SELECCIÓN DE OSTEOSÍNTESIS EN LA RECONSTRUCCIÓN MAXILAR CON INJERTO

La reconstrucción ósea maxilar con injertos libres junto a la osteotomía Le Fort I ha sido desarrollada para dar respuesta a las necesidadesclínicas funcionales y estéticas de los pacientes, debido principalmente a la discrepancia antero-posterior de las maxilasatróficas. Dentro de la técnica, existe necesidad de osteosíntesis mediante fijación interna rígida (FIR) que puede ser desarrolladatanto con dispositivos metálicos como con dispositivos reabsorbibles. El presente estudio evalúa el uso de ambos materiales defijación, relatando las características, comparaciones y situaciones clínicas que podrían estar asociados a su elección. (KIRU.2013;10(2):161-5)

Evaluation of the carboximetilcelulosis carrier associated with anorganic bovine matrix used in defects made in dog's calviaria : radiological and histological analyses

Orientador: Renato MazzonettoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Os procedimentos cirúrgicos envolvendo a reabilitação da região maxilofacial freqüentemente requerem o uso de enxertos ósseos para a reconstrução de deformidades congênitas ou adquiridas, assim como para correções esqueléticas com finalidade estética. Com o objetivo de evitar a abordagem de áreas doadoras para obtenção de enxerto ósseo, os substitutos ósseos foram desenvolvidos. Visando minimizar a dificuldade de adaptação dos substitutos ósseos na área doadora, os veículos para inserção destes vêm sendo estudados. Para o presente estudo, foram utilizados 8 cães, machos, sem distinção de raça, provenientes do biotério da Unicamp. Após tricotomia e anti-sepsia com polivinilpirrolidona iodo a 10% foram realizados 4 defeitos bicorticais de 8mm de diâmetro na calota craniana de cada animal. O preenchimento das cavidades se deu do seguinte modo: Grupo I - coágulo sangüíneo, Grupo II - osso autógeno particulado, Grupo III - matriz óssea bovina anorgânica, Grupo IV - matriz óssea bovina anorgânica associada a carboxi-metilcelulose. Os períodos de sacrifício foram de 3 e 6 semanas. Através de análise descritiva radiológica e histológica, observou-se no período de 3 semanas a presença de tecido conjuntivo, vasos sangüíneos, material utilizado para preenchimento, assim como as bordas nítidas em todos defeitos. O Grupo II foi o único a apresentar regiões de aposição de novo tecido ósseo. No período de 6 semanas observou-se a presença de tecido conjuntivo, vasos sangüíneos e material utilizado para preenchimento em todos defeitos. O Grupo II foi o único que apresentou as partículas de osso autógeno utilizadas para o preenchimento em estágio de reabsorção avançado sendo também o único a não apresentar as bordas entre o defeito e osso pré-existente nítidas, no período de 6 semanas. Desta forma observou-se que, apesar do enxerto de osso autógeno apresentar melhores resultados em termos de reparação óssea, a matriz óssea bovina anorgânica demonstrou ser biocompatível, servindo como osteocondutor, assim como que o carreador carboxi-metil-celulose influênciou de maneira negativa o processo de reparação óssea.Abstract: Surgical procedures involving maxillofacial region frequently require bone grafting to reconstruct the congenital or acquired defects, as well to aesthetic. Meaning to avoid the donate areas to obtain grafts, the biomaterials have been developed, especially to minimize the hardiness adaptation of them. This way, several vehicles to insert of these bone substitutes are been studied. To perform the present studied were used 8 dogs, males, without pedigree, from the Unicamp vivarium. After trichotomy and antisepsis with PVPI 10% were performed 4 bicortical defects having 8mm of diameter on the calvarium of each animal. The cavities were filled up thru the following way: Group I - Blood clot, Group II - particulate autogenous bone graft, Group III - anorganic bovine bone matrix, Group IV - anorganic bovine bone matrix associated with a carboxi-metil-celulosis. The sacrifice periods were 3 and 6 weeks. Thru the descriptive radiologic and histological analysis, it was observed on 3 weeks period, presence of connective tissue, blood vessels, material used for fulfillment, as well as periphery of the defects well delimited. The Group II was the only one that presented new bone aposition. On the 6 weeks sacrifice period, it was noted the presence of connective tissue, blood vessels, material used for fulfillment in all defects. The Group II was the only one that showed advanced resorption stage of the bone grafts particles used for fulfillment being, also the only one that showed periphery of the defects without limit, on the 6 weeks period. The present work demonstrated that, despite the autogenous bone grafts lead to the best result in terms of bone defect repair, the anorganic bovine bone matrix demonstrated to be biocompatible, being osteoconductible, as well the carrier carboximetil- celulosis interfered negatively on the bone repair process.MestradoCirurgia e Traumatologia Buco-Maxilo-FaciaisMestre em Clínica Odontológic

Accuracy between virtual surgical planning and actual outcomes in orthognathic surgery by iterative closest point algorithm and color maps : a retrospective cohort study

To evaluate the accuracy between actual outcomes and virtual surgical planning (VSP) in orthognathic surgery regarding the use of three-dimensional (3D) surface models for registration using iterative closest point (ICP) algorithm and generated color maps. Construction of planning and postoperative 3D models in STL files format (M0 and M1, respectively) from CBCT of 25 subjects who had been submitted to bimaxillary orthognathic surgery was performed. M0 and M1 were sent to Geomagic software in semi-automatic alignment surface mesh order of M0 and M1 for registration using ICP algorithm to calculate mean deviation (MD, MD+, MD-, SD) and root mean square (RMS ? 3D Error). Color maps were generated to assess qualitative congruence between M0 and M1. From deviation analysis, 3D Error was defined as accuracy measurement. To assess the reproducibility, the workflow was performed by two evaluators multiple times. t-tests were used to assess whether all means of MD, MD+, MD-, SD and 3D Error values would be ? - 2 mm and ? 2 mm. High intra and inter evaluators correlation were found, supporting the reproducibility of the workflow. t-tests proved that all MDs and 3D Error values were > - 2 mm and < 2 mm. 3D error mean was within the standards of clinical success lower than 2 mm. ICP algorithm provided a reproducible method of alignment between 3D models and generated color maps to evaluate 3D congruence but did not answer all methodological parameters regarding the assessment of accuracy in orthognathic surgery

Malignant lymphoma of the oral cavity and the maxillofacial region: overall survival prognostic factors

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

Evaluation on the incorporation process of particulate and block bone grafts : studies in animal model

Orientador: Renato MazzonettoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Desde o desenvolvimento da implantodontia, associou-se estética à função nas reabilitações, aumentando a necessidade de enxertos ósseos visando a instalação adequada destes implantes. O processo de incorporação dos enxertos geralmente é acompanhado através de análise clínica e exames de imagem. Deste modo, diversos estudos vêm sendo desenvolvidos. O presente trabalho apresenta 3 pesquisas em modelo animal, descritas nos Capítulos à seguir. CAPITULO I: Comparação histológica das diferenças existentes no processo de reparo ósseo em defeitos criados em calotas cranianas de cães, preenchidos com coágulo e enxerto ósseo autógeno particulado, a fim de se estabelecer uma classificação, defeito crítico ou não crítico, dos defeitos de 8mm de diâmetro. Observou-se, em dois períodos de sacrifício, correspondentes as fases inicial e tardia do processo de reparo ósseo, que os defeitos preenchidos com coágulo sangüíneo apresentaram um processo de reparo inferior ao grupo preenchido por enxerto ósseo autógeno, sendo este o único que apresentou aposição de tecido ósseo nos dois períodos. Deste modo, pode ser concluído que os métodos que auxiliam no processo de reparo ósseo estão indicados em casos de defeitos iguais ou maiores que 8mm, sendo este classificado como crítico. CAPITULO II: O propósito deste capítulo foi estabelecer uma relação entre os exames radiográficos e o processo de incorporação de enxertos ósseos de origem autógena, heterógena (matriz óssea bovina anorgânica) e coágulo sangüíneo, em defeitos criados em calotas cranianas de cães. Observou-se nos periodos correspondentes às fases inicial e final do processo de reparo ósseo os exames de imagem. Apesar de apresentarem-se divergentes na proservação do processo de incorporação destes enxertos, obtiveram resultados semelhantes as análises histológicas somente nos grupos de coágulo sangüíneo e enxerto ósseo de origem autógena. Deste modo, os exames radiográficos servem como parâmetro na proservação de procedimentos de reconstrução somente quando são utilizados enxertos ósseos de origem autógena, assim como casos de reparação espontânea através do coágulo sangüíneo. CAPITULO III: O objetivo deste estudo foi avaliar histológica e histométricamente a interface enxerto ósseo versus leito receptor em cães.Para tanto foram obtidos dois blocos de enxerto ósseo córtico-medular de cada cão, sendo que um destes foi fixado com a interface cortical voltada para o leito receptor, enquanto o outro foi fixado com a face medular voltada ao leito receptor. Os 6 cães foram divididos em dois períodos de sacrifício. Pode-se observar presença de tecido conjuntivo, vasos sangüíneos, tecido ósseo neoformado em ambos grupos nos dois períodos de sacrifício. A analise histométrica evidenciou que a formação de tecido ósseo neoformado foi estatisticamente semelhante em ambos grupos. Deste modo, pode-se concluir que a estrutura cortical ou medular não interferiu na formação de tecido ósseo na região de interface entre enxerto e leito receptorAbstract: Since the implantodontology was developed, aesthetics was associated to function, increasing the requirement of bone grafting meaning the correct installation of them. The bone grafting integration process generally are accompanied thru out clinical and images exams. Thus, several studies are being developed. The present work performed 3 researches using animal model, divided in Chapters. CHAPTER I: Had the meaning to compare, thru out descriptive histological analysis, the differences that exists on bone healing in defects created in dogs calvarium, fulfilling with clot and particulate autogenous bone graft , meaning the establish a classification, such as critic or non-critic, of the 8mm diameter defects created on dogs calvarium. It was observed, on both sacrifice periods, similar to earlier and late phases of the bone healing repair, that the defects fulfilled with blood clot presented an inferior healing process when compared with the autogenous bone graft group, being this the unique that showed apposition of mineralized tissue on both periods. Thus, bone defects over 8mm can be considered critical, being necessary some method to help tissue repair, as well as, autogenous bone grafts works well when helping this regeneration process, being indicated to assist bone repair like this performed on this study. CHAPTER II: The aim of this research was to establish a relation between radiographic exams and bone grafting integration of autogenous bone graft and heterogenous bone graft (anorganic bovine bone matrix) and blood clot in defects performed on dogs calvarium. It was observed that on the correspondent periods of initial and delay phases of bone healing repair the radiographic exams. Besides presented divergent on the accompaniment of heterogenous bone graft, they obtained similar results from histological analysis on blood clot and autogenous graft groups. As concluded, radiographic tests can de used as a parameter for reconstruction proservation only when autogenous bone grafts are used, as well as in cases of spontaneous repair through blood clot. CHAPTER III: The proposal of these chapter was value, thru out histological descriptive and histometric analysis,the interface between bone graft and receipt area in dogs.To perform that, it was obtained 2 cortical-medullar bone blocks from each dog, being one fixed with the cortical face in contact to the receipt area and another fixed with the medullar face in contact to the receipt area. It was observed the presence of connective tissue, blood vessel, and mineralized tissue formation on both sacrifice periods. The histometric analyze showed that the bone tissue formation in this region was found to be statistically similar and did not influence the autogenous bone graft incorporation processDoutoradoCirurgia e Traumatologia Buco-Maxilo-FaciaisDoutor em Clínica Odontológic

Diagnosis and Treatment in Unilateral Condylar Hyperplasia

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 &lt; 0.05 were considered to be statistically significant. Forty-nine patients between 10 and 45 y.o. (average age: 19.1 &plusmn; 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

RELACIÓN ENTRE ÉXITO Y FRACASO EN LOS PROCEDIMIENTOS IMPLANTOLÓGICOS: ANÁLISIS RETROSPECTIVA DE 06 AÑOS

Los implantes dentales oseintegrados son actualmente una opci&oacute;n de tratamiento segura e previsiblepara la rehabilitaci&oacute;n de pacientes desdentados. De esta manera el objetivo del presente estudio fueevaluar retrospectivamente el &iacute;ndice de &eacute;xito y fracaso de los implantes oseointegrados instalados por el&Aacute;rea de Cirug&iacute;a y Traumatolog&iacute;a Bucomaxilofacial de la Facultad de Odontolog&iacute;a de Piracicaba de laUniversidad Estatal de Campinas (FOP-UNICAMP) en el per&iacute;odo de Junio del 2001 hasta Julio del 2007.Durante este per&iacute;odo fueron encontrados 1,800 historias cl&iacute;nicas de pacientes tratados con implantes,siendo que de estos fueron seleccionados 492 que cumpl&iacute;an los criterios de inclusi&oacute;n-exclusi&oacute;nestablecidos. Los resultados muestran que el &iacute;ndice de fracaso fue de 10,6% siendo que en 6,3 % de los casos hubo p&eacute;rdida primaria y en 4,3% hubo p&eacute;rdida tard&iacute;a; mientras que el &iacute;ndice de &eacute;xito fue del89,4%. En conclusi&oacute;n, se observa que los resultados encontrados se encuentran pr&oacute;ximos de los padrones normales relatados en la literatura.ABSTRACT The osseointegraveis dental implantations are currently an option of safe and previsible treatment for the white washing of edentate patients. Being thus, the objective of the present study is retrospectively to evaluate the index of success and failure of the osseointegraveis implantations installed by the area ofBuco-Maxilo-Face Surgery of the Fop/Unicamp in the period of June of 2001 the July of 2007. During thisperiod they had been found a total of 1.800 handbooks of patients dealt with implantations, being that of these 492 had been selected that they fulfilled to the criteria of established inclusion/exclusion. The results show that the failure index was of 10,6%, being that in 6,3% of the cases it had primary loss andin 4,3% had delayed loss; where as the success index was of 89,4%. In conclusion, it is observed that the&nbsp;joined results are next to the normal standards told by literature