Complicações após expansão de maxila cirurgicamente assistida

Introduction: The treatment of adult transverse maxillary deficiency is the surgically assisted maxillary expansion. Several surgical techniques have been described for this and complications have been related to these procedures. Objective: the aim of this study was evaluate the incidence of complications associated with surgically assisted maxillary expansion. Material and method: 33 individuals undergone surgically assisted maxillary expansion by subtotal Le Fort I osteotomy with a step in the zygomatic-maxillary buttress and associated to pterigomaxillary disjunction and osteotomy of intermaxillary suture. Operative complications, post-operative complications and the distance between the upper teeth were recorded. Result: 12 men and 21 women with an average age of 24.64 years undergone the procedure. The interdental distances increased from preoperative to 2 months post?operative time. The prevalent complications were sinusitis (6%) and teeth displacement and inclination (6%). Conclusion: Surgically assisted maxillary expansion is an effective and low morbidity procedure to treat transverse maxillary deficiency in adults.

Morphological characterization of the nasopalatine region in human fetuses and its association to pathologies

The nasopalatine region is composed of structures such as the vomeronasal organ and nasopalatine duct. The nasopalatine duct may provide the communication of the mouth to the nasal cavity in human fetuses and can be obliterated in an adult human. Knowledge on the development of the nasopalatine region and nasopalatine duct in humans is necessary for understanding the morphology and etiopathogenesis of lesions that occur in this region. Objective: The aim of the present study was to describe the morphological aspects of the nasopalatine region in human fetuses and correlate these aspects with the development of pathologies in this region. Material and Methods: Five human fetuses with no facial or palatine abnormalities were used for the acquisition of specimens from the nasopalatine region. After demineralization, the specimens were histologically processed. Histological cuts were stained with methylene blue to orient the cutting plane and hematoxylin-eosin for the descriptive histological analysis. Results: The age of the fetuses was 8.00, 8.25, 9.00 and 9.25 weeks, and it was not possible to determine the age in the last one. The incisive canal was observed in all specimens as an opening delimited laterally by the periosteum and connecting oral and nasal cavity. The nasopalatine duct is an epithelial structure with the greatest morphological variation, with either unilateral or bilateral occurrence and total patent, partial patent and islet forms. The vomeronasal organ is a bilateral epithelized structure located alongside the nasal septum above the incisive canal in all the fetuses. Conclusions: The incisive canal, nasopalatine duct and vomeronasal organ are distinct anatomic structures. The development of nasopalatine duct cysts may occur in all forms of the nasopalatine duct.

Dentoskeletal changes induced by the Jasper jumper and the activator-headgear combination appliances followed by fixed orthodontic treatment

Introduction: The aim of this study was to compare the dentoskeletal changes of patients with Class II Division 1 malocclusion treated with either the Jasper jumper appliance or the activator-headgear combination, both associated with fixed appliances. Methods: The sample comprised 72 subjects with Class II Division 1 malocclusion divided into 3 groups: group 1 included 25 subjects treated with fixed appliances and the force modules of the Jasper jumper at an initial mean age of 12.72 years, group 2 included 25 subjects treated with the activator-headgear combination followed by fixed appliances at an initial mean age of 11.07 years, and group 3 included 22 untreated subjects at an initial mean age of 12.67 years. Initial cephalometric characteristics and dentoskeletal changes were compared with analysis of variance. Results: Both experimental groups had similar dentoskeletal changes: restrictive effect on the maxilla, clockwise mandibular rotation and a slight increase in anterior face height, retrusion of the maxillary incisors, distalization of the maxillary molars, protrusion of the mandibular incisors, extrusion of the mandibular molars, and significant improvements of the maxillomandibular relationship, overjet, overbite, and the molar relationship. Conclusions: The effects of the Jasper jumper and the activator-headgear combination followed by fixed orthodontic appliances were similar in Class II malocclusion treatment.

Neurovascular anatomical variations in the anterior palate observed on CBCT images

Objective: This study aimed to assess the presence of additional foramina and canals in the anterior palate region, through cone beam computed tomography (CBCT) images, describing their location, direction, and diameter. Materials & Methods: CBCT exams of 178 subjects displaying the anterior maxilla were included and the following parameters were registered: gender; age group; presence of additional foramina in the anterior palate (AFP) with at least 1 mm in diameter; location and diameter of AFP; and direction of bony canals associated with AFP. Results: Twenty-eight patients (15.7%) presented AFP and in total 34 additional foramina were registered. No statistical differences between patients with or without AFP were found for gender or age. The average diameter of AFP was 1.4 mm (range from 1 to 1.9 mm). Their location was variable, with most of the cases occurring in the alveolar process near the incisors or canines (n = 27). In 18 cases, AFP was associated with bony canals with upward or oblique direction toward the anterior nasal cavity floor. In 14 cases, the canal presented as a direct extension of the canalis sinuosus, in an upward direction laterally to the nasal cavity aperture. In two cases, the canal was observed adjacent to the incisive and joined the nasopalatine canal superiorly. Discussion: CBCT images have a crucial role in the recognition of anatomical variations by allowing detailed tridimensional evaluations. Additional foramina and canals in the anterior region of the upper jaw are relatively frequent. Practitioners should be aware and trained to identify these variations. Conclusions: Over 15% of the population studied had additional foramina in the anterior palate, between 1 mm and 1.9 mm wide, with variable locations. In most cases the canals associated with these foramina either presented as a direct extension of the canalis sinuosus, or coursed towards the nasal cavity floor.

Prevalência de dentes supranumerários na região dos pré-molares e sua associação com a presença dos terceiros molares

O objetivo do presente estudo foi determinar a prevalência de supranumerários na região dos pré-molares nos estágios de dentadura decídua, mista e permanente, além de verificar sua associação com a presença de terceiros molares. Foram avaliadas radiografias panorâmicas de 1.976 pacientes matriculados no curso de Ortodontia Preventiva e Interceptiva da Profis (Sociedade de Promoção Social do Fissurado Lábio-Palatal), em Bauru-SP. As radiografias foram analisadas em negatoscópio, em ambiente escurecido, por um único examinador que determinou a presença de supranumerários na região dos pré-molares, bem como a presença de terceiros molares. A associação entre o aparecimento de supranumerários e a presença de terceiros molares foi verificada pelo Teste de McNemar. O Teste exato de Fisher foi aplicado para verificar o dimorfismo sexual. Constatou-se uma prevalência de 0,45% de supranumerários na região dos pré-molares na amostra estudada, sendo 11% na maxila e 89% na mandíbula, e não foi observado dimorfismo sexual em relação ao aparecimento dos supranumerários (p=0,32). Nas radiografias avaliadas, foi observado que os quatro terceiros molares estavam presentes sempre que verificada a presença dos supranumerários, detectando uma associação estatisticamente significante (p < 0,01) entre o aparecimento dos pré-molares supranumerários e a presença dos terceiros molares. Concluiu-se que a incidência de pré-molares supranumerários foi baixa na população estudada, e que existe associação entre o aparecimento destes supranumerários com a presença dos terceiros molares.

Avaliação da qualidade de vida após sinusectomia endoscópica para rinossinusite crônica

A rinossinusite crônica é uma doença de etiologia não definida que impacta significativamente a qualidade de vida dos pacientes. A sinusectomia endoscópica foi demonstrada como um tratamento eficaz em melhorar a qualidade de vida dos pacientes em outros países; contudo, não existem estudos nacionais. OBJETIVO: Avaliar a associação cirurgia endoscópica nasossinusal com a qualidade de vida doença-específica dos pacientes com rinossinusite crônica com e sem polipose nasossinusal pelo SNOT-20. Desenho: Estudo prospectivo. PACIENTES E MÉTODOS: Pacientes submetidos à sinusectomia endoscópica após ausência de melhora ao tratamento medicamentoso foram avaliados pelo questionário SNOT-20p antes e 12 meses após a cirurgia. Avaliou-se a melhora na pontuação total e nos cinco itens considerados mais importantes por cada paciente. Avaliamos também a presença de correlação entre a pontuação pré-operatória e a melhora pós-operatória e se havia diferença entre a melhora segundo sexo. RESULTADOS: Incluímos 43 pacientes com idade de 44 (19), md (IIQ); e 60,5% (26/43) do sexo masculino. Os pacientes apresentaram melhora estatisticamente significativa no SNOT-20 e SNOT-20 (5+), e correlação entre a pontuação pré-operatória e a melhora da pontuação (p<0.001). Não houve diferença entre melhora da pontuação na qualidade de vida segundo o sexo. CONCLUSÃO: A sinusectomia endoscópica em pacientes com rinossinusite crônica apresenta associação com melhora da QV doença-específica estatisticamente significativa.

Facial lesions caused by renal osteodystrophy in a patient with chronic renal insufficiency: a case report

PURPOSE: Chronic renal insufficiency (CRI) is the last stage of a chronic renal condition in which the kidney loses its filtration and endocrine functions. Chronic endocrine hypofunction causes generalized damage to the body known as Uremic Syndrome, which affects the central nervous system as well as the cardiovascular, hematologic, dermatologic, ophthalmic, endocrine, respiratory, gastrointestinal and skeletal systems. The present study reports the case of a female patient with CRI who presented facial osteodystrophy of the osteitis fibrosa type, and highlights the main features of this condition. CASE DESCRIPTION: A 24-year old, female, Caucasian patient presented chronic glomerulonephritis recurrence and lost the transplanted kidney five years before, undergoing arteriovenous fistula hemodialysis three times a week. She presented swelling of the left masseter area with a hard consistency on palpation, covered by intact skin, swelling at the bottom of the left atrium, with a hard consistency on palpation, a mucosa-like color and absence of inflammation signs, suggesting expansive bone lesions on the face. These features were compatible with hyperparathyroidism brown tumor and/or osteodystrophy. The CT scan showed expansive bone lesions of heterogeneous appearance on the left jaw, maxilla/nasal floor, and right frontotemporal suture areas. The clinical and histopathological characteristics of the lesion, in association with PHT hormone high serum levels led to renal osteodystrophy diagnosis. The patient was referred to the nephrology services. CONCLUSION: Osteodystrophic bone alterations have a high prevalence in renal disease patients, and the dentist must take these alterations into consideration in bone lesion diagnosis for this specific group of patients.

Effect of rapid maxillary expansion on the dimension of the nasal cavity and on facial morphology assessed by acoustic rhinometry and rhinomanometry

OBJECTIVE: To assess the effects of rapid maxillary expansion on facial morphology and on nasal cavity dimensions of mouth breathing children by acoustic rhinometry and computed rhinomanometry. METHODS: Cohort; 29 mouth breathing children with posterior crossbite were evaluated. Orthodontic and otorhinolaryngologic documentation were performed at three different times, i.e., before expansion, immediately after and 90 days following expansion. RESULTS: The expansion was accompanied by an increase of the maxillary and nasal bone transversal width. However, there were no significant differences in relation to mucosal area of the nose. Acoustic rhinometry showed no difference in the minimal cross-sectional area at the level of the valve and inferior turbinate between the periods analyzed, although rhinomanometry showed a statistically significant reduction in nasal resistance right after expansion, but were similar to pre-treatment values 90 days after expansion. CONCLUSION: The maxillary expansion increased the maxilla and nasal bony area, but was inefficient to increase the nasal mucosal area, and may lessen the nasal resistance, although there was no difference in nasal geometry. Significance: Nasal bony expansion is followed by a mucosal compensation.

Cephalometric effects of the use of 10-hour Force Theory for Class II treatment

OBJECTIVE: This study aimed to evaluate the cephalometric effects promoted by the orthodontic treatment of Class II malocclusion patients with the use of the 10-Hour Force Theory, that consists in the use of fixed appliances with 8 hours a day using a cervical headgear appliance and 16 hours a day using Class II elastics, 8 hours on the first mandibular molar and 8 hours in the second mandibular molar. METHODS: Sample comprised 31 patients with mean initial age of 14.90 years, final mean age of 17.25 years and mean treatment time of 2.35 years. The lateral cephalograms in pre-treatment and post-treatment stages were evaluated. Evaluation of cephalometric changes between initial and final treatment phases was performed by paired t test. RESULTS: The cases treated with the 10-Hour Force Theory presented a slight restriction of anterior displacement of the maxilla, increase in the effective length of the mandible, significant improvement of the maxillomandibular relationship, significant increase in anterior lower face height, distal tipping of the maxillary premolar crowns, extrusion and distal tipping of the roots of maxillary molars, significant proclination and protrusion of mandibular incisors, significant extrusion and mesialization of mandibular molars, besides a significant correction of the molar relationship, overjet and overbite. CONCLUSION: The use of the 10-Hour Force Theory in treatment of Class II malocclusion provided satisfactory results.

Caratteristiche ortopediche-ortodontiche in pazienti affetti da Sindrome di Nooan

La sindrome di Noonan (SN) è una patologia a trasmissione autosomica dominante caratterizzata da bassa statura, difetti cardiaci congeniti, dismorfia facciale. In letteratura sono stati pubblicati pochi case reports riguardanti le condizioni orali-facciali in pazienti affetti da SN. Obiettivo. Individuare patologie di pertinenza ortopedico-ortodontica caratteristiche della sindrome utilizzando un campione di pazienti con diagnosi di SN. Metodi. Un gruppo di 10 pazienti affetti da SN è stato sottoposto a esame obiettivo extraorale ed intraorale, ortopantomografia, teleradiografia latero-laterale, impronte delle arcate dentarie. Le misurazioni sulle TLL sono state effettuate sulla base dell'analisi MBT; i valori palatali provengono dai modelli di studio dell’arcata superiore. È stata utilizzato il test t-Student per mettere a confronto il gruppo di studio e il gruppo di controllo riguardo le misure cefalometriche e i valori palatali. Risultati. Nel gruppo di studio sono state rilevate anomalie di numero (un dente deciduo soprannumerario e una agenesia di un dente permanente). Il test t-Student rivela differenze statisticamente significative per 7 variabili cefalometriche su 13 e per 2 variabili palatali. Conclusioni. Basandosi su questo studio è possibile concludere che i pazienti con SN mostrano II classe scheletrica di tipo mandibolare, crescita iperdivergente, tendenza al morso aperto scheletrico, palatoversione degli incisivi superiori, palato stretto. Questi risultati possono fornire informazioni utili sia per la diagnosi di SN sia per la pianificazione del corretto trattamento ortodontico.

Ergebnisse der Behandlung mit Kortikalisschrauben

Im Rahmen der vorliegenden Dissertation wurden 106 Minipins bei 62 Patienten (29 Männer und 33 Frauen)untersucht.rnÜberlebensrate betrug 76,4%. Misserfolge, die zum Verlust der Minipins führten wie Mukositis, Lockerung oder Wurzelperforation, stellten sich in 23,7 % (n=25) der Fälle ein. Dabei gingen beim Auftreten von Mukositis 9 von 14 (8,5 %), bei der Lockerung der Minischrauben 8 von 10 (7,5 %) der Minischrauben verloren. Eine Wurzelperforation trat in einem Fall auf. rnDie einzige lingual im Unterkiefer implantierte Schraube ging verloren. Implantation palatinal im Oberkiefer führte in zwei von vier Fällen zum Verlust. rnDie Sofortbelastung der kieferorthopädischen Kortikalisschrauben erscheint ein praktikables Belastungskonzept zu sein.rnDie Verlustraten bei der vestibulären Implantation betrugen 3,8 % (n=4) für den Oberkiefer und 15,1 % (n=16) für den Unterkiefer.rnBei der Implantation in befestigte bzw. unbefestigte Mukosa betrug die Überlebensrate entsprechend 83,3 % (n=72) und 62,3 % (n=22). rn

Riabilitazione del mascellare posteriore atrofico mediante impianti corti (6-8 mm) o rialzo di seno con contestuale inserimento di impianti di lunghezza standard: studio retrospettivo con follow up a 3 anni

Background: sebbene la letteratura recente abbia suggerito che l’utilizzo degli impianti corti possa rappresentare una alternative preferibile alle procedure di rigenerazione ossea nelle aree posteriori atrofiche, perché è un trattamento più semplice e con meno complicazioni, esistono solo pochi studi a medio e lungo termine che abbiano comparato queste tecniche. Scopo: lo scopo di questo studio retrospettivo è quello di valutare se gli impianti corti (6-8 mm) (gruppo impianti corti) possano presentare percentuali di sopravvivenza e valori di riassorbimento osseo marginali simili a impianti di dimensioni standard (≥11 mm) inseriti contemporaneamente ad una grande rialzo di seno mascellare. Materiali e Metodi: in totale, 101 pazienti sono stati inclusi: 48 nel gruppo impianti corti e 53 nel gruppo seno. In ciascun paziente da 1 a 3 impianti sono stati inseriti e tenuti sommersi per 4-6 mesi. I parametri clinici e radiografici valutati sono: i fallimenti implantari, le complicazioni, lo stato dei tessuti molli, e il riassorbimento osseo marginale. Tutti i pazienti sono stati seguiti per almeno 3 anni dal posizionamento implantare. Risultati: il periodo di osservazione medio è stato di 43.47 ± 6.1 mesi per il gruppo impianti corti e 47.03 ± 7.46 mesi per il gruppo seno. Due su 101 impianti corti e 6 su 108 impianti standard sono falliti. Al follow-up finale, si è riscontrato un riassorbimento osseo medio di 0.47 ± 0.48 mm nel gruppo impianti corti versus 0.64 ± 0.58 mm nel gruppo seno. Non sono presenti differenze statisticamente significative fra i gruppi in termini di fallimenti implantari, complicazioni protesiche, tessuti molli, e riassorbimento osseo. Il gruppo seno ha presentato, invece, un maggior numero di complicazioni chirurgiche. Conclusioni: entrambe le tecniche hanno dimostrato un simile tasso di successo clinico e radiografico, ma gli impianti corti hanno ridotto il numero di complicazioni chirurgiche.

Occurrence and types of dental injuries among patients with maxillofacial fractures

The aim of this retrospective study was to clarify the occurrence and types of dental injuries in 389 patients who had been diagnosed with facial fractures, and to analyze whether the occurrence of dental injury correlates to gender, age, trauma mechanism and type of facial fracture. Dental injuries were observed in 62 patients (16%). The most common type of injury was a crown fracture (48%). Dental injuries were multiple in most patients (63%). Almost half (48%) of all injured teeth were severely injured. Most injured teeth (61%) were in the maxilla. The incisor region was the most prevalent site in both the mandible (45%) and the maxilla (56%). The occurrence of dental injury correlated significantly with trauma mechanism and fracture type: motor vehicle accidents and mandibular fracture were significant predictors for dental trauma. The notable rate of dental injury observed in the present study emphasizes the importance of a thorough examination of the oral cavity in all patients who have sustained facial fracture. Referral to a dental practice for further treatment and follow up as soon as possible after discharge from hospital is fundamental.

Craniofacial morphology in complete unilateral cleft lip and palate patients consecutively treated with 1-stage repair of the cleft

OBJECTIVE: To retrospectively evaluate the craniofacial morphology of children with a complete unilateral cleft lip and palate treated with a 1-stage simultaneous cleft repair performed in the first year of life. METHODS: Cephalograms and extraoral profile photographs of 61 consecutively treated patients (42 boys, 19 girls) who had been operated on at 9.2 (SD, 2.0) months by a single experienced surgeon were analyzed at 11.4 (SD, 1.5) years. The noncleft control group comprised 81 children (43 boys and 38 girls) of the same ethnicity at the age of 10.4 (SD, 0.5) years. RESULTS: In children with cleft, the maxilla and mandible were retrusive; the palatal and mandibular planes were more open, and sagittal maxillomandibular relationship was less favorable in comparison to noncleft control subjects. Soft tissues in patients with cleft reflected retrusive morphology of hard tissues--subnasal and supramental regions were less convex, profile was flatter, and nasolabial angle was more acute relative to those of the control subjects. CONCLUSIONS: Craniofacial morphology after 1-stage repair was deviated in comparison with noncleft control subjects. However, the degree of deviation was comparable with that found after treatment with alternative surgical protocols.

Optimal sites for orthodontic mini-implant placement assessed by cone beam computed tomography

OBJECTIVES: To determine (1) the optimal sites for mini-implant placement in the maxilla and the mandible based on dimensional mapping of the interradicular spaces and cortical bone thickness and (2) The effect of age and sex on the studied anatomic measurements. MATERIAL AND METHODS: The cone beam computed tomography images of 100 patients (46 males, 54 females) divided into two age groups (13-18 years), and (19-27 years) were used. The following interradicular measurements were performed: (1) Buccolingual bone thickness; (2) Mesiodistal spaces both buccally and palatally/lingually; and (3) Buccal and palatal/lingual cortical thicknesses. RESULTS: In the maxilla, the highest buccolingual thickness existed between first and second molars; the highest mesiodistal buccal/palatal distances were between the second premolar and the first molar. The highest buccal cortical thickness was between the first and second premolars. The highest palatal cortical thickness was between central and lateral incisors. In the mandible, the highest buccolingual and buccal cortical thicknesses were between the first and second molars. The highest mesiodistal buccal distance was between the second premolar and the first molar. The highest mesiodistal lingual distance was between the first and second premolars. The highest lingual cortical thickness was between the canine and the first premolar. The males and the older age group had significantly higher buccolingual, buccal, and palatal cortical thicknesses at specific sites and levels in the maxilla and the mandible. CONCLUSIONS: A clinical guideline for optimal sites for mini-implant placement is suggested. Sex and age affected the anatomic measurements in certain areas in the maxilla and the mandible.