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A hiperplasia hemimandibular é responsável por prejuízos estéticos, funcionais, motores e psicossociais. Com etiologia incerta, ocorre frente ao desequilíbrio de fatores regulatórios de crescimento presentes na camada cartilaginosa do côndilo. O relato objetiva descrever a tomada de decisões baseada em exames complementares específicos aliados à adequada intervenção cirúrgica da lesão. Paciente gênero feminino, 33 anos de idade, compareceu à clínica particular com queixa principal de "face assimétrica", foi requerido uma avaliação cintilográfica objetivando e confirmando a interrupção do crescimento condilar, descartando a hipótese de Osteocondroma e condilectomia. Após preparo ortodôntico prévio, os exames tomográficos foram utilizados na criação de um protótipo que foi impresso após a realização dos movimentos ósseos planejados. Mediante à reconstrução, foi concluído que a assimetria presente não seria totalmente corrigida somente através da intervenção ortognática, sendo necessária também uma osteotomia removendo parte da base do corpo e ângulo mandibular, através da confecção de um guia de corte, promovendo à reanatomização sem a necessidade de acesso extra oral submandibular, evitando uma cicatriz em face feminina. Paciente encontra-se em pós-operatório de 60 meses, sem queixas e satisfeita. Portanto, é evidenciado cada vez mais a influência positiva que o planejamento virtual pode trazer aos profissionais na otimização dos resultados cirúrgicos.

Hemimandibular hyperplasia is responsible for aesthetic, functional, motor, and psychosocial impairments. With an uncertain etiology, it occurs due to the imbalance of regulatory growth factors present in the cartilaginous layer of the condyle. The report aims to describe decision-making based on specific complementary exams combined with the appropriate surgical intervention for the condition. A 33-year-old female patient presented at a private clinic with the main complaint of "asymmetric face." A scintigraphic evaluation was requested to objectively confirm the interruption of condylar growth, ruling out the hypothesis of Osteochondroma and condylectomy. After prior orthodontic preparation, tomographic exams were used to create a prototype that was printed after planned bone movements. Through the reconstruction, it was concluded that the existing asymmetry would not be entirely corrected through orthognathic intervention alone, necessitating also an osteotomy to remove part of the base of the body and mandibular angle. This was done through the creation of a cutting guide, allowing for reanatomization without the need for submandibular extraoral access, thus avoiding a scar on the female face. The patient is 60 months postoperative, with no complaints and satisfied. Therefore, the increasingly positive influence of virtual planning on optimizing surgical outcomes for professionals is evident.

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Introdução: A parestesia é uma neuropatia que afeta a função sensorial. O Laser de Baixa Potência (LBP), por sua vez, apresenta propriedades analgésicas, bioestimuladoras e reparadoras. Objetivo: Realizar um levantamento na literatura científica sobre os aspectos gerais e benefícios do LBP no manejo terapêutico da parestesia, além de identificar a classificação e métodos de obtenção do diagnóstico desta condição. Materiais e Métodos: Tratou-se de uma revisão narrativa da literatura através da busca nas plataformas PubMed, SciELO, LILACS e Google Schoolar. Após o cruzamento dos descritores com os operadores booleanos e aplicação dos critérios de inclusão/exclusão, 26 estudos foram incluídos. Resultados: A parestesia pode ser classificada em neuropraxia, axonotmese e neurotmese, subdivididas em Grau I ao V. Seu diagnóstico pode ser executado através de testes subjetivos e objetivos. O LBP compreende em um dispositivo tecnológico com efeitos analgésico, anti-inflamatório e fotobiomodulador, que estimula o reparo neural. Os estudos mostram que a dosimetria nos comprimentos de onda vermelho e infravermelho, aplicação intra e extra oral, e com mais de uma sessão semanal exerce efeito modulatório positivo do reparo neural, com retorno progressivo da atividade sensitiva. Além disso, os estudos trazem uma ampla variação no número de pontos de aplicação, bem como no tempo de irradiação e quantidade de sessões, em virtude da extensão e tempo de diagnóstico da parestesia. Considerações finais: Apesar da alta complexidade da parestesia, o LBP exerce efeitos benéficos através do retorno da sensibilidade parcial ou total, além de ser um dispositivo bem tolerado pelo organismo e minimamente invasivo.

Introduction: Paresthesia is a neuropathy that affects sensory function. The Low-Level Laser (LLL), in turn, has analgesic, biostimulating and reparative properties. Purpose: Carry out a survey at the scientific literature on the general aspects and benefits of LLL in the therapeutic management of paresthesia in addition to identifying the classification and methods for obtaining a diagnosis of this condition. Materials and Methods: It was a narrative literature review through search in platforms PubMed, SciELO, LILACS and Google Schoolar. After crossing the descriptors with boolean operators and applying the inclusion/exclusion criteria, 26 articles were included in this study. Results: Paresthesia can be classified into neuropraxia, axonotmesis and neurotmesis, subdivided into Grades I to V. Its diagnostic can be carried out through subjective and objective tests. The LLL consists in a technological device with analgesic, anti-inflammatory and photobiomodulatory effects, which stimulates neural repair. Studies show that LLL in dosimetry at red and infrared wavelengths with intra and extra oral application and with more than one-week use exerts a positive modulatory effect on neural repair, with a progressive return of sensory activity. Furthermore, the studies show a wide variation in the number of application points, as well as the irradiation time and number of sessions, due to the extent and time of diagnosis of paresthesia. Final Considerations: Despite the high complexity of paresthesia, the LLL has beneficial effects through the return of partial or total sensitivity in addition being a device well tolerated by the body and minimally invasive.

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Objectives: To evaluate the positions of the mandibular foramen (MF) and mandibular canal (MC) between different skeletal classes to highlight the implications for bilateral sagittal split osteotomy (BSSO). Methods: A cross-sectional study was performed using cone-beam computed tomography on 90 patients classified into classes I, II and III. Linear measurements were performed on multiplanar reconstructions as follows: from the MF to the edge of the mandibular ramus (1), to the mandibular notch (2), to the ramus width (3) and to the occlusal plane (4); and from the MC to the alveolar crest (A), to the lower border of the mandible (B) and to the mandibular buccal cortical bone (C). Mandibular thickness (D), width (E) and height (F) of the MC were measured. Intra-class correlation coefficient (ICC) checked the reliability. Two-way ANOVA and Tukey's test were used to compare measurements and classes. Results: Linear measurements 2 presented a statistically significant difference between classes I and II. There was no statistically significant difference between the classes and measurements B, C, D, E and F. Linear measurements A were shorter in class III than in class II. Conclusions: Although most measurements suggest that the BSSO technique does not need to be modified for each skeletal class, measurements from the MF to the mandibular notch in class II and from the MC to the alveolar crest on distal of the second molars in class III could help surgeons to recognize critical regions.

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Given the high prevalence of skeletal and mandibular diseases in the Patagonian Huemul, comprehensive anatomical studies are essential to understand the impact of nutritional deficiencies and support conservation efforts. The aim of this study is to provide a detailed anatomical characterisation of three exhumed mandibles of Patagonian huemul (Hippocamelus bisulcus) through three-dimensional reconstructions obtained from computed tomography data and semi-automatic segmentation, documenting their distinctive features. The findings revealed distinctive features in the mandible, consistent with the browsing habits of herbivores, such as a robust coronoid process, a wide and deep pterygoid fossa, a significantly lower mandibular condyle compared to other deer species and a unique configuration of the mandibular canal with a curved caudal portion and a straight rostral portion. These anatomical adaptations are likely related to the species' feeding habits and behaviour. The study also addressed the challenges of researching an endangered species, given that access to biological material is restricted by strict regulations in Chile and Argentina. These restrictions limited the available sample size and hindered the acquisition of additional specimens, which could affect the generalisation of the results. Despite these limitations, the research provides valuable anatomical insights that are fundamental for the biology, clinical practice and management of specimens. In conclusion, the mandibles of both juvenile and adult Patagonian huemul demonstrate distinctive features characteristic of browsing herbivores. The findings can serve as a basis for future comparative studies on mandibular anatomy and function in this endangered deer species as well as in other herbivorous deer.

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When developing, the mandible presents great plasticity and contains condensed mesenchymal cells that develops into Meckel's cartilage, of which the anterior part forms the mandibular symphysis. Mandible human development studies focus on investigating whether the beginning of mandibular fusion in fetal period is related to symphysis ossification and the tensions imposed on it, considering that tongue movements, mouth opening, and closing can be seen in fetuses. This research analyses tissue modifications during human mandibular symphysis growth using light and scanning electron microscopy to relate them to its functional structure. The study sample consisted of 12 human fetuses distributed into two groups: Group I (GI) of 10-14 weeks old and Group II (GII) of 20-24 weeks old. Fragments of mandibular symphysis were removed en bloc together with the surrounding tissues to preserve the relation with adjacent structures. Decalcified specimens were prepared in semi-serial coronal sections 5-µm-thick and stained with hematoxylin and eosin, Masson՚s trichrome, Verhoeff, and Sirius red for histological analysis with light microscopy. Collagen fibers Type I or III and elastic fibers were quantified by volume fraction (Vv). Coronal sections of the GI and GII symphyseal region were submitted to scanning electron microscopy. Comparison between groups used independent t-test. Our study presents the different endochondral ossification stages in the anterior part of Meckel's cartilage in GI. Both groups showed abundantly vascularized mesenchymal tissue with intense cellular activity forming the mandibular symphysis, such as a source of new osteoblasts adjacent to the newly deposited bone matrix. Scanning electron microscopy analysis revealed an invasion of the bony trabecula in the transverse direction from the hemimandible, rectilinear in GI and sinuous in GII due to interdigitating bone process, promoting its ossification. In collagen Vv analysis was verified a prevalence of type I in GII and type III in GI, indicating a proportional relation between maturation and tissue arrangement. Functionally, the collagen and elastic fibers in the mandibular symphysis were arranged in a pantographic network, and the fibrillar interconnectivity clearly contributes to resilience capacity and efficiency of the force transfer. This study inferred the functional significance of the knowledge about the tissue composition of mandibular symphysis, and the importance of this tissue for surrounding structures. The mesenchymal tissue of mandibular symphysis participates in bone growth process, revealing an adaptation mechanism of mandibular symphysis in the fetal period investigated.

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Radix accessoria dentis are anatomical variations of the mandibular molars and identifying them radiographically can be challenging for the clinician, especially in specific areas such as endodontics. The objective this study was to determine the prevalence of radix accessoria dentis evaluated in cone-beam computed tomography in a northern Peruvian population. The study design was descriptive and cross-sectional. The sample consisted of 2640 permanent mandibular first and second molar teeth evaluated by cone beam tomography. Non-probabilistic convenience sampling was used. For the analysis of radix accesoria dentis, the axial and coronal views of the tomography were evaluated. Prevalence was evaluated according to sex and according to type of tooth and average length. The statistical analyses used were the chi-square test and Kruskal-Wallis H test to find the correlation of the variables. A prevalence of 2.5 % of radix accesoria dentis was determined. According to sex, radix accesoria dentis was present in 1.36 % in females and 1.14 % in males (p > 0.05). The tooth 4.6 obtained the highest prevalence with 1.33 % (p > 0.05) and the average length of radix accesoria dentis found was 9.27 mm (p > 0.05). The prevalence of the radix accesoria dentis evaluated in cone beam tomography in a northern Peruvian population is low. Sex does not influence its presentation. Mandibular first molars are the ones that present the greatest amount of this anatomical variation and the average length of the radix accesoria dentis is less than 10 mm.

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The inferior alveolar nerve (IAN), contained within the mandibular canal (MC), is a structure prone to damage in clinical and surgical procedures on the mandible. This study aimed to analyze the MC morphology and its anatomical variants in a Chilean subpopulation using cone beam computed tomography (CBCT). In total, 342 images from patients with the following parameters were observed: 120 kV, 9 mA, field of view 12 × 9 MC, and voxel size 0.12 mm. The average length of the MC recorded a mean value of 70.493 ± 4.987 mm on the right side and 70.805 ± 5.177 mm on the left side. The location of the mental foramen (MF) was most frequently found between the mandibular first and second premolar. The greatest bone thickness was found at the level of the basilar border of the 2MPM. The root closest to the MC was distal from the mandibular second molar. The lowest thickness was in the lingual area at 1MM. The prevalence of the anterior loop (AL) (61.5%) and the retromolar canal (RC) (17.5%) showed no significant differences between men and women. The results obtained showed that the morphology of the MC in the Chilean subpopulation can vary.

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BACKGROUND: Neuroplasticity induced by mandibular advancement appliance (MAD) in patients with obstructive sleep apnoea (OSA) is poorly documented. OBJECTIVE: This randomised placebo-controlled crossover mechanistic study assessed the effects of short-term use of a MAD on corticomotor excitability of the masseter and tongue in patients with OSA. METHODS: Adults (n = 28) with mild or moderate OSA were randomly allocated to sleep with a MAD for 2-weeks with 40% of the maximal protrusion (MAD active position) and without any jaw protrusion (MAD placebo position). The outcomes were assessed at baseline, and after 2 and 6 weeks, with a 2-week washout period. The primary outcome was the amplitude of motor evoked potential (MEP) assessed on the right masseter, right side of tongue and right first dorsal interosseous with transcranial magnetic stimulation. Corticomotor map volume of the same muscles was also assessed. Repeated-measures ANOVAs followed by Tukey test were applied to the data (p < .050). RESULTS: There was a significant increase in the MEP amplitude of the masseter and tongue following the MAD active position compared with the baseline and MAD placebo (Tukey: p < .001). There were no significant MEP amplitude differences between the baseline and placebo positions (p > .050). Moreover, there was a significant increase in corticomotor map volume for the masseter and tongue muscles following the MAD active position compared with baseline and MAD placebo (Tukey: p < .003). CONCLUSION: Excitability of the masseter and tongue motor pathways is, at least transiently, increased in patients with OSA following a short-term use of MAD. This novel finding of MAD-induced neuroplasticity in corticomotor pathways may contribute to a further understanding of the mechanisms of oral appliances for treating OSA.

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Introducción: hemos observado en nuestra práctica ortodóncica una gran cantidad de pacientes con plano oclusal inclinado, con un ángulo goníaco alto y postero-rotación mandibular. Todo parece indicar que el plano oclusal juega un papel muy importante en el desarrollo de las maloclusiones. Objetivo: mostrar en el presente caso clínico de un niño, si existe una correlación entre la inclinación del plano oclusal, la altura del ángulo goníaco, la longitud de la rama mandibular y la proyección del mentón antes y después, al corregirlo y hacerlo más horizontal con tratamiento ortodóncico. Caso clínico: paciente masculino de 11 años de edad, hiperdivergente, clase II esquelética severa, perfil convexo, apiñamiento dental superior e inferior, clase II molar, incompetencia labial severa, mordida profunda, overjet aumentado, mentón retrusivo, cervicales rectificadas y anterorotación de cabeza. El tratamiento de ortodoncia se realizó con brackets Roth slot 22 y extracciones de primeros premolares superiores e inferiores y primeros molares superiores (siendo reemplazados por los terceros molares superiores), curvas inversas, cierre de espacios con pérdida de anclaje y ajuste oclusal. Resultados: al finalizar el tratamiento, se logró mejorar la estética facial, un ángulo goníaco más desarrollado con mayor crecimiento vertical, mayor proyección del mentón, un plano oclusal más horizontal, un adecuado overbite y overjet, clase I molar y canina, antero-rotación mandibular, buena intercuspidación, oclusión funcional y excelente estabilidad oclusal sin retención, mejoría en lordosis cervical y posición de la cabeza. Conclusiones: la corrección de un plano oclusal inclinado en niños y adolescentes hiperdivergentes, puede mejorar de manera importante el vector de crecimiento, ayudar a un mayor desarrollo en la altura del ángulo goníaco y longitud de la rama mandibular, proyección del mentón al corregirlo y hacer el plano oclusal más horizontal con la mecánica ortodóntica de curvas inversas; por lo tanto, en el presente caso clínico: sí existe una correlación muy importante entre la inclinación del plano oclusal, la altura del ángulo goníaco y la proyección del mentón antes y después del tratamiento ortodóncico (AU)

Introduction: we have observed in our orthodontic practice a large number of patients with inclined occlusal plane, with a high goniac angle and posterior mandibular rotation. Everything seems to indicate that the occlusal plane plays a very important role in the development of malocclusions. Objective: to show in the present clinical case of a child, if there is a correlation between the inclination of the occlusal plane, the height of the goniac angle, the length of the mandibular branch and the projection of the chin before and after, when correcting it and making it more horizontal with orthodontic treatment. Case report: an 11 year old male patient, hyperdivergent, severe skeletal class II, convex profile, upper and lower dental crowding, molar class II, severe labial incompetence, deep bite, increased overjet, retrusive chin, rectified cervicals, and anterorotation of the head. Orthodontic treatment was performed with Roth slot 22 brackets and extractions of upper and lower first premolars and upper first molars (being replaced by upper third molars), inverse curve, space closure with loss of anchorage and occlusal adjustment. Results: at the end of the treatment, it was possible to improve facial aesthetics, a more developed gonial angle with greater vertical growth, greater chin projection, a more horizontal occlusal plane, an adequate overbite and overjet, molar and canine class I, mandibular anterorotation, good intercuspidation, functional occlusion and excellent occlusal stability without retention, improvement in cervical lordosis and head position. Conclusions: the correction of an inclined occlusal plane in hyperdivergent children and adolescents can significantly improve the growth vector, help further development in the height of the gonial angle and length of the mandibular ramus, chin protection when correcting it and making the most horizontal occlusal plane with the orthodontic mechanics of inverse curves; therefore, in the present clinical case: there is a very important correlations between the inclination of the occlusal plane, the height of the gonial angle and chin projection before and after orthodontic treatment (AU)

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A useful approach to deepen our knowledge about the origin and evolution of venom systems in Reptilia has been exploring the vast biodiversity of this clade of vertebrates in search of orally produced proteins with toxic actions, as well as their corresponding delivery systems. The occurrence of toxins in anguimorph lizards has been demonstrated experimentally or inferred from reports of the toxic effects of the oral secretions of taxa within the Varanidae and Helodermatidae families. In the present study, we have focused on two alligator lizards of the Anguidae family, the Mexican alligator lizard, Abronia graminea, and the red-lipped arboreal alligator lizard, A. lythrochila. In addition, the fine morphology of teeth of the latter species is described. The presence of a conserved set of proteins, including B-type natriuretic peptides, cysteine-rich secretory proteins, group III phospholipase A2, and kallikrein, in submandibular gland extracts was demonstrated for both Abronia species. These proteins belong to toxin families found in oral gland secretions of venomous reptile species. This finding, along with previous demonstration of toxin-producing taxa in both paleo- and neoanguimorpha clades, provides further support for the existence of a handful of conserved toxin families in oral secretions across the 100+ million years of Anguimorpha cladogenesis.

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Implant-supported complete dentures are a common procedure for patients with mandibular edentulism problems. This article documents the protocol for immediate functional loading of fixed transient mandibular prostheses with fully moldable attachments and distal extensions to prevent fractures. A 56-year-old female patient was referred to the Oral Rehabilitation and Implantology Service due to periodontal problems, difficulty in chewing capacity and aesthetic compromise. The patient was treated in a single surgical procedure with dental extractions, guided regularization of the alveolar process and guided placement of five interforaminal implants and placement of functional fixed mandibular prostheses with immediate loading with personalized UCLA'S, distal extensions and short arc occlusal scheme. At 3 months postoperatively, the definitive placement of fixed mandibular metal acrylic prostheses and conventional upper prostheses was performed. The functional and aesthetic integrity of the fixed mandibular prosthesis implant preserved with UCLA'S documents that implant placement in the interforaminal zone with an immediate loading protocol is a viable treatment option for prosthetic rehabilitation of the fully edentulous mandibular arch and that design with distal extensions in the posterior sector of the mandibular arch is an effective option to avoid fracture of the prostheses, presenting a survival of the five mandibular implants of 100% at 1 year postoperatively.

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Rheumatoid arthritis and osteoarthritis both affect the articular cartilage, and are characterized by signs and symptoms that can affect the functions of the human body. This cross-sectional observational study evaluated electromyographic activity in the masseter and temporalis muscles, molar bite force, and mandibular mobility in adult women with rheumatoid arthritis or osteoarthritis. A total of 42 women were distributed into 3 groups: rheumatoid arthritis group (ARG, n=14); osteoarthritis group (OAG, n=14); and a healthy control group (CG, n=14). Electromyography was used to evaluate mandibular tasks at rest, right and left laterality, protrusion, and dental clenching during maximum voluntary contraction, with and without parafilm, and a dynamometer was used to analyse the right and left molar bite forces. A digital caliper was used to measure the range of mandibular movement for maximum mouth opening, right and left laterality, and protrusion. Statistical analyses were performed, including analysis of variance and Tukey's test (P<0.05). Electromyography showed no significant differences between the groups when evaluating the masticatory muscles during the mandibular tasks. Significant difference was observed between the ARG and CG, however, in the maximum right (P=0.007) and left (P=0.02) molar bite forces. Significant difference was observed in the maximum mouth opening of the ARG and OAG groups compared with that of the CG (P=0.009), suggesting that adult women with rheumatoid arthritis or osteoarthritis experience functional alterations in the stomatognathic system, particularly in molar bite force and maximum mouth opening.

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Objective: This study aims to identify fracture patterns on the lingual aspect of the mandible following Bilateral Sagittal Osteotomy of the Mandibular Ramus and correlate these patterns with mandibular anatomical characteristics in patients with cleft lip and palate. Methods: Two hundred cone beam CT scans were analyzed, with 100 scans in the preoperative period to assess mandibular anatomy and 100 in the postoperative period to evaluate the course of fractures on the lingual surface after surgery. Results: Statistical analysis revealed no correlation between the depth of the mandibular fossa and the type of fracture after bilateral sagittal osteotomy. Similarly, there was no association between the height and angle of the mandibular body and the type of fracture. The most common fracture type observed was the type 3 pattern, characterized by a line running through the mandibular canal. Furthermore, no relationship was identified between the studied anatomical aspects and the occurrence of undesired fractures. Conclusions: The anatomical data presented in this study can assist surgeons in selecting the safest surgical techniques and optimal osteotomy sites, particularly in patients with cleft lip and palate.

Objetivo: Este estudio tiene como objetivo identificar los patrones de fractura en la superfície lingual de la mandíbula después de la osteotomía sagital bilateral de la rama mandibular y correlacionar estos patrones con las características anatómicas mandibulares en pacientes com fisura labiopalatina. Métodos: Se analizaron doscientas tomografías computarizadas de haz cónico, con cien tomografías en el período preoperatorio para evaluar la anatomía mandibular y cien en el período postoperatorio para evaluar el curso de las fracturas en la superficie lingual después de la cirugía. Resultados: El análisis estadístico no reveló correlación entre la profundidad de la fosa mandibular y el tipo de fractura después de la osteotomía sagital bilateral. Del mismo modo, no hubo asociación entre la altura y el ángulo del cuerpo mandibular y el tipo de fractura. El tipo de fractura más común observado fue el patrón tipo 3, caracterizado por una línea que atraviesa el canal mandibular. Además, no se identificó relación entre los aspectos anatómicos estudiados y la ocurrencia de fracturas no deseadas. Conclusiones: Los datos anatómicos presentados en este estudio pueden ayudar a los cirujanos a seleccionar las técnicas quirúrgicas más seguras y los sitios de osteotomía óptimos, especialmente en pacientes con fisura labiopalatina.

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Objetivo: El cóndilo mandibular bífido es una alteración morfológica de la articulación temporomandibular en la que el cóndilo presenta un surco en la superficie superior que genera dos cabezas condilares. Esta alteración puede ser unilateral o bilateral. La mayoría de los cóndilos mandibulares bífidos se detectan mediante radiografías panorámicas, sin embargo, la tomografía computarizada Cone Beam de articulación temporomandibular es considerado el examen de elección para el diagnóstico de esta alteración. El propósito de este trabajo es presentar un caso de cóndilo mandibular bífido bilateral detectado incidentalmente mediante una tomografía computarizada Cone Beam solicitada por un diagnóstico presuntivo de osteoartritis. Caso clínico: Una paciente de 22 años sin antecedentes de traumatismos cráneo faciales solicita una tomografía computarizada Cone Beam de articulaciones temporomandibulares por diagnóstico presuntivo de osteoartritis. En la exploración del volumen se encontraron cóndilos mandibulares bífidos con dos cabezas condilares, medial y lateral de forma bilateral, siendo más acentuado en el cóndilo derecho.(AU)

Aim: The bifid mandibular condyle is a morphological alteration of the temporomandibular joint in which the condyle has a groove on its upper surface that generates two condylar heads. This alteration can be unilateral or bilateral. Most bifid mandibular condyles are detected by panoramic radiographs, however, Cone Beam computed tomography of the temporomandibular joint is considered the test of choice for the diagnosis of this alteration. The purpose of this work is to present a case of bilateral bifid mandibular condyle, incidentally detected by Cone Beam computed tomography requested for a presumptive diagnosis of osteoarthritis. Clinical case: A 22-year old female patient with no history of craniofacial trauma requests a Cone Beam computed tomography of the temporomandibular joints due to a presumptive diagnosis of osteoarthritis. In the volume exploration, bifid mandibular condyles were found with two condylar heads, medial and lateral bilaterally, being more accentuated in the right condyle.(AU)

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El torus mandibular es un crecimiento exofítico óseo benigno en la parte interna de la mandíbula, generalmente presente en ambos lados. Su etiología se relaciona a diversos factores como la herencia, grado de estrés, factores ambientales, nutricionales y trauma oclusal. Puede causar problemas funcionales y estéticos, como dificultad en la pronunciación, mal aliento, molestias al comer con prótesis mal adaptadas y ulceraciones. En la mayoría de los casos no es necesario el tratamiento, excepto cuando se requiere para mejorar la función protésica o solucionar problemas funcionales. En este artículo presentamos la situación clínica que describe la escisión exitosa del torus mandibular bilateral en un paciente de 57 años para la posterior rehabilitación protésica. La escisión del torus mandibular bilateral es un procedimiento seguro y predecible que ayuda a prevenir complicaciones protésicas y biológicas, mejorando la estabilidad y la función del sistema estomatognático (AU)

The mandibular torus is a benign bony exophytic growth in the inner part of the mandible, usually present on both sides. Its etiology is related to various factors such as heredity, degree of stress, environmental and nutritional factors, and occlusal trauma. It can cause functional and aesthetic problems, such as difficulty in pronunciation, bad breath, discomfort when eating with ill-fitting prostheses, and ulcerations. In most cases, treatment is not necessary, except when it is required to improve prosthetic function or solve functional problems. In this article we present the clinical situation that describes the successful excision of the bilateral mandibular torus in a 57-year-old patient for subsequent prosthetic rehabilitation. Bilateral mandibular torus excision is a safe and predictable procedure that helps prevent prosthetic and biological complications, improving the stability and function of the stomatognathic system (AU)

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BACKGROUND: This study aims primarily to assess the mandibular condyles and patient response to MAD therapy using cone-beam computed tomography (CBCT). Also, the study proposes to analyze whether variations in condylar position, OSA severity and mandibular protrusion influence patient response. METHODS: 23 patients diagnosed with mild/moderate OSA and treated with MAD comprised the sample. Clinical, CBCT, and PSG assessments were conducted at baseline and with MAD in therapeutic protrusion (4-6 months of MAD use). The condyle position was vertically and horizontally evaluated at baseline and at the therapeutic protrusion. RESULTS: The condyle position significantly changed with MAD, showing anterior (7.3 ± 2.8 mm; p < 0.001) and inferior (3.5 ± 1 mm; p < 0.001) displacement. Patients with mild OSA required more protrusion (p = 0.02) for improvement. Responders exhibited a significantly prominent (p = 0.04) anterior baseline condyle position. A negative modest correlation was found between treatment response and baseline condyle anterior position (p = 0.03; r=-0.4), as well as between OSA severity and the percentage of maximum protrusion needed for therapeutic protrusion (p = 0.02; r=-0.4). The patient protrusion amount did not predict condylar positional changes. Neither condyle position, OSA severity, nor therapeutic protrusion were predictors of MAD treatment response. CONCLUSION: MAD resulted in anterior and inferior condylar displacement, and the amount of protrusion did not predict condylar positional changes. Responders showed a more anterior baseline condyle position. OSA severity and mandibular protrusion did not predict treatment response.

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Hyperplasia of the coronoid process is a rare alteration that is characterized by the exaggerated and progressive development of said process over periods of months or years, both in height and volume, which finally causes mandibular hypomobility. It is important to highlight the importance of imaging for the correct diagnosis and treatment of said entity, taking into consideration the great variety of differential diagnoses that can occur. In this sense, conventional radiographs constitute a basic and indispensable tool for approaching the diagnosis. However, it is actually the CT scan that offers the greatest precision. The case of a 14-year-old male patient is presented, with no contributing medical history, who was referred for presenting progressive opening limitation since childhood, for which, after clinical and imaging evaluation, he was treated with total bilateral coronoidectomy, postoperative follow-up was performed. for a year in which recurrence of said entity could be observed. This case demonstrates the importance of correct diagnosis, as well as postoperative control and the rehabilitation scheme carried out by the patient.

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OBJECTIVE: To share our experience in creating precise anatomical models using available open-source software. METHODS: An affordable method is presented, where from a DICOM format of a computed tomography, a segmentation of the region of interest is achieved. The image is then processed for surface improvement and the DICOM format is converted to STL. Error correction is achieved and the model is optimized to be printed by stereolithography with a desktop 3D printer. RESULTS: Precise measurements of the dimensions of the DICOM file (CT), the STL file, and the printed model (3D) were carried out. For the C6 vertebra, the dimensions of the horizontal axis were 55.3 mm (CT), 55.337 mm (STL), and 55.3183 mm (3D). The dimensions of the vertebral body were 14.2 mm (CT), 14.551 mm (STL), and 14.8159 mm (3D). The length of the spinous process was 18.2 mm (CT), 18.283 mm (STL), and 18.2266 mm (3D), while its width was 8.5 mm (CT), 8.3644 mm (STL), and 8.3226 mm (3D). For the C7 vertebra, the dimensions of the horizontal axis were 58.6 mm (CT), 58.739 mm (STL), and 58.7144 mm (3D). The dimensions of the vertebral body were 14 mm (CT), 14.0255 mm (STL), and 14.2312 mm (3D). The length of the spinous process was 18.7 mm (CT), 18.79 mm (STL), and 18.6458 mm (3D), and its width was 8.9 mm (CT), 8.988 mm (STL), and 8.9760 mm (3D). CONCLUSION: The printing of a 3D model of bone tissue using this algorithm is a viable, useful option with high precision.

OBJETIVO: Compartir nuestra experiencia para crear modelos anatómicos precisos utilizando software con licencia abierta disponibles. MÉTODOS: Se presenta un método asequible, en donde a partir de un formato DICOM de una tomografía computarizada se logra una segmentación de la región de interés. Posteriormente se procesa la imagen para una mejora de superficie y se realiza la conversión de formato DICOM a STL. Se logra la corrección de errores y se optimiza el modelo para luego ser impreso por medio de estereolitografía con una impresora 3D de escritorio. RESULTADOS: Se efectuaron mediciones precisas de las dimensiones del archivo DICOM (TC), del archivo STL y del modelo impreso (3D). Para la vértebra C6, las dimensiones del eje horizontal fueron 55.3 mm (TC), 55.337 mm (STL) y 55.3183 mm (3D). Las dimensiones del cuerpo vertebral fueron 14.2 mm (TC), 14.551 mm (STL) y 14.8159 mm (3D). La longitud de la apófisis espinosa fue de 18.2 mm (TC), 18.283 mm (STL) y 18.2266 mm (3D), mientras que su ancho fue de 8.5 mm (TC), 8.3644 mm (STL) y 8.3226 mm (3D). Para la vértebra C7, las dimensiones del eje horizontal fueron 58.6 mm (TC), 58.739 mm (STL) y 58.7144 mm (3D). Las dimensiones del cuerpo vertebral fueron 14 mm (TC), 14.0255 mm (STL) y 14.2312 mm (3D). La longitud de la apófisis espinosa fue de 18.7 mm (TC), 18.79 mm (STL) y 18.6458 mm (3D), y su ancho fue de 8.9 mm (TC), 8.988 mm (STL) y 8.9760 mm (3D). CONCLUSIÓN: La impresión de un modelo en 3D de tejido óseo mediante este algoritmo resulta una opción viable, útil y con una alta precisión.

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INTRODUCTION: Medication-associated osteonecrosis of the jaws (MRONJ) is characterized by the presence of exposed bone or an intraoral or extraoral fistula in the maxillofacial region in patients with a history of treatment with anti-resorptive and anti-angiogenic drugs, such as monoclonal antibodies, and without a history of radiotherapy or metastatic diseases in the area. OBJECTIVE: The aim of this study is to report a case of a pathological mandibular fracture in an area of MRONJ in a patient diagnosed with Crohn's disease treated with infliximab. CASE REPORT: A 53-year-old male patient, an active smoker for 35 years, diagnosed with Crohn's disease, undergoing intravenous administration of infliximab 300 mg for 1 year and 3 months, with no previous history of anti-angiogenic or anti-resorptive medication, presenting with an extraoral fistula in the submandibular region for 4 months, with painful symptoms, diagnosed as MRONJ. He was initially treated conservatively, using antimicrobial photodynamic therapy (aPDT), antibiotic therapy, and the PENTO protocol. However, the patient evolved with a pathological fracture in the mandibular parasymphysis, requiring surgical reconstruction. FINAL CONSIDERATIONS: Pathological fracture of the mandible is a complication of MRONJ that compromises the patient's quality of life. The management of patients with MRONJ is complex and challenging.

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PURPOSE: To assess the presence of mandibular canal bifurcation (BMC) and classify these variations by correlating findings with sex, age and facial skeletal pattern, measurements were made, including height, width, and distance from bifurcation to anatomical cortical bones. METHODS: BMC was identified in cone beam CT exams of 301 patients and classified according to its origin, location, direction, configuration and ending. The height and width of the MC before and after the bifurcation; height and width of the BMC; and distance from BMC to alveolar (C1), buccal (C2), lingual (C3) and basal (C4) bone cortices were measured. All data were correlated with sex, age, and facial skeletal pattern (class I, II, III). The significance level was 5%. RESULTS: 67 BMC (22.26%) were identified in 55 patients (18.28%). Bifurcations were more prevalent in females (p = 0.57), aged 18-39 years (p = 0.40), class I (p = 0.77). Single bifurcations, located in the posterior region of the mandible, originating in the MC, with a superior direction and ending in the retromolar foramen were more prevalent (p > 0.05). Mean cortical measurements were higher in male individuals, with significant differences only at C1 (p = 0.03). The mean height and width of BMC were 2.24 (± 0.62) and 1.75 (± 0.45) mm. There was no association between BMC classification and the variables studied (p > 0.05). CONCLUSION: Approximately 1/5 of the population studied had BMC. There were no associations of BMC presence or characteristics with sex, age, and facial skeletal pattern. The distance from bifurcation to alveolar (superior) cortical bone is greater in male individuals.

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