Consequências sistêmicas da cirurgia bariátrica e suas repercussões na saúde bucal

INTRODUÇÃO: O controle da obesidade mórbida pode ser realizado através da cirurgia bariátrica que leva à restrição e/ou à má-absorção de alimentos. O objetivo dessa revisão foi identificar consequências desse procedimento e suas repercussões na saúde bucal. MÉTODO: Foi realizada busca na Biblioteca Virtual em Saúde, sendo incluídos artigos com relação direta ou indireta entre cirurgia bariátrica e saúde bucal e publicados nos últimos dez anos. RESULTADOS: Verificaram-se algumas complicações decorrentes dessa operação, como regurgitação crônica e deficiências nutricionais, que podem trazer repercussões na cavidade bucal como erosão dentária, perda óssea e cárie dentária. Por outro lado, existem consequências positivas como controle da diabetes, da apnéia e melhora da auto-estima, que tornam os pacientes menos susceptíveis à complicações na cavidade oral, como xerostomia e doença periodontal. CONCLUSÃO: A manutenção da saúde bucal adequada em pacientes submetidos à cirurgia bariátrica contribui para o sucesso após a operação, resguardando os benefícios e minimizando os efeitos colaterais.

Prediction of dental implant torque with a fast and automatic finite element analysis: a pilot study

Despite its importance, implant removal torque can be assessed at present only after implantation. This paper presents a new technique to help clinicians preoperatively evaluate implant stability.

Efficiency of arthroscopic lysis and lavage for internal derangement of the temporomandibular joint correlated with Wilkes classification

OBJECTIVES: To compare the outcome of arthroscopic lysis and lavage of TMJ with internal derangement of Wilkes stages II, III, IV, and V. STUDY DESIGN: Arthroscopic lysis and lavage was performed in 45 TMJ of 39 patients with internal derangement. The cases were divided into 4 groups corresponding to Wilkes stages II, III, IV, and V. Two parameters were compared pre- and postoperatively: pain and mouth opening. Statistical significance was determined using the chi(2) test. RESULTS: Overall success rate was 86.7% (Wilkes stage II 90.9%, Wilkes stage III 92.3%, Wilkes stage IV 84.6%, Wilkes stage V 75%). There were no statistically significant differences between the success rates for Wilkes stages II, III, IV, and V. CONCLUSION: Arthroscopic lysis and lavage should be performed as a standard operation for internal derangement of the TMJ after failure of conservative treatment in all Wilkes stages.

Cervical soft tissue imaging using a mobile CBCT scanner with a flat panel detector in comparison with corresponding CT and MRI data sets

OBJECTIVE: The aim of this study was to evaluate soft tissue image quality of a mobile cone-beam computed tomography (CBCT) scanner with an integrated flat-panel detector. STUDY DESIGN: Eight fresh human cadavers were used in this study. For evaluation of soft tissue visualization, CBCT data sets and corresponding computed tomography (CT) and magnetic resonance imaging (MRI) data sets were acquired. Evaluation was performed with the help of 10 defined cervical anatomical structures. RESULTS: The statistical analysis of the scoring results of 3 examiners revealed the CBCT images to be of inferior quality regarding the visualization of most of the predefined structures. Visualization without a significant difference was found regarding the demarcation of the vertebral bodies and the pyramidal cartilages, the arteriosclerosis of the carotids (compared with CT), and the laryngeal skeleton (compared with MRI). Regarding arteriosclerosis of the carotids compared with MRI, CBCT proved to be superior. CONCLUSIONS: The integration of a flat-panel detector improves soft tissue visualization using a mobile CBCT scanner.

Comparative dose measurements by spiral tomography for preimplant diagnosis: the Scanora machine versus the Cranex Tome radiography unit

Objective. The purpose of this study was to determine the dose profile of the Cranex Tome radiography unit and compare it with that of the Scanora machine.Study design. The radiation dose delivered by the Cranex Tome radiography unit during the cross-sectional mode was determined. Single tooth gaps in regions 3 (16) and 30 (46) were simulated. Dosimetry was carried out with 2 phantoms, a head and neck phantom and a full-body phantom loaded with 142 thermoluminescent dosimeters (TLD) and 280 TLD, respectively; all locations corresponded to radiosensitive organs or tissues. The recorded local mean organ doses were compared with those measured in another study evaluating the Scanora machine.Results. Generally, dose values from the Cranex Tome radiography unit reached only 50% to 60% of the values measured for the Scanora machine. The effective dose was calculated as 0.061 mSv and 0.04 mSv for tooth regions 3 (16) and 30 (46), respectively. Corresponding values for the Scanora machine were 0.117 mSv and 0.084 mSv.Conclusion. Cross-sectional imaging in the molar region of the upper and the lower jaw can be performed with the Cranex Tome unit, which delivers only approximately half of the dose that the Scanora machine delivers.

Effects of dose reduction on the detectability of standardized radiolucent lesions in digital panoramic radiography

Dose reduction in digital panoramic radiography was studied. Intentional underexposure was performed with the Orthophos DS while six different human mandibles were radiographed. Exposure settings were 69 kV/15 mA (standard), 64 kV/16 mA, and 60 kV/16 mA. Standardized spherical defects, each either 1 or 1.25 mm in diameter, were simulated in 288 of 432 images, and seven observers decided whether defects were present or not. Areas under the receiver operating characteristics curves were calculated. They showed no significant differences in the detectability of the 1-mm defect at 69, 64, or 60 kV. For the 1.25-mm defect, no difference was found between the 69 and 60 kV images, but a statistically significant different detectability was found for 64 kV images in comparison with both 69 and 60 kV images. A dose reduction of up to 43% was ascertained with a Pedo-RT-Humanoid phantom when panoramic radiography was performed at 60 kV/16 mA. The conclusion is that with the Orthophos DS, it seems possible to reduce the dose rate of x-rays without loss of diagnostic quality in the case of radiolucent changes.

Changing trends in causes and patterns of facial fractures in children

OBJECTIVE: To review the epidemiology of facial fractures in children and to analyze whether it has changed over time. STUDY DESIGN: Retrospective review of records of children aged < or = 15 years diagnosed for fracture during 2 10-year periods. RESULTS: A total of 378 children were diagnosed with fractures, 187 in 1980-1989 and 191 in 1993-2002. The proportion of children with mandibular fractures decreased by 13.6 percentage-points from the first period to the second, whereas the proportion of patients with midfacial fractures increased by 18.7 percentage-points. Assault as a causative factor increased by 5.5 percentage-points, almost exclusively among children aged 13-15 years, with a high percentage (23.5%). CONCLUSIONS: Recognition of a change in fracture patterns over time is probably due to the increased use of computerized tomographic scanning.

Evaluation of 15 mandibular reconstructions with Dumbach Titan Mesh-System and particulate cancellous bone and marrow harvested from bilateral posterior ilia

This study reports on 15 mandibular reconstructions using the Dumbach Titan Mesh-System and particulate cancellous bone and marrow harvested from bilateral posterior ilia. All cases showed segmental defects. Eleven cases involved patients with malignant tumor. Six patients had received irradiation of 40-50 Gy. Reconstructions were performed immediately in 1 patient and secondarily in the remaining 14 patients. In 13 cases, mandibles were successfully reconstructed. Of these 13 patients, 9 reconstructions were completed without complications, whereas the other 4 cases showed complications. In 2 cases, reconstruction failed completely. Overall success rate was 87%. Statistical analysis revealed the extent of mandibular defect, but not malignancy of the original disease or radiotherapy of

Bilateral malformation of maxillary third molars

A case of bilateral compound odontomas in the region of the third molars in the maxilla is reported. The differential diagnosis for this case is discussed.

A posteriori registration and subtraction of panoramic compared with intraoral radiography

OBJECTIVES: To demonstrate the feasibility of panoramic image subtraction for implant assessment. STUDY DESIGN: Three titanium implants were inserted into a fresh pig mandible. One intraoral and 2 panoramic images were obtained at baseline and after each of 6 incremental (0.3, 0.6, 1.0, 1.5, 2.0, 2.5 mm) removals of bone. For each incremental removal of bone, the mandible was removed from and replaced in the holding device. Images representing incremental bone removals were registered by computer with the baseline images and subtracted. Assessment of the subtraction images was based on visual inspection and analysis of structured noise. RESULTS: Incremental bone removals were more visible in intraoral than in panoramic subtraction images; however, computer-based registration of panoramic images reduced the structured noise and enhanced the visibility of incremental removals. CONCLUSION: The feasibility of panoramic image subtraction for implant assessment was demonstrated.

Adenosquamous carcinoma of the head and neck: report of 20 cases and review of the literature

PURPOSE To assess the clinical profile and prognostic factors in patients with adenosquamous carcinoma (ASC) of the head and neck treated by surgery and/or radiation therapy with or without chemotherapy. METHODS Data from 20 patients with stage I-II (n = 4), III (n = 5), or IVA (n = 11) head and neck ASC, treated between 1989 and 2010 were collected in a retrospective multicenter Rare Cancer Network study. Surgery was performed in 16 patients. Seventeen patients received combined modality treatment. RESULTS After a median follow-up of 15.5 months, 12 patients recurred. The 3-year and median overall survival, disease-free survival (DFS), and loco-regional control were 52% and 39 months, 32% and 12 months, and 47% and 33 months respectively. In multivariate analysis, DFS was negatively influenced by the presence of extracapsular extension and advanced stage. CONCLUSION Overall prognosis of locoregionally advanced ASC remains poor. However, early stage ASC patients managed with combined modality treatment may have prolonged DFS.

AVALIAÇÃO CEFALOMÉTRICA DA ESTABILIDADE PÓS-EXPANSÃO RÁPIDA DA MAXILA ASSISTIDA CIRURGICAMENTE

Este estudo avaliou a estabilidade das alterações dentárias e esqueléticas produzidas pela Expansão Rápida da Maxila Assistida Cirurgicamente (ERMAC), no sentido transversal e vertical. A amostra selecionada para este estudo retrospectivo foi composta de 60 telerradiografias em norma frontal, de 15 pacientes, sendo 6 do sexo masculino e 9 do sexo feminino, com média de idade de 23 anos e 3 meses. Utilizou-se o disjuntor tipo Hyrax e o procedimento cirúrgico foi caracterizado pela osteotomia sagital mediana da maxila e não abordagem da sutura pterigopalatina. O início da ativação ocorreu no terceiro dia pós-operatório, sendo que, os limites para a expansão foram determinados por critérios eminentemente clínicos. Todos os pacientes foram radiografados nas fases pré-expansão (T1), pós-expansão imediata (T2), 3 meses pós- expansão (com o próprio disjuntor como contenção) (T3) e 6 meses pós-expansão (com a placa de acrílico removível como contenção) (T4). Medidas lineares foram obtidas a partir dos traçados cefalométricos gerados por um programa computadorizado (Radiocef Studio 2) e analisadas estatisticamente pelo teste de variância (ANOVA) e Tukey ao nível de 5% de significância. Concluiu-se que a ERMAC produziu um aumento estatisticamente significante, da cavidade nasal, largura maxilar, distância intermolares superiores, de T1 para T2, e que se mantiveram em T3 e T4. A largura facial e as distâncias intermolares inferiores não apresentaram alterações após a ERMAC. Avaliando o comportamento vertical da face, notou-se um aumento da AFAI nos tempos T1 para T2 que, diminuiu após a contenção de 3 meses (T3) e permaneceu estável em T4, embora aumentada se comparada com T1.(AU)