RESUMO

Facial asymmetry associated with unilateral condylar hyperplasia (UCH) is a rare disease. The aim of this study was to evaluate the clinical conditions of progressive facial asymmetry in young subjects treated with high condylectomy. A retrospective study was performed including nine subjects diagnosed with UCH type 1B and progressive facial asymmetry around 12 years old with an upper canine progressing towards dental occlusion. After an analysis and a decision of treatment, orthodontics began one to two weeks prior to the condylectomy (with a mean vertical reduction of 4.83 ± 0.44 mm). Facial and dental asymmetry, dental occlusion, TMJ status and an open/closing mouth were analyzed before surgery and in the final stage of treatment, almost 3 years after surgery. Statistical analyses were performed using the Shapiro-Wilk test and a Student's t-test considering a p value of <0.05. Comparing T1 (before surgery) and T2 (once orthodontic treatment was finalized), the operated condyle showed a similar height to that observed in stage 1 with a 0.12 mm difference in height (p = 0.8), whereas the non-operated condyle showed greater height increase with an average of 3.88 mm of vertical growth (p = 0.0001). This indicated that the non-operated condyle remained steady and that the operative condyle did not register significant growth. In terms of facial asymmetry in the preoperative stage, a chin deviation of 7.55 mm (±2.57 mm) was observed; in the final stage, there was a significant reduction in the chin deviation with an average of 1.55 mm (±1.26 mm) (p = 0.0001). Given the small number of patients in the sample, we can conclude that high condylectomy (approx. 5 mm), if performed early, especially in the mixed-dentition stage before full canine eruption, is beneficial for the early resolution of asymmetry and thus the avoidance of future orthognathic surgery. However, further follow-up until the end of facial growth is required.

RESUMO

Unilateral condylar hyperplasia (UCH) is an uncommon disease involving progressive facial asymmetry. The aim of this research was to perform an analysis of the diagnosis and treatment of patients with UCH in a clinical series. An observational retrospective study was performed on subjects with progressive facial asymmetry in the lower third of the face; all the subjects were under treatment with condylectomy and orthodontics to improve occlusion and face balance. Variables such as age, sex, clinical type, SPECT (single photon emission computed tomography) intensity and a requirement for secondary surgery were included; the Shapiro Wilk test was performed to analyze the normality of the data and nonparametric analysis and the Kruskal-Wallis or Mann-Whitney tests were used to assess the association between the SPECT difference and the variables, where 2-tailed p values < 0.05 were considered to be statistically significant. Forty-nine patients between 10 and 45 y.o. (average age: 19.1 ± 7.4 y.o.) were included in the study. There were 41 female (83.6%) and 8 male (16.4%) subjects. The SPECT analysis comparing the right and left condyles with more than 10% in caption of the isotope was present in 46 subjects; the results obtained using SPECT were not statistically related to the age or sex of the sample (p = 0.277). The patients were classified into clinical types I, II and III, and no correlations could be confirmed between the clinical type and other variables. High condylectomy was conducted on all patients, among which 14 patients underwent a secondary surgery for orthognathic or cosmetic treatment, and was not related to the initial variables used in diagnosis (p = 0.98); interestingly, the second surgical treatment was more present in the clinical type I and in subjects under 16 years old with no statistical differences. Clinical analysis, medical records, 3D imaging and SPECT should be used as a complementary analysis in assessing the diagnosis of UCH and progressive facial asymmetry.

RESUMO

Dentofacial deformities (DFD) presenting mainly as Class III malocclusions that require orthognathic surgery as a part of definitive treatment. Class III patients can have obvious signs such as increasing the chin projection and chin throat length, nasolabial folds, reverse overjet, and lack of upper lip support. However, Class III patients can present different facial patterns depending on the angulation of occlusal plane (OP), and only bite correction does not always lead to the improvement of the facial esthetic. We described two Class III patients with different clinical features and inclination of OP and had undergone different treatment planning based on 6 clinical features: (I) facial type; (II) upper incisor display at rest; (III) dental and gingival display on smile; (IV) soft tissue support; (V) chin projection; and (VI) lower lip projection. These patients were submitted to orthognathic surgery with different treatment plannings: a clockwise rotation and counterclockwise rotation of OP according to their facial features. The clinical features and OP inclination helped to define treatment planning by clockwise and counterclockwise rotations of the maxillomandibular complex, and two patients undergone to bimaxillary orthognathic surgery showed harmonic outcomes and stables after 2 years of follow-up.

RESUMO

Assess clinical studies regarding accuracy between virtual planning of computer-guided surgery and actual outcomes of dental implant placements in total edentulous alveolar ridges. A PubMed search was performed to identify only clinical studies published between 2011 and 2016, searching the following combinations of keywords: "Accuracy AND Computer-Assisted Surgery AND Dental Implants." Study designs were identified using the terms: Case Reports, Clinical study, Randomized Controlled Trial, Systematic Reviews, Meta-Analysis, humans. Level of agreement between the authors in the study selection process was substantial (k = 0.767), and the study eligibility was considered excellent (k = 0.863). Seven articles were included in this review. They describe the use of bone and muco-supported guides, demonstrating angular deviations cervically and apically ranging from (minimum and maximum means), respectively, 1.85-8.4 (°), 0.17-2.17 (mm), and 0.77-2.86 (mm). Angular deviations obtained most inaccuracy in maxila. For cervical and apical deviations, accuracy was preponderantly lower in maxilla. Despite the similar deviations measurement approaches described, clinical relevance of this study may be useful to warn the surgeon that safety margins in clinical situations.

RESUMO

The aim of this study is to compare the bone formation in maxillary sinus lift with an autogenous bone graft in histological evaluation at 2 or 6 months. A comparative study was designed where 10 patients with missing teeth bilaterally in the posterior zone of the maxilla were selected. Patients received a particulate autogenous bone graft under the same surgical conditions, selecting a site to collect a biopsy and histological study at two months and another at six months postoperatively. Histomorphometry was performed and were used Kolmogorov-Smirnov test, student's t-test and Spearman's correlation coefficient, considering a value of p<0.05. Differences were observed in inflammatory infiltrate and vascularization characteristics; however, the group analyzed at two months presented 38.12% ± 6.64 % of mineralized tissue, whereas the group studied at 6 months presented an average of 38.45 ± 9.27 %. There were no statistical differences between the groups. It is concluded that the bone formation may be similar in intrasinus particulate autogenous bone grafts in evaluations at two or six months; under these conditions, early installation of implants is viable.

RESUMO

A cirurgia ortognática é uma opção terapêutica viável no tratamento daqueles pacientes que apresentam deformidades dento-esqueléticas. De acordo com a literatura, esse procedimento cirúrgico possibilita aos pacientes resultados funcionais e estéticos, proporcionando mudanças significativas na vida destes. Sendo assim, este trabalho teve por objetivo relatar uma série de casos de pacientes submetidos à cirurgia ortognática, cujos resultados pós-operatórios demonstram uma importante melhora na harmonia facial destes, o que vem a confirmar que esse procedimento é um importante instrumento de mudança na vida dos pacientes, possibilitando uma convivência normal destes em sociedade... (AU)

The orthognathic surgery is a viable therapeutic option in the treatment of those patients who have dental-skeletal deformities. According to the literature, this surgical procedure allows the functional and aesthetic results patients, providing significant changes in their lives. Thus, this study aimed to report a case series of patients undergoing orthognathic surgery whose postoperative results show a significant improvement in facial harmony of the same, which confirms that this procedure is an important tool change in the lives of patients, allowing a normal coexistence of these patients in society... (AU)

Assuntos

RESUMO

A perda de grande parte do osso mandibular, seja devido à necessidade de ressecção óssea ou por outros fatores como a ocorrência de traumatismos, afeta diretamente a vida dos pacientes. Mesmo com a melhoria contínua dos materiais, surgimento de novas tecnologias e técnicas cirúrgicas, o tratamento dessas grandes lesões e perdas ósseas permanece como grande desafio ao cirurgião. Nesse sentido, o objetivo do presente trabalho foi relatar dois casos clínicos de pacientes, sendo um de fibroma ossificante central de mandíbula que foi submetido à ressecção mandibular e tratado através da colocação de uma placa de reconstrução do sistema 2.4 mm. O segundo caso envolveu perda de substancia devido a paciente ter sido vitima de ferimento por arma de fogo (FAF), evoluindo com fratura do sistema de fixação colocado na primeira cirurgia. Em segundo momento cirúrgico a paciente foi submetida à reconstrução óssea do defeito, associado à colocação de nova fixação. Deste modo, podemos afirmar que os procedimentos reconstrutivos são importantes instrumentos para tratamento dos pacientes.

The loss of much of the mandibular bone, is due to the need for bone resection or by other factors such as the occurrence of injuries, directly affects the lives of patients. Even with the continuous improvement of materials, development of new technologies and surgical techniques, treatment of these large lesions and bone loss is still a major challenge for the surgeon. In this sense, the objective of this study was to report two clinical cases of patients, a central ossifying fibroma of the mandible who underwent mandibular resection and treated by placement of a reconstruction plate system 2.4mm. The second case involved loss of substance because the patient has been the victim of injury by firearms (FAF), evolving with fracture fixation system placed in the first surgery. In the second surgical time the patient underwent bone reconstruction of the defect associated with the placement of new fixation. Thus, we can say that reconstructive procedures are important tools for treatment of patients.

Assuntos

RESUMO

Os cistos são lesões formadas por uma cavidade revestida de tecido epitelial, as quais contêm, em seu interior, material líquido ou semisólido, podendo ser classificados em cistos odontogênicos e não odontogênicos. Apesar de existirem diversas modalidades de tratamentos descritas na literatura para tratamentos dos cistos da cavidade oral, até o presente momento, não se observa um consenso em relação à qual técnica que oferece os melhores resultados. Sendo assim, procurou-se relatar um caso clínico com a utilização da técnica de descompressão, procurando evidenciar suas indicações, vantagens, desvantagens e demais peculiaridades... (AU)

Cysts are lesions formed by a cavity lined with epithelial tissue, which contains in its interior material liquid or semisolid, and may be classified into odontogenic cysts and non-odontogenic. Although there are several treatment modalities described in the literature for treatment of cysts of the oral cavity, to date not seen a consensus as to which technique offers the best results. Therefore, we sought to a case report using the technique of decompression, seeking to highlight their indications, advantages, disadvantages and other peculiarities... (AU)

Assuntos

RESUMO

La reconstrucci¢n ¢sea maxilar con injertos libres junto a la osteotom¡a Le Fort I ha sido desarrollada para dar respuesta a las necesidades cl¡nicas funcionales y est‚ticas de los pacientes, debido principalmente a la discrepancia antero-posterior de las maxilas atr¢ficas. Dentro de la t‚cnica, existe necesidad de osteos¡ntesis mediante fijaci¢n interna r¡gida (FIR) que puede ser desarrollada tanto con dispositivos met licos como con dispositivos reabsorbibles. El presente estudio eval£a el uso de ambos materiales de fijaci¢n, relatando las caracter¡sticas, comparaciones y situaciones cl¡nicas que podr¡an estar asociados a su elecci¢n.

The maxillary bone reconstruction with free flaps with LeFort I osteotomy has been developed to give answer to the functional and aesthetic clinical needs of patients, mainly due to the anteroposterior discrepancy of atrophic maxillae. Within the technique, there is need for osteosynthesis though rigid internal fixation (RIS) that can be developed as both metal devices and absorbable devices. This study evaluates the use of both fixing materials, relating the features, comparisons and clinical situations that might be associated with its choice.

Assuntos

RESUMO

Surgical procedures involving the rehabilitation of the maxillofacial region frequently require bone grafts; the aim of this research was to evaluate the interface between recipient and graft with cortical or cancellous contact. 6 adult beagle dogs with 15 kg weight were included in the study. Under general anesthesia, an 8 mm diameter block was obtained from parietal bone of each animal and was put on the frontal bone with a 12 mm 1.5 screws. Was used the lag screw technique from better contact between the recipient and graft. 3-week and 6-week euthanized period were chosen for histometric evaluation. Hematoxylin-eosin was used in a histologic routine technique and histomorphometry was realized with IMAGEJ software. T test was used for data analyses with p<0.05 for statistical significance. The result show some differences in descriptive histology but non statistical differences in the interface between cortical or cancellous bone at 3 or 6 week; as natural, after 6 week of surgery, bone integration was better and statistically superior to 3-week analyses. We conclude that integration of cortical or cancellous bone can be usefully without differences.

Assuntos

RESUMO

The purpose of this study was to determine the survival and prognostic factors of patients with diffuse large B-cell lymphoma (DLBCL) of the oral cavity and maxillofacial region. Retrospectively, the clinical records of patients with a primary diagnosis of DLBCL of the oral cavity and maxillofacial region treated at the A.C. Camargo Hospital for Cancer, São Paulo, Brazil, between January 1980 and December 2005 were evaluated to determine (A) overall survival (OS) at 2 and 5 years and the individual survival percentage for each possible prognostic factor by means of the actuarial technique (also known as mortality tables), and the Kaplan Meier product limit method (which provided the survival value curves for each possible prognostic factor); (B) prognostic factors subject to univariate evaluation with the log-rank test (also known as Mantel-Cox), and multivariate analysis with Cox's regression model (all the variables together). The data were considered significant at p ≤ 0.05. From 1980 to 2005, 3513 new cases of lymphomas were treated, of which 151 (4.3%) occurred in the oral cavity and maxillofacial region. Of these 151 lesions, 48 were diffuse large B-cell lymphoma, with 64% for OS at 2 years and 45% for OS at 5 years. Of the variables studied as possible prognostic factors, multivariate analysis found the following variables have statistically significant values: age (p = 0.042), clinical stage (p = 0.007) and performance status (p = 0.031). These data suggest that patients have a higher risk of mortality if they are older, at a later clinical stage, and have a higher performance status.

Assuntos

RESUMO

PURPOSE: To assess the long-term behavior of wedge-shaped implants and evaluate the influence of the associated risk factors on implant survival rates. MATERIALS AND METHODS: A retrospective review of clinical records of patients treated with wedge-shaped implants between 1992 and 2011 was conducted. Data on patient sex, age, smoking habits, and history of periodontitis; details of implant length, diameter, angle, and location; and data on surgical, reconstructive, and prosthetic procedures, and systemic disease were selected for analysis. RESULTS: A total of 1,169 implants placed in 154 patients (mean age 55.17 ± 11.33 years) were evaluated. Women received 637 implants, and men received 532 implants; 60.4% were placed in patients who were undergoing periodontal maintenance care, 17.9% in smokers, 17.7% in hypertensive patients, 5.7% in diabetic patients, and 4.4% in cardiac patients. The mean overall survival for implants was 194.26 ± 9.91 months. Seventy-three implants were lost: 3 before implant loading and 70 after loading. The cumulative survival rates at 5 and 10 years were 96.6% (confidence interval [CI]: 95.5% to 97.7%) and 91.8% (CI: 90.1% to 94.1%), respectively. Univariate analysis indicated tobacco smoking (P = .014) and implant location (P < .001) as significant risk factors for implant failure. The multivariate analysis showed tobacco smoking (P = .016), location (P = .001), and male sex (P = .038) as significant, and the latter factor was associated with previous periodontal disease. CONCLUSIONS: Overall survival of the wedge-shaped implant showed good long-term results. Male sex, tobacco smoking, and posterior maxillary location were associated with a greater risk of implant failure.

Assuntos

RESUMO

The purpose of this study was to determine the survival and prognostic factors of patients with diffuse large B-cell lymphoma (DLBCL) of the oral cavity and maxillofacial region. Retrospectively, the clinical records of patients with a primary diagnosis of DLBCL of the oral cavity and maxillofacial region treated at the A.C. Camargo Hospital for Cancer, São Paulo, Brazil, between January 1980 and December 2005 were evaluated to determine (A) overall survival (OS) at 2 and 5 years and the individual survival percentage for each possible prognostic factor by means of the actuarial technique (also known as mortality tables), and the Kaplan Meier product limit method (which provided the survival value curves for each possible prognostic factor); (B) prognostic factors subject to univariate evaluation with the log-rank test (also known as Mantel-Cox), and multivariate analysis with Cox's regression model (all the variables together). The data were considered significant at p≤0.05. From 1980 to 2005, 3513 new cases of lymphomas were treated, of which 151 (4.3%) occurred in the oral cavity and maxillofacial region. Of these 151 lesions, 48 were diffuse large B-cell lymphoma, with 64% for OS at 2 years and 45% for OS at 5 years. Of the variables studied as possible prognostic factors, multivariate analysis found the following variables have statistically significant values: age (p=0.042), clinical stage (p=0.007) and performance status (p=0.031). These data suggest that patients have a higher risk of mortality if they are older, at a later clinical stage, and have a higher performance status.

Assuntos

RESUMO

OBJECTIVE: To identify the overall survival and prognostic factors of malignant lymphoma of the oral cavity and the maxillofacial region. STUDY DESIGN: Clinical records data were obtained in order to determine overall survival at 2 and 5 years, the individual survival percentage of each possible prognostic factor with the actuarial technique, and the survival regarding the possible prognostic factors with the actuarial technique and the Log-rank and Cox's regression tests. RESULTS: Of 151 subjects, an overall survival was 60% at 2 years, and 45% at 5 years. The multivariate analysis demonstrated statistically significant differences for clinical stage (p=0.002), extranodal involvement (p=0.030), presence of human immunodeficiency virus (p=0.032), and presence of Epstein-Barr virus (p=0.010). CONCLUSION: The advanced clinical stage and the larger number of involved extranodular sites are related to a lower overall survival, as well as, the presence of previous infections such as the human immunodeficiency and the Epstein-Barr virus.

Assuntos

RESUMO

After extensive research, the practice with dental implants has been used on a large scale. With the increase in its indications in various local conditions, more complications have been observed. Among these, one of the most frequent is the installation of the implants in a three-dimensional altered position, making the prosthesis and aesthetics more difficult to achieve. For this reason, techniques such as segmental osteotomy have been developed and adapted to implantology to reestablish the adequate position of these implants with correct aesthetic outcome and function. The present clinical report shows the segmental osteotomy technique in a malposed osseointegrated dental position of the upper central incisor with 1-year follow-up.

Assuntos

RESUMO

Craniofacial implants are being increasingly used to treat patients with sequelae of oncological resections, trauma, and congenital deficiencies, among other issues. The aim of this investigation was to establish the minimum and maximum bone dimensions present in the most used places for the insertion of craniofacial implants. A descriptive study was designed analyzing 40 human skulls using cone-beam computed tomography; in the volumetric reconstruction the points most often used in clinical investigations for the insertion of implants were selected, representing the orbital, perinasal, zygomatic bone and periauricular regions, measuring the distance between the cortical bones on the sagittal, axial and coronal planes; comparisons between gender and with other investigations with a similar aim were also made. In the supraorbital area, values of 7.92+/-1.82 mm were found and in the lateral area values of 7.54+/-0.98 mm, allowing the placement of implants 5 or 6 mm in length. In the area of the zygomatic bone, dimensions of 10.4+/-2.35 mm were obtained, allowing the placement of implants 8 mm in length. In the periauricular area values were obtained of 2.93+/-0.55 mm in the superior region and 3.1+/-0.7 mm in the inferior region, whereas in the perinasal area implants 4 mm in length can be placed. We concluded that the craniomaxillofacial bone structure presents acceptable widths for the installation of implants; the periauricular region presents lower dimensions, with the possibility of intracranial communication in areas above the external auditory meatus...

Los implantes craneofaciales están siendo cada vez más utilizado para tratar a pacientes con secuelas de resecciones oncológicas, traumatismos, y deficiencias congénitas, entre otras. El objetivo de esta investigación fue establecer las dimensiones óseas mínimas y máximas presentes en los lugares más utilizados para la inserción de implantes craneofaciales. Se diseño un estudio descriptivo que analizó 40 cráneos humanos utilizando cono Tomografía computarizada Cone-Beam; en la reconstrucción volumétrica fueron seleccionados los puntos más utilizados en las investigaciones clínicas para la inserción de implantes, que representan la orbital, hueso perinasal, hueso cigomático y regiones periauriculares. La medición de la distancia entre los huesos corticales en los planos sagital, axial y coronal, y las comparaciones entre el sexo y otras investigaciones con el mismo objetivo fueron realizadas. En el área supraorbital, se encontraron valores de 7,92 +/- 1,82 mm y en las áreas laterales de 7,54 +/- 0,98 mm, lo que permite la colocación de implantes de 5 o 6 mm de longitud. En el área del hueso cigomático se obtuvieron,dimensiones de 10,4 +/- 2,35 mm, permitiendo la colocación de los implantes de 8 mm de longitud. En la región periauricular se obtuvieron valores de 2,93 +/- 0,55 mm en la región superior y 3,1 +/- 0,7 mm en la región inferior, mientras que en lo zona perinasal se puede colocar implantes de 4 mm de longitud. Llegamos a la conclusión de que la estructura de los huesos craneomaxilofaciales presenta anchos aceptables para la instalación de implantes; la región periauricular presenta menores dimensiones, con la posibilidad de comunicación intracraneal en zonas sobre el meato auditivo externo...

Assuntos

RESUMO

El objetivo de esta investigación fue describir la influencia del diámetro y largo de los implantes en la pérdida tardía del implante. Se diseñó un estudio retrospectivo para estudiar 375 pacientes que habían sido sometidos a rehabilitación oral sobre implantes durante un periodo de 11 años; se incluyeron en el estudio todos aquellos documentos debidamente completados y con estudios radiográficos preoperatorios, posterior a la instalación del implante y posterior a la instalación de la prótesis. Los implantes fueron clasificados de acuerdo al diámetro como estrecho, regular y ancho y de acuerdo al largo como corto, medio y largo; el análisis de datos fue realizado con la prueba Chi Cuadrado con valor de p<0,05. Del total de 939 implantes y se identificó la pérdida de 55 implantes posterior a la etapa protésica (5,8 por ciento). En base a la pérdida, no se logró establecer ninguna relación estadísticamente significativa con el diámetro del dispositivo (p=0,475) y tampoco con el largo del implante (p=0,064). Podemos concluir que el largo y el diámetro de implantes dentales no influyen en la pérdida tardía del mismo.

The aim of this research was to describe the influence of diameter and length of dental implant related to late implant faliure. In a retrospective study was evaluated 375 patients in a 11 year period; were inclued the complet medical record with image study in the preoperative period, posteriorly to implant installation and to prosthesis installation. The implant was classified according to diameter in narrow, regular and wide, and according to length as short, regular and long. The statistical analysis was realized with Chi-Squaare test with p value <0.05. We studied 939 implants and observed 55 implant failure posteriorly to prosthesis phases (5.8 percent). No statistical relation with diameter (p=0.475) or lenght (p=0.064) was observed. We conclude that the length and diameter of dental implant is not an influence for late failure of the implant.

Assuntos

RESUMO

The purpose of this research was to compare the bone formation around submerged and non-submerged implants installed in a mandible of dog. Seven beagle dogs were used in this protocol; initially, was performed extraction of posterior teeth of mandible and after 3 month healing were installed two dental implants with surface treatment (subtraction of titanium via acidification) in each hemimandible. A transmucosal healing screw of 7 mm without oclusal contact was installed at the anterior implant as a model of non-submerged implant; in the posterior implant were installed a cover screw, using the submerged technique. After six weeks of healing, histomorphometric analysis of osseous tissue between the threads was performed. Was analyzed the implant unit as well as the cervical, meddle and apical region of implant. Student t test with 5 percent significance was used. The non-submerged implant model showed more bone formation than submerged implant without statistically significance (p=0.106); for regional analyses, cervical area shows more osseous formation than middle and apical areas. The regional analyses did not present statistical difference between areas for comparative analysis of submerged and non-submerged implant model. Non-submerged implant model it's not an obstacle for osseous formation.

El objetivo de esta investigación fue comparar la formación ósea alrededor de implantes dentales sumergidos y no sumergidos instalados en mandíbula de perro. Siete perros Beagle fueron utilizados en este protocolo; inicialmente fueron realizadas las exodoncias de dientes posteriores de mandíbula y luego de 3 meses de recuperación fueron instalados dos implantes dentales con tratamiento de superficie en cada hemimandíbula (substracción de titanio vía acidificación). En el implante anterior fue instalado también un conector transmucoso de 7 mm sin contacto oclusal y en el implante posterior fue instalado el tornillo de cierre. Luego de 6 semanas de recuperación, se realizó un análisis histomorfométrico del tejido óseo presente entre las roscas. Se analizó el implante como unidad así como también sus sectores cervical, medio y apical. Se utilizó la prueba estadística t de student con 5 por ciento de significancia estadística. El implante no sumergido presentó mayor formación ósea sin diferencias estadísticamente significativa (p=0.106); en los análisis regionales, el área cervical presentó mayor formación ósea que las áreas medianas y apicales. El análisis regional no presentó diferencias estadísticamente significativas entre ambos tipos de implante. El modelo de implante no sumergido no es un obstáculo para la formación ósea.

Assuntos

RESUMO

Objective: To evaluate the factors that lead to complications in autogenous bone grafting. Methods: Review of clinical records of the patients that were candidates for rehabilitation, between May 2004 and December 2008. With regard to the donor area, of the 199 reconstructions, 175 were autogenous bone graft procedures and 210 donor areas were acted upon.Results: A total of 48 procedures (24.12%) were grafts using particulate bone while sinus lift grafts were performed on 28 patients (14.07%).Osteogenesis distraction and inferior alveolar nerve lateralization were performed in five (2.51%) and three (1.51%) procedures respectively.Eleven autogenous bone grafts were lost, of which 90.9% were onlay block. Conclusion: The use of autogenous bone grafting in atrophic alveolar ridge reconstruction is a highly successful treatment, and the sinus lift procedure is the most predictable form of treatment.

Objetivo: Avaliar os fatores que levam às complicações em enxertia óssea autógena. Métodos: A amostra foi composta pela revisão de prontuários clínicos de pacientes candidatos à reabilitação no período entre maio de 2004 e dezembro de 2008. Em relação à área doadora, das 199 reconstruções, 175 foram procedimentos de enxerto de osso autógeno, sendo abordadas 210 áreas doadoras. Resultados: Os enxertos com osso particulado totalizaram 48 procedimentos (24,12%). O levantamento de seio maxilar foi realizado em 28 pacientes (14,07%). Já a distração osteogênica e lateralização do nervo alveolar inferior foi realizada em cinco (2,51%) e três (1,51%) procedimentos respectivamente. Foi registrada a falha de 11 enxertos com osso autógeno. Dos enxertos perdidos, 90,9% deles foram os de bloco tipo onlay. Conclusão: A utilização de enxertos ósseos autógenos nas reconstruções de rebordos alveolares que apresentam atrofia é um tratamento com alto índice de sucesso, destacando-se a cirurgia de levantamento de soalho de seio maxilar como a modalidade mais previsível de reconstrução óssea.

Assuntos

RESUMO

Quando o tema refere-se a enxertos e reconstruções ósseas em grandes proporções, sabe-se que o osso autógeno ainda é o biomaterial de escolha do profissional, sendo a região de crista ilíaca a mais utilizada como área doadora. Porém, dentre as desvantagens da sua utilização destaca-se o alto potencial de reabsorção deste enxerto, que em alguns casos pode ser observado no momento da colocação do implante, inviabilizando a sua inserção. O presente trabalho teve como objetivo apresentar um relato de caso clínico de reconstrução óssea de maxila severamente reabsorvida com a utilização de enxerto ósseo autógeno de crista ilíaca, apresentando considerações clínicas que otimizaram esta modalidade de tratamento. A prévia compressão da porção medular do enxerto em bloco, o preenchimento com osso particulado autógeno dos espaços entre os blocos inseridos, bem como a redução do tempo entre a enxertia e a inserção dos implantes foram determinantes na ausência de reabsorção do osso autógeno observada no momento do segundo tempo cirúrgico, adotando-os como protocolo cirúrgico para este tipo de reabilitação.

This study aimed to present a case report on the reconstruction of a severely resorbed maxilla using the autogenous iliac crest bone graft, highlighting clinical considerations to optimize this treatment modality. Previous compression of the marrow portion added to the filling with particulate autogenous bone between block grafts, as well as less time between grafting and implant placement were instrumental in the absence of bone resorption at the second-stage moment, adopting this protocol for this procedure.

Assuntos