Laparoscopic management of iatrogenic lesions

Purpose: To present our series of patients who underwent laparoscopic correction of iatrogenic lesions and a review of the literature.Patients and Methods: We evaluated 23 patients who underwent laparoscopic correction of iatrogenic lesions. Thirteen patients had open surgery, 6 had an endoscopic procedure, and 4 had a laparoscopic approach as the first surgical procedure. Vesicovaginal fistulas (VVF) developed in seven patients after open abdominal hysterectomies, and 1 patient presented with a VVF after ureterolithotripsy. A urethral cutaneous fistula developed in one patient after a laparoscopic resection of endometriosis nodules, and 1 patient presented with a ureterovaginal fistula after a perineoplasty. Three patients presented with encrusted ureteral stents after ureterolithotripsy. Ureteral stenosis developed in seven patients: three after open abdominal surgery, three after ureteroscopy, and one after pyeloplasty. One patient had a ureteral injury during laparoscopic partial nephrectomy, and two patients had bowel injuries after a tension-free vaginal tape procedure and a laparoscopic radical prostatectomy.Results: All patients underwent laparoscopic correction of the iatrogenic injuries. One patient had an early recurrence of a VVF, and one patient had a recurrence of a ureteral stenosis. There was one conversion to open surgery because of technical difficulties and one major bleeding event that necessitated blood transfusion. A lower limb compartmental syndrome developed in one patient.Conclusion: Despite the small number of patients and different types of surgeries performed, laparoscopic management of iatrogenic lesions seems to be feasible and safe in experienced hands. Its precise role in the management of this stressful condition still needs to be determined.

Avaliação ultrassonográfica da anomalia vascular portossistêmica em cão: relato de caso

Relata-se a avaliação ultrassonográfica, com auxílio do Doppler em cores, da anomalia vascular portossistêmica em um cão da raça Poodle Toy, que apresentou edema pulmonar e alterações gastrintestinais. Ao exame ultrassonográfico, foram observados vasos portais dilatados e tortuosos. Esses resultados associados aos achados clínicos e laboratoriais permitem identificar a anomalia vascular portossistêmica no paciente.

In situ evaluation of the remineralizing capacity of pit and fissure sealants containing amorphous calcium phosphate and/or fluoride

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Clinical and histological evaluation of subepithelial connective tissue after collagen sponge implantation in the human palate

Rocha AL, Shirasu BK, Hayacibara RM, Magro-Filho O, Zanoni JN, Araujo MG. Clinical and histological evaluation of subepithelial connective tissue after collagen sponge implantation in the human palate. J Periodont Res 2012; 47: 758765. (c) 2012 John Wiley & Sons A/S Background and Objective: Successful root-coverage treatment depends on the thickness of the donor tissue. This study aimed to evaluate the thickness of donor tissue after augmentation of the connective tissue in the palatal area by implantation of lyophilized collagen sponge (Hemospon (R)). Material and Methods: Ten patients with an indication for root coverage, whose palate was deficient in adequate connective tissue, were recruited. The procedure was carried out in two stages. In the first stage, the palatal thickness in the donor site was measured at three standardized points (points 1, 2 and 3), from the distal of the canine to the distal of the first molar, and the lyophilized collagen sponge was inserted. In the second stage, the palatal thickness over the implant was measured (at points 1, 2 and 3), two biopsies of the palatal mucosa were collected one over the implant (experimental sample) and the other on the contralateral side (control sample) and then root-coverage treatment was performed. Analyses consisted of clinical assessment of the palatal measurements before and after sponge implantation, and histological assessment of the experimental and control biopsy samples. Data were analyzed using the Wilcoxon test. Results: Both analyses showed a significant increase in mean thickness, of 1.08 mm of neoformed tissue in the clinical analysis (the tissue at point 2 was the thickest of the three points) and of 0.53 mm in the histological analysis. Conclusion: The insertion of lyophilized collagen sponge induced a significant increase in the thickness of palatal connective tissue.

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.)

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)

Prosthetic Treatments for Patients With Oronasal Communication

The prosthetic treatments play a role in the rehabilitation of patients with congenital and acquired cleft palate. To prepare the surgical field and/or correct inevitable sequelae of the surgery, the rehabilitation with obturator prosthesis is an auxiliary or complementary treatment to surgical treatments. In cases where the surgical treatment is contraindicated, the prosthetic rehabilitation becomes a definitive treatment. The denture is planned and fabricated according to each patient. Therefore, the aim of this study was to discuss the prosthetic rehabilitation performed in patients with oronasal communication.

Prevalence of removable partial dentures users treated at the Aracatuba Dental School - UNESP

Objectives: The aim of this study was to evaluate the frequency of removable partial dentures (RPD) at the Aracatuba Dental School.Methods: The study was conducted by analysing 412 clinical history of patients attended at the RPD clinics in the period from 2000 to 2007.Results: 412 charts were analysed: 148 (35.9%) men and 264 (64.1%) women. The mean age was 53.8 years (men) and 52.4 years (women). A total of 556 dentures were made; of these, 233 (41.90%) were maxillary and 323 (58.09%) were mandibular dentures. The most frequent Kennedy classification found was Class III (maxilla) and Class I (mandible). In the maxilla, 55% (126) of the major connectors were of the anterior-posterior palatal bar, while in the mandible, 64% (202) were the lingual bar. As regards the claps, 401 were circumferential and 318 were bar claps.Conclusion: The mean age of the patients was 52.9 years with higher prevalence of female patients; the most frequent Kennedy's classification was Class I in mandible and Class III in maxilla; the most common major connector was anterior-posterior palatal bar for maxilla and lingual bar for mandible; the circumferential clasps were the most common retainer used in both jaws.

Regular and Platform Switching: Bone Stress Analysis Varying Implant Type

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

Photoelastic Analysis of Implant-Retained and Conventional Obturator Prostheses With Different Attachment Systems and Soft Relining

Complete and partial loss of maxillary bone may jeopardize oral physiology and generate complications as oral-sinus-nasal communication. Palatal obturator prostheses are a treatment alternative for rehabilitation of these patients. The aim of this study was to assess stress distribution, through photoelasticity, on palatal obturator prostheses associated with different attachment systems (o'ring, bar clip, and o'ring/bar clip) of implants and submitted to relining. Two photoelastic models were fabricated according to an experimental maxillary model with oral-sinus-nasal communication. One model did not present implants, whereas the other included 2 implants with 13.0 mm in length in the left ridge. Four colorless maxillary obturator prostheses were fabricated and relined with soft silicone. One of these prostheses presented no attachment system, whereas the remaining prostheses included attachment systems adapted to the implants. The assembly (model/attachment system/prosthesis) was positioned in a circular polariscope during loading with 100 N at 10 mm/s. The results were based on observation during the experiment and photographic records of stress on the photoelastic model. The bar clip system exhibited the highest stress concentration followed by o'ring/bar clip and o'ring systems. The attachment systems presented different stress distribution with greater concentration surrounding the implants and homogenous stress distribution on the photoelastic model without implants. The highest concentration of fringes occurred, in ascending order, with o'ring, o'ring/bar clip, and bar clip systems.

Photoelastic analysis to compare implant-retained and conventional obturator dentures

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

Effect of salivary stimulation on erosion of human and bovine enamel subjected or not to subsequent abrasion: An in situ/ex vivo study

This in situ/ex vivo study evaluated whether saliva stimulated by chewing gum could prevent or reduce the wear and the percent change in microhardness (%SMH) of bovine and human enamel submitted to erosion followed by brushing abrasion immediately or after 1 h. During 2 experimental 7-day crossover phases, 9 previously selected volunteers wore intraoral palatal devices, with 12 enamel specimens (6 human and 6 bovine). In the first phase, the volunteers immersed the device for 5 min in 150 ml of cola drink, 4 times per day (at 8, 12, 16 and 20 h). Immediately after the immersions, no treatment was performed in 4 specimens, 4 other specimens were immediately brushed (0 min) using a fluoride dentifrice, and the device was replaced into the mouth. After 60 min, the remaining 4 specimens were brushed. In the second phase, the procedures were repeated, but after the immersions, the volunteers stimulated the salivary flow rate by chewing a sugar-free gum for 30 min. Changes in wear and %SMH were measured. ANOVA and Tukey's test showed statistical differences (p < 0.05) for the following comparisons. The chewing gum promoted less wear and %SMH. A decreasing %SMH and an increasing enamel wear were observed in the following conditions: erosion only, 60 min and 0 min. The human enamel presented greater %SMH and less wear compared to bovine enamel. The data suggest that the salivary stimulation after an erosive or erosive/abrasive attack can reduce the dental wear and the %SMH.

Comportamento da sutura palatina mediana em crianças submetidas à expansão rápida da maxila: avaliação mediante imagem de tomografia computadorizada

OBJETIVO: o presente estudo, de caráter prospectivo, objetivou avaliar a imagem da sutura palatina mediana em crianças submetidas à expansão rápida da maxila por meio de tomografia computadorizada, após a fase de contenção. METODOLOGIA: a amostra constou de 17 crianças de ambos os gêneros, na faixa etária compreendida entre 5 anos e 2 meses e 10 anos e 5 meses no início do tratamento, provenientes da Clínica de Ortodontia Interceptiva da Sociedade de Promoção Social do Fissurado Lábio-Palatal da Universidade de São Paulo (PROFIS-USP), Bauru/SP. Tomografias computadorizadas foram implementadas para avaliar o comportamento da sutura palatina mediana em diferentes momentos do tratamento. RESULTADOS E CONCLUSÕES: constatou-se que, após um período médio de 8 a 9 meses de contenção com o aparelho expansor, a sutura palatina mediana mostrou-se completamente ossificada, desde a região da espinha nasal anterior até a espinha nasal posterior. Tal informação esclarece o comportamento da sutura palatina mediana frente à expansão rápida da maxila e reitera o senso comum quanto ao caráter biológico do procedimento.

Short-term in situ/ex vivo study of the anticariogenic potential of a resin-modified glass-ionomer cement associated with adhesive systems

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Effect of different concentrations of fluoride in dentifrices on dentin erosion subjected or not to abrasion in situ/ex vivo

This in situ/ex vivo study assessed the effect of different concentrations of fluoride in dentifrices on dentin subjected to erosion or to erosion plus abrasion. Ten volunteers took part in this crossover and double-blind study performed in 3 phases (7 days). They wore acrylic palatal appliances containing 4 bovine dentin blocks divided in two rows: erosion and erosion plus abrasion. The blocks were subjected to erosion by immersion ex vivo in a cola drink (60 s, pH 2.6) 4 times daily. During this step, the volunteers brushed their teeth with one of three dentifrices D (5,000 ppm F, NaF, silica); C (1,100 ppm F, NaF, silica) and placebo (22 ppm F, silica). Then, the respective dentifrice slurry (1: 3) was dripped on dentin surfaces. While no further treatment was performed in one row, the other row was brushed using an electric toothbrush for 30 s ex vivo. The appliances were replaced in the mouth and the volunteers rinsed with water. Dentin loss was determined by profilometry and analyzed by 2-way ANOVA/Bonferroni test (alpha = 0.05). Dentin loss after erosive-abrasive wear was significantly greater than after erosion alone. Wear was significantly higher for the placebo than for the D and C dentifrices, which were not significantly different from each other. It can be concluded that the presence of fluoride concentrations around 1,100 ppm in dentifrices is important to reduce dentin wear by erosion and erosion + abrasion, but the protective effect does not increase with fluoride concentration. Copyright (C) 2008 S. Karger AG, Basel.