% dos homens entre 40 e 65 anos de idade e 2% das mulheres após a menopausa. A obesidade é um fator predisponente para esta doença e a totalidade dos pacientes apresenta episódios de ronco noturno.Os principais sinais e sintomas da SAOS são o sono não reparador e agitado, sonolência diurna, cefaléia e distúrbios comportamentais. A longo prazo os efeitos desta doença incluem o surgimento de doenças cardiovasculares que, em última instância, irão diminuir a expectativa de vida dos pacientes que porventura não receberem nenhum tipo de tratamento.O diagnóstico da SAOS é feito com base nos achados clínicos e no exame de polissonografia. De acordo com a quantidade de episódios de apnéia durante o sono, esta pode ser classificada em leve, moderada e grave.O tratamento desta condição varia de acordo com a gravidade e com a identificação/eliminação de possíveis agentes etiológicos. De forma geral, os casos de apnéia leve e moderada são tratados de forma conservadora. Já os casos de apnéia grave requerem algum tipo de intervenção cirúrgica, sendo que a cirurgia ortognática ocupa lugar de destaque, tanto pela efetividade a longo prazo quanto pela previsibilidadeO objetivo deste trabalho é apresentar o caso clínico de uma paciente de 52 anos portadora de Síndrome da Apnéia Obstrutiva do Sono grave a qual foi submetida cirurgia ortgnática para avanço do complexo maxilo-mandibular. Os resultados obtidos serão discutidos e a literatura pertinente será apresentada.

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.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:41:12Z No. of bitstreams: 1 S1517-74912001000200009.pdf: 85663 bytes, checksum: 192fae1f2d92006bdb39cccc44845b5f (MD5) Made available in DSpace on 2013-08-22T18:41:12Z (GMT). No. of bitstreams: 1 S1517-74912001000200009.pdf: 85663 bytes, checksum: 192fae1f2d92006bdb39cccc44845b5f (MD5) Previous issue date: 2001-06-01 Made available in DSpace on 2013-09-30T19:27:36Z (GMT). No. of bitstreams: 2 S1517-74912001000200009.pdf: 85663 bytes, checksum: 192fae1f2d92006bdb39cccc44845b5f (MD5) S1517-74912001000200009.pdf.txt: 22141 bytes, checksum: bea3c3cfbf6b87f83d7830555817e63f (MD5) Previous issue date: 2001-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:45:12Z No. of bitstreams: 2 S1517-74912001000200009.pdf: 85663 bytes, checksum: 192fae1f2d92006bdb39cccc44845b5f (MD5) S1517-74912001000200009.pdf.txt: 22141 bytes, checksum: bea3c3cfbf6b87f83d7830555817e63f (MD5) Made available in DSpace on 2014-05-20T13:45:12Z (GMT). No. of bitstreams: 2 S1517-74912001000200009.pdf: 85663 bytes, checksum: 192fae1f2d92006bdb39cccc44845b5f (MD5) S1517-74912001000200009.pdf.txt: 22141 bytes, checksum: bea3c3cfbf6b87f83d7830555817e63f (MD5) Previous issue date: 2001-06-01 A proposta do presente estudo foi de analisar, através de análise cefalométrica por telerradiografias de perfil, a altura óssea na região mandibular anterior após a realização de vestibuloplastia pela técnica de inversão de retalhos. Foram avaliados 13 pacientes (8 mulheres e 5 homens), com média igual a 54,3 anos que apresentavam, em média, 25,01 mm de altura mandibular anterior. As medidas foram obtidas utilizando-se traçado cefalométrico e comparando-se o período pré-operatório com os períodos pós-operatórios, que consistiram de 30, 90 e 180 dias. Durante o período analisado, houve uma redução da altura mandibular anterior, estatisticamente não significante, de 0,6 mm. The aim of this study was to determine, through cephalometric analysis, the anterior height of the mandible after vestibuloplasty through the lipswitch technique. Thirteen patients (8 women and 5 men) with ages between 32 and 77 years (mean age of 54.3 years) were evaluated. The postoperative periods were 30, 90 and 180 days. During this time there was a reduction of 0.6 mm in the anterior height of the mandible, which was not significant. Universidade de São Paulo Faculdade de Odontologia de Ribeirão Preto Disciplina de Cirurgia Universidade de São Paulo Faculdade de Odontologia de Ribeirão Preto Universidade Estadual Paulista Faculdade de Odontologia de Araraquara Disciplina de Cirurgia Universidade Estadual Paulista Faculdade de Odontologia de Araraquara Disciplina de Cirurgia