Chin augmentation with conchal cartilage

Profile enhancement most frequently involves mentoplasty. For this purpose, the author performs conchal grafts to the chin. A total of 28 women aged 15 to 76 years (mean age, 38.11 ± 15.11 years) requested mentoplasty by itself or combined with rhinoplasty, rhytidoplasty, or submental lipoplasty. The conchal cartilage was harvested subperichondrally through a posterior 3-cm incision. The specimen measured 3 x 1 cm, which was sufficient to project the chin 2 to 3 mm. For 4 to 5 mm of projection, both cartilages were used. The graft was positioned under the periosteum and held with two 5-0 nylon sutures. In these cases, the conchal cartilage graft was a suitable option for chin augmentations up to 5 mm.

Optimizing maxillary aesthetics of a severe compromised tooth through orthodontic movement and dental implants

Treatment of severe compromised tooth in the maxillary anterior area still poses great challenge to the clinicians. Several treatment modalities have been proposed to restore the function and aesthetics in teeth with advanced periodontal disease. The present study aims to report a case of traumatic injury of a left-maxillary central incisor with ridge preservation, orthodontic movement, and implant therapy. A 45-year-old woman underwent the proposed treatment for her left central incisor: basic periodontal therapy, xenogenous bone graft, and guided bone regeneration (GBR). Six months after the graft procedure, orthodontic movement by means of alignment and leveling was made and a coronal displacement of the gingival margin and vertical bone apposition could be observed after 13 months of active movement. Afterwards, a dental implant was placed followed by a connective tissue graft and immediate provisionalization of the crown. In conclusion, orthodontic movement was effective to improve the gingival tissue and alveolar bone prior to implant placement favoring the aesthetic results. Six years postoperatively, the results revealed height and width alveolar bone gain indicating that the treatment proposed was able to restore all the functional and aesthetic parameters.

Bladder augmentation in rabbits with anionic collagen membrane, with or without urotelial preservation. Cistometric and hystologic evaluation

The use of bowel segments to perform bladder augmentation is associated with several metabolic and surgical complications. A great variety of synthetic materials, biodegradable or not, have been tested. Collagen-based biomaterials have shown effectiveness for the regeneration and obtainment of a functional bladder. Assess the functional and histological response of the rabbit bladder to anionic collagen membrane (ACM), either when it is anastomosed to the bladder or it is placed onto bladder after vesicomyectomy. In 15 male rabbit a partial cystectomy was performed. After 4 weeks they were divided in 3 groups. Group 1 (G1) - bladder augmentation with ACM. Group 2 (G2) ACM is placed onto bladder after vesicomyectomy. Group 3 (G3) control group. Maximal bladder capacity (MBC) and weight were assessed with 4 (M1), 8 (M2) and 12 (M3) weeks after partial cystectomy. In M3 was performed the sacrifice and extraction of the bladder and kidneys for anatomopathologic study. There were neither bladder stones, nor implant extrusion in M3. There was a significant increase in MBC in G1 and G2 (p<0.05), but no statistical differences in G3 (p=0.35). There is no significant difference comparing G1 and G2. In M3, both groups have shown a bigger MBC than G3 (p<0.05). The microscopic assessment showed an inflammatory reaction in the bladder augmented, with urothelium preserved. The ACM was effective for the increase of MBC. The bladders with preservation of the urothelium have shown an extensive inflammatory process.

Obturator prostheses versus free tissue transfers: a systematic review of the optimal approach to improving the quality of life for patients with maxillary defects

Patient perspectives on the treatment options for maxillary defects, which include free tissue transfers or obturator prostheses, may help eliminate current uncertainty as to the best choice of treatment plan. The purpose of this systematic review was to evaluate the quality of life (QoL) of patients with maxillary defects who had undergone restoration with obturator prostheses and/or free tissue transfers. A systematic search of Medline/PubMed and Web of Science databases for articles published before April 2015 was performed by 2 independent reviewers. A manual search of articles published from January 2005 to March 2015 was also conducted. Studies published in English that evaluated the QoL in patients with head and neck cancers were included. The Cohen kappa method was used to calculate inter-reviewer agreement. Ten studies were included. The University of Washington Head and Neck Questionnaire (UW-QOL) was most commonly used to measure QoL. The majority of maxillary defects were Class IIa-b. Two studies reported that the global QoL for patients with obturator prostheses is equivalent to or even better than that of other chronic disease populations. One study revealed no significant difference in QoL when the 2 treatment options were compared. The limited data indicate that the QoL of patients treated with obturator prostheses and that of patients free of tumors is similar. Well-designed clinical studies are necessary to draw definitive conclusions about how obturator prostheses compare with free tissue transfers in terms of affecting patient QoL.

Analysis of residual stress and hardness in regions of pre-manufactured and manual bends in fixation plates for maxillary advancement

The aim of this study was to analyze, through Vickers hardness test and photoelasticity analysis, pre-bent areas, manually bent areas, and areas without bends of 10-mm advancement pre-bent titanium plates (Leibinger system). The work was divided into three groups: group I-region without bend, group II-region of 90° manual bend, and group III-region of 90° pre-fabricated bends. All the materials were evaluated through hardness analysis by the Vickers hardness test, stress analysis by residual images obtained in a polariscope, and photoelastic analysis by reflection during the manual bending. The data obtained from the hardness tests were statistically analyzed using ANOVA and Tukey's tests at a significance level of 5 %. The pre-bent plate (group III) showed hardness means statistically significantly higher (P < 0.05) than those of the other groups (I-region without bends, II-90° manually bent region). Through the study of photoelastic reflection, it was possible to identify that the stress gradually increased, reaching a pink color (1.81 δ / λ), as the bending was performed. A general analysis of the results showed that the bent plate region of pre-bent titanium presented the best results.

Does a mandibular RDP and new maxillary CD improve masticatory efficiency and quality of life in patients with a mandibular Kennedy class I arch?

To evaluate the change in masticatory efficiency and quality of life of patients treated with mandibular Kennedy class I removable partial dentures (RPDs) and maxillary complete dentures at the Department of Dentistry of the Federal University of Rio Grande do Norte. A total of 33 Kennedy class I patients were rehabilitated with maxillary complete dentures, and mandibular RPDs were selected for this non-randomized prospective intervention study. The patients had a mean age of 59.1 years. Masticatory efficiency was evaluated by colorimetric assay using fuchsin capsules. The measurements were conducted at baseline and 2 and 6 months after prosthesis insertion. Quality of life was evaluated using the Oral Health Impact Profile (OHIP-14) at baseline and 6 months after denture insertion. The Kolmogorov-Smirnov normality test was applied. Masticatory efficiency was evaluated by repeated measures ANOVA. Oral health-related quality of life was compared using the paired t test. There was no statistically significant difference in masticatory efficiency after denture insertion (p = 0.101). Significant differences were found (p = 0.010) for oral health-related quality of life. A significant improvement in psychological discomfort (p < 0.01) and psychological disability (p < 0.01) was observed. Mean difference value (95 % confidence interval) was 6.8 (3.8 to 9.7) points, reflecting a low impact of oral health on quality of life, considering the 0-56 range of variation of the OHIP-14 and a Cohen's d of 1.13. According to the results of the present study, rehabilitation with Kennedy class I RPDs and complete dentures did not influence masticatory efficiency but improved oral health-related quality of life. The association between the patient's quality of life and the masticatory efficiency is important for treatment predictability.

Frontal sinus recognition for human identification

Many methods based on biometrics such as fingerprint, face, iris, and retina have been proposed for person identification. However, for deceased individuals, such biometric measurements are not available. In such cases, parts of the human skeleton can be used for identification, such as dental records, thorax, vertebrae, shoulder, and frontal sinus. It has been established in prior investigations that the radiographic pattern of frontal sinus is highly variable and unique for every individual. This has stimulated the proposition of measurements of the frontal sinus pattern, obtained from x-ray films, for skeletal identification. This paper presents a frontal sinus recognition method for human identification based on Image Foresting Transform and shape context. Experimental results (ERR = 5,82%) have shown the effectiveness of the proposed method.

Surgical techniques for maxillary bone grafting: literature review

For oral rehabilitation with implant-supported prostheses, there are required procedures to create the bone volume needed for installation of the implants. Thus, bone grafts from intraoral or extraoral donor sites represent a very favorable opportunity. This study aimed to review the literature on the subject, seeking to discuss parameters for the indications, advantages and complications of techniques for autogenous bone grafts.

Radiographic and clinical evaluation of zygomatico-maxillary complex fractures treated by 2.0 miniplates system

The zygomaticomaxillary complex (ZMC) is the second highly incidental of facial fractures. According to the anatomical complexity, there are many reports in the literature about this trauma, mainly related to treatment for these fractures. With the purpose of evaluating clinically and radiographically the stability of unilateral zygomatic fractures treated by surgical reduction and fixed in two points by stable internal fixation, this research was proposed. Twenty patients with zygomatic fractures were evaluated and compared with twenty nonfractured patients. The results showed that there were no statistically significant differences among the obtained data, perimeter and area, of the treated and contra-lateral sides of the experimental group. When compared to the control group the differences were not statistically significant. We also performed a comparison of the distance between the nasal bone and zygomatic prominence in all groups the results were also satisfactory.

Reconstruction of the anterior wall of the frontal sinus using bovine bone matrix: histological study with monkeys

The purpose of this study was to evaluate the repair process in the reconstruction of the anterior wall of the frontal sinus of monkeys with bovine bone matrix. Four adult Cebus apella monkeys underwent an ostectomy of the anterior wall of the frontal sinus. The frontal sinus mucosa and the nasofrontal duct were not manipulated. Reconstruction occurred with implants of bovine bone matrix laminae measuring 2.0 x 2.5 cm and 0.4 mm thick, stabilized under pressure in the lateral wall of the frontal sinus. The monkeys were sacrificed over a period of 150 days and routine laboratory procedures were followed for hematoxylin-eosin staining and histologic evaluation of the specimens. Neoformed bone tissue was observed in contact with the frontal sinus mucosa and the bovine bone matrix. The frontal sinus mucosa remained whole without fibrous tissue or cystic formations. There was no occurrence of cellularization as well as revascularization of the bovine bone matrix, though it has permitted bone conduction on this surface. It was possible to conclude that the demineralized bovine bone matrix was biotolerable, being incorporated into the bone without the presence of inflammatory cells with characteristics of inertness and antigenicity and behaved as an osteoconductive material.

Surgical-orthodontic tractio for impacted maxillary canines: a critical review and suggested protocol

Maxillary canine impaction is a common occurrence, especially in the palate, despite sufficient space in the arch for tooth alignment. A proper approach requires knowledge of different specialties of dentistry, such as orthodontics, surgery, radiology, and periodontology, which are generally not centered on a single professional. The causes for canine impaction may be either generalized or localized, and the diagnosis should be made through specific clinical and radiographic examination. The prognosis of surgical-orthodontic treatment depends on the position of the canine in relation to the neighboring teeth and height of the alveolar process, in addition to careful surgical technique, considering that there are risks involved, such as ankylosis, loss of tooth vitality, root resorption of the involved tooth and adjacent teeth, and damage to supporting tissues. Given the important role played by impacted maxillary canines, their traction is the treatment of choice in orthodontically treated patients. The present study reviews the literature on important factors to be considered when approaching impacted canines, such as therapeutic possibilities, their advantages and disadvantages.

Relationship between the morphology of the maxillary central incisor and horizontal and vertical measurements of the face

Purpose: In order to assist in the selection of artificial teeth for complete dentures, this study aimed to assess the relationship between horizontal and vertical measurements of the face and the morphology of the maxillary central incisor. Materials and Methods: This was a study of 50 plaster casts and 100 teleradiographs - 50 in lateral norm and 50 in frontal norm, belonging to 50 individuals, Caucasian, with a naturally optimal occlusion, matching at least four of the six keys of Andrews. Images of the upper central incisors were obtained by scanning the plaster casts (three-dimensional) and subjectively classified by three examiners as oval, triangular or quadrangular. Facial measures (vertical and horizontal) were defined by means of teleradiographs. In order to check inter-examiner agreement on the classification of central incisor, the Kappa test was used. To verify whether data had normal distribution, the Kolmogorov-Smirnov test was used ( P > 0.2) was used. One-way analysis of variance was employed to assess the association between variables (P > 0.05). Results: When vertical measurements were compared with the three incisor shapes, there was no statistically significant difference (P > 0.05): Triangular (0.54), oval (0.63) and quadrangular (0.51). Similarly, no difference (P > 0.05) was found for facial width (139.08, 143.37, 141.65), maxillary width (76.68, 78.99, 76.91) and mandibular width (103.47, 105.50, 103.11). Conclusions: The majority of cases showed that horizontal and vertical measurements of the face cannot be used as a reference for determining the morphology of the maxillary central incisor crown. It is relevant to analyze and compare other morphological structures to improve the oral health-related quality of life for the conventional denture wearer.

Magnet-retained facial prosthesis combined with maxillary obturator

Prosthetic rehabilitation of the midfacial defects has always perplexed prosthodontists. These defects lead to functional and esthetic deficiencies. The purpose of this clinical case report was the presentation of the prosthetic rehabilitation of an extraoral-intraoral defect using two-piece prosthesis magnetically connected. This prosthesis has dramatically improved the patient’s speech, mastication, swallowing, and esthetic.