Aparelho Herbst x osteotomia sagital mandibular bilateral no tratamento do padrão II, classe II, divisão 1 em adultos: relato de casos

Two treatment options are available for adult patients with skeletal Class II malocclusion caused by mandibular deficiency: combined mandibular advancement surgery and orthodontic treatment or mandibular advancement appliance. This study aimed to analyze the effects of two therapeutic modalities of Class II malocclusion treatment with mandibular deficiency. Two distinct individuals with Class II malocclusion division 1 and mandibular deficiency were treated after growth spurt. The first individual used the Herbst appliance as a therapeutic option and the second individual was treated with bilateral sagittal osteotomy. The cephalometric, occlusion and face results were evaluated for both individuals. Correction of Class II malocclusion was observed on both Herbst and surgery patients resulting on a normal occlusal relationship with normal overjet and overbite. Therefore it was concluded that Herbst appliance can be used to treat borderline skeletal Class II in adult patients.

Estabilidade sagital da condiloplastia associada à cirurgia ortognática para o tratamento do osteocondroma mandibular

The aim of this study was to evaluate the stability of the conservative condylectomy technique and articular disc repositioning as the surgical treatment approach for management of mandibular condylar osteochondroma, with appropriate Orthognathic surgery. Fifteen patients (12 females and 3 males), average age of 32.3 years (range, 13 to 56 years), with unilateral active osteochondroma of the mandibular condyle were analyzed. All patients underwent conservative condylectomy, recontouring of the remaining condylar neck stump and articular disc repositioned and indicated orthognatic surgical procedures. Average post surgical follow-up was 19 months. Each patient's lateral cephalograms were traced at 3 intervals (presurgery, immediate post surgery and long-term follow-up). Immediate after surgery the oclusal plane angle decreased -2.8 ± 4.5o, the maxillomandibular complex rotated counter-clockwise with advancement at menton 5.3 ± 5.6 mm, pogonion 5.0 ± 5.1 mm, B point 3.4 ± 4.2 mm and A point 1.0 ± 1.5 mm. The long-term follow-up showed significant changes in overbite (-0.6 ± 0.5 mm) and SNGoMe (0,93° ± 1,53°). Horizontally and vertically small instabilities occurred in Me (-1.21 ± 1.94 mm) and PNS (-1.48 ± 1.67 mm) respectively. The treatment protocol studied produced counterclockwise rotation and maxillofacial mandibular advancement. The long-term follow-up showed solid dental and skeletal stability with horizontal instability of Me and PNS in the vertical direction.

Influencia dos hábitos de sucção na manifestação de dor temporo-mandibular: revisão sistemática

Objective: To assess the attitudes and knowledge about hepatitis by scholars and dental practitioners from Recife and its metropolitan region. Method: The research protocol was submitted and approved by the Ethics and Human Research Committee of the Federal University of Pernambuco. There were included 230 undergraduate students in dentistry and 104 dentists who exercise their professional activity in Recife and its Metropolitan Region. They signed a consent form and answered a questionnaire, the evaluative instrument, with objective questions about biosafety, transmission of hepatitis and sexually transmitted diseases. Results: About the types of hepatitis 133 (57.8%) students and 61 (58.7%) professionals claimed to know the types A, B and C. Concerning transmission 31 (13.5%) students and 25 (24.0%) professionals said that the main route of transmission were sexual and bloodstream respectively. Relating to imunization 221 (96.1%) students and 99 (95.2%) professionals reported that have been vaccinated against hepatitis B, however, only 126 (54.8%) students and 55 (52.9%) professionals have followed the immunization’s schema. Regarding the cleaning of the office equipment, 18.7% of the students replied that they do not know who does it. 56.7% of professionals said that it was performed with alcohol 70 ° GL.Conclusions: The findings indicate that there is a concern for biosafety but the knowledge about the forms of hepatitis transmission and biosecurity measures need to be better settled.

Avaliação radiográficada fusão das corticias lateral e medial do ramo mandibular: estudo em mandíbulas secas

Purpose: to radiographically evaluate the distance between mandibular lingula and the exact spot where buccal and lingual cortical bone plates merge in the mandibular ramus. Materials and Methods: 54 dry mandibles, divided into 3 subgroups (SG1: dentate, SG2: partially dentate and SG3: edentulous) were used in this study. Lingula position was marked with a metallic sphere and radiographs were taken. The distance between mandibular notch and lingula (I/L) and the distance between mandibular lingula and cortical bone plates fusion (L/FC) were measured. Statistical analysis was applied to the values obtained. Results: mean values for L/FC were 8,18mm, 7,30mm and 8,98mm for SG1, SG2 e SG3 respectively. Moreover, mean values for I/L were 14,02mm, 13,90mm and 12,34mm for SG1, SG 2 and SG3 respectively. The results also showed that cortical bone plates fusion took place in half I/L distance in 28,57% of the mandibles in SG1, in 46,67% of the mandibles in SG2 and in 9,09% of the pieces in SG3. Conclusions: there were no statistically significant differences in the height where cortical bone plates took place in all 3 subgroups. In SG3, the correlation between the mean value for L/FC and the mean value for I/L suggests a reduction in bone density and bone mass, which can correlate to the evaluation of older mandibles in this subgroup.

Frequência de ressonância e sondagem peri-implantar em implantes curtos sob carga imediata com prótese total fixa em cantiléver na arcada mandibular: acompanhamento de um ano

This paper presents a case report with the use of short dental implants and immediate prosthesis placement. After 13 months of follow-up, peri-implant probing values are near 1.87 mm and ISQ values around 78.56.

Protocolo mandibular com implantes curtos

Jaws atrophy represents a great challenge to Implantology regarding rehabilitation of edentulous areas. This paper reports an extreme mandibular atrophy with only 9mm of height between the mental foramina. In these situations, treatment options include bone augmentation techniques, transmandibular, or short dental implants. It is well accepted that bone grafts to improve height do not have good predictability. Besides, osteogenic distraction is associated with a great patient discomfort and transmandibular implants are related with high failure rates. Also, surgical-prosthetic rehabilitations with short dental implants had been associated to good success rates. The purpose of this clinical case is to report a severe mandibular atrophy, successfully treated with four short dental implants between mental foramina for implant-supported prosthesis.

Comparison of compressive strength between three different plates for mandibular angle fractures fixation

The present study aims to compare three types of internal fixation for fractures of the mandibular angle. Mechanical testing was performed on replicas of polyurethane hemimandibles sectioned at the angle region to simulate a fracture and fixed with three different hardwares. Fixation devices enrolled on this survey included the grid plates with and without an intermediate bar and the method described by Champy and colleagues in 1978 and the sample consisted of 10 hemimandibles for each group. Vertical loadings were applied on each hemimandible and recorded after a vertical displacement of 3 and 5 mm. Statistical analysis was made by means of the variance analysis (ANOVA) and the Duncan test with a significance level of 5%. The Champy technique showed a statistically significant increased resistance when compared to the grid plates after vertical displacements of 3 and 5 mm. The results of this survey suggest that the Champy technique, when compared to the grid plate positioned at the middle of the mandibular bone (placement site selected for this study), is more resistant than the grid plate and that the inclusion or not of an intermediate bar to the grid plates does not improve its resistance after linear vertical loadings.

Treatment of Atrophic Mandibular Fractures with the Pencilboneplate: Report of 2 Cases

The incidence of fractures of the atrophic edentulous mandible is still low, even with the increasing life expectancy. The reduced blood supply of the sclerotic bone, the diminished contact area between bone fragments and the patient’s systemic condition makes the treatment of those fractures a challenge for any professional. Treatment of atrophic mandibular fractures by means of miniplate osteosynthesis has not been the preferred method of fixa- tion by many authors. Yet, many surgeons have applied this type of fixation for the atrophied jaw sections. This paper reports 2 cases of fractured atrophic mandibles treated with the pencilboneplate, a monocortical 2.0 mm titanium, 8 or 10-hole hardware with reinforcement on its middle portion, highlighting important considerations of its use. The pencilboneplate appears to be a valuable option for the treatment of atrophic mandibular fractures, espe- cially by an intra-oral approach, and warrants further bio- mechanical and clinical studies.

Fractal dimension of the mandibular trabecular bone measured on digital and digitized images.

Aims: This study compared fractal dimension (FD) values on mandibular trabecular bone in digital and digitized images at different spatial and contrast resolutions. Materials and Methods: 12 radiographs of dried human mandibles were obtained using custom-fabricated hybrid image receptors composed of a periapical radiographic film and a photostimulable phosphor plate (PSP). The film/ PSP sets were disassembled, and the PSPs produced images with 600 dots per inch (dpi) and 16 bits. These images were exported as tagged image file format (TIFF), 16 and 8 bits, and 600, 300 and 150 dpi. The films were processed and digitized 3 times on a flatbed scanner, producing TIFF images with 600, 300 and 150 dpi, and 8 bits. On each image, a circular region of interest was selected on the trabecular alveolar bone, away from root apices and FD was calculated by tile counting method. Two-way ANOVA and Tukey’s test were conducted to compare the mean values of FD, according to image type and spatial resolution (α = 5%). Results: Spatial resolution was directly and inversely proportional to FD mean values and standard deviation, respectively. Spatial resolution of 150 dpi yielded significant lower mean values of FD than the resolutions of 600 and 300 dpi ( P < 0.05). A nonsignificant variability was observed for the image types ( P > 0.05). The interaction between type of image and level of spatial resolution was not signi fi cant (P > 0.05). Conclusion: Under the tested, conditions, FD values of the mandibular trabecular bone assessed either by digital or digitized images did not change. Furthermore, these values were in fluenced by lower spatial resolution but not by contrast resolution.

Treatment of severe facial asymmetry secondary to osteochondroma of the mandibular condyle: case report

Osteochondroma (OC) is the most common benign tumor of long bones. However it is rarely found in the facial skeleton, being the coronoid process and mandibular condyle the most affected sites in this region. It basically consists in bone growth covered by cartilage. The etiology is still controversial: neoplastic, developmental, reparative and traumatic origins have been discussed in literature. The treatments of these lesions include total condylectomy or local resection of the lesion. This paper aims to report a case of a patient with history of trauma and possible fracture of the mandibular condyle in childhood, which in youth developed dentofacial deformity with severe facial asymmetry. The treatment consisted of resection of lesion both with maxillary and mandibular osteotomies associated with graft from the iliac crest bone. Actually, the patient is with a favorable aesthetic, without functional deficit and absence of lesion’s recurrence.

Implant-supported rehabilitation after treatment of atrophic mandibular fractures: report of two cases

Objective The objective of this article is to present options of rehabilitation with dental implants in two cases of severely atrophic mandibles (<10 mm) after rigid internal fixation of fractures. Patients and method Two patients who sustained fractures in severely atrophic mandibles with less than 10 mm of bone height were treated by open reduction and internal fixation through a transcervical access. Internal fixation was obtained with 2.4-mm locking reconstruction plates. The first patient presented satisfactory bone height at the area between the mental foramens and after 2 years, received flapless guided implants in the anterior mandible and an immediate protocol prosthesis. The second patient received a tent pole iliac crest autogenous graft after 2 years of fracture treatment and immediate implants. After 5 months, a protocol prosthesis was installed in the second patient. Results In both cases, the internal fixation followed AO principles for load-bearing osteosynthesis. Both prosthetic devices were Branemark protocol prosthesis. The mandibular reconstruction plates were not removed. Both patients are rehabilitated without complications and satisfied with esthetic and functional results. Conclusion With the current techniques of internal fixation, grafting, and guided implants, the treatment of atrophic mandible fractures can achieve very good results, which were previously not possible.

An alternative technique for fabrication of frameworks in an immediate loading implant fixed mandibular prosthesis

The oral rehabilitation of edentulous patients with immediate loading has become a safe procedure with high predictability. The success is related to immediate fabrication of a passive fit framework to attach the implants. Based on these considerations, this case report shows an alternative technique for mandibular rehabilitation using implants immediately loaded, where the framework was fabricated using cylinders with internal reinforcement and precast pieces, electrowelding, and conventional welding providing esthetics and function to the patient in a short period of time.

Imagen de hipertrofia bilateral del proceso coronoides mandibular a través de la tomografía computarizada cone-beam

The hypertrophy of the mandibular coronoid process is a rare condition, progressive and of unknown etiology, characterized by the over development of the coronoid process determining their size increased, resulting in progressive and painful limitation of mouth opening. The mandibular hypomobility is a present symptom in several diseases and associates it to a specific cause requires detailed clinical and imaginologic examination. The cone-beam computed tomography has the potential to provide complementary informations above than conventional radiography. It also has the advantage of eliminate overlaps, provide high resolution image, helping not only in diagnosis, but also in planning the surgical procedure. Here we report a case of male patient, who appeared at the clinic for an evaluation of a trismus. He had no pain, only discomfort for progressive limitation of mouth opening. On physical examination, only a limited mouth opening has been found. Although the movements of laterality and protrusión were posible, they were very limited. Cone-beam computed tomography examination was performed, that showed an image compatible with bilateral hypertrophy of the mandibular coronoid process.

Estudo anatomico da posição do forame mandibular e da língula em mandíbulas secas

Purpose: The authors tried to verify the anatomic location of the mandibular foramen and língula in dry jaws regarding the anterior and posterior border of the mandible and the incisure, alveolar border and mandibular base, in order to correlate the data with the sagittal split ramus osteotomy. Methods: There were evaluated 44 mandibles (88 sides) from the Morphology Department of the Araraquara Dental School of the São Paulo University (UNESP). The distances measured were previously deter - mined according to the figures presented in this article and were done by the use of a sliding caliper (Brow & Sharpe Digit-Cal Plus), with the mandibles positioned over a Erickson table, and the distan - ces were always measured in millimeters. Results: The pre-determined points and distances founded were X=17,67; Y=14,35; W=20,96 and Z=21,89 for the mandibular foramen, and the relationship between this anatomical structure and the língula shows that the mandibular foramen is in average 5,82 mm below the língula. Conclusions: The authors conclude that the mandibular foramen is lightly posterior in comparison with the ramus mandibular center and that the língula is a very important anatomic landmark for the ramus surgeries as well the knowledge of the distance between it and the mandibular foramen entrance.

Comparative analysis of three rotary instruments used for coronal pre-enlargement in radicular dentin thickness and root canal area of mandibular molars

Purpose: The purpose of this study was to evaluate the increase of the cervical area and dentin thickness in mesial and distal walls of the mesial canals from mandibular molars after the use of LA Axxess (LA), CP Drill (CP) and Gates-Glidden (GG) rotary instruments. Material and Methods: Sixty root canals from thirty mandibular first molar were sectioned 3 mm below the cement-enamel junction, divided in 3 groups (n = 20 root canals, each) according to rotary instrument used, and the cervical images were captured before and after pre-enlargement instrumentation. The increase of the instrumented cervical area (mm2) and the dentin removal thickness (mm), at mesial and distal walls were calculated using Image tools software, by comparison of images. Data were analyzed by ANOVA and Tukey tests (p=0.05). Results: All rotary instruments promoted thickness reduction in dentin walls. In mesial wall, all rotary instruments promoted similar thickness reduction of dentinal wall and did not differ from each other (p>0.05). In distal wall, LA Axxess instrument promoted higher dentin thickness reduction than other groups (p<0.05). The three rotary instruments promoted different increase at the instrumented cervical area (p<0.05), LA promoted the highest increase area and GG and CP presented similar results. Conclusion: LA 20/0.06 promoted the highest thickness reduction in distal wall and increase of cervical area of root canal. On the other hand, CP was the safest instrument, with lower dentin removal of distal wall and similar increased area to GG.