Doenças respiratórias e fatores associados: estudo de base populacional em São Paulo, 2008-2009

OBJETIVO: Estimar a prevalência de bronquite aguda, rinite e sinusite em crianças e adolescentes e identificar fatores associados. MÉTODOS: Estudo transversal, de base populacional. Foi realizado inquérito domiciliar com 1.185 crianças e adolescentes de São Paulo, SP, de 2008 a 2009. Os participantes foram selecionados a partir de amostragem probabilística, estratificada por sexo e idade e por conglomerados em dois estágios. Para análise ajustada foi realizada regressão múltipla de Poisson. RESULTADOS: Dos entrevistados, 7,3% referiram bronquite aguda, 22,6% rinite e 15,3% sinusite. Após análise ajustada, associaram-se à bronquite aguda auto-referida: idade de zero a quatro anos (RP = 17,86; IC95%: 3,65;90,91), cinco a nove anos (RP = 37,04; IC95%: 8,13;166,67), dez a 14 anos (RP = 20,83; IC95%: 4,93;90,91), referir ter alergia (RP = 3,12; IC95%: 1,70;5,73), cor da pele preta/parda (RP = 2,29; IC95%: 1,21;4,35) e morar em domicílio com um a três cômodos (RP = 1,85; IC95%: 1,17;2,94); à rinite auto-referida: idade dez a 14 anos (RP = 2,77; IC95%: 1,60;4,78), 15 a 19 anos (RP = 2,58; IC95%: 1,52;4,39), referir ter alergia (RP = 4,32; IC95%: 2,79;6,70), referir ter asma (RP = 2,30; IC95%: 1,30;4,10) e morar em apartamento (RP = 1,70; IC95%: 1,06;2,73); à sinusite auto-referida: idade cinco a nove anos (RP = 2,44; IC95%: 1,09;5,43), dez a 14 anos (RP = 2,99; IC95%: 1,36;6,58), 15 a 19 anos (RP = 3,62; IC95%: 1,68;7,81), referir ter alergia (RP = 2,23; IC95%: 1,41;3,52) e apresentar obesidade (RP = 4,42; IC95%: 1,56;12,50). CONCLUSÕES: As doenças respiratórias foram mais prevalentes em grupos populacionais com características definidas, como grupo etário, doenças auto-referidas, tipo de moradia e obesidade.

Aumento de gengiva queratinizada em mucosa peri-implantar

Introduction: Recent studies have evaluated the relationship between the width of keratinized mucosa and peri-implant tissue health. Insufficiently wide keratinized tissue can be increased surgically, for example by free gingival grafting. The presence or reconstruction of keratinized tissue around the implant can facilitate restorative procedures, promote aesthetics and allow the maintenance of an oral hygiene routine without irritation or discomfort to the patient. Objective: To describe a patient who underwent free gingival graft surgery to increase the width of keratinized tissue in the region of previously implants to support a type of prosthetic protocol. Case report: A patient who had received dental implants to support a type of prosthetic protocol presented with inflamed peri-implant mucosa, but with no keratinized tissue. Free gingival tissue was obtained from the palate and grafted into the anterior maxilla. Sixty days after muco-gingival surgery, we observed that the free gingival graft favored peri-implant health and prosthetic casting. Conclusion: The free gingival graft technique is both easy to perform and effective in increasing the width of keratinized mucosa following implantation.

Surgical techniques for maxillary bone grafting: literature review

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.

Correção da deficiência transversa da maxila por meio da expansão rápida da maxila cirurgicamente assistida

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.

Fechamento de fístula buco-sinusal usando tecido adiposo bucal

The Oro-antral Fistula is a common pathologic event, which occurs an opening or communication of the maxillary sinus with the oral cavity through dental extractions of upper posterior elements whose roots have close relationship with the maxillary sinus. This study aims to clarify the Surgeon Dentist about the possible etiological factors responsible for Oro-antral Communication, to identify its clinical and radiographic signs, to explain the Buccal Fat Pad’s anatomy and functioning and to describe the surgical technique adopted front of these cases. For this, the authors present a case of a patient who had a fistula in the region where there was a dental extraction of the upper posterior element. The treatment of Oro-antral Fistula using the buccal fat pad provides to be a safe and effective surgical method, because this element presents a rich blood supply and easy access. Many authors have found that this method have a broad application, large index of success, lower risk of infection, provides a comfortable post-operative for the patient. However, it needs to be done properly so that you have minimum incidence of failures, and this requires some caution on the part of professional.

Displasia cemento-óssea florida: relato de caso

The florid cemento-osseous dysplasia is an asymptomatic lesion present in the fibro-osseous maxilla and mandible of uncertain etiology. It has higher expression in females, and patients melanoderm, middle-aged to elderly. This dysplasia is an asymptomatic condition that can be discovered when a radiograph is performed. A biopsy is contraindicated to avoid infection difficult to treat. We report the case of a white woman 52 years old, who searched the Clinic of Surgery and Traumatology Bucco-maxillofacial surgery, Faculty of Dentistry of Araçatuba with pain in the posterior portion of left mandible. After radiographic examination was diagnosed with florid cementoosseous dysplasia. Treatment was instituted clinical and radiographic.

Solução estética para prótese sobre implante

Próteses sobre implantes esteticamente favoráveis estão diretamente relacionadas com a condição dos tecidos moles e duros que as envolvem. A preservação dos tecidos mucogengivais ao redor de implantes dentários instalados na maxila anterior propicia um sorriso harmonioso, com uma estética bastante agradável. No entanto, em alguns casos, isso não ocorre principalmente pela grande reabsorção tecidual na região, na qual deveria ter sido realizado enxerto ósseo, antes mesmo da instalação dos implantes. Desse modo, o objetivo deste trabalho foi apresentar uma solução reabilitadora estética para essas possíveis falhas durante o planejamento com reabilitações sobre implantes, por meio de gengiva artificial cerâmica.

Distal extension removable partial denture with resilient attachment connect to an anterior fixed implant-supported prosthesis: a clinical report

Background: Considering the limited qualitative and quantitative bone in the posterior arch, this modality of prosthetic treatment could provide a positive emotional factor reestablished by immovability of the anterior fixed implant-supported segment. Objective: This clinical report demonstrates the possibility of achieving positive results with a removable partial denture connected to an implant-supported fixed prosthesis associated to an extra resilient attachment. Clinical significance: In cases of posterior mandibular and maxilla atrophy added to the patients desire against the bone graft, this kind of prosthetic treatment has an important place as an alternative.

O impacto das próteses implantosuportadas na harmonia facial

Many patients seeking dental care wish to improve facial and smile aesthetics to be accepted in modern day society. In denture wearers, the physiological resorption causes atrophy mainly in the maxilla, being necessary to carry out reconstruction techniques and sometimes orthognathic surgery to improve occlusal stability and facial harmony. The aim of this study is to discuss the features related to the rehabilitation of edentulous patients with indication for reconstruction of the maxilla using bone grafts and orthognathic surgery by means of a clinical case. In the present case, after the prosthetic rehabilitation, the patient was full satisfied with obtained results and dismissed the initially proposed surgical protocol. Therefore, professionals should provide therapeutic options but the patient’s opinion should prevail provided its clinical feasibility.

Fibroma ossificante periférico: relato de caso

The Peripheral ossifying fibroma is a reactive proliferative lesion, non neoplastic, slow growth, which can produce recurrence after removal. It´s etiology is uncertain, but is associated with local irritants, and is found mostly in the anterior maxilla. Clinically it is characterized by an asymptomatic increase in volume, which may, over time, facial asymmetry. The aim of this paper is to describe a case of peripheral ossifying fibroma in a patient 40, female, exophytic lesion in the jaw, unusual for its large dimensions and with a history of three recurrences, leading to facial asymmetry. She underwent surgery to remove the lesion along with the likely irritants, and the pathological diagnosis of peripheral ossifying fibroma. We conclude that it is fundamentally important for complete removal of the lesion to reduce the tendency to relapse, including the periosteum and the periodontal ligament, in addition to possible causes.

Microbiota asociated with infections of the jaws

The microbial infections involving the craniofacial skeleton, particularly maxilla and mandible, have direct relationship with the dental biofilm, with predominance of obligate anaerobes. In some patients, these infections may spread to bone marrow or facial soft tissues, producing severe and life-threatening septic conditions. In such cases, local treatment associated with systemic antimicrobials should be used in order to eradicate the sources of contamination. This paper discuss the possibility of spread of these infections and their clinical implications for dentistry, as well as their etiology and aspects related to microbial virulence and pathogenesis.

Expansão rápida de maxila assistida cirurgicamente por meio da piezocirurgia: relato de caso

Aim: the purpose of this study is to present a case of surgically assisted rapid maxillary expansion using piezosurgery and describe the benefits of using this device in this type of procedure. Case description: patient had adento-skeletal deformity Cl III with asevereatresia of jaw and underwent a rapid maxillary expansion and surgically assisted with the use of piezosurgery. Conclusion: the piezosurgerycan be used as an alternative in oral and maxillofacial surgery wich features provide greater accuracy and safety in surgery

Reconstrução de maxila severamente atrófica via enxerto ósseo autógeno de calota craniana: descrição de técnica

Bone reconstructions are traditionally conducted with autogenous grafts harvested from intra- or extra-oral donor sites to reestablish the lost bone volume for further implant-prosthetic rehabilitation. The calvarial bone has been studied as an excellent donor site in large atrophic situations, presenting low resorption rates, as well as complications and minimal morbidity. The hospitalization time is short, with low pain levels, short functional limitations, and invisible scars. The skull microarchitecture is predominantly cortical in the presence of growth factors that demonstrate their osteogenic, osteoinductive, and osteoconductive abilities resulting in low resorption rate and high predictability when compared to the iliac crest. Dural lacerations, extra and subdural bleeding, cerebrospinal fluid leakage, and brain damage have been minimized due to the development of surgical technique. The delimitation of diploe, preserving the internal skull cortex before osteotomy at the donor made it possible to reduce accidents and complications. The aim of this paper is to show a technical and to discuss aspects of the use of calvarial bone in the reconstruction of severely atrophic maxilla for oral rehabilitation with osseointegrated implants.

Particularities in the technique of calvaria graft

Calvaria grafts provide good bone quantity for the reconstruction of the atrophic maxilla, and have lower morbidity and resorption rates when compared to iliac crest. The aim of this paper is to present the technique for obtaining a graft of the skull. Initially, the depth of the osteotomy is determined by a manually conducted bur, which establishes the limits of the structures of the skull (outer table, diploe and inner table), making the removal of bone blocks easier and safer. Thus, osteotomies of the blocks are made with greater security, avoiding the complications inherent to surgical technique. The case that will be presented it is from a male patient of 65 years who refused to submit to the iliac crest graft, opting for the calvaria, despite being bald, that is a contraindication for this treatment modality. A delicate suture associated with placement of titanium mesh to maintain the conformation of the patient's skull in the region of the bone defect, created after removal of the graft, provided a good cosmetic result at the donor site. The use of titanium mesh for re-anatomization of bone defects created in the grafts is well indicated for bald patients.

Reabilitação de maxila atrófica com tecido ósseo homógeno e prótese fixa implantossuportada

The techniques of bone reconstruction for atrophic maxillae have been improved in order to promote bone tissue growth in both height and thickness. The grafts performed with use of autogenous bone is considered the gold standard by most researchers, for demonstrating osteogenic capacity and not to promote antigenic response. However, this type of grafting is not possible to get bone tissue in large quantity for extensive renovations. In recent years, alternatives have been researched to overcome the limitations of autogenous bone. Several alternatives have been investigated to supply the disadvantages of autogenous bone grafts. In such studies, allogeneic bone grafts which are obtained from individuals with different genetic load, but from the same species have been extensively used. They can be indicated in cases of arthrosplasty, surgical knee reconstruction, and large bone defects as well as in oral and maxillofacial reconstruction. Besides showing great applicability and biocompatibility, this type of bone is available in unlimited quantities. To rehabilitate atrophic maxillae an option that has been performed with high success rate is the reconstruction with bone graft followed by osseointegrated dental implants to rehabilitate the patient aesthetics and functionally. This paper aims to show the feasibility of allogenic bone as material for reconstruction of atrophic maxilla, and subsequent rehabilitation with metal ceramic fixed prosthesis implant and dental restoration with accompanying three years through literature review and clinical case report.