Psammomatoid juvenile ossifying fibroma (PJOF) is a rare benign tumor that usually affects the paranasal sinuses, orbit, and skull. In most cases, extensive incisions are necessary for full access to the tumor site. The aim of this paper is to report a case of extensive PJOF in which an intraoral surgical approach was performed with complete excision of the tumor. A female patient, 18-year old had a deforming volume increase in the region of the left facial middle third with an approximate evolution time of 2 years. She complained of headache, epiphora in the left eye, and total obstruction of the left nostril. Extraoral examination showed facial asymmetry with dystopia, ocular proptosis, and considerable sclera exposition of the left eye. Tomography examination showed a mixed aspect lesion on the left side of the face, well delimited. The intraoral surgical approach was chosen for the excision of the lesion. Under general anesthesia and nasotracheal intubation, total resection was performed, followed by exodontia of the directly involved teeth. In the definitive histopathological examination, the diagnosis was confirmed. The patient is currently with 2 years and 6 months of postoperative follow-up and has good healing of intraoral surgical wounds and stable occlusion. Extraoral examination showed harmonic projection of the facial middle third, but still with excessive exposure of the sclera of the left eye due to the defect in the orbital floor. The surgical treatment of PJOF was possible by intraoral approach, even taking into account the limitations of the access and the complexity of the anatomy of the facial bones involved.
ResumoIntrodução: Os antimicrobianos são caracterizados como um dos mais notáveis exemplos do avanço da Medicina moderna. Contudo, a adaptabilidade dos microrganismos propicia resistência a determinados antimicrobianos. Objetivo: Apresentar, por meio de pesquisa realizada com alunos do curso de Odontologia e Cirurgiões-Dentistas na cidade de Aracaju-SE, um perfil do conhecimento destes sobre antibioticoterapia, propondo oferecer uma oportunidade de identificar e reconhecer os riscos relacionados à administração incorreta destes fármacos. Material e método: Investigação observacional, transversal, com base em um questionário respondido por 80 alunos do curso de Odontologia e 50 Cirurgiões-Dentistas, escolhidos de forma aleatória, para verificar o conhecimento sobre o tema proposto. Resultado: Dentre os entrevistados, aproximadamente 40% eram profissionais e 60% acadêmicos de Odontologia; destes, cerca de 40% relataram que prescrevem utilizando como critério de seleção que o antimicrobiano seja seletivo e bactericida, enquanto que 90% dos entrevistados afirmam prescrever antibiótico somente quando necessário, como forma de evitar a resistência bacteriana. Conclusão: De acordo com a metodologia empregada, pode-se concluir que os dois grupos mostraram desconhecimento sobre a diferença entre antibioticoterapia, profilaxia antimicrobiana e terapêutica medicamentosa.Descritores: Antimicrobianos; prescrição inadequada; Odontologia. AbstractIntroduction: Antimicrobial agents are a striking example of the evolution of modern medicine. However the adaptability of microorganisms provides resistance to certain antimicrobial drugs. Objective: To assess the knowledge of dentistry undergraduate students and dentists in the city of Aracaju, Sergipe State, about antibiotic therapy, thus providing an opportunity to identify and recognize the risks related to improper administration of these drugs. Material and method: This is an observational, cross sectional study based on a questionnaire given to 80 undergraduate students of dentistry and 50 dentists, ramdomly chosen, to assess the knowledge on the matter. Result: Among the interviewees, about 40% were dentists and 60% were dentistry students, 40% of respondents reported to prescribe antimicrobials using as selection criteria that it be selective and bactericidal, and 90% of respondents said they prescribe antibiotics only when necessary, in order to avoid bacterial resistance. Conclusion: According to the methodology applied it can be concluded that both groups showed lack of knowledge about the difference between antibiotic therapy, antimicrobial prophylaxis and drug therapy.
ResumoObjetivo: Analisar a resistência à fratura por fadiga dos conjuntos implante-pilar, nos tipos reto e angulado, submetidos a cargas cíclicas similares às mastigatórias. Material e método: Foram utilizados 32 implantes (3,75 × 11 mm) com sistema cone Morse e 32 pilares, separados em dois grupos: pilares retos e angulados (n=16) (Neodent, Curitiba, PR, Brasil). Os conjuntos foram submetidos a testes cíclicos em equipamento servo-hidráulico, fixando-se o número de ciclos em cinco milhões. Conclusão: Os dois tipos de pilares (retos e angulados), em condições in vitro, comportaram-se estatisticamente de forma semelhante, sendo aceita a hipótese nula de que não há diferença de resistência à fratura entre os grupos.Descritores: Implantes dentários; resistência de materiais; fenômenos mecânicos. AbstractObjective: The aim of this study was to verify the fatigue fracture resistance of the implant-abutment joint, in straight and angled types, subject to cyclic loads similar to chewing. Material and method: It was used 32 implants system (3.75 × 11mm) with Morse taper and 32 abutment, divided in two groups: abutment straight and angled (n = 16) (Neodent, Curitiba, PR, Brazil). The sets were submitted to cyclic testing using servo-hydraulic equipment, fixing the number of cycles at 5 million. It was evaluated the number of cycles, load and moment force of the samples. The Fisher test and ANOVA were applied (p<0,005). Fractured samples were analyzed in the scanning electron microscopy (SEM). Result: Straight abutment, four resisted the cycles number established, supporting loads between 470N and 510N. Angled abutment: nine resisted to loads between 570N and 890N. Regarding the fractured samples below the number of cycles, in the straight abutment, nine fractured with loads between 470N and 630N. In the angled abutment, five fractured with loads ranging from 760N and 890N. The moment of the force was calculated for each joint implant-abutment (Averages: Straight Group -4335,23Nmm, angled Group -3923,37Nmm). Conclusion: Two types of abutments (straight and angled), in vitro conditions, statistically behaved similarly, and accepts the null hypothesis that there is no difference in fracture resistance between groups.Descriptors: Dental implants; material resistance; mechanical phenomena. INTRODUÇÃOO uso de implantes dentários osseointegrados tornou-se modalidade previsível de reabilitação bucal, confi rmada pelo alto sucesso em restaurações unitárias, parciais ou completas dos arcos edêntulos 1,2 . Entretanto, apesar do sucesso dos implantes osseointegrados, problemas de ordem mecânica, como a soltura ou fratura do pilar, o afrouxamento do parafuso de fi xação de coroas unitárias e a instabilidade protética, são problemas comumente relatados na literatura 3 .Durante os movimentos mastigatórios, os dentes naturais e os componentes protéticos são submetidos a cargas geradas pelo contato entre elementos antagonistas, de forma direta ou através da interposição de alimentos 4,5 . São geradas tensões na coroa a partir
Os defeitos mandibulares devido à ressecção de lesão óssea interferem a harmonia e estética facial comprometendo a qualidade de vida dos pacientes. Grandes defeitos exigem planejamento minucioso, principalmente quando lançamos mão de enxertos e placas de reconstrução, evitando assim resultados insatisfatórios ou até mesmo sequelas. Apesar de algumas classificações dos defeitos mandibulares vêm sendo discutidas ao longo dos anos, ainda não há um protocolo definido para reconstrução mandibular. O uso de prototipagem na Cirurgia Bucomaxilofacial tem se tornado cada vez mais frequente; a precisão da reconstrução, diminuição do tempo de cirurgia reflete em recuperação mais rápida do paciente. Mesmo com a ferramenta da prototipagem, grandes lesões e perdas ósseas permanecem como grande desafio ao cirurgião. O objetivo deste trabalho é relatar um caso clínico de reconstrução mandibular no qual houve a necessidade de ser tratado com remoção de placa de reconstrução e nova reabilitação cirúrgica do paciente.Descritores: Mandíbula; Reconstrução Mandibular; Modelos Biológicos.ReferênciasSantos LCS, Seixas AM, Barbosa B, Cincura RNS. Adaptação de placas reconstrutivas: uma nova técnica. Rev Cir Traumatol Buco-Maxilo-Fac. 2011;11(2):9-14.Lin PY, Lin KC, Jeng SF. Oromandibular reconstruction: the history, operative options and strategies, and our experience. ISRN Surg. 2011;2011:824251.Martins Jr. JC, Keim FS. Uso de prototipagem no planejamento de reconstrução microcirúrgica da mandíbula. Rev Bras Cir Craniomaxilofac. 2011;14(4):225-28.Montoro JR, Tavares MG, Melo DH, Franco Rde L, Mello-Filho FV, Xavier SP, Trivellato AE, Lucas AS. Mandibular ameloblastoma treated by bone resection and imediate reconstruction. Braz J Otorhinolaryngol. 2008;74(1):155-57.Nóia CF, Ortega-Lopes R, Chaves Netto HDM, Nascimento FFAO, Sá BCM. Desafios na reconstrução mandibular devido a lesões extensas ou traumatismos. Rev Assoc Paul Cir Dent. 2015;69(2):158-63.Cohen A, Laviv A, Berman P, Nashef R, Abu-Tair J. Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):661-6.Rana M, Warraich R, Kokemüller H, Lemound J, Essig H, Tavassol F et al. Reconstruction of mandibular defects - clinical retrospective research over a 10-year period. Head Neck Oncol. 2011;3:23.Fariña R, Alister JP, Uribe F, Olate S, Arriagada A. Indications of Free Grafts in Mandibular Reconstruction, after Removing Benign Tumors: Treatment Algorithm. Plast Reconstr Surg Glob Open. 2016;4(8):e845.Fariña R, Plaza C, Martinovic G. New transference technique of position of mandibular reconstructing plates using stereolithographic models. J Oral Maxillofac Surg. 2009;7(11):2544-48.Mooren RE, Merkx MA, Kessler PA, Jansen JA, Stoelinga PJ. Reconstruction of the mandible using preshaped 2.3-mm titanium plates, autogenous cortical bone plates, particulate cancellous bone, and platelet-rich plasma: a retrospective analysis of 20 patients. J Oral Maxillofac Surg. 2010;68(10):2459–67.Brown JS, Barry C, Ho M, Shaw R.A new classification for mandibular defects after oncological resection. Lancet Oncol. 2016;17(1):23-30Urken ML, Weinberg H, Vickery C, Buchbinder D, Lawson W, Biller HF. Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects. Arch Otolaryngol Head Neck Surg. 1991;117(7):733-44.Shnayder Y, Lin D, Desai SC, Nussenbaum B, Sand JP, Wax MK. Reconstruction of the Lateral Mandibular Defect: A Review and Treatment Algorithm. JAMA Facial Plast Surg. 2015;17(5):367-73.Wei FC, Celik N, YangWG, Chen IH, Chang YM, Chen HC. Complications after reconstruction by plate and soft-tissue free flap in composite mandibular defects and secondary salvage reconstruction with osteocutaneous flap. Plast Reconstr Surg. 2003;112(1):37-42.Li BH, Jung HJ, Choi SW, Kim SM, Kim MJ, Lee JH. Latissimus dorsi (LD) free flap and reconstruction plate used for extensive maxillo-mandibular reconstruction after tumour ablation. J Craniomaxillofac Surg. 2012;40(8):293-300.
Hemimandibular hyperplasia was first described in 1836 by Adams as a disorder that causes condylar hyperplasia, deforming facial asymmetry and has an unknown etiology. The objective of this study was to report a patient with surgical correction through orthognathic surgery and high condilectomy for the treatment of hemimandibular hyperplasia. The patient complained of pain and cracking in the right temporomandibular joint region and was dissatisfied with the aesthetic appearance of the face. Virtual planning was done for bimaxillary orthognathic surgery and preparation of prototyped surgical guides. Stereolithographic models were used for the preparation of the acrylic guides of the osteotomies for the high condilectomy and the contour of the mandibular base. Orthognathic surgery resulted in the maxillary repositioning with correction of the inclination of the occlusal plane, reduction of the height of the ramus and right mandibular body and class I dental attachment. Mandibular contour osteotomy was performed with acrylic guide in the basilar. The condilectomy was performed by endaural access. In 2-year follow-up, there are no signs of recurrence.
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