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Pycnodysostosis is a rare, autosomal recessive genetic condition, which causes a decrease in bone remodeling, resulting in different clinical and radiographic manifestations. This case series aims to describe two clinical cases diagnosed at the Department of Oral and Maxillofacial Surgery and Traumatology of a University on the Northeast of Brazil. There are two complex cases involving osteomyelitis and dental and bone alterations of the jaws. It is concluded that the knowledge of oral and maxillofacial characteristics of this syndrome are required to plan appropriate treatment for patient in order to avoid complications of dental treatments due to inadequate bone remodeling.

A 40-year-old female patient attended the oral and maxillofacial surgery service with complaint of an increase in volume in the anterior region of the mandible. With a time of evolution of 6 months, the region of the lesion presented blue coloration, hardened consistency, and painful symptomatology, measuring approximately 4 cm. Displacement of dental elements (31, 32, and 33) was evidenced. Radiographically, a multilocular radiolucent osteolytic lesion was observed. Diagnostic hypotheses were given for odontogenic keratocysts and botryoid cyst. The incisional biopsy was performed, obtaining the histopathologic diagnosis of glandular odontogenic cyst. The patient was submitted to excisional biopsy, confirming the previous histopathologic diagnosis. Due to the aggressiveness and the high recurrence rate inherent to this lesion, segmental resection of the lesion was performed, followed by block graft reconstruction. This case highlights the importance of an effective diagnosis to provide adequate treatment and absence of relapses.

Pycnodysostosis is a rare, autosomal recessive genetic condition that causes a decrease in bone remodeling due to a mutation in the cathepsin K gene, resulting in clinical and radiographic manifestations, characteristic of the syndrome. This report aims to describe 2 clinical cases of pycnodysostosis with orofacial involvement. The patients had a short stature, height ranging from 134 cm to 152 cm, stunted extremities, open fontanelles and cranial sutures, osteosclerosis, and medical history of repeated fractures in the left tibia, associated with small impact traumas. In the buccomaxillofacial complex, absence of pneumatization of the facial sinuses, maxillary osteomyelitis after dental extraction, maxillary atresia, increased mandibular angle, and enamel hypoplasia were related. It is concluded that the knowledge of clinical, radiographic, and oral and maxillofacial findings of this syndrome are important for the diagnosis and treatment of patients in the multiprofessional context, thus avoiding complications arising from dental procedures.

The glandular odontogenic cyst (GOC) is an uncommon developmental cyst that presents glandular differentiation and has potential for recurrence. Clinically, it is asymptomatic and it has slow growing. This report proposes to describe a clinical case of GOC diagnosed at the Service of Pathological Anatomy of a university in the northeast of Brazil, in the posterior region of the mandible, which was treated with mandibular resection and bone graft with iliac crest. One may conclude that clinical, microscopic and radiographic parameters were crucial tools for treatment choice.

A 22-year-old female patient attended the service of Oral Maxillofacial Surgery of UFRN, with anatomopathologic report of solid ameloblastoma. On physical examination, the patient presented discrete volume increase in the posterior region of right mandible, satisfactory buccal opening, and preserved inferior alveolar nerve integrity. At tomographic examination, osteolytic lesion can be observed, located in branch, angle, and right mandibular body, approximately 6 cm in its largest diameter. Mandibular reconstruction with unilateral mandibular prosthesis was planned, but it had to be authorized. She underwent a first surgical procedure for resection of the lesion and installation of reconstruction plaque of 2.4-mm system. After 6 months, the plaque was removed from the reconstruction and disarticulation of proximal segment for the installation of a prototyped mandibular prosthesis. The patient evolved in the postoperative period of 3 years presenting mandibular contour, mandibular movements, and preserved facial mime, including a total social reinsertion.

Juvenile ossifying fibroma is a benign fibro-osseous neoplasm of mesenchymal origin that affects young individuals and has an aggressive clinical behavior with high rates of recurrence. A 5-year-old female patient presented intraosseous growth, approximately 1.5 cm in size, normochromic, hard in consistency, sessile, with painful symptoms and 1-month of evolution. Imaging examination revealed well-delimited hypodense lesion and buccal and lingual cortical expansion. The patient had already performed an incisional biopsy with ossifying fibroma diagnosis. Then, an excisional biopsy was accomplished in association with local bone curettage. Microscopic examination showed fusiform and oval mesenchymal cell proliferation. There was deposition of numerous bone trabeculae with varying degrees of maturation, exhibiting prominent osteoblastic paving. After 1 year, the patient is still on regular follow-up, with no signs of recurrence.

The glandular odontogenic cyst (GOC) is a cyst of unusual development, with glandular differentiation and potential for recurrence. This report proposes the description of a clinical case of GOC in the posterior region of the mandible exhibiting slight asymmetry to the extra-oral physical examination, multilocular radiographic appearance, expansion of the cortical bone, and reabsorption of involved teeth. An incisional biopsy and anatomopathologic examination were performed. Seven criteria for diagnosis of GOC according to the World Health Organization (2017) were found, and 4 criteria were indicative of aggression and recurrence. In view of the aggressive behavior of these lesions, the indicated treatment was mandibular resection associated with bone graft of the iliac crest. Currently, the patient is being followed up with no signs of relapse for 2 years. It is concluded that clinical, microscopic, and radiographic parameters are useful tools in the prognosis of GOC and should be evaluated in the therapeutic choice to avoid relapses.

The calcifying odontogenic cyst (COC) is a benign odontogenic cyst that occurs in the gnathic bones. This cyst is part of a spectrum of lesions characterized by odontogenic epithelium containing “ghost cells,” which may undergo calcification. Areas of an eosinophilic matrix material compatible dentinoid also may present adjacent to the epithelial component. However, these areas of dentinoid commonly do not appear so abundant in COCs. In this study, we report a case of intraosseous COC with extensive areas of dentinoid and perform an update regarding the clinical, radiographical, histopathological, and differential diagnosis, treatment, and prognosis of this cystic lesion.

Background: This study aimed to evaluate patients undergoing placement of zygomatic implants by Stella and Warner’s technique, considering the survival rate of conventional and zygomatic implants, and assess the health of the maxillary sinuses and the level of patient satisfaction. Methods: In this retrospective cohort study, 28 patients had received a combination of conventional and zygomatic implants (group I) and 14 were rehabilitated with only conventional implants (group II). Results: The results showed that Stella and Warner’s technique, thought to minimize the presence of the implant into the maxillary sinus, improving the emergence of the implant, proved to be effective, allowing a high survival rate of conventional and zygomatic implants (100 %). The follow-up period ranged from a minimum of 15 months to a maximum of 53 months after prosthetic rehabilitation (average of 34 months). No pathological changes were found on the periimplant tissues. Radiographs showed satisfactory bone levels in conventional implants of oral rehabilitation with zygomatic implants and a good positioning of the apex of the zygomatic implants in relation to the zygomaticbone. The tomographic findings revealed no characteristics of sinus disease. There were no cases of obstruction of the maxillary sinus ostium. Conclusions: The placement of zygomatic implants by Stella and Warner’s technique proved to be a predictable technique with high implant survival rate in patients with atrophic maxilla and was not associated with sinus disease in the sample analyzed. However, a long-term follow-up is necessary to confirm the initial findings of this study.

The aim of this study was to evaluate, in vitro, the bending strength of internal fixation with absorbable and metallic screws in mandibular ramus sagittal split osteotomy in sheep hemimandibles. The screws were inserted as lag screws, with an inverted "L" configuration, and the set was submitted to bending strength tests. The load and displacement of the peak and final load averages were, respectively, 18.45 kgf, 8.19 mm and 14.38 kgf for Group I, and 16.67 kgf, 6.73 mm and 13.98 kgf for Group II. The results were submitted to statistical analysis by Student’s t test and by the Pearson correlation analysis. The groups showed no statistically significant differences, indicating the feasibility of both for osteosynthesis in mandibular ramus sagittal split osteotomies.O objetivo deste estudo foi avaliar, in vitro, a resistência à flexão da fixação interna, através do uso de parafusos absorvíveis e metálicos, na osteotomia sagital do ramo em hemimandíbulas de carneiros. Os parafusos foram inseridos como "lag screw", com configuração em "L" invertido e o conjunto submetido ao teste de resistência à flexão. As médias da carga e do deslocamento do pico e da carga final do Grupo I foram de 18,45 kgf, 8,19 mm e 14,38 kgf, e do Grupo II de 16,67 kgf, 6,73 mm e 13,98 kgf, respectivamente. Os resultados foram submetidos à análise estatística pelo teste t de Student e pela análise de correlação de Pearson. Os grupos exibiram diferenças estatisticamente não significativas, indicando a viabilidade de ambos para a osteossíntese em osteotomias sagitais do ramo mandibular.

Purpose This descriptive analytical study evaluated the cause, type, incidence, demographic, and treatment data of zygomatico-orbital complex and zygomatic arch fractures managed at our program during a 5-year period. Patients and Methods A total of 1,857 charts of patients presenting maxillofacial trauma and treated by the Division of Oral and Maxillofacial Surgery, from the Piracicaba Dental School (UNICAMP), were reviewed. A total of 371 patients presented with zygomatico-orbital complex and/or zygomatic arch fractures. Patients with isolated orbital fractures were excluded. The patients ranged in age from 2 to 88 years. Epidemiological data including age, gender, etiology, site of injury, and details of treatment were collected and tabulated in Excel software (Microsoft). All maxillofacial injuries were assessed and treated by residents and staff surgeons. Other concomitant bodily injuries were treated by pertinent consulting specialists. Results The majority of fractures were sustained by males between 21 and 40 years old, usually resulting from falls, altercations, and bicycle accidents. Unilateral fractures of zygomatico-orbital complex were present in 266 patients (71.69%). Bilateral fractures were found in 22 cases (5.93%). Unilateral zygomatic arch fractures occurred in 39 cases (10.51%). A total of 210 patients (56.60%) did not receive surgical treatment. Surgical intervention was done in 161 patients (43.40%). The surgical treatment was conducted using the approach as reported by Ellis and Kittidumkerng in 1996. A complication incidence of 6.47% was observed, which is compatible with related articles in the literature. Conclusions The study revealed interesting features about etiology, demonstrated by the high occurrence of bicycle accidents. The treatment protocol proposed to the patients showed adequate results as evidenced by low complication frequency. The findings of this study bring information about an area in Sao Paulo State, Brazil, that is valuable in reaffirming previously established trends and identifying new patterns of disease frequency.

Orientador: Jose Ricardo de Albergaria-Barbosa Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba Resumo: O objetivo deste estudo foi revisar, por um período de 5 anos, os casos de fraturas do complexo zigomático-orbitário e do arco zigomático tratados pela Área de Cirurgia e Traumatologia Buco-Maxilo-Faciais da Faculdade de Odontologia de Piracicaba ¿ Unicamp. A distribuição da idade e gênero, tipos anatômicos das fraturas, traumas buco-maxilo-faciais e não buco-maxilo-faciais associados e a etiologia das lesões são descritas. Foram avaliados 1857 pacientes com traumatismo buco-maxilo-facial. Um total de 371 casos de fraturas do compexo zigomático-orbitário e arco zigomático foi encontrado na população estudada. Após a análise dos prontuários, observou-se que a maioria das fraturas ocorreu em indivíduos do gênero masculino (82,75%) e em brancos (56,84%). O grupo etário entre 21 e 40 anos foi o mais afetado pelas fraturas do complexo zigomático-orbitário e arco zigomático (59,84%). A maioria dos pacientes relatava uso de tabaco e álcool (45,55%) e tinham higiene bucal regular (54,45%). As etiologias incluíram as quedas (21,83%), as agressões físicas (19,41%), os acidentes ciclísticos (15,63%), acidentes motociclísticos (13,48%), acidentes automobilísticos (12,67%), acidentes esportivos (7,82%) e acidentes de trabalho (3,77%). As fraturas isoladas do complexo zigomático-orbitário compreenderam 266 casos (38,27%) e as do arco zigomático 39 casos (10,51%). Os traumas faciais adicionais envolveram as fraturas mandibulares (7,55%), maxilares (5,39%) e nasais (5,12%). Os traumatismos não buco-maxilo-faciais associados estiveram presentes em 45,55% casos, envolvendo os membros superiores (61,54%), os membros inferiores (36,09%), o crânio (24,85%), tórax (17,75%), o abdômen (5,33%) e o pescoço (4,73%). O tratamento das fraturas do complexo zigomáticoorbitário e arco zigomático variaram de acordo com o tipo e a condição da fratura. Neste estudo, 56,60% dos pacientes não foram submetidos a tratamento cirúrgico. A incidência geral de complicações foi de 6,20%, relacionada principalmente com infecção (17,39%), cicatrizes hipertróficas (8,70%), ectrópio (8,70%) e a esclera aparente (8,70%). Um paciente desenvolveu deficiência visual (4,35%). Observou - se, portanto, maior ocorrência de traumas de baixa energia devido, principalmente, às quedas e os acidentes ciclísticos, em adultos jovens do gênero masculino. Baseados nos resultados e na revisão da literatura, este estudo fornece importante informação epidemiológica, caracterizando assim, a população e os traumas nesta região do Estado de São Paulo, Brasil Abstract: The purpose of this study was review, during a five-year period, the zygomatic-orbital complex and zygomatic arch fractures treated by the Division of Oral and Maxillofacial Surgery of Piracicaba Dental School ¿ Unicamp. The age and sex distribution, anatomical types of fractures, associated maxillofacial and nonmaxillofacial trauma, causes of injuries were described. One thousand eight hundred and fifty seven patients with oral and maxillofacial trauma were evaluated. A total of 371 zygomatic-orbital complex and zygomatic arch fractures cases were found in the population. After the chart records analysis it was noticed the majority of fractures were sustained by males (82.75%) and whites (56.84%). The age group ranging from 21 to 40 years was most afflicted by zygomatic-orbital complex and zygomatic arch fractures (59.84%). Most patients presented tobacco and alcohol addiction (45.55%) and regular oral hygiene (54.45%). The etiology included falls (21.83%), altercations (19.41%), cyclistic accidents (15.63%), caraccidents (12.67%), motorcycle accidents (13.48%), sport related accidents (7.82%) and work accidents (3.77%). Isolated zygomatic-orbital complex fractures comprised 266 cases (38.27%) and zigomatic arch fractures 39 cases (10.51%). Additional facial trauma often involved mandible (7.55%), maxilla (5.39%) and nasal (5.12%) fractures. Associated nonmaxillofacial trauma was present in 45.55% cases, involving upper extremities (61.54%), lower extremities (36.09%), skull (24.85%), thoracic (17.75%), abdominal (5.33%) and neck (4.73%). The treatment of zygomatic-orbital complex and zygomatic arch fractures depended on the type of fracture and the give circumstance. In this study, 56.60% of the patients had no surgical intervention. The complication incidence was 6.20% related mainly with infection (17.39%), hypertrophic scars (8.70%), ectropion (8.70%) and scleral show (8.70%). One patient developed visual deficiency (4.35%). It was noticed most injuries were low-energy trauma, caused by falls and cyclistic accidents, involving mainly young adult male. Based on the results and review of the literature, this study gives important epidemiologic data, then featuring the population and traumas in this area at Sao Paulo State, Brazil Doutorado Cirurgia e Traumatologia Buco-Maxilo-Faciais Doutor em Clínica Odontológica

The aim of this study was to evaluate, in vitro, the bending strength of internal fixation with absorbable and metallic screws in mandibular ramus sagittal split osteotomy in sheep hemimandibles. The screws were inserted as lag screws, with an inverted "L" configuration, and the set was submitted to bending strength tests. The load and displacement of the peak and final load averages were, respectively, 18.45 kgf, 8.19 mm and 14.38 kgf for Group I, and 16.67 kgf, 6.73 mm and 13.98 kgf for Group II. The results were submitted to statistical analysis by Student’s t test and by the Pearson correlation analysis. The groups showed no statistically significant differences, indicating the feasibility of both for osteosynthesis in mandibular ramus sagittal split osteotomies. O objetivo deste estudo foi avaliar, in vitro, a resistência à flexão da fixação interna, através do uso de parafusos absorvíveis e metálicos, na osteotomia sagital do ramo em hemimandíbulas de carneiros. Os parafusos foram inseridos como "lag screw", com configuração em "L" invertido e o conjunto submetido ao teste de resistência à flexão. As médias da carga e do deslocamento do pico e da carga final do Grupo I foram de 18,45 kgf, 8,19 mm e 14,38 kgf, e do Grupo II de 16,67 kgf, 6,73 mm e 13,98 kgf, respectivamente. Os resultados foram submetidos à análise estatística pelo teste t de Student e pela análise de correlação de Pearson. Os grupos exibiram diferenças estatisticamente não significativas, indicando a viabilidade de ambos para a osteossíntese em osteotomias sagitais do ramo mandibular.

Orientador : Renato Mazzonetto Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba Resumo: O objetivo deste estudo foi avaliar, in vitra, a resistência à flexão da fixação interna, através do uso de parafusos absorvíveis e metálicos, na osteotomia sagital do ramo em hemimandíbulas de carneiros. A técnica de lag screw foi empregada para a fixação dos segmentos proximal e distal, com três parafusos em "L"-invertido e o conjunto submetido ao teste de resistência à flexão. As médias da carga e do deslocamento do pico e da carga final do Grupo I foram de 18,45 kgf, 8,19 mm e 14,38 kgf, e do Grupo 11 de 16,67 kgf, 6,73 mm e 13,98 kgf, respectivamente. Os resultados foram submetidos à análise estatística pelo Teste t-Student (nível de significância de 5%) e pela Análise de Co"elação de Pearson. Ambos grupos não mostraram diferenças estatisticamente significantes. Houve uma correlação positiva entre os valores da carga do pico e final, para o grupo fixado com o material absorvível. O comportamento das hemimandíbulas porém diferiu, pois os segmentos distais das hemimandíbulas fixadas com o material absorvível tenderam sofrer flexão, na área de fixação, durante todo o deslocamento, enquanto que naquelas fixadas com parafusos metálicos, ocorreram fraturas horizontais na corticallateral do segmento proximal Abstract: The aim of this study was to evaluate the bending strength of internal fixation, using absorbable and metal screws in the sagittal split ramus osteotomy in sheep hemimandible. The lag screw technique was used to proximal and distal segments fixation, with three screws in a inverted L-shaped configuration and the set submitted to bending test. The mean of peak load and displacement and final load to Group I were 18.45 kgf, 8.19 mm and 14.38 kgf, and to Group 1116.67 kgf, 6.73 mm and 13.98 kgf, respectively. The results were submitted to statistic analysis by t-Student Test (5% of significance) and Pearson Correlation Analysis. 80th groups didn't show statistically significant difference. There was a positive correlation between peak and finalload values to absorbable material fixed group. Although, the hemimandibles behaviour was a quite difterent because the distal segments in the absorbable material fixed group tending to bend through ali displacement in the test, while in that with metal fixation, horizontallines fractures occurred on the lateral cortical in the proximal segment Mestrado Cirurgia e Traumatologia Buco-Maxilo-Faciais Mestre em Clínica Odontológica