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Genioplasty is a widely used surgical approach to address chin deformities by performing an osteotomy on the inferior border of the mandible to allow for comprehensive repositioning of the chin. This study aimed to compare the accuracy of freehand chin repositioning with a guided technique that employed specialised surgical guides. For this retrospective study, data from 30 adult patients who underwent orthognathic surgery to correct dentofacial deformities were analysed. All patients underwent virtual planning before surgery, with half of them treated using freehand chin repositioning and the other half using the guided technique. The surgical outcomes were measured and compared with the virtual plan to assess the positional and rotational accuracy of the techniques. In terms of translational assessment, noteworthy values that exceeded clinically acceptable limits were observed only in sagittal movement in the freehand group (0.97 mm, interquartile range (IQR) 0.73-2.29 mm). Regarding rotational accuracy, both groups exhibited an IQR that surpassed acceptable limits for pitch (3.26°, IQR 2.06-5.20 for the guided group and 2.57°, IQR 1.63-4.24° for the freehand group). The Mann-Whitney test indicated no statistical differences between the groups in any translational or rotational assessment. In conclusion, although there was no statistical difference, the guided technique proved effective in achieving clinically acceptable accuracy in all positions and almost all rotations, displaying superior results in sagittal positioning compared with the freehand technique. To fully harness the advantages of guides and to guarantee accuracy in all rotations, we recommend further research involving guides made of more rigid materials, and customised implants.

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Facial fractures and their historical link to potential blindness have been well-documented, often attributed to optic canal injuries or retinal vascular occlusion. This dire consequence can result from both direct and indirect ocular trauma, including retrobulbar hemorrhage. Traumatic orbital compression can manifest in various forms, such as hematomas, fractured bone fragments, and emphysema, all posing a significant threat to vision, necessitating immediate intervention. In this study, 9 clinical cases of traumatic orbital compression are presented, each characterized by distinct etiologies. The study delves into traumatic orbital compressive syndromes, underscoring the critical imperative of early recognition and treatment to prevent vision loss. Orbital compression, whether from edema, hematoma, or emphysema, collectively culminates in elevated intraorbital pressure and the potential for optic nerve ischemia. Through the presentation of these 9 clinical cases, the article emphasizes the pressing need for timely intervention in addressing orbital compressive syndromes to avert vision loss. Various surgical techniques are elucidated, highlighting the pivotal role of expeditious medical intervention. This article offers invaluable insights into the diagnosis, management, and outcomes of traumatic orbital compressive syndromes.

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Chlorhexidine (CHX) is a prime choice to control the oral microbiota. However, it's a chemical agent leading to side effects such as teeth strains, taste disturbance, and desquamation of oral mucosa. Alternatively, the lactoferrin and oxygen-based Blue®M has been introduced as an alternative to the CHX, not disturbing tissue repair. Therefore, the study aimed to evaluate the effects of Blue®M and CHX on oral human fibroblasts (HGF-1) and keratinocytes (NOK-SI). Cell cultures using HGF-1 and NOK-SI evaluated cell proliferation, cell cycle, apoptosis and necrosis, and migration. In the dose-effect test, Blue®M reduced the HGF-1 sample in a 4-fold concentration than CHX (CHX: 173.07 ±10.27; Blue®M: 43.86 ±3.04). The proliferation test revealed an eightfold reduction of the sample for CHX, while for Blue®M, the proliferation rate was eighteen times lower. The apoptosis and necrosis rates increased by 25% (p<0.0001) for HGF-1 for both substances. In NOK-SI, the apoptosis rates increased by 10% (p=0.02) and 15% (p=0.001) for CHX and Blue®M, respectively. Furthermore, the fibroblast had a lower capacity for wound closure in the Scratch Assay (monolayer cell migration) for Blue®M. Despite the limitations of this in vitro study, the results of the lactoferrin and oxygen-based Blue®M demonstrated cytotoxicity in doses over the Minimum inhibitory concentration and Minimum bactericidal concentration for Oral fibroblasts (HGF- 1) and Keratinocytes (NOK-SI).

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(1) Background: Biphasic bioceramics are synthetic bone substitutes that provide greater safety and better predictability in guided bone regeneration. This study aimed to evaluate the bone repair process using a new biphasic bioceramic of synthetic origin (Plenum® Osshp-70HA: 30ß-TCP) in critical calvarial defects. (2) Methods: seventy-four defects were created in rat calvaria and divided into two groups-Plenum® Osshp (PO), right side, and Straumann® BoneCeramic™ (BC), left side. Euthanasia was performed at 7, 15, 30, and 60 days after surgery. (3) Results: Lower gene expression was observed for runt-related transcription factor 2 (RUNX2) and vascular endothelial growth factor (VEGF) and higher expression for Integrin Binding Sialoprotein (IBSP). The results correlated with moderate immunolabeling for osteocalcin (OCN) and slight immunolabeling for osteopontin (OPN) in the PO group. Histometry showed a greater amount of biomaterial remaining in the PO group at 60 days. The microtomographic analysis showed a lower density of bone connectivity and a greater thickness of the trabeculae for the remnants of the PO group. (4) Conclusions: the Plenum® Osshp showed no differences compared to BoneCeramic™ and is therefore considered an effective option as a synthetic bone substitute in bone regeneration.

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Cephalometric tracing done manually was considered gold standard for the cephalometric analysis in the last decades. The digital radiographs began to be commonly used in order to make that in a digital way. The objective was to define the accuracy of the predictive and final cephalometric tracings performed manually and virtually. The authors selected 20 patients submitted to bimaxillary orthognathic surgery. The data were collected from lateral cephalometric radiographs, in the preoperative and postoperative periods. The interest were: points, angles (Sella-Nasion to A point angle; Sella-Nasion to B point angle; Frankfurt plane to Mandibular plane angle; Frankfurt plane to occlusal plane angle; Upper and lower central incisors long axes angle; Incisor to Mandibular plane angle; Upper incisor axis to Sella-Nasion plane angle) distances (Co-A; Co-Gn). Data were submitted to the Shapiro-Wilk, analysis of variance, and Kruskal-Wallis tests. The measurement differences were compared using a t test. Descriptive statistics were performed in Excel 2013 and SPSS software, P <0.05 being considered significant. No statistically significant difference was found between the mean values predictive and postoperative of the angles and distances within the manual and digital groups. When comparing the means of the differences between the predictive values and the final values, only the 1:1 angle presented a statistically significant difference, indicating a greater accuracy of the digital predictive tracing for this measure. In conclusion, both methods for obtaining predictive tracings are accurate, which shows that clinical results can be successfully simulated by the most accessible technique.

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Complex odontoma or odontogenic hamartoma is the most common odontogenic tumor, diagnosed mainly in the first two decades of life, rarely exceeding 3 cm. This paper aim is report a clinical case of complex odontoma in the retromolar region that could induce an imminent risk of mandibular fracture. The patient reported local pain, discomfort, an area with hardened edema and absence of the lower right second molar. Using computed tomography, a three-dimensional model was printed and a mandibular reconstruction plate 2.4 mm pre-bent. Through intraoral access, osteotomy was performed to remove the tumor, the tooth and fixation of the plate. With intraoral access, peripheral osteotomy was performed to remove the tumor and the tooth, then fixed a pre-folded plate. The odontogenic hamartoma is a benign and asymptomatic tumor, but can reach large proportions until diagnosed. The surgical planning of large complex odontomas in the mandible must be done with carefull, using technological resources when is possible to help predict the treatment, avoid possible complications, better esthetic result, less invasive procedure and better recovery.

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Study Design: A systematic review according to PRISMA statement has been designed to answer the preliminary question: "In titanium mesh exposures, is there a treatment alternative which leads to an increased graft maintenance?" and fill the PICO assessment out. Objective: To review studies published in the past 20 years (1999-2019) in which mesh exposure has occurred, detecting the suitable approaches to treat exposure allowing the graft maintenance. Methods: Initial search on PUBMED, SCOPUS, and COCHRANE databases resulted in 777 articles, and hand-searching identified 6 articles. After removing duplicates and unrelated articles, eligibility criteria were applied, and 31 studies were selected (randomized clinical trials, retrospective/prospective clinical trials, and case series). Results: A total of 677 surgical sites and 225 cases of mesh exposure were identified. Eleven treatments have been identified. Chlorhexidine was the primary approach in 46% of cases, followed by oral hygiene instructions and follow-up with 22.5% of occurrences. In 21% of clinical situations, titanium mesh removal was the treatment of choice, associated with other measures (i.e., antibiotic prescription). There seems to be a consensus in cases of infection. When this complication was associated with tissue dehiscence, the primary treatment was mesh removal. The same does not occur when the site needs to be cleaned for long-term periods. Conclusion: In 2 decades of use of titanium meshes, the available treatments do not seem to have evolved, and there is not enough data to establish a guideline.

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OBJECTIVE: The aim of this study was to compare bone formation between 2 distraction osteogenesis protocols by analyzing cone beam computed tomography (CBCT) scan data. STUDY DESIGN: In this retrospective study, the efficacy of 2 different surgically assisted rapid maxillary expansion protocols (group 1 [G1], 3 × 0.25 mm/d; group 2 [G2], 1 mm start followed by 2 × 0.25 mm/d) was analyzed using CBCT scans obtained at 3 time points: preoperatively (T0), immediately after surgery (T1), and 6 months after surgery (T2). Bone formation at T0, T1, and T2 was analyzed using the Dolphin Imaging 11 program. RESULTS: At T1, both groups had significantly higher bone volume than at T0 (G1, 135.6 vs 124.65 mm3, respectively; G2, 153.49 vs 118.9 mm3, respectively), with no significant difference between groups (P = .6). Moreover, bone density measured in the region of interest was similar between groups at all 3 time points; however, in both groups, bone density was significantly lower at T1 and T2 than at T0 (P < .01), with no difference between T1 and T2. CONCLUSIONS: Bone density between the incisors decreased with progressive distraction (i.e., increasing volume), regardless of the distraction protocol used; thus, both protocols can be used safely in clinical practice. Nevertheless, our results indicate that stress should not be applied to the incisors within 6 months of surgery, regardless of the protocol used. Surgeons and orthodontists should therefore consider immature bone formation and avoid using excessive force to close a diastema.

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ABSTRACT: Orbital lymphoma is a rare condition with non-specific and variable clinical course. This features are the main obstacle for diagnosis and treatment. A 43-year-old female patient complaining of vision loss and hemiface paresthesia, Proptosis was noted associated with an expansive lesion involving the right temporal lobe and orbital region. Craniotomy was performed to allow orbital decompression and anatomopathogical analysis. Final diagnosis was Burkitt Lymphoma. Patient evolved to death after seven days. A 40-year-old male patient complaining excessive tearing and sight disturbance. Proptosis on the right eye was noticed. Extra-conal expansive lesion was observed. Final diagnosis was mucosa-associated lymphoid tissue lymphoma. Radio and chemotherapy protocol was initiated. In a 3 year follow-up, there are no signs of recurrence or ocular/orbital impairment. Maxillofacial surgeons should be aware of the initial clinical presentation and always include lymphoid neoplasms as a differential diagnosis in cases which acute functional alterations are present.

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OBJECTIVES: This study evaluated the bone quality of the maxilla and mandible by using the classification proposed by Lekholm and Zarb (L & Z) and histomorphometry. METHODS: Sixty edentulous areas were evaluated. The classification by L & Z was obtained through the evaluation of periapical and panoramic radiographs associated with the surgeon's tactile perception during milling and implant installation. Before implant installation, bone biopsies of standardized sizes were performed for histological evaluation. RESULTS: Type III bone quality was more frequent in the posterior (73.33%) and anterior (73.33%) maxilla, whereas type II bone quality was more frequent in the posterior (53.33%) and anterior (60.00%) mandible. Through histometry, statistical difference was observed for the amount of bone tissue of the posterior region of the maxilla in relation to the anterior and posterior regions of the mandible (P ≤ 0.043). However, there was no difference in osteocyte counts between alveolar regions (P = 0.2946). In the female gender, the age showed a low positive correlation with the L & Z classification (rho = 0.398; P = 0.006) and in the male gender, a moderate negative correlation was observed (rho = -0.650, P = 0.016). CONCLUSIONS: Both methods detected differences in the bone quality of the alveolar regions of the maxilla/mandible and that the classification by L & Z is a reliable method, since it was consistent with histomorphometry, considered the "gold standard" method for the evaluation of bone quality and greater bone density was observed in older men.

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OBJECTIVE: The aim of this study is to evaluate through gene expression, immunohistochemical and microtomographic (micro-CT) analysis the response of peri-implant bone tissue around titanium implants with different surface treatments, placed in bone defects filled or not with bone substitute materials. In addition, to investigate the hypothesis that porous-hydrophilic surface induces a faster bone formation. MATERIALS AND METHODS: Twenty-six animals were divided into two groups according to implant surface treatment. In each tibia, a bone defect was created followed by the placement of one implant. On the left tibia, the defect was filled with blood clot (BC), and on the right tibia, the defect was filled with biphasic hydroxyapatite/ß-tricalcium-phosphate (HA/TCP) generating four subgroups: BC-N: bone defect filled with blood clot and porous surface titanium implant installed; BC-A: bone defect filled with blood clot and porous-hydrophilic surface titanium implant installed; HA/TCP-N: bone defect filled with bone substitute material and porous surface titanium implant installed; and HA/TCP-A: bone defect filled with bone substitute material and porous-hydrophilic surface titanium implant installed. The animals were submitted to euthanasia at 15, 30, and 60 days after implant installation. The expression of two genes was evaluated: RUNX2 and BSP. Immunohistochemical analyses were performed for detection of RUNX2, OPN, OCN, OPG, and RANKL antibodies and bone matrix proteins. Finally, four parameters were chosen for micro-CT analysis: trabecular number, separation and thickness, and connectivity density. RESULTS: Descriptive analysis showed similar findings among the experimental groups. Moreover, porous-hydrophilic surfaces presented a higher expression of RUNX2, which is probably an indicative of better osteogenesis; although the data from this study may be considered an insufficient support for a concrete statement. CONCLUSION: Porous hydrophilic surface can improve and accelerate protein expression and bone formation.

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This study evaluated the optical bone density of the maxilla and mandible and correlate with the classification of bone quality of the Lekholm and Zarb (L & Z). Sixty edentulous areas were evaluated. Panoramic and periapical radiographs were performed with an aluminum scale to evaluate the optical bone density. L & Z classification was also applied. By using periapical radiographs, a statistically significant difference was observed in the optical bone density of the posterior maxilla (2.38 ±â€Š1.06) and the posterior mandible (3.84 ±â€Š0.68), when compared to the other regions (P ≤ 0.015). However, with panoramic radiographs, no differences were observed in the optical bone density (P = 0.6322). A negative correlation was observed between the L & Z classification and the optical bone density obtained by the periapical radiographs (rho = -0.463; P < 0.001), that is, the worse the bone quality, the lower the bone density. However, there was no significant correlation with the bone density obtained by panoramic radiographs (rho = -0.009; P = 0.948). As for gender, a correlation between aging and the presence of medullary bone was observed in females, assessed by the L & Z classification (rho = 0.398; P = 0.006). However, there was a correlation between aging and a denser and less medullary presence in males, both assessed by the L & Z classification (rho = -650; P = 0.016), as well as the optical density assessed by periapical (rho = 0.621; P = 0.023) and panoramic (rho = 0.588; P = 0.035) radiographs. These results suggest that gender and age interfere with the bone quality and periapical radiographs are an acceptable method for evaluating bone density. However, a panoramic radiograph was not found to be a reliable method.

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OBJECTIVE: To perform an integrative review associating current literature with a clinical series regarding the use of Le Fort I osteotomy for the removal of tumors located in the midface and central region of the skull base. METHODS: A systematic review was performed through the PubMed, SCOPUS, and Cochrane databases. In addition, 4 different patients operated using the above-cited technique are described in this study. RESULTS: Initially, 123 articles were found. After the removal of duplicates, and title and abstract reading, 27 articles were selected for data extraction. The Le Fort I surgical approach of tumors was performed in 183 patients. CONCLUSION: The Le Fort I surgical approach allows lesion exeresis with good visualization, low rates of recurrences and complications, and without aesthetic compromises for the patient.

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OBJECTIVES: The objective of this study was to evaluate the peri-implant bone tissue formation around titanium implants with different surface treatments, placed in bone defects filled or not with bone substitute material (BSM). MATERIALS AND METHODS: Ten animals were divided into two groups according to implant surface treatment. In each tibia, a bone defect was created followed by the placement of one implant. On the left tibia, the defect was filled with blood clot (BC), and on the right tibia, the defect was filled with biphasic hydroxyapatite/ß-tricalcium-phosphate (HA/TCP) generating four subgroups: BC-N: blood clot and porous surface; BC-A: blood clot and porous-hydrophilic surface; HA/TCP-N: BSM and porous surface; HA/TCP-A: BSM and porous-hydrophilic surface. The animals were submitted to euthanasia 60 days after implant installation. After light-curing resin inclusion, the blocks containing the implant and the bone tissue were stained and evaluated by means of histomorphometry to assess the percentages of bone implant contact (% BIC). Data was normally distributed and the group differences were examined using the parametric tests of Two-Way ANOVA. RESULTS: The BC-A group presented the higher mean value of BIC (46.43%). The HA/TCP-A group presented the higher mean value of BIC. The porous-hydrophilic surfaces presented better results of BIC when compared to the porous surface in both conditions of defect filling. No statistically significant differences were found among all groups (95% confidence interval and P < .05). CONCLUSION: According to histomorphometric analysis, after 60-days in a rabbit model, hydrophilic and hydrophobic surfaces have the same behavior in the presence or absence of HA/TCP.

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PURPOSE: This study aimed to perform a systematic review about the use of xenogenous bonegraft in horizontal ridge augmentation to answer the following question: In implant patients, treated with xenografts for horizontal ridge augmentation, what would be the outcomes in terms of bone gain, bone resorption, implant survival, and complication rates? METHODS: The main search was performed at PubMed, Cochrane, and Scopus databases, and found 2610 articles. After selection and duplicate removal, 29 studies were included in the final review. The collected data were sample size, number and type of graft, site, horizontal gain, resorption rate, and complications. RESULTS: A total of 610 patients were submitted to 853 bone grafts, both in the maxilla and mandible. Most studies (n = 26) used particulate grafts, isolated or associated with autogenous bone, and covered by collagen membrane or titanium mesh. The mean of horizontal bone gain was 4.44 mm. In addition, the augmented ridges allowed placement of 1325 successful dental implants. The complication rate was 7.85%, and membrane exposure was the most reported complication. CONCLUSIONS: Although the autogenous bone graft remains as the gold standard for alveolar reconstruction, this review suggests that xenogenous bone graft is a feasible alternative for horizontal bone augmentation.

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OBJECTIVES: To evaluate the effect of Cisplatin on bone repair and mineralization around implants and on the mechanical properties of bone tissue. MATERIALS AND METHODS: Forty-three Wistar rats were randomly divided into two groups: Cisplatin (CIS, medication) and control (CTL, placebo solution), administered once a week for 4 weeks. After 4 weeks, implants were installed in both tibiae metaphysis. After 30 and 60 days, the animals were sacrificed and their femurs and tibiae were removed. Femurs were subjected to mechanical tests and tibiae for removal torque, arrangement and distribution of collagen fibers, morphometrical analyses (bone tissue in contact with the implant surface [BIC] and areal fraction between implant threads occupied by bone tissue [BAFO]) and scanning electron microscopy to calcium and calcium/phosphorus analysis. Data were analyzed by ANOVA or MANOVA, and Tukey or Games-Howell post hoc tests, respectively (α = 0.05). RESULTS: The CTL specimens had significantly higher values (0.0001 ≤ p≤0.036) of strength (N), removal torque (N/cm2 ), %BIC, and %BAFO than CIS specimens, being their best results at day 60. No significant differences were found among the groups regarding the values of deformation, percentage of calcium, and calcium/phosphorus ratio. In CIS groups, there was a reduction in the organization of collagen at the bone/implant interface, resulting in a trabecular bone with thin trabeculae and birefringent collagen and irregular arrangement. CONCLUSIONS AND CLINICAL IMPLICATIONS: Cisplatin interfered negatively in the repair and mineralization around dental implants, as well as on the quality of the bone tissue, mainly in the period of 30 days after the implant placement.

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ABSTRACT Marfan's (MFS) syndrome is characterized by a defect in the connective tissue, which affects multiple organic systems. Therefore, the management of these patients requires a multidisciplinary approach. This case reports the orthodontic-surgical treatment of a patient who presented both Marfan's and obstructive sleep apnea syndrome. Patient had malocclusion, TMJ clicking, vertical maxillary excess, mandibular retrognathia, severe esthetic compromise, signs and symptoms of obstructive sleep apnea syndrome, as well as alterationsin joints, cardiovascular and respiratory systems. He was treated with bimaxillary surgery aimed to enhance esthetics, occlusion and address the obstructive sleep apnea syndrome. The clinical results show that a desirable functional occlusion was achieved and both patient's facial esthetics and quality of life were significantly improved. After a 9-year follow-up period, these pleasing features were maintained. The diagnosis and management of Marfan's patients is challenging and require multidisciplinary follow-up.

RESUMO A síndrome de Marfan (SMF) é caracterizada por um defeito no tecido conjuntivo que afeta múltiplos sistemas orgânicos. Portanto, o manejo desses pacientes requer uma abordagem multidisciplinar. Este artigo relata o tratamento ortodôntico-cirúrgico de um paciente com síndrome de Marfan e síndrome da apneia obstrutiva do sono (SAOS). Ele manifestava má oclusão, estalidos na ATM, excessovertical de maxila, retrognatismo mandibular, comprometimento estético severo, sinais e sintomas de síndrome da apneia obstrutiva do sono, além de alterações nas articulações, nos sistemas cardiovascular e respiratório. O tratamento incluiu cirurgia bimaxilar com o objetivo de melhorar a estética, a oclusão e tratar sua apneia obstrutiva do sono. Os resultados clínicos mostram que uma oclusãofuncional desejável foi alcançada e tanto a estética facial quanto a qualidade de vida do paciente foram significativamente melhoradas. Após um período de 9 anos de acompanhamento, essas características agradáveis foram mantidas. O diagnóstico e tratamento de pacientes com síndrome de Marfan é desafiador e requer acompanhamento multidisciplinar.

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Oral rehabilitation with osseointegrated implants is frequently the best alternative for replacement of lost teeth. Several techniques and materials allow achievement of excellent function and esthetics. In the case of maxillary or mandibular atrophy, extensive grafting may be necessary before implants can be properly placed. This is a case of maxillary reconstruction with autogenous iliac crest bone grafts, followed by placement of guided implants. After integration of the grafts, planning and insertion of implants allowed installation of an implant-supported prosthesis, recovering the morphology, function, and esthetics.

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Orbital fractures are high prevalent and result in several complications such as diplopia, muscular entrapment, visual impairment, and enophthalmos. The goal of orbital reconstruction is to restore orbital anatomy, volume, and globe symmetry. This case report aims to describe the use of transantral endoscopy and 3D printed model for treatment of an orbital floor fracture. A 54-year-old woman presented orbital floor fracture with diplopia and extraocular muscle entrapment. The surgical treatment was performed using a standard titanium mesh bended over 3D printed model, and transantral endoscopy to verify fracture extension and implant adaptation. The postoperative evaluation demonstrates correction of diplopia and ocular motility restriction. Computed tomography scan showed reestablishment of the orbital anatomy. The association of transantral endoscopy and 3D printed models is a feasible technique to improve orbital reconstruction.

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The objective of this study was to review the medical records of patients with a history of mandibular angle fracture who were attended at the Service of Oral and Maxillofacial Surgery and Traumatology of FOAr/UNESP in the last 5 years. The data collected were subjected to chi-squared test (significance level of 5%). The authors reviewed 19 medical records. The main cause was physical aggression (58.00%), but with no statistical difference in relation to the other etiologies (P > 0.05). Regarding the type of fixation, one 2.0-mm system plate associated with one 2.4-mm system plate and the fixation using only two 2.0-mm system plates were used in 7 patients each. The fixation method with a monocortical plate at the upper border was used in 5 patients. However, there was no statistically significant difference in the frequency of complications among the 3 fixation methods used (P > 0.05). In 52.64% of the patients, the third molar was removed intraoperatively. Despite this, there was no statistically significant difference in the frequency of complications when the third molar was in the fracture line or when it was removed postoperatively (P > 0.05). The complications observed were dehiscence associated with pain (44.44%), trismus (22.22%), infection (22.22%), and presence of bone spicules (11.11%). However, no statistical differences were observed between the frequency of different types of complications (P = 0.779). In the sample studied, there were no differences in the frequency of complications among the fixation methods applied.

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