Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: Institutional outcomes assessment and the role of the Laboratory of Physiology

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 3: Oral and Maxillofacial Surgery

This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face

Avaliação Longitudinal de Sítios Periodontais Através de Terapia Cirúrgica e não Cirúrgica, Monitorados por meio de Avaliação de Alterações no Nível de Inserção, Utilizando Sonda Computadorizada de Força Constante.

Neste trabalho realizou-se o monitoramento de 2010 sítios de 14 pacientes, com idade entre 18 e 45 anos, por meio de sonda de força constante (Florida Probe), com o objetivo de verificar a efetividade de terapias cirúrgicas (Retalho Widman Modificado, Retalho Posicionado Apicalmente com ou sem osteotomia/osteoplastia e enxerto ósseo) e não cirúrgica (Raspagem e Polimento Corono-radicular), por um período de seis meses. Na fase inicial, todos os pacientes foram raspados com ultra-som e receberam instrução de higiene oral e foram registradas as medidas do nível de inserção de todos os sítios. As terapias foram indicada conforme a necessidade de cada área. Após três e seis meses foram realizadas novas sondagens. A terapia não cirúrgica (RPC), em quase todos os pacientes apresentou pequena perda de inserção inicialmente de 0,01 a 0,25mm e ganho nos meses subsequentes de 0,09 a 0,34mm, principalmente naqueles que apresentaram bolsas rasas. Quanto às terapias cirúrgicas em geral, houve ganho de inserção no final do estudo (0,04 a 0,85mm). Este trabalho demonstrou que todas as terapias podem ser eficazes no tratamento da doença periodontal e que a manutenção da higiene oral, em muitos casos, é fator importantíssimo para a preservação da saúde periodontal, principalmente em pacientes de maior risco.In this study a 6 month follow-up of 2010 periodontal sites in 14 patientes, age between 18 and 45 years, was evalueted with probing (Florida Probe), with the main objective to verify the effectiveness of different surgical therapies (Modified Widman Surgery, Apical reposition of the flaps with or without osseous surgery and osseous graffiting) and no surgical therapies (Coronal and root planning and oral hygiene instructions. The initial measurements of all sites for attachment level were also recorded. The therapy selection based on each earea necessity. After 3 and 6 months, the attachment level was gain in the following months of 0,9 to 0,34mm, specially on the shallow pockets. For all surgical therapies a gain of probing attachment was obtained after can be effective on periodontal disease treatment and that oral hygiene maintence, in most of the case, in a very important factor to preserve the periodontal health on risk patients

Avaliação Longitudinal de Sítios Periodontais Através de Terapia Cirúrgica e não Cirúrgica, Monitorados por meio de Avaliação de Alterações no Nível de Inserção, Utilizando Sonda Computadorizada de Força Constante.

Neste trabalho realizou-se o monitoramento de 2010 sítios de 14 pacientes, com idade entre 18 e 45 anos, por meio de sonda de força constante (Florida Probe), com o objetivo de verificar a efetividade de terapias cirúrgicas (Retalho Widman Modificado, Retalho Posicionado Apicalmente com ou sem osteotomia/osteoplastia e enxerto ósseo) e não cirúrgica (Raspagem e Polimento Corono-radicular), por um período de seis meses. Na fase inicial, todos os pacientes foram raspados com ultra-som e receberam instrução de higiene oral e foram registradas as medidas do nível de inserção de todos os sítios. As terapias foram indicada conforme a necessidade de cada área. Após três e seis meses foram realizadas novas sondagens. A terapia não cirúrgica (RPC), em quase todos os pacientes apresentou pequena perda de inserção inicialmente de 0,01 a 0,25mm e ganho nos meses subsequentes de 0,09 a 0,34mm, principalmente naqueles que apresentaram bolsas rasas. Quanto às terapias cirúrgicas em geral, houve ganho de inserção no final do estudo (0,04 a 0,85mm). Este trabalho demonstrou que todas as terapias podem ser eficazes no tratamento da doença periodontal e que a manutenção da higiene oral, em muitos casos, é fator importantíssimo para a preservação da saúde periodontal, principalmente em pacientes de maior risco.In this study a 6 month follow-up of 2010 periodontal sites in 14 patientes, age between 18 and 45 years, was evalueted with probing (Florida Probe), with the main objective to verify the effectiveness of different surgical therapies (Modified Widman Surgery, Apical reposition of the flaps with or without osseous surgery and osseous graffiting) and no surgical therapies (Coronal and root planning and oral hygiene instructions. The initial measurements of all sites for attachment level were also recorded. The therapy selection based on each earea necessity. After 3 and 6 months, the attachment level was gain in the following months of 0,9 to 0,34mm, specially on the shallow pockets. For all surgical therapies a gain of probing attachment was obtained after can be effective on periodontal disease treatment and that oral hygiene maintence, in most of the case, in a very important factor to preserve the periodontal health on risk patients

Gingival recession in maxillary canines and central incisors of individuals with clefts

Background. Mucogingival alterations are inherent to clefts and may be worsened by the several plastic surgeries required in these individuals. Objective. The aim of this study was to evaluate the prevalence, severity, and some possible etiologic factors of gingival recessions in teeth adjacent to the cleft. Study design. A total of 641 teeth ( maxillary canines and central incisors) of 193 individuals with cleft lip and/or palate were examined. A generalized linear model was used, and the Wilcoxon test was used to compare the recession with cleft types. Results. Comparison among cleft types as to the presence of recession revealed a statistically significant positive relationship for the maxillary right and left central incisors only in the group with left cleft lip, alveolus, and palate (P = .034). The most frequently affected tooth was the right maxillary canine (26.16%). Conclusion. The prevalence of recession in teeth close to the cleft was higher, although it was not very severe. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 37-45

Are Teeth Close to the Cleft More Susceptible to Periodontal Disease?

Objective: To evaluate whether teeth close to the cleft area present higher prevalence and severity of periodontal disease than teeth in other regions. Design: Cross-sectional. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo. Patients: There were 400 Individuals with complete unilateral or bilateral cleft lip and palate, aged 15 to 49 years, without any previous periodontal treatment. Main Outcome Measures: All clinical parameters were evaluated in six sites for each tooth. The arithmetic means were calculated for each sextant. Results: Of the sextants, 86.75% presented means of probing depth smaller than or equal to 3 mm. No sextant exhibited means of probing depth greater than or equal to 6 mm. There was a statistically significant difference (p < .001) in probing depth according to age, types of cleft, and sextant; 95.87% of sextants presented mean attachment levels smaller than or equal to 3 mm, The sextant with cleft did not present higher means of probing depth, clinical attachment level, plaque index, and gingival index. There was gingival bleeding in 99.08% of the sample and plaque In 97.40%. The type of cleft was not an Important factor Influencing the prevalence of periodontal disease. Age seems to be an Important factor influencing the prevalence and severity of periodontal disease for all aspects Investigated. Conclusions: Periodontal disease In individuals with clefts occurred in a similar manner as observed in other populations. The presence of the cleft does not seem to Increase the prevalence of the disease

Survival of Dental Implants in the Cleft Area-A Retrospective Study

Objective To evaluate the survival rate of dental implants placed in the cleft area Design Retrospective study Setting Hospital for Rehabilitation of Craniofacial Anomalies, Brazil Institutional Tertiary Healthcare Center Patients 120 patients who received dental implants in the grafted cleft area in the years 1999 to 2005 Interventions Clinical data were evaluated from the records of 120 patients according to the following criteria placement grafted, cleft area, and age at surgery, age at placement of dental implants, site and dimension of implants, interval between placement of implants and the last clinical follow-up, and interval between placement and removal or indication for removal of implants Main Outcome Measures Percentage of survival rate of implants Results Mean age at placement of the bone graft was 17 6 years and 21 years at placement of implants A total of 123 cleft areas received secondary bone graft and bone graft to install implants (regraft) The mean survival rate was 34 months since placement of the implant to the last clinical follow-up and 26 months since placement of the prosthesis Seven dental implants were removed The survival rate since placement to the last clinical follow-up was 94 3% Conclusion Rehabilitation of the cleft area with dental implants is a viable and secure alternative, with good prognosi

Correction of a Mucogingival Defect Using an Implant-Retained Postoperative Stent in a Severely Resorbed Mandible: Case Report

This case report describes a technique that uses a palatal mucosal graft and an acrylic resin postoperative stent in an attempt to increase the layer of keratinized tissue around osseointegrated implants in an atrophic mandible. During second-stage surgery a split-thickness labial flap is reflected and apically repositioned by being sutured onto the periosteum and connective tissue. A palatal mucosal graft is then sutured onto the recipient site. The stent is worn for at least 4 weeks following surgery. This procedure helps to eliminate mobility of the mucosa in the area, deepen the vestibule, and prevent muscle reinsertion. (Int J Periodontics Restorative Dent 2008;28:617-623.

XXVI.—On the branchial currents of the Bivalve Mollusca

Volume: 4Start Page: 242End Page: 24