Search

Introdução: A Odontologia possui um amplo campo de atuação, exercida em âmbito ambulatorial e hospitalar. Por conseguinte, seus limites de trabalho confluem-se com a área médica, levando a indagações quanto às atribuições que já possuem previsão legal para cada uma das profissões. Esse tipo de situação é comum e ocorre, principal- mente, em circunstâncias de urgências e emergências, sejam essas ambulatoriais ou hospitalares. Método: Visando esclarecer o que compete a cada um desses profissionais no momento do atendimento emergencial, com enfoque no ambiente hospitalar, o presente trabalho realizou um estudo transversal, retrospectivo, da literatura nacional e internacional, entre 2000 e 2017, nas bases PubMed, Bireme, SciELO e Lilacs. Resultados: A partir da avaliação de 6 artigos, 5 livros, 2 leis e 4 resoluções, pôde-se verificar que, desses, 10 referiram que os limites são definidos a partir dos aspectos de complexidade e 7 dispuseram que a atuação se refere à formação específica de cada área. Conclusão: O trabalho multidisciplinar, descentralizado da pretensa figura hegemônica médica, é o mecanismo para que essas lacunas sejam preenchidas e se possa realizar um atendimento médico-odontológico responsável, salvaguardando o bem mais precioso: a vida do paciente.

In this experimental protocol, the objective was to evaluate the biological behavior of two xenogenic scaffolds in alcohol-induced rats through histomorphometric and Picrosirius Red staining analysis of non-critical defects in the tibia of rats submitted or not to alcohol ingestion at 25% v/v. Eighty male rats were randomly divided into four groups (n = 20 each): CG/B (water diet + Bio-Oss® graft, Geistlich Pharma AG, Wolhusen, Switzerland), CG/O (water diet + OrthoGen® graft, Baumer, Mogi Mirim, Brazil), AG/B (25% v/v alcohol diet + Bio-Oss® graft), and AG/O (25% v/v alcohol diet + OrthoGen® graft). After 90 days of liquid diet, the rats were surgically obtained, with a defect in the tibia proximal epiphysis; filled in according to their respective groups; and euthanized at 10, 20, 40 and 60 days. In two initial periods (10 and 20 days), all groups presented biomaterial particles surrounded by disorganized collagen fibrils. Alcoholic animals (AG/B and AG/O) presented, in the cortical and medullary regions, a reactive tissue with inflammatory infiltrate. In 60 days, in the superficial area of the surgical cavities, particles of biomaterials were observed in all groups, with new compact bone tissue around them, without complete closure of the lesion, except in non-alcoholic animals treated with Bio-Oss® xenograft (CG/B), where the new cortical interconnected the edges of the defect. Birefringence transition was observed in the histochemical analysis of collagen fibers by Picrosirius Red, in which all groups in periods of 10 and 20 days showed red-orange birefringence, and from 40 days onwards greenish-yellow birefringence, which demonstrates the characteristic transition from the formation of thin and disorganized collagen fibers initially to more organized and thicker later. In histomorphometric analysis, at 60 days, CG/B had the highest volume density of new bone (32.9 ± 1.15) and AG/O the lowest volume density of new bone (15.32 ± 1.71). It can be concluded that the bone neoformation occurred in the defects that received the two biomaterials, in all periods, but the Bio-Oss® was superior in the results, with its groups CG/B and AG/B displaying greater bone formation (32.9 ± 1.15 and 22.74 ± 1.15, respectively) compared to the OrthoGen® CG/O and AG/O groups (20.66 ± 2.12 and 15.32 ± 1.71, respectively), and that the alcoholic diet interfered negatively in the repair process and in the percentage of new bone formed.

Introduction. This report aims at demonstrating the treatment of complex mandibular fracture functional reimplantation of the maxillary alveolar fragment (FRAF), denoting the possibility and feasibility of this reduction with an excellent prognosis. Case Report. Patient E.M.S, 25 years old, male, leucoderma, referred to the Emergency Room of our institute. He reported being a victim of physical aggression, occlusal alteration, limitation of mouth opening, sensibility loss in the mentalis region, right infraorbital, and denied visual alteration. On physical examination, during the inspection and palpation, the crackling was observed in the right mandibular region and apical displacement of the maxillary alveolar process, corresponding to elements 13, 14, and 15. Conclusion. The rigid fixation of the complex jaw fracture and alveolar maxilla process, through functional reduction, indicated satisfactory applicability, and favorable prognosis.

A osteoporose é um distúrbio esquelético que afeta a densidade do tecido ósseo e predispõe a fraturas patológicas devido ao aumento da fragilidade. O tratamento desta condição se dá através do uso de medicamentos que podem induzir a osteonecrose dos maxilares devido a sua interferência na osteoclastogênese, por vezes com exposição e sequestro desse osso necrótico. Dessa forma, o objetivo desse trabalho é um relato de caso de uma paciente, de 63 anos de idade, sob tratamento de osteoporose com alendronato de sódio por aproximadamente 10 anos, que apresentou perda dos implantes dentários devido a ocorrência de osteonecrose dos maxilares, a qual foi descoberta após tentativa de reabilitação. A paciente passou por remoção dos implantes, curetagem dos sequestros ósseos e remoção dos tecidos moles friáveis. Após 60 dias, a mesma apresentou-se com a mucosa fechada e normocorada, com ausência de exposição de tecido ósseo e dor. O que evidencia que a sequestrectomia pode ser utilizada para tratamento de MRONJ de modo efetivo e mostra a importância do reconhecimento dos fatores relacionados ao desenvolvimento desta alteração do metabolismo ósseo e suas implicações para realização de terapias reabilitadoras. Entretanto, é imperativo que os profissionais estejam atentos as possíveis alterações do tecido ósseo e do tecido mole de recobrimento, tendo em vista a meia vida longa desses medicamentos.

Because of the anterior disposition on the face and the fragility of the anatomy, the mandible is commonly affected in facial fractures, and the angle region represents 32% of the mandibular fractures; therefore, the objective of the paper was to present a proposal for late correction of the mandibular fracture already consolidated and with occlusal alteration. Patient J.C.P.R., 32, during anamnesis reported loss of sensibility in the mentalis region as well as unilateral posterior open bite for having been a victim of an automobile accident about 1 year and 3 months ago. Physical examination showed elevation in the right mandibular angle region due to the poor positioning of fractured stumps. It has been found that the patient suffered a simple fracture at the mandibular angle, but that had not been treated previously, and it was necessary to treat the fracture sequel. Refraction was performed with a new reduction and fixation through titanium plates and screws, showing that, even being late, the procedure to reduce the fracture sequela was effective, even with the correct functional occlusal adjustment.

Adenomatoid Odontogenic Tumor (AOT) was considered a variant of the ameloblastoma, being called “adenoameloblastoma”; however, its clinical characteristics and biological behavior indicate that it is a separate entity. It has probable origin of the remnants of the dental blade. Patient EWRO, male, 16 years old, leucoderma, in routine care by the orthodontist, presented a radiolucent, sclerotic borders image, inverted drop shape, between the canine and the lateral incisor and superiorly the margim the floor of the nasal cavity, in addition to superficially, expanding the vestibular wall compromising its integrity suggesting injury. The patient was referred to the Bucomaxillofacial Surgery and Traumatology Service of the Hospital Beneficencia Portuguesa de Bauru. After completing a clinical and complementary examination, the patient had a diagnostic hiphotesys of AOT, and the Partsch II Technique with Immediate Suture was recommended for removal. Although presenting confused diagnosis to the clinical dentist surgeon, the AOT has peculiar features and invasive surgical treatment, since its removal is brief and the correct surgical care is an injury of unlikely recurrence and possible rehabilitation.

Aim Acceptable facial aesthetics is a common desire among patients presenting with dentofacial deformities planning to undergo orthognathic surgeries. Thus, professionals must be alert to their patients’ complaints as well as their desires regarding facial morphology, because this is quite subjective and personal. This research aimed at evaluating the different views of orthodontists and oral maxillofacial surgeons regarding the facial analysis of patients who undergo orthognathic surgery. Methods Thirty individuals were selected with a minimum postoperative period of 6 months and photographed in the frontal and profile norm. Facial morphology characteristics were recorded to observe the agreement of the assessments of four professionals (two orthodontists and two surgeons). Results A significant agreement was seen between the orthodontists regarding the nasolabial angle (80%). In the frontal analysis, the agreement percentage (60%) between orthodontists and surgeons was considerable regarding facial asymmetry assessment. Conclusions Professionals must keep alert to facial analysis, especially in terms of tegumental harmony, for the orthognathic surgery to reestablish, satisfactorily, the facial aesthetics in all parameters set.

Made available in DSpace on 2016-01-28T16:53:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2013. Added 1 bitstream(s) on 2016-01-28T17:01:02Z : No. of bitstreams: 1 ISSN2179-233X-2013-02-02-18-22-en.pdf: 662295 bytes, checksum: 75d99c7dfa3e8a4be46946ef749e5ac0 (MD5). Added 1 bitstream(s) on 2016-01-28T17:01:02Z : No. of bitstreams: 2 ISSN2179-233X-2013-02-02-18-22-en.pdf: 662295 bytes, checksum: 75d99c7dfa3e8a4be46946ef749e5ac0 (MD5) ISSN2179-233X-2013-02-02-18-22-pt.pdf: 678304 bytes, checksum: ed9da528462ab5c95fa420b217ec76d2 (MD5) Fundamentação: A correção das deficiências transversais da maxila envolve procedimentos ortodônticos e cirúrgicos, que podem ser realizados antes ou após a maturidade esquelética. A expansão rápida da maxila cirurgicamente assistida (ER MCA) é realizada por meio de osteotomias nas paredes laterais da maxila, pilares zigomáticos e caninos, sutura palatina mediana e sutura pterigomaxilar, ocasionando a disjunção maxilar. Seguido da ativação do aparelho expansor até a sobre-expansão desejada visando a correta intercuspidação posteriormente. Objetivo: O propósito deste trabalho foi discutir a respeito do diagnóstico da atresia maxilar, bem como as indicações e a técnica cirúrgica da ER MCA, por meio de caso clínico. Métodos: Paciente do sexo masculino, 19 anos de idade, apresentava severa deficiência transversal da maxila, com padrão facial III , Classe III , com grande incompetência labial. O mesmo se submeteu a ER MCA sob anestesia geral, em ambiente hospitalar, pela técnica descrita por Epker e Wolford (1980). No pós-operatório, o paciente realizou as ativações diárias por 15 dias e após 6 meses, o ortodontista instalou aparelho fixo e prosseguiu com a mecânica ortodôntica para posterior Cirurgia Ortognática. Conclusão: O diagnóstico por meio da avaliação clínica e dos modelos de estudo é essencial para a indicação da ER MCA e este procedimento proporciona boa previsibilidade na correção da deficiência transversal, com mínima morbidade. Fundamentation: The correction of maxillary transverse deficiencies involves orthodontic and surgical procedures that can be performed before or after skeletal maturity. The surgically assisted rapid maxillary expansion (SAR ME) is performed by osteotomies through the lateral walls of the maxilla, zygomatic and canines buttresses, palatal and pterygomaxillary sutures, causing the maxillary disjunction. Followed by activation of the expander to the desired over-expansion in order to correct intercuspal later. Objective: The purpose of this study was to discuss the issues involved in the diagnosis of maxillary atresia, SAR ME indications, as well as surgical technique, through a case study. Methods: The male patient, 19 years old, had severe transverse maxillary deficiency with facial pattern III , Class III , with great lip incompetence. The patient underwent general anesthesia in a hospital environment, the osteotomies was done according to the technique described by Epker and Wolford (1980). Postoperatively, the patient underwent activations daily for 15 days and after 6 months, the orthodontist installed fixed orthodontic appliance to prepare the patient to orthognathic surgery later. Conclusion: The diagnosis by clinical evaluation and models study is essential for the indication of SAR ME and this procedure provides good predictability in the correction of transverse deficiency, with minimal morbidity. Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Faculdade de Odontologia de Araçatuba (FOA), Departamento de Cirurgia e Clínica Integrada, Rua José Bonifácio, 1193 - Prédio 10A, Vila Mendonça, CEP 16015-050, Araçatuba, SP, Brasil Residência em Cirurgia e Traumatologia Buco Maxilo Facial, Associação Hospitalar de Bauru, Bauru, SP, Brasil Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Faculdade de Odontologia de Araçatuba (FOA), Departamento de Cirurgia e Clínica Integrada, Rua José Bonifácio, 1193 - Prédio 10A, Vila Mendonça, CEP 16015-050, Araçatuba, SP, Brasil

Procedures for the surgical correction of dentofacial deformities may produce important complications, whether due to the potential for vascular injury or to prolonged surgery, both of which may lead to severe blood loss. Fluid replacement with crystalloid, colloid, or even blood products may be required. The aim of this study was to assess blood loss and transfusion requirements in 45 patients (18 males and 27 females; mean age 29.29 years, range 16–52 years) undergoing orthognathic surgery, assigned to one of two groups according to procedure type—rapid maxillary expansion or double-jaw orthognathic surgery. Preoperative hemoglobin and hematocrit levels and intraoperative blood loss were measured. There was a substantial individual variation in pre- and postoperative hemoglobin values (10.3–17 and 8.8–15.4 g/dL, respectively; p < 0.05). Mean hematocrit values were 41.53 % preoperatively (range 31.3–50.0 %) and 36.56 % postoperatively (range 25–43.8 %) (p < 0.05). Mean blood loss was 274.60 mL (range 45–855 mL). Only two patients required blood transfusion. Although blood loss and transfusion requirements were minimal in the present study, surgical teams should monitor the duration of surgery and follow meticulous protocols to minimize the risks.

Made available in DSpace on 2016-01-28T16:53:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2014. Added 1 bitstream(s) on 2016-01-28T17:00:54Z : No. of bitstreams: 1 S0100-69912014000100061-en.pdf: 2179981 bytes, checksum: 5c22c986cb95b96d381908e2c6c7ed88 (MD5). Added 1 bitstream(s) on 2016-01-28T17:00:54Z : No. of bitstreams: 2 S0100-69912014000100061-en.pdf: 2179981 bytes, checksum: 5c22c986cb95b96d381908e2c6c7ed88 (MD5) S0100-69912014000100061-pt.pdf: 2182100 bytes, checksum: bea5d73a19a30566d8e85cc211332874 (MD5) Para a reabilitação bucal com as próteses implantossuportadas é necessário a realização de procedimentos para criar o volume ósseo necessário para a instalação dos implantes. Com isso, os enxertos ósseos provenientes de áreas doadoras intrabucais ou extrabucais, representam uma possibilidade bastante favorável. O presente trabalho objetivou realizar uma revisão da literatura em que procurou discutir parâmetros para as indicações, as vantagens e complicações para as técnicas dos enxertos ósseos autógenos. For oral rehabilitation with implant-supported prostheses, there are required procedures to create the bone volume needed for installation of the implants. Thus, bone grafts from intraoral or extraoral donor sites represent a very favorable opportunity. This study aimed to review the literature on the subject, seeking to discuss parameters for the indications, advantages and complications of techniques for autogenous bone grafts. Universidade Estadual Paulista, Departamento de Cirurgia e Clínica Integrada, Faculdade de Odontologia de Araçatuba

The present study aimed at reporting a clinical and surgical case of bilateral coronoidectomy, using an intraoral approach. The patient is a 26-year-old man, who sought attendance complaining of a gradual reduction of his oral opening in the past 3 years; however, he had an aggravation in the last 2 months. After clinical examination and imaging evaluation, the diagnosis of coronoid process hyperplasia was confirmed, and the surgical treatment was proposed. Under general anesthesia, with nasotracheal intubation guided by a nasofiberendoscope, using an intraoral approach, the bilateral coronoidectomy was performed. In the immediate postoperative period, an increase of the buccal opening measured 29 mm, representing an enhancement of 11 mm, and in the 30th postoperative day, it measured 31.12 mm. During the clinical follow-up period, a reestablishment of the mandibular movements was observed. Therefore, coronoidectomy by an intraoral approach and the physiotherapy performed in the postoperative period were efficient procedures.

ResumoA expansão rápida de maxila apresenta alto índice de insucesso se realizada em pacientes com idade esquelética avançada, sendo indicada apenas àqueles com maturidade óssea incompleta. As aplicações das técnicas ortodônticas- cirúrgicas possibilitam a correcção de deformidades transversais em pacientes adultos com uma previsibilidade bastante aceitável e com poucos relatos de complicações, tornando-se uma excelente escolha de tratamento para estes pacientes. Uma breve revisão de literatura e a apresentação de um caso clínico-cirúrgico tratado no Serviço de Cirurgia e Traumatologia Buco-Maxilo-Faciais do Hospital de Base de Bauru, São Paulo, Brasil é demonstrado neste artigo, com as vantagens, indicações e técnica cirúrgicas sendo discutidas.AbstractThe rapid expansion of the maxilla presents a high index of failure if carry out in patients with increased age, being indicated only to those with incomplete bone formation. The surgical-orthodontic technique makes the correction of maxillary transversal deformities in adult patients possible, with a sufficiently acceptable previsibility and few cases of complications, becoming an excellent choice of treatment for these patients. A literature review and the presentation of a surgical case treated at the Service of Oral and Maxillofacial Surgery at Base Hospital in Bauru, São Paulo, Brazil is demonstrated in this article, with the advantages, surgical indications and technique being argued.