Treatment of Zygomatic Arch Fracture With Lag Screws

Zygomatic arch fractures often occur as part of a zygoma fracture or Le Fort type III fractures of the maxillary. Isolated fractures of the zygomatic arch comprise around 10% of all zygoma fractures. The main etiologic factors are traffic accidents, falls, assaults, and sport accidents. Treatment may involve minimally invasive surgical procedures for slightly dislocated fractures or surgery with more extensive access for large dislocations of bone segments. This article reports the case of a 41-year-old male victim of physical aggression to the face with a steel sickle with an exposed, unstable fracture of the zygomatic arch. The patient underwent general anesthesia, and after the reduction of the fractures, the bone segments were fixed with 2.0-mm screws.

Bond Strength of Fiber Posts in Different Root Thirds Using Resin Cement

Purpose: The aim of the study was to assess the in vitro bond strength (BS) of glass fiber posts (GF) and carbon fiber posts (CF) in the cervical, middle, and apical thirds of root canals cemented with RelyX-Unicem (RX) and Cement-Post (CP). Materials and Methods: Forty maxillary canines were divided into 4 groups (n = 10) according to the cement and post used: group 1: GF and RX; group 2: CF and RX; group 3: GF and CP; group 4: CF and CP. The push-out test was applied in the cervical, middle and apical thirds of each specimen to assess bond strength of the cement/post complex to the root canal wall. The data obtained were submitted to ANOVA (Bonferroni test, p < 0.05), and fracture analysis was done with SEM. Results: The GF posts presented the best results when cemented with RX and with CF (p < 0.05). RX presented the highest BS values for both GF and CF (p < 0.05). For all the groups, BS was higher in the cervical third, followed by the middle and apical thirds. Fracture analysis showed a predominance of cohesive fracture of posts for RX, and a predominance of adhesive fracture between dentin/cement, and mixed failure mode for CP. Conclusion: GF posts cemented with RX presented the highest BS values in all root thirds.

Impact of socioeconomic and clinical factors on child oral health-related quality of life (COHRQoL)

Child oral health-related quality of life (COHRQoL) has been increasingly assessed; however, few studies appraised the influence of socioeconomic status on COHRQoL in developing countries. This study assessed the relationship of COHRQoL with socioeconomic backgrounds and clinical factors. This study followed a cross-sectional design, with a multistage random sample of 792 schoolchildren aged 12 years, representative of Santa Maria, a southern city in Brazil. Participants completed the Brazilian version of the Child Perceptions Questionnaire (CPQ(11-14)), their parents or guardians answered questions on socioeconomic status, and a dental examination provided information on the prevalence of caries, dental trauma and occlusion. The assessment of association used hierarchically adjusted Poisson regression models. Higher impacts on COHRQoL were observed for children presenting with untreated dental caries (RR 1.20; 95% CI 1.07-1.35) and maxillary overjet (RR 1.19; 95% CI 1.02-1.40). Socioeconomic factors also associated with COHRQoL; poorer scores were reported by children whose mothers have not completed primary education (RR 1.30; 95% CI 1.17-1.44) and those with lower household income (RR 1.13; 95% CI 1.02-1.26). Poor socioeconomic standings and poor dental status have a negative impact on COHRQoL; reducing health inequalities may demand dental programmes and policies targeting deprived population.

Holoprosencephaly and Holoprosencephaly-Like Phenotypes: Review of Facial and Molecular Findings in Patients From a Craniofacial Hospital in Brazil

Here we report on the clinical and genetic data for a large sample of Brazilian patients studied at the Hospital de Reabilitacao de Anomalas Craniofaciais-Universidade de Sao Paulo (HRAC-USP) who presented with either the classic holoprosencephaly or the holoprosencephaly-like (HPE-L) phenotype. The sample included patients without detected mutations in some HPE determinant genes such as SHH, GLI2, SIX3, TGIF, and PTCH, as well as the photographic documentation of the previously reported patients in our Center. The HPE-L phenotype has been also called of HPE ``minor forms"" or ""microforms,"" The variable phenotype, the challenge of genetic counseling, and the similarities to patients with isolated cleft lip/palate are discussed. (c) 2010 Wiley-Liss, Inc.

A New Yardstick for Rating Dental Arch Relationship in Patients With Complete Bilateral Cleft Lip and Palate

Objective: To develop yardsticks for assessment of dental arch relationship in young individuals with repaired complete bilateral cleft lip and palate appropriate to different stages of dental development. Participants: Eleven cleft team orthodontists from five countries worked on the projects for 4 days. A total of 776 sets of standardized plaster models from 411 patients with operated complete bilateral cleft lip and palate were available for the exercise. Statistics: The interexaminer reliability was calculated using weighted kappa statistics. Results: The interrater weighted kappa scores were between .74 and .92, which is in the ""good"" to ""very good"" categories. Conclusions: Three bilateral cleft lip and palate yardsticks for different developmental stages of the dentition were made: one for the deciduous dentition (6-year-olds` yardstick), one for early mixed dentition (9-year-olds` yardstick), and one for early permanent dentition (12-year-olds` yardstick).

A Longitudinal Three-Center Study of Dental Arch Relationship in Patients With Bilateral Cleft Lip and Palate

Objective: To compare and evaluate longitudinally the dental arch relationships from 4.5 to 13.5 years of age with the Bauru-BCLP Yardstick in a large sample of patients with bilateral cleft lip and palate (BCLP). Design: Retrospective longitudinal intercenter outcome study. Patients: Dental casts of 204 consecutive patients with complete BCLP were evaluated at 6, 9, and 12 years of age. All models were identified only by random identification numbers. Setting: Three cleft palate centers with different treatment protocols. Main Outcome Measures: Dental arch relationships were categorized with the Bauru-BCLP yardstick. Increments for each interval (from 6 to 9 years, 6 to 12 years, and 9 to 12 years) were analyzed by logistic and linear regression models. Results: There were no significant differences in outcome measures between the centers at age 12 or at age 9. At age 6, center B showed significantly better results (p = .027), but this difference diminished as the yardstick score for this group increased over time (linear regression analysis), the difference with the reference category (center C, boys) for the intervals 6 to 12 and 9 to 12 years being 10.4% (p = .041) and 12.9% (p = .009), respectively. Conclusions: Despite different treatment protocols, dental arch relationships in the three centers were comparable in final scores at age 9 and 12 years. Delaying hard palate closure and employing infant orthopedics did not appear to be advantageous in the long run. Premaxillary osteotomy employed in center B appeared to be associated with less favorable development of the dental arch relationship between 9 and 12 years.

Nonsyndromic Alar Clefts: Report of Five Brazilian Patients

Nonsyndromic alar clefts are rare and they range from a small notch to variable size of clefts of the nasal ala. Usually they are restricted to the alar region, but other minor anomalies such as midline nasal sinuses and small midline or ""northbound"" clefts can be present. To date all reported cases of nonsyndromic alar clefts have been sporadic. Here we report on five new cases of isolated and nonsyndromic alar clefts. (C) 2009 Wiley-Liss, Inc.

Tooth Abnormalities of Number and Position in the Permanent Dentition of Patients With Complete Bilateral Cleft Lip and Palate

Objective: To radiographically evaluate the prevalence of tooth abnormalities of number and position in the permanent dentition of individuals with complete bilateral cleft lip and palate. Design: Cross-sectional retrospective. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil. Patients: Two hundred five individuals with complete bilateral cleft lip and palate. Interventions: Analysis of patient records and panoramic radiographs. Main outcome measures: Evaluation of hypodontia and supernumerary teeth and analysis of the position of the permanent maxillary lateral incisor in relation to the alveolar cleft. Results: Hypodontia was observed in 144 patients (70.2%), and the highest prevalence was observed for the maxillary lateral incisor. When both lateral incisors were present (43%), they were primarily located on the distal side of the cleft (25%). Supernumerary teeth were observed in 11.7% of individuals. Conclusion: Patients with cleft lip and palate presented high prevalence of hypodontia and supernumerary teeth. The prevailing characteristics of their location may suggest the presence of a similar genetic component for the occurrence of hypodontia and cleft.

Stress distribution in orthodontic mini-implants

The objective of this study was to evaluate the stress distribution in the resin in contact with the spirals of cylindrical and conical mini-implants, when submitted to lateral load and insertion torsion. A photoelastic model was fabricated using transparent gelatin to simulate the alveolar bone. The model was observed with a plane polariscope and photographically recorded before and after activation of the two screws with a lateral force and torsion. The lateral force application caused bending moments on both mini-implants, with the uprising of fringes or isochromatics, characteristics of stresses, along the threads of the mini-implants and in the apex. When the torsion was exerted in the mini-implants, a great concentration of stress upraised close to the apex. The conclusion was that, comparing conical with cylindrical mini-implants under lateral load, the stresses were similar on the traction sides. The differences appear (1) on the apex, where the cylindrical mini-implant showed a greater concentration of stress, and (2) along the spirals, in the compression side, where the conical mini-implant showed a greater concentration of stress. The greater part of the stress produced by both mini-implants, after torsion load in insertion, were concentrated on the apex. With the cylindrical mini-implant, the greater concentration of tension was close to the apex, while with the conical one, the stresses were distributed along a greater amount of apical threads.

Placas maxilo-dentárias em Rincossauros Hyperodapedon Huxley, 1859. Histologia e morfogênese maxilo-dental: nova abordagem.

O estudo das estruturas da placas maxilo-dentárias dos rincossauros Hyperodapedon Huxley, 1859, do Triássico da Formação Santa Maria, em nova abordagem histológica e ontogênica resultou na identificação da natureza do esmalte aprismático verdadeiro, de variados elementos histológicos dentinários e osteológicos, e de um centro de ossificação periosteal primário. Também foram encontradas evidências histológicas dos mecanismos de fusionamento maxilo-dentinário e amelo-maxilar. Com estes elementos, inferimos os modelos de organogênese dental, da ontogênese maxilar e dos mecanismos de fusionamento maxilodental. Encontrou-se uma singular e raríssima coroa dental, imatura e ainda não erupcionada, na região posterior da placa dental e assim evidenciou-se a correta posição da margem odontogenicamente ativa. Adicionalmente inferiu-se a localização da posição da lâmina dentária embrionária. Constatou-se a não formação de alvéolos dentários, de cemento radicular e do espaço necessário à formação do ligamento periodontal e, assim, se deduziu a não formação do folículo dental embriônico. As presenças de especiais elementos anatômicos e histológicos nos tecidos ósseos periapicais evidenciam o crescimento radicular contínuo, enquanto a forma e o fusionamento radicular imediato depõe a favor de uma função dentária fisiológica diferenciada para as baterias dentárias maxilares dos Rincossauros do gênero Hyperodapedon. Os mecanismos que possibilitaram o controle embriônico para a deposição das lamelas de tecido ósseo coronal e seu preciso fusionamento sobre o esmalte dentário, declinam por modificações nas funções tardias do órgão reduzido do esmalte e pela presença de uma membrana oral com funções osteogênicas e também protetivas, situada nas porções posteriores da placa maxilo-dentária em desenvolvimento. Mudanças heterocrônicas no tempo de diferenciação das células da crista neural embriônica e em seus derivados, como a lâmina dentária e órgãos dentários embrionários ou correlacionadas com a organogênese das placas maxilo-dentárias e seus anexos periodontais, todos como condições plesiomórficas para Diápsidas Triássicos, poderiam ser as causas responsáveis pela origem e evolução deste estranho aparelho estomatognático nos clados de Hyperodapedon sp..

Prevalência de oclusopatias e caracteríticas cefalométricas e dentais de escolares cearense da cidade de Fortaleza

The people of Ceará state are descended from miscegenation between the Portuguese colonizers and the native population, resulting in a different facial pattern from other populations. It is important that this pattern be thoroughly understood, along with its minimum and maximum values so that they can be assessed and respected, allowing professionals who deal with the craniofacial complex to work more efficiently and scientifically. Aim: To characterize the morphological pattern of individuals from Ceará state, whose father and grandfather are also native from Ceará, in the 10-12 year age group, not submitted to previous orthodontic treatment, in order to determine: 1) the prevalence of occlusal pattern; 2) the prevalence of dental anomalies (DA) and, 3) the skeletal and dental cephalometric characteristics of individuals that present with normal occlusion and harmonious facial pattern. Methodology: A list of 10-12 year-olds was obtained from 515 schools containing 162,713 students (Education Secretariat of Ceará State), from which 234 individuals were examined (107 boys and 157 girls). The assessment criteria adopted were: 1) Angle s Classification System to determine occlusal pattern. The occlusal characteristics were measured through overbite, overjet, crowding and interincisal diastema. 2) DA are anomalies of number, shape, size, eruption and structure and, 3) in the group that presented with normal occlusion, we used cephalometric analysis measures proposed by Downs, Steiner, Tweed, Holdaway, Jacobson and McNamara. Results: 1) 25.8% of the schoolchildren had normal occlusion, 47.5% class I malocclusion, 22.3% class II malocclusion and 4.2% class III malocclusion. No statistically significant difference was found between the age group studied and sex. Thirty percent of the individuals had normal overbite, while 36.7% and 19.7% had increased and reduced overbite, respectively. Normal overjet was found in 33.7% of the individuals, increased overjet in 50% and reduced in 16.3%. Dental crowding was observed in 62.5% of the individuals and the presence of interincisal diastema in 14.8%. 2) The prevalence of DA was 56.1%, 6.8% in the number, 10.8% in shape, 4.1% in size, 34.5% in eruption, 26.4% in structure and 17.4% had more than one DA. No association was found between DA and sex, but DA was significantly associated to malocclusion (p<0.05); 3) there was no association between sex or facial type between the measures of nasal-labial angle, position and effective maxillary length, effective mandibular length and the sagittal relationship between the molars, overjet and overbite, position of upper incisors, lower incisors and between the incisors themselves. There was a difference between sex, on the VERT index and in lower anterior facial height, upper incisor inclination and line-H, between facial types for the occlusal plane angles, mandibular plane, facial axis, lower incisor inclination, mandibular position, upper incisor position, lower anterior facial height, ANB and line-H. It was concluded that: 1) the most prevalent occlusal type was class I malocclusion, with no distinction for sex or age group, and the assessment of occlusal characteristics showed that excessive overbite and overjet were the most predominant findings, along with a high occurrence of tooth crowding; 2) a high prevalence of DA was found, particularly eruption anomalies, not influenced by sex but significantly associated to malocclusion and 3) individuals from Ceará are predominantly brachyfacial, exhibiting a number of similarities inherent to their facial pattern, such as a convex profile, retracted jaw, reduced lower third and protruded lower incisors. This study was multidisciplinary, involving researchers from the areas of epidemiology, radiology and dentistry, thereby meeting the multidisciplinarity requirements of the Postgraduate Program in Health Sciences

A influência do sorriso gengival no vedamentos labial

Ideally the smile should expose minimal gingival, therefore patients with gummy smile and passive eruption altered or excessive marginal gingivae, usually excessive gingival display because incomplete anatomical crown exposure is present. If the maxillary incisor show at rest is optimal, active upper incisor intrusion should not be iniciated. To achieve a smile with minimal gingival exposure, the anatomic crown should be fully exposed by surgical crown lengthening. Precise determination of the location of cementoenamel junction prior to surgery, precise placement of incisions and correct establish of biological width are necessary in order to achive this goal. One protocol is decribed and clinical results from 15 brazilian subjects, after three years post surgery are showed

Prevalência e determinantes de oclusopatias nas dentições decídua, mista e permanente na cidade do Natal/RN

This work is intended to bring a contribuition to the verification of the prevalance of malocclusion in the deciduous, permanent and mixed dentition in the student population in the city of Natal, Brazil. In this purpose, a sectional study of infantiles aging 5, 8 and 12 years old was carried out. The average prevalance of malocclusions in the group as a whole was 76,5%. Considering the different dentitions separately, the study showed malocclusion prevalence as follows: Deciduous Dentition 75,5%; Mixed Dentition 84% and Permanent Dentition 70,5%. The most common malocclusion cases found in the deciduous dentition were openbite (20.6%); overbite (16.6%) and maxillary overjet (14,7). Mixed Dentition: the most commonly found occlusional malfunctions in this dentitional phase were maxillary overjet (33,8%); crowding (28,3%), and mandillary discrepancy (19,9%). In the univaried analysis, he application of the Chi square test of independence, (significance 5%), has indicated a meaningful association of the variables social class (p=0,019), primata space (p = 0,036), habits (p= 0,002) and time-and-habit (P=0,03). The same test on the permanent dentition group revealed a significant association for the independent variables, as follows: Social class (p=O,OOO), School (p=O,OOI), Income (p=O,OOO), housing standard (p=0,001), facial pattem (p=0,004), caries record (p=0,031). No significant association was found in the mixed dentition. The Logistic Regression analysis on the deciduous dentition has shown that income, ethnicity, habit and canine relationship constitute factors of risk regardless of the other variables. As for the permanent dentition, only Facial Pattem was pointed as a factor of risk for the formation of malocclusion

Avaliação clínica de pacientes submetidos à colocação de implantes zigomáticos pela técnica de Stella & Warner

This study aimed to evaluate patients who underwent placement of zygomatic implants technique by Stella & Warner, considering the survival of conventional and zygomatic implants, sinus health and level of patient satisfaction in relation to oral rehabilitation. We evaluated 28 patients where 14 had received conventional and zygomatic implants, being rehabilitated with implant-fixed dentures (group 1) and 14 were rehabilitated only with conventional implants and implant-fixed dentures (group 2). The study had four phases, represented by radiographic evaluation of implants (stage I), clinical evaluation (stage II), assessing the health of the maxillary sinus (stage III) and a questionnaire to measure satisfaction of rehabilitation with fixed prosthesis implant Total -backed (stage IV). Group 2 underwent only stage IV, while group 1 participated in all stages. Descriptive analysis and statistics were performed, using the t test for independent samples in the evaluation of phase IV. The results demonstrated that the technique of Stella & Warner proved effective, allowing a high survival rate of conventional implants and zygomatic (100%), considering a minimum follow-up of 15 months and maximum 53 months after prosthetic rehabilitation. There were no pathological changes in tissues periimplants conventional and zygomatic implants analyzed. Radiographic findings showed satisfactory levels bone implants in the oral rehabilitation with conventional zygomatic implants and a good positioning of the apex of the zygomatic implants over the zygomatic bone. The presence of the zygomatic implant did not cause sinus and the t test showed a satisfaction index lower in group 1 compared with group 2. The zygomatic implant placement technique by Stella & Warner proved to be a predictable technique with high survival rate in patients with atrophic jaws, necessitating long-term follow-up to confirm the initial findings of the study

Eficiência mastigatória e impacto da saúde oral na qualidade de vida em pacientes reabilitados com próteses totais removíveis implanto-suportadas

Edentulous patients with complaint about mandibular conventional denture might experience poor masticatory function and negative impact of oral health on quality of life. The aim of this controlled clinical trial was to evaluate the effect of mandibular overdenture on oral health-related quality of life and masticatory efficacy in patients wearing mandibular complete dentures. The edentulous patients (n=16) were rehabilitated with new maxillary and mandibular complete dentures and, after 3 months, mandibular overdentures retained by 2 implants (bar-clip system) were fabricated. The Brazilian version of OHIP-Edent questionnaire was used to assess the oral healthrelated quality of life. Masticatory efficacy was evaluated through a colorimetric method with chewing capsules. The mean OHIP-Edent score was 8.5 with conventional dentures and 2.0 with mandibular overdenture, which means a positive impact of oral health on quality of life with overdentures (p=0.001). The mean absorbance for masticatory efficacy was 0.025 for conventional dentures and 0.073 for overdentures. There was statistically significant difference for masticatory efficacy before and after implants rehabilitation (p=0.003). However, there was no correlation between masticatory efficacy and OHIP (p>0.05). So, mandibular overdenture retained by 2 implants improved the quality of life and masticatory efficacy of edentulous patients with complaint about mandibular conventional complete dentures