Inferior Alveolar Nerve Lateralization and Implant Placement in Atrophic Posterior Mandible

The aims of this article were to describe the surgical technique of the inferior alveolar nerve lateralization followed by implant installation by means of a clinical report and also to discuss the importance of an adequate surgical and prosthetic planning for atrophic posterior mandible rehabilitation.

Correction of a Mucogingival Defect Using an Implant-Retained Postoperative Stent in a Severely Resorbed Mandible: Case Report

This case report describes a technique that uses a palatal mucosal graft and an acrylic resin postoperative stent in an attempt to increase the layer of keratinized tissue around osseointegrated implants in an atrophic mandible. During second-stage surgery a split-thickness labial flap is reflected and apically repositioned by being sutured onto the periosteum and connective tissue. A palatal mucosal graft is then sutured onto the recipient site. The stent is worn for at least 4 weeks following surgery. This procedure helps to eliminate mobility of the mucosa in the area, deepen the vestibule, and prevent muscle reinsertion. (Int J Periodontics Restorative Dent 2008;28:617-623.)

Monostotic Fibrous Dysplasia of the Mandible

Fibrous dysplasia is a benign fibro-osseous disease that affects 1 or more bones. Deformities leading to aesthetic and functional disorders are observed in almost all cases. Plastic surgery is often recommended when the jaws are involved. Monostotic fibrous dysplasia of the mandible is an unusual manifestation of the disease that is usually benign, occurs in young individuals, and is managed by conservative curettage or debridement, such as surgical sculpting. The authors report a case of a 15-year-old patient with a large monostotic fibrous dysplasia located in the right mandible, which was treated by contouring bone. The lesion did not recur on follow-up for 4 years after the surgical procedure.

A modified approach for vestibuloplasty in severely resorbed mandible using an implant-retained postoperative stent: a case report

Background. Severely resorbed mandibles often present a short band of keratinized tissue associated with a shallow vestibule. As a result, prominent muscle insertions are present, especially in the mental region of the mandible. This case report describes the deepening of the vestibular sulcus in an atrophic mandible by combining free gingival grafts harvested from the palate and a postoperative acrylic resin stent screwed on osseointegrated implants placed at the anterior region of the mandible.Study design. During the second-stage surgery, a split-thickness labial flap was reflected and apically sutured onto the periosteum. Two free gingival grafts were obtained and then sutured at this recipient site. A previously custom-made acrylic stent was then screwed onto the most distally positioned implants. To document the procedure's stability over time, a metal ball was placed in the most apical part of the vestibule and standardized cephalometric radiographs were taken before and 6 months after the procedure. Linear measurements of vestibular depths over the observation time were realized using specific software for radiographic analysis.Results. The proposed technique augmented the band of attached masticatory mucosa, deepened the vestibule and prevented the muscle reinsertion. The difference between the 2 measurements of vestibular depths was 9.39 mm (initial 20.88 mm, final 11.49 mm) after a 6-month postoperative period.Conclusion. The technique, in combination with palatal mucosal graft and use of a postoperative stent, decreased the pull of mentalis muscle and provided a peri-implantally stable soft tissue around implants. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: e7-e14)

Patients' Satisfaction After Surgical Facial Reconstruction or After Rehabilitation With Maxillofacial Prosthesis

The matching of the aesthetic, functional, and psychosocial results of a facial deformity may produce devastating effects in its carriers, especially if the lesion is extensive or the treatment is aggressive. Because of this, the objective of the present article was to evaluate patient's satisfaction rating after surgical facial reconstruction or rehabilitation with oral and maxillofacial prosthesis, by means of reviewing the literature.

Most Frequent Tumors in Maxillofacial Area Rehabilitated Through Surgical Reconstruction and Prostheses

Cancer is regarded as the abnormal cellular multiplication; it is not controlled by the organism; and its cells present a differentiated DNA. Initially, the disease does not show clinical signs, but it can be diagnosed by laboratorial examinations. When tumors are present in the maxillofacial area, they can entail the loss of these area organs, which become responsible for the carrier's social environment exclusion. This paper aimed at showing, through a literature review, the cancers that more commonly happen in the face and the possibilities of regenerating in the patient mutilated through surgical reconstruction and prostheses.

Reconstruction of Skull Defects: Currently Available Materials

The restoration and recovery of a compromised skull continues to be a challenge to craniofacial surgeons and neurosurgeons. Different operative techniques and implant materials are being used to reconstruct the rigid framework of the skull. However, no currently available materials satisfy all of these criteria. According to this premise, the aim of this study was to report on the currently available materials for the reconstruction of the cranial vault and to describe their main characteristics, advantages, and disadvantages. Although the use of the materials discussed in this study is clearly positive for the reconstruction of skull defects and cranioplasties, there is a need for more complex studies and research into developing these materials to achieve all the ideal prerequisites stipulated by the scientific community and to evaluate their properties and aesthetic and functional results in the long term.

Electromyographic activity of the mandible muscles at the beginning and end of masticatory cycles in patients with complete dentures

The aim of this study was to assess the electrical activity of the masseter and anterior temporal muscles in subjects with severe bone resorption at two different times: ( a) the initial period, with the complete dentures they had worn for over 10 years, and (b) the final period, 5 months after having new dentures put into place. Twelve asymptomatic subjects were asked to respond to the questionnaire, according to the research diagnostic criteria for temporomandibular disorders, before denture rehabilitation and 5 months after the new dentures were put in place. The electrical activity of the muscles was recorded during mastication in the initial and final period, using artificial food (Optocal). The operator monitored the 35 chewing cycles that were repeated to grind the artificial food. After wearing the new dentures for 5 months, the right anterior temporal muscle showed a statistical difference before and after denture rehabilitation at the beginning and end of mastication. Muscular capacity and ability reduced the electrical activity in the masseter muscles after rehabilitation. Copyright (c) 2008 S. Karger AG, Basel.

Management of Orbital Reconstruction

One of the concerns after a major trauma to the orbit is to be rebuilt. This can be achieved with care in management of orbital reconstruction, techniques, types of materials, and osseointegrated implants; it allows satisfactory aesthetic recuperation and well-being, whereas psychological therapy allows for patients' re-insertion in social and family environment to make them feel happier and safer.

Bone regeneration after demineralized bone matrix and castor oil (Ricinus communis) polyurethane implantation

Innocuous biocompatible materials have been searched to repair or reconstruct bone defects. Their goal is to restore the function of live or dead tissues. This study compared connective tissue and bone reaction when exposed to demineralized bovine bone matrix and a polyurethane resin derived from castor bean (Ricinus communis). Forty-five rats were assigned to 3 groups of 15 animals (control, bovine bone and polyurethane). A cylindrical defect was created on mandible base and filled with bovine bone matrix and the polyurethane. Control group received no treatment. Analyses were performed after 15, 45 and 60 days (5 animals each). Histological analysis revealed connective tissue tolerance to bovine bone with local inflammatory response similar to that of the control group. After 15 days, all groups demonstrated similar outcomes, with mild inflammatory reaction, probably due to the surgical procedure rather than to the material. In the polymer group, after 60 days, scarce multinucleated cells could still be observed. In general, all groups showed good stability and osteogenic connective tissue with blood vessels into the surgical area. The results suggest biocompatibility of both materials, seen by their integration into rat mandible. Moreover, the polyurethane seems to be an alternative in bone reconstruction and it is an inexhaustible source of biomaterial.

Biologic width changes around loaded implants inserted in different levels in relation to crestal bone: histometric evaluation in canine mandible

Objectives: The aim of the present study was to evaluate histometric changes around dental implants inserted at different levels in relation to the crestal bone, under different loading conditions.Material and methods: Thirty-six implants were inserted in the edentulous mandible of six mongrel dogs. Each implant was assigned to an experimental group according to the distance from the top of the implant to the crestal bone: Bone Level (at the crestal bone level), Minus 1 (1 mm below the crestal bone) or Minus 2 group (2 mm below the crestal bone). Each hemimandible was submitted to a loading protocol: conventional or immediate restoration. After 90 days, the animals were killed. Specimens were processed, and measurements were performed concerning the length of soft and hard peri-implant tissues. Data were analyzed using ANOVA and Student's t test (alpha=5%).Results: Among conventionally restored sites, the distance from the most coronal position of soft tissue margin (PSTM) and first bone-implant contact (fBIC) was greater for Minus 2 than for Bone Level and Minus 1 sites (P=0.03), but significant differences were not observed among immediately restored sites. Differences among groups were not observed concerning the PSTM, and the distance from the implant-abutment junction to fBIC. Greater amounts of lateral bone loss were observed for conventionally than for immediately restored sites (P=0.006).Conclusions: These findings suggest that the apical positioning of the top of the implant may not jeopardize the position of soft peri-implant tissues, and that immediate restoration can be beneficial to minimize lateral bone loss. Further studies are suggested to evaluate the clinical significance of these results in longer healing periods.

Immediate reconstruction of frontal sinus fractures: review of 26 cases

Purpose: the purpose of this study was to evaluate complications occurring after immediate reconstruction of severe frontal sinus fractures, including cases where the fracture was not limited to the anterior wall and also involved the posterior wall and/or sinus floor.Patients and Methods: the records of twenty-six patients presently undergoing follow-up for frontal sinus fracture reconstruction were reviewed. Information regarding demographics, fracture characteristics and causes, associated facial fractures, use of grafts or implants, type of fixation used, nasofrontal duct management, use of antibiotics, and complications were noted. Patients were asked to return for clinical and radiographic follow-up to access late complications.Results: the average age of patients with frontal fractures was 29.1 years and 92.3% were male. Mean follow-up was 3.6 years. The most common causes of fracture were motor vehicle accidents and physical aggression. All patients presented with comminuted and dislocated anterior wall fractures, 34.6% presented with posterior wall fractures, and 46% had sinus floor fractures. Complications occurred in 7 patients (26.92%) and included pneumoencephalus, frontal cutaneous fistula, frontal bone irregularity, and sinusitis.Conclusions: Frontal sinus reconstruction is a good procedure for immediate fracture treatment if there is not excessive comminution, dislocation, or instability of the posterior wall and if the frontonasal duct area is intact or can be repaired. Most complications result from incorrect indication for reconstruction. (C) 2004 American Association of Oral and Maxillofacial Surgeons.

Tests of one Brazilian facial reconstruction method using three soft tissue depth sets and familiar assessors

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

3D reconstruction and scanning electron microscopy of salivary glands of the millipede Rhinocricus padbergi (Verhoef, 1938) (Diplopoda: Spirobolida)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Intraosseous foreign-body granuloma in the mandible subsequent to a 20-year-old work-related accident

The purpose of this article was to describe the clinical and microscopic features of an intraosseous foreign-body granuloma in the mandible that developed after the traumatic implantation of metal fragments during a work-related accident. A 65-year-old male patient had a severe pain in the body of mandible. Clinical examination showed facial asymmetry and a scar, extending to the left mental region. Intraoral examination revealed a soft mass involving the left alveolar bone with normal appearance of the mucosa surface. Panoramic radiographs showed a radiolucent lesion along the mandible extending from the central incisive to the first molar. Computed tomography revealed an osteolytic mass in the same area. His medical history included a work-related accident twenty years prior to evaluation. During the biopsy an important amount of bright metal-like pieces surrounded by soft tissue were found. A microscopic examination showed a foreign body associated with an aggregation of multinucleated giant cells. The final diagnosis was a foreign body granuloma. Even though foreign-body granulomas in the mandible are rare lesions, dentists should be familiar with their features and include them in the differential diagnosis of tissue masses.