Maxillary Bone Defect Reconstruction Using Porous Polyethylene Implants

Purpose: The aim of this study was to evaluate the bone repair process in the maxillary sinus in monkeys treated with high-density porous polyethylene (Medpor)Methods: Four capuchin monkeys (Cebus apella) were submitted to bilateral horizontal osteotomies in the anterior wall of the maxillary sinus and divided into 2 groups: control group, left side with no implants, and porous polyethylene group, right side with Medpor. After a period of 145 days after implant placement, the maxillae were removed for histologic and histometric analyses.Results: Bone repair in osteotomized areas took place by connective tissue in 58.5% and 58.7% in the control group and the porous polyethylene group, respectively. In the contact surface with Medpor, bone repair occurred in 41.3%.Conclusions: Medpor was not reabsorbed within the period of this study and allowed bone repair surrounding it. The porous polyethylene constitutes a feasible alternative for bone defect reconstruction.

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.

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.

Influence of a Parafunctional Oral Habit on Root Fracture Development After Trauma to an Immature Tooth

Root fractures in immature teeth are rare because the resilience of the alveolar bone is more favorable to the occurrence of luxation. This article reports a case of traumatic injury in an immature permanent tooth that progressed to root fracture, having a parafunctional oral habit as the possible modifying factor of case evolution. A 12-year-old boy presented for treatment complaining of a defective restoration and mild pain on the maxillary right central incisor. The patient had a history of crown fracture in this tooth due to trauma 2 years before. The clinical examination showed healthy gingival tissues and no abnormal tooth mobility, whereas radiographic projections revealed healthy periradicular tissues, incomplete root formation, and no visible root fracture. As pulp necrosis was diagnosed, calcium hydroxide therapy was started for canal disinfection and subsequent obturation. However, after 4 weeks of treatment, a horizontal fracture line was observed radiographically in the root's middle third. The patient denied a new traumatic injury, but revealed the habit of chewing on a pencil. Refraining from the deleterious oral habit was strongly advised, and root canal filling with mineral trioxide aggregate was performed to treat the root fracture. After 4 years of follow-up, the tooth has normal function and no abnormal mobility. Images suggestive of remodeling at the apical end of the coronal segment and replacement resorption of the apical segment are seen radiographically. This case demonstrates the need of following cases of dental trauma and the possible influence of parafunctional oral habits as modifying factors of case progression.

Flabby Ridge Correction Using an Auxiliary Technique With Connective Tissue Graft

A common finding in patients with edentulous maxilla and partially dentate mandible is mainly the presence of flabbiness in the anterior edentulous alveolar ridge that can compromise the retention and stability of a denture. Thus, this case report presents the correction of a flabby ridge, using an auxiliary technique combining surgical excision and autogenous connective tissue grafting. The technique improved the quality of the osteomucosal support of the alveolar ridge and increased the vestibule deepness, whose result increased the success rate of the new conventional total prosthesis.

Recession Defects Associated With Scraped Roots Treated With Subepithelial Connective Tissue Graft

The objective of the current study was to assess histo-morphometrically the healing process of recession defects associated with scraped roots treated with subepithelial connective tissue graft (SCTG). Six dogs were used. Bone dehiscence defects (6 x 8 mm) and root planing were carried out on maxillary canine teeth. Following a split-mouth model, according to the treatment, left canines (control) were covered with coronally positioned flap (CPF). Right canines were submitted to treatments with SCTG. After a 3-month postoperative period, the animals were killed, and the blocks processed for the histomorphometric assessment. Data assessment demonstrated that the CPF group showed parameters of a new connective tissue attachment, length of new cement (NC), length of new bone (mean +/- SD: 0.95 +/- 0.53, 2.44 +/- 1.97, and 1.96 +/- 2.29 mm, respectively), which were higher than those of SCTG group (mean +/- SD: 0.71 +/- 0.36, 2.21 +/- 1.28, and 1.52 +/- 1.31 mm, respectively), although not significantly (P > 0.05). The length of both epithelial tissue and connective tissue apposition in the SCTG group (mean +/- SD: 1.70 +/- 0.53 and 2.62 +/- 1.52 mm, respectively) were higher than those of the CPF group (mean +/- SD: 1.18 +/- 0.49 and 2.03 +/- 1.03 mm, respectively), although showing no significant differences (P > 0.05). Within the limits of the current study, it was possible to conclude that there were no significant differences between the groups according to the histologic parameters assessed.

Occurrence of Odontogenic Infections in Patients Treated in a Postgraduation Program on Maxillofacial Surgery and Traumatology

This study assessed the occurrence and characteristics of oral and maxillofacial infections in patients treated at a Brazilian oral and maxillofacial emergency service during a 7-year period. The clinical files of all patients treated at the Oral and Maxillofacial Surgery and Traumatology Service of the Aracatuba Dental School, São Paulo State University, Brazil, between 2002 and 2008 were reviewed. From a population of 3645 patients treated in this period, the study sample consisted of 93 subjects who presented odontogenic infections. Data referring to the patients' sex, age, medical history, and the etiology, diagnosis, complications, drug therapy/treatment, and evolution of the pathologic diseases were collected and analyzed using the Epi Info 2000 software. of these patients, 54 were men (58.1%) and 39 were women (41.9%). Most patients were in the 31- to 40-year-old (20.7%) and 21- to 30-year-old (19.6%) age groups. The most frequent etiology was pulp necrosis due to caries (80.6%). Regarding the treatment, antibiotics were administered to all patients, surgical drainage was done in 75 patients (82.4%), and 44 patients (47.3%) needed hospital admission. First-generation cephalosporin alone or combined with other drugs was the most prescribed antibiotic (n = 26) followed by penicillin G (n = 25). Most patients (n = 85, 91.4%) responded well to the treatment. Five cases had complications: 3 patients needed hospital readmission, 1 case progressed to descending mediastinitis, and 1 patient died. Odontogenic infections can be life-threatening and require hospital admission for adequate patient care. Complications from odontogenic infections, although rare, may be fatal if not properly managed.

Periodontal and Prosthetic Biologic Considerations to Restore Biological Width in Posterior Teeth

\ The biologic width is an essential dental space that always needs to be maintained to ensure periodontal health in any dental prosthetic restorations. An iatrogenic partial fixed prosthesis constructed in lower posterior teeth predisposed the development of subgingival caries, which induced violation of the biologic width in involved teeth, resulting in an uncontrolled inflammatory process and periodontal tissue destruction. This clinical report describes a periodontal surgical technique to recover a violated biologic width in lower posterior teeth, by crown lengthening procedure associated with free gingival graft procedure, to ensure the possibility to place a modified partial fixed prosthesis in treated area. The procedure applied to recover the biologic width was crown lengthening with some modifications, associated with modified partial fixed prosthesis to achieve health in treated area. The modified techniques in both surgical and prosthetic procedures were applied to compensate the contraindications to recover biologic width by osteotomy in lower posterior teeth. The result, after 4 years under periodic control, seems to achieve the projected goal. Treating a dental diseased area is necessary to diagnose, eliminate, or control all etiologic factors involved in the process. When the traditional methods are not effective to recover destructed tissues, an alternative, compensatory, and adaptive procedure may be applied to restore the sequelae of the disease, applying a restorative method that respects the biology of involved tissues.

Functional Aesthetic Treatment of Patient With Phenytoin-Induced Gingival Overgrowth

Gingival overgrowth (GO) may be related to the frequent use of certain medications, such as cyclosporin, phenytoin (PHT), and nifedipine, and is therefore denominated drug-induced GO. This article reports a case of a patient who with chronic periodontitis made use of PHT and presented generalized GO. A 30-year-old man with GO was referred to the clinic of the Universidade Estadual Paulista, Brazil. The complaint was poor aesthetics because of the GO. The patient had a medical history of a controlled epileptic state, and PHT was administered as an anticonvulsant medication. The clinical examination showed generalized edematous gingival tissues and presence of bacterial plaque and calculus on the surfaces of the teeth. The diagnosis was GO associated with PHT because no other risk factors were identified. Treatment consisted of meticulous oral hygiene instruction, scaling, root surface instrumentation, prophylaxis, and daily chlorhexidine mouth rinses. After this stage, periodontal surgery was performed, and histopathologic evaluation was made. The patient has been under control for 3 years after the periodontal surgery, and up to the present time, there has been no recurrence. It can be concluded that PHT associated with the presence of irritants favored gingival growth and that the association of nonsurgical and surgical periodontal therapies was effective in the treatment of GO. Besides, motivating the patient to maintain oral hygiene is a prerequisite for the maintenance of periodontal health.

Conservative Treatment of Odontogenic Myxoma

Odontogenic myxomas (OMs) are nonencapsulated rare benign tumors that can occur in gnathic bones. They are locally invasive and have a high recurrence rate. Radiologically, OMs show a multilocular (in the majority of cases) or unilocular radiolucency, with either distinct or poorly defined margins. Histopathologically, OMs are characterized by spindle-, wedge-, or stellate-shaped cells loosely arranged in an abundant mucoid background. Myxomas are mainly asymptomatic. Radical surgery, excision, and enucleation followed by curettage of the surrounding bony tissue have all been advocated as treatment options. This study presents a successful case of conservative treatment of OMs with a 5-year follow-up.

Mandibular Movement Restoration Through Bilateral Coronoidectomy by Intraoral Approach

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.

Large Unicystic Ameloblastoma of the Mandible: Management Guided by Biological Behavior

Ameloblastoma is a true neoplasm of odontogenic epithelial origin. It is a slow-growing benign tumor of the jaw, and patients usually present late after the tumor achieves considerable size to cause facial disfigurement. Diagnosis mainly from tissue biopsy and radiograph findings does assist in differentiating between types of ameloblastoma. Unicystic ameloblastoma is a tumor with a strong propensity for recurrence. There is a difference in biological behavior between mural unicystic ameloblastoma and those which are simply cystic or show intraluminal proliferation. The challenges in the management of this tumor are to provide complete excision in addition to reconstructing the bony defect, to provide the patient with reasonable cosmetic and functional outcome. The authors report a case of a mural unicystic ameloblastoma in a 23-year-old man who was treated by partial resection of the mandible. Biomedical prototypes were used because they provide acceptable precision and are useful for treatment planning.

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.

Passivity Versus Unilateral Angular Misfit: Evaluation of Stress Distribution on Implant-Supported Single Crowns: Three-Dimensional Finite Element Analysis

The aim of this study was to evaluate the effect of unilateral angular misfit of 100 Km on stress distribution of implant-supported single crowns with ceramic veneering and gold framework by three-dimensional finite element analysis. Two three-dimensional models representing a maxillary section of premolar region were constructed: group 1 (control)-crown completely adapted to the implant and group 2-crown with unilateral angular misfit of 100 Km. A vertical force of 100 N was applied on 2 centric points of the crown. The von Mises stress was used as an analysis criterion. The stress values and distribution in the main maps (204.4 MPa for group 1 and 205.0 MPa for group 2) and in the other structures (aesthetic veneering, framework, retention screw, implant, and bone tissue) were similar for both groups. The highest stress values were observed between the first and second threads of the retention screw. Considering the bone tissue, the highest stress values were exhibited in the peri-implant cortical bone. The unilateral angular misfit of 100 Km did not influence the stress distribution on the implant-supported prosthesis under static loading.

Comparison of Single-Standing or Connected Implants on Stress Distribution in Bone of Mandibular Overdentures: A Two-Dimensional Finite Element Analysis

This study aimed to compare the influence of single-standing or connected implants on stress distribution in bone of mandibular overdentures by means of two-dimensional finite element analysis. Two finite element models were designed using software (ANSYS) for 2 situations: bar-clip (BC) group-model of an edentulous mandible supporting an overdenture over 2 connected implants with BC system, and o'ring (OR) group-model of an edentulous mandible supporting an overdenture over 2 single-standing implants with OR abutments. Axial loads (100 N) were applied on either central (L1) or lateral (L2) regions of the models. Stress distribution was concentrated mostly in the cortical bone surrounding the implants. When comparing the groups, BC (L1, 52.0 MPa and L2, 74.2 MPa) showed lower first principal stress values on supporting tissue than OR (L1, 78.4 MPa and L2, 76.7 MPa). Connected implants with BC attachment were more favorable on stress distribution over peri-implant-supporting tissue for both loading conditions.