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AIMS: To report the case of chronic osteomyelitis of a maxilla in a woman with uncontrolled diabetes mellitus (DM), glucose-6-phosphate dehydrogenase (G6PD) deficiency and mental illness, in an attempt to clarify its pathogenesis and treatment. METHODS AND RESULTS: A case of a woman with moderate G6PD deficiency (Class III) who developed bilateral and asynchronous chronic suppurative osteomyelitis (CSO) of her maxilla with extensive bone sequestra, fistulae and whose management was performed by local surgery for bony sequestra and fistulae removal; closure communication under 4 weeks antibiotic cover. CONCLUSIONS: CSO of the jaw may be a complication of the G6PD deficiency and DM and its severity depends on patient's medical status.
Assuntos
Doenças Ósseas , Diabetes Mellitus , Deficiência de Glucosefosfato Desidrogenase , Osteomielite , Feminino , Humanos , Maxila , Osteomielite/complicações , Osteomielite/cirurgiaRESUMO
Osteomyelitis of the jaws (OM) is an infectious pathology involving the bone marrow. It is due to various etiologies, the main one being odontogenic. The diagnosis of OM is a challenge for dentists, who must rely on clinical and imaging examinations. Panoramic radiography is the most frequently used imaging test, but it has some limitations that have improved with the incorporation of new imaging methods such as computed tomography, cone beam computed tomography, magnetic resonance imaging, and bone scintigraphy with radionuclides. The purpose of this review was to describe the imaging characteristics of OM of the jaws according to the radiological diagnostic methods available in the literature in order to provide radiologisst with greater knowledge and improve reporting in daily practice.
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Objetivo: avaliar a previsibilidade das reabilitações de maxilas edêntulas através da técnica all-on-four, mensurada pelas tensões sobre implantes em estudos laboratoriais e sobrevida de próteses, perda óssea marginal e sucesso dos implantes em estudos clínicos. Revisão de literatura: foi executada uma busca na literatura nas bases de dados Lilacs, SciELO e PubMed/Medline, utilizando termos relacionados ao tema, sem restrição temporal e adaptados para cada base. As buscas foram realizadas por um único examinador no período de setembro a novembro de 2019. Após a leitura crítica dos 21 artigos selecionados, constata-se que existem vários estudos com muitos delineamentos que avaliaram a previsibilidade mensurada de várias formas. Considerações finais: diante das evidências científicas encontradas, a reabilitação de maxilas edêntulas com a técnica all-on-four demonstra ser previsível e estável. Estudos retrospectivos, prospectivos e revisões sistemáticas relatam altos índices de sucesso, baixa perda óssea marginal, embasando o uso da técnica all-on-four na odontologia.(AU)
Objective: to assess the predictability of edentulous maxillary rehabilitation using the all-on-four technique, measured by tensions over implants in laboratory studies and prosthetic survival, marginal bone loss and implant success in clinical studies. Literature Review: A literature search was performed in the Lilacs, SciELO and PubMed/ Medline databases, using terms related to the theme, without time restriction and adapted for each base. The searches were carried out by a single examiner from September to November 2019. After a critical reading of the 21 selected articles, it appears that there are several studies with many designs that evaluated the predictability measured in various ways. Final considerations: In view of the scientific evidence found, the rehabilitation of edentulous jaws with the all-on-four technique proves to be predictable and stable. Retrospective, prospective studies and systematic reviews report high success rates, low marginal bone loss, basing the use of the all-on-four technique in dentistry.(AU)
Assuntos
Humanos , Arcada Edêntula/reabilitação , Prótese Dentária/métodos , Reabilitação Bucal/métodos , Perda do Osso AlveolarRESUMO
Campylorrhinus lateralis, also known as "wry nose," is a congenital malformation that mainly affects Thoroughbreds. These horses have a unilateral deviation of the maxillae that may be to one side or the other side, and it causes airway obstruction and dental malocclusion. The choice of treatment is not necessarily operation; however, the treatment of choice, which aims to repair the maxillae deviation, is surgical to improve the horse's respiratory condition and correct the dental occlusion. There are currently no reports describing the first surgical technique for such deformity described by Valdez et al. The present study describes the case of a 2-month-old foal of the Mangalarga Marchador breed that was diagnosed with wry nose. The foal presented with accentuated maxillae deviation to the right side, malocclusion of the incisor teeth, and respiratory noises. After diagnosis and physical examination, the foal was treated by surgical correction of the deviation. To correct the deviation, the bone distraction technique with unilateral osteotomy of the right maxillae and fixation of the external bone distractor was chosen. After 90 days, the bone distractor was removed; consequently, malocclusion of the incisors was greatly improved, and respiratory noises were eliminated.
Assuntos
Doenças dos Cavalos , Doenças Nasais , Animais , Cavalos , Incisivo/cirurgia , Maxila/diagnóstico por imagem , Doenças Nasais/veterinária , Osteotomia/veterináriaRESUMO
In many clinical situations, rehabilitation with implants in the posterior maxillary region is complicated by limited bone availability. In this context, the use of 4 mm long implants (known as extra-short implants) may be used thanks to the concept of osseointegration enhancement. It has been demonstrated that short implants offer an alternative to the regeneration procedures involved in placing longer implants in areas where bone height is compromised. This prospective pilot study tested a treatment protocol in which 11 extra-short (4 mm) implants were splinted to 11 mesially placed longer (8 mm) implants in the posterior maxillary regions of partially edentulous patients, without using supplementary bone regeneration procedures. Eleven patients were included in this single cohort study. The clinical performance of the extra-short implants was assessed during a two-year follow-up period, obtaining a 100% survival rate and mean bone loss of 0.3 mm. Implant stability measured by resonance frequency analysis (RFA) at the time of placement was 54.9 ± 4.9, increasing to 77.0 ± 2.6 at 24 months. The study demonstrated the gradual consolidation of osseointegration in bone of less-than-ideal quality in the posterior maxillary region. The results obtained show that a partially edentulous maxilla with reduced bone height may be rehabilitated by using an extra-short implant splinted to a mesial implant of 8mm length or longer. Despite the small sample size, this pilot study observed that extra-short implants achieved adequate bone stability and clinical performance after a 24-month follow-up.
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O objetivo desse estudo retrospectivo foi avaliar os efeitos esqueléticos do Bionator de Balters na maxila em pacientes portadores de maloclusão Classe II, divisão 1 de Angle nos diferentes tipos faciais. Foram obtidas radiografias em norma lateral de 60 pacientes divididos por tipo facial (sendo 15 pacientes dolicofaciais, 27 pacientes braquifaciais e 18 pacientes mesofaciais assim classificados, utilizando-se o índice VERT de Ricketts). Os pacientes com idades entre 7 a 12 anos foram tratados por um mesmo ortodontista com mais de 20 anos de experiência por um período médio de 26 meses. Um grupo de 15 pacientes portadores de maloclusão Classe II divisão 1, não tratados com idades entre 8 e 12 anos foi acompanhado por um ano e utilizado como grupo controle. Foram analisadas as medidas do ângulo Ba-Na-A, para avaliar a posição sagital da maxila, e do ângulo S-Na-PP, para avaliar a rotação da maxila. Nenhuma das medidas teve alteração clinicamente significante e também não houve diferenças significantes entre os grupos estudados. Baseado nesses resultados, conclui-se que o Bionator de Balters utilizado no tratamento da maloclusão Classe II de Angle não afeta a posição e inclinação da maxila durante o tratamento deste tipo de maloclusão.
The aim of this retrospective investigation was to evaluate the skeletal effects of the Balters Bionator on the maxillae of patients with Class II-1 malocclusion in the various facial types. Lateral radiographs of 60 patients classified according to the facial type (15 dolichofacial, 27 brachifacial and 18 mesofacial, according to Ricketts VERT index). The patients age ranged from 7 to 12 years and were treated by the same clinician who had more than 20 years of experience for a mean period of 26 months. A group of 15 patients with Class II malocclusion untreated and with age ranging from 8 to 12 years was observed for a year to be used as a control group. The angle Ba-Na-A was used for the evaluation of the sagittal position of the maxillae and the angle S-Na-PP, for the rotation. None of the measurements had any clinically significant change, and there were no statistically significant differences between the studied. Based on these results, it is concluded that the Balters Bionator used on the treatment of the Class II Angle malocclusion, does not affect the position and inclination of the maxillae during the treatment of this type of malocclusion.
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Severe resorption in the posterior maxilla sectors as a result of tooth loss along with the process of pneumatization of the maxillary sinus, difficult the prosthetic rehabilitation supported by conventional implants due to the shortage of vertical bone availability. So that over the years they have designed therapeutic alternatives to help overcome these drawbacks. The zygomatic implant was introduced in 1988 by Branemark. This implant has a design which allows it to be positioned over the ridge to the height of the first molar, reducing vestibular cantilever up to 20 percent and reducing complications of peri-implant inflammation, infection and gingival hyperplasia, which may lead to perforation horizontal process of the palatine bone. The purpose of this review is to determine the success rate of zygomatic implants for rehabilitation of severely atrophied maxillae. A total of 1410 zygomatic implants and 1673 Traditional implants were included in selected articles. Of these 1410 zygomatic Implants, 365 were conventional loading and 1045 were immediately and early loading, these had a success rate of 98.3 percent and 98.7 percent, respectively. Of these 1673 Traditional Implants, 463 were conventional loading and 1210 were immediately and early loading, they had a success rate of 93.9 percent and 97.8 percent, respectively. The overall success rate of zygomatic implants and Conventional implants was 98.6 percent and 96.8 percent, respectively. The rehabilitation of severely atrophied maxilla with fixed prosthesis immediately and conventional loaded by zygomatic implants gives excellent results in the medium term. When comparing traditional treatment modalities, proposals for prosthetic reconstruction of severely atrophied maxilla, the zygomatico implant has the highest success rate over conventional treatments...
La reabsorción severa en sectores posteriores del maxilar, como resultado de la pérdida de dientes junto con el proceso de neumatización del seno maxilar, resulta en una difícil rehabilitación protésica conel apoyo de los implantes convencionales, debido a la escasez de hueso vertical disponible. A lo largo de los años se han diseñado alternativas terapéuticas para ayudar a superar estos inconvenientes. El implante cigomático fue introducido en 1988 por Branemark. Este implante tiene un diseño que permite colocarse sobre la cresta hasta la altura del primer molar, reduciendo el voladizo bucal hasta en un 20 %, con la consecuente reducción de las complicaciones del peri-implantarias, como inflamación, infección y la hiperplasia gingival, que pueden conducir al desarrollo del proceso de perforación horizontal del hueso palatino. El propósito de esta revisión fue determinar la tasa de éxito de los implantes cigomáticos para la rehabilitación del maxilar gravemente atrófico. Un total de 1410 implantes cigomáticos y 1673 implantes tradicionales fueron descritos en los artículos seleccionados. De estos 1410 implantes cigomáticos, 365 eran de carga convencional y 1045 fueron de carga inmediata y temprana, teniendo una tasa de éxito del 98,3 % y 98,7 %, respectivamente. De los 1673 implantes tradicionales, 463 fueron de carga convencional y 1210 fueron de carga inmediata y temprana, presentando una tasa de éxito del 93,9 % y 97,8 %, respectivamente. La tasa de éxito de los implantes cigomáticos y los implantes convencionales fue del 98,6 % y 96,8 %, respectivamente. La rehabilitación del maxilar severamente atrofiado con prótesis fija convencional cargado inmediatamente y por los implantes cigomáticos otorgó excelentes resultados en el mediano plazo. Al comparar las modalidades de tratamiento tradicionales, propuestas para la re-construcción protésica del maxilar severamente atrofiado, el implante cigomático tiene la mayor tasa de éxito respecto a los tratamientos convencionales.
Assuntos
Humanos , Arcada Edêntula/cirurgia , Atrofia Periodontal/cirurgia , Zigoma , Implantação Dentária Endóssea/métodos , Implantes Dentários , Resultado do TratamentoRESUMO
Biomechanical measurements show that tilted implants, when part of a prosthetic support, avoid the use of distal cantilever units. This study included 20 women (78%) and 12 men (22%), aged over 50 years old (89%), with a total of 156 implants. A delayed occlusal loading protocol was used and the average distal implant length and diameter were 10 mm and 4 mm respectively. Patients were followed up for 2 to 5 years after prosthesis connection. The aims of this study are to analyze the use of tilted implants in prosthetic rehabilitation of maxillae to reduce cantilevers length, and to study the biomechanical implications of implant-bone interface.
Mediciones biomecánicas demuestran que los implantes inclinados, cuando son parte de un soporte de prótesis, evitan el uso de unidades distales en voladizo. Se incluyeron 20 mujeres (78%) y 12 hombres (22%), mayores de 50 años (89%), con un total de 156 implantes. Se utilizó un protocolo de carga oclusal retardada, y la longitud y el diámetro promedios del implante a nivel distal distal, fue de 10 mm y 4 mm, respectivamente. Los pacientes fueron seguidos durante 2 a 5 años después de la conexión de la prótesis. El objetivo de este estudio consiste en analizar el uso de los implantes inclinados en la rehabilitación protésica de maxilares para reducir la longitud de los voladizos, y estudiar las implicaciones biomecánicas de la interfase hueso-implante.
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BACKGROUND: In the absence of autologous bone for harvesting, fresh-frozen bone allografts turned into an alternative for bone reconstruction procedures. PURPOSE: The purpose of this study was to make a histological analysis of fresh-frozen onlay bone allografts (ALs), compared with autografts, in patients who needed maxillary reconstruction prior to dental implants placement. MATERIALS AND METHODS: Twelve patients with bone deficiencies (width inferior to 4 mm) in the sites where the implants were planned were enrolled in the study. From these, six were elected to be treated with autogenous (AT) bone grafts and six with fresh-frozen bone AL. This last group included the patients who had absence of a convenient amount of bone in donor sites. Each patient received from one to six graft blocks, totalling to 12 ATs and 17 ALs. Seven months after grafting procedures, biopsies of the grafts were made using 2-mm internal diameter trephine burs, and processed for histological analysis. One biopsy was retrieved from each patient. RESULTS: Clinically, all grafts were found to be firm in consistency and well-incorporated to the receptor bed. Histological analysis showed a large amount of necrotic bone surrounded by few spots of new-formed bone in the AL group, suggesting low rate of graft remodeling. In the AT group, an advanced stage of bone remodeling was seen. CONCLUSIONS: Human fresh-frozen bone block AL showed clinical compatibility for grafting procedures, although associated to slow remodeling process. Further studies are needed to define, at long term, the remodeling process chronology the clinical longitudinal results for fresh-frozen bone AL.
Assuntos
Aloenxertos/anatomia & histologia , Aumento do Rebordo Alveolar/métodos , Autoenxertos/anatomia & histologia , Transplante Ósseo/classificação , Maxila/cirurgia , Adulto , Aloenxertos/transplante , Autoenxertos/transplante , Biópsia/métodos , Remodelação Óssea/fisiologia , Parafusos Ósseos , Colágeno , Criopreservação/métodos , Implantação Dentária Endóssea/métodos , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Arcada Edêntula/cirurgia , Arcada Parcialmente Edêntula/cirurgia , Masculino , Membranas Artificiais , Pessoa de Meia-Idade , Necrose , Osteócitos/citologia , Osteogênese/fisiologia , Procedimentos de Cirurgia Plástica/métodosRESUMO
A forma mais comum de reabilitação de maxilas totalmente edêntulas com implantes osseointegrados é a prótese total fixa parafusada tipo protocolo de Brånemark, na qual os implantes são esplintados. Este relato de caso clínico apresenta uma forma alternativa para reabilitação de maxilas edêntulas com 14 implantes de conexão cone-morse, pilares retos e coroas totais metalocerâmicas isoladas, com infra-estruturas em titânio, empregando-se a tecnologia CAD/CAM. Neste trabalho foram discutidos aspectos referentes ao planejamento, com ênfase ao planejamento virtual, à necessidade de disponibilidade óssea, às facilidades de higienização, biomecânica (possíveis riscos em manter os implantes isolados), à seleção adequada dos implantes e dos componentes protéticos, aos benefícios do conceito de platform switching, às facilidades de confecção das infra-estruturas em titânio pela tecnologia CAD/CAM, entre outros aspectos. Este tipo de reabilitação maxilar mostrou-se muito eficiente, apresentando como principais vantagens a estética melhorada, a facilidade de higienização, o aspecto emocional muito favorável e a satisfação do paciente.
Oral rehabilitation of completely edentulous maxillary arch has been represented by splinted osseointegrated implants according to classic Brånemark protocols. This case report presents an alternative approach with 14 cone-morse connection type implants, universal abutments, and single ceramic-veneered titanium frameworks using the CAD/CAM technology. All aspects regarding to the virtual treatment planning, bone availability, easiness of cleaning, biomechanics (non-splinted units), adequate implant and prosthetic component selection, the benefits of platform-switching mode, titanium framework fabrication using CAD/CAM technology, among others, are discussed as well. This modality demonstrated efficacy, improved esthetics and hygiene, also with a more favorable emotional aspect and patient satisfaction.
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Humanos , Masculino , Pessoa de Meia-Idade , Coroas , Implantes DentáriosRESUMO
OBJECTIVE: To present a case and discuss the clinicopathological characteristics of nasopalatine duct cyst and discuss the etiology, diagnosis, treatment and prognosis, with a review of the literature. DISCUSSION: Nasopalatine duct cyst occurs in approximately 1% of the population. Presentation may be asymptomatic or include swelling, pain, and drainage from the hard palate. Surgical treatment was carried out under local anesthesia and comprised the dissection and removal of the cyst adopting a usually palatine approach.
OBJETIVO: Apresentar um caso e discutir as características clínico-patológicas do cisto de ducto nasopalatino, discutinfo a etiologia, diagnóstico, tratamento e prognóstico, revisando a literatura. DISCUSSÃO: Os cistos naso-palatinos ocorrem em aproximadamente 1% da população. A apresentação pode ser assintomática ou incluir edema, dor e drenagem purulenta do palato duro. O tratamento cirúrgico foi sob anestesia local e constituiu de dissecção e remoção do cisto, via acesso palatino.
Assuntos
Humanos , Feminino , Adulto , Cistos não Odontogênicos/patologia , Cistos não Odontogênicos/cirurgia , Palato Duro/patologia , Incisivo/patologia , Radiografia DentáriaRESUMO
O emprego de fixações zigomáticas e implantes convencionais em sistema de carga imediata para reabilitações de maxilas atróficas constitui alternativa recente e vem sendo amplamente descrito na literatura científica, assim como a busca constante pela otimização de índices de sucesso dos implantes. Neste trabalho, procurar-se-á verificar o índice de sobrevida destas fixações, além de verificar o comportamento das FZs em procedimentos de dois estágios e carga imediata, fazendo um estudo retrospectivo de longo prazo, utilizando uma amostra mais representativa. Para este estudo, avaliou-se 59 prontuários de pacientes submetidos a reabilitações maxilares através da instalação de fixações zigomáticas e convencionais, atendidos no período de janeiro de 2000 a dezembro de 2006. Os dados foram registrados por meio de uma ficha cadastral especialmente desenvolvida para este estudo, quantificados e correlacionados. Verificou-se o emprego de 151 FZs e 187 implantes convencionais instalados, sendo 57,63% dos casos com protocolo de duas FZs associadas a quatro implantes convencionais, em sistema de carga imediata. O índice de sucesso foi de 95,36% para as FZs submetidas à carga imediata ou em duas fases cirúrgicas.
The application of zygomatic fixations and conventional implants in a immediate loading system for rehabilitation in atrophic upper jaws consists on a recent alternative and it's being widely described on scientific literature, as well as the constant search of success indexes optimization on implants. On this work, it will be aimed to verify the index of permanence of these fixations, besides verifying the comportment of ZFs in two stages and immediate loading procedures, making a long term retrospective study, using a more representative sample. For this study, 59 handbooks of patients submitted to upper jaw rehabilitations were evaluated, through the installation of zygomatic and conventional fixations. They were attended on the period of January. 2000 to December, 2006. The data were registered through a chart, specially made for this study, quantified and correlated. It could be verified the application of 1 51 ZFs and 187 installed conventional implants, being 57.63% of cases as protocol of two ZFs, associated to four conventionai implants in immediate loading system. The index of success was 95.36% to the ZFs submitted to immediate loading or in two surgical phases.
Assuntos
Humanos , Masculino , Feminino , Carga Imediata em Implante Dentário , Reabilitação Bucal , Maxila/anormalidades , Maxila/cirurgia , Técnicas de Fixação da Arcada Osseodentária , ZigomaRESUMO
A fixação zigomática, desenvolvida em 1989 pelo Prof. Brånemark, tem representado uma bem sucedida alternativa de ancoragem para a reabilitação de maxilas atróficas. A busca por áreas de ancoragem para implantes osseointegrados, como alternativas cirúrgicas ao enxerto ósseo, depende de profundo conhecimento das relações topográficas destas regiões com estruturas anatômicas importantes, para que se tenha segurança na realização do procedimento. O objetivo deste artigo é realizar uma abordagem anatômica e relacioná-la com possíveis acidentes e complicações inerentes à cirurgia de instalação das fixações zigomáticas.
Zygomatic implants, which were developed by Prof. Brånemark in 1989, have proved to be a successful surgical alternative to bone grafts in the rehabilitation of atrophic maxillae. However, for these procedures to be executed safely, it is essential to identify anchorage areas, and this requires a thorough knowledge of the topography of regions which include important structures. This study is an anatomicai analysis of the accidents and complications related to the installation of zygomatic implants.
Assuntos
Humanos , Crânio/anatomia & histologia , Face/anatomia & histologia , Maxila/cirurgia , Zigoma/cirurgia , Seio Maxilar , Maxila/anormalidadesRESUMO
Frente a crescente utilização de implantes osseointegrados nas reabilitações orais, as dificuldades foram surgindo junto a necessidade de reabilitar arcos dentários com níveis avançados de comprometimento dos rebordos alveolares remanescentes. Assim, os enxertos ósseos passaram a ser uma opção no sentido de possibilitar e/ou até mesmo melhorar os resultados finais da prótese sobre implante sobre tudo em maxila. Os autores relatam o caso clínico de uma paciente de 40 anos de idade, portadora de prótese total superior que desejava substituí-la por implantes. Detectado a avançada reabsorção óssea da maxila planejou-se cirurgia de enxerto autógeno da crista ilíaca. A técnica usada foi do tipo onlay, e simultâneo levantamento e preenchimento bilateral do seio maxilar. Conclui-se que a reconstrução de maxilas extremamente atróficas com o uso de protocolos de enxertos de osso autógeno oriundo da crista ilíaca podem devolver o volume em espessura do osso maxilar viabilizando a fixação futura de implantes e facilitando o sucesso das próteses
Due to the increasing use of osseointegrated implants in oral rehabilitations, difficulties have been arisen with the need of rehabilitating dental arches with advanced levels of remaining alveolar ridge involvement. Thus, bone grafts have become an option in the sense of both making possible and improving the results of prostheses over implants mainly in the maxilla. The authors report a clinical case of a 40-year-old patient who desired to substitute an upper total prosthesis for implants. The autogenous iliac crest graft has been chosen due to the advanced bone resorption the maxilla. The onlay technique has been used with simultaneous lifting and bilateral filling of the maxillary sinus. It has been concluded the reconstruction of extremely atrophic maxillas with autogenous iliac crest grafts may restore the maxillary bone thickness making possible the future placement of implants for better prosthetic results