Data de entrada do artigo: 04/08/2013 Data de aceite do artigo: 05/12/2013 Introdução: Os pacientes com doença renal crônica têm condições sistêmicas e orais características, que exigem precauções especiais durante o tratamento odontológico. Os medicamentos devem ser administrados com cautela e os pacientes que são submetidos à diálise devem receber atenção especial. Antes do início de qualquer tratamento odontológico, o cirurgião dentista deve consultar o médico do paciente a respeito das precauções específicas. Um plano de tratamento deve ser constituído, protegendo contra possíveis riscos. Objetivo: Descrever as manifestações sistêmicas e orais, a fisiopatologia e considerações gerais e farmacológicas para o tratamento oral de pacientes que apresentam doença renal crônica. Materiais e Métodos: Uma revisão analítica, retrospectiva e descritiva da literatura do tópico foi realizada utilizando informações e protocolos atualizados. Conclusão: Para o tratamento desses pacientes, os clínicos devem ter a capacidade de reconhecer o nível de risco, estar cientes dos protocolos farmacológicos, características do atendimento clínico e alterações psicológicas que esses pacientes podem apresentar. É importante também reconhecer as diferentes necessidades e os ajustes que devem ser feitos individualmente para cada um dos casos. Palavras-chave: nefropatias; insuficiência renal; assistência odontológica. RESUMO Introduction: Patients with chronic renal disease have specific systemic and oral conditions, which require special precautions during oral treatment. Drugs must be administered with caution and patients undergoing dialysis must receive special consideration. Before any oral treatment, the dentist should consult the patient's physician about specific precautions. A treatment plan should be built in order to protect from potential risks. Objective: To describe the physiopathology, systemic and oral manifestations, as well as overall and pharmacological considerations for the oral treatment of patients with chronic renal disease. Materials and Methods: An analytical retrospective descriptive literature review on the subject was performed using up-to-date information and protocols. Conclusion: For the treatment of patients with chronic renal disease, clinicians should be capable to recognize the level of risk in those individuals, be aware of pharmacological protocols, clinical management and psychological changes that these patients may present. It is also important to recognize the different necessities and adjustments that must be made for each case individually.

The technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with significant improvements regarding stability, better bone contact between the segments, and possibilities of osteosynthesis. However, paresthesia is common in the postoperatory, sometimes permanent, and undesirable fractures in the subcondylar region can occur leading to longer operative time and extraoral scars. The short lingual split technique is an easy technique that simplifies the horizontal osteotomy of the ramus and decreases the risk of undesirable fractures with a neurosensitive recovery of patients in a much shorter time because of minor trauma and nerve manipulation during the execution.

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Temporomandibular joint (TMJ) and the associated muscles turn possible mandibular movements as a complex engineering appliance that may be affected by signs and symptoms such as pain, including in head and neck areas, abnormal jaw movement and clicking or crepitus sounds, classified as temporomandibular disorders (TMD). Some procedures such as discopexy, eminectomy, or arthroplasties, which we consider conservative, can result in ankylosis, even resorption and joint degeneration, limiting surgical options to treat TMJ. The alloplastic prosthesis becomes an option. Total joint reconstruction using prosthesis becomes the treatment choice during the following conditions: previous surgeries including autogenous grafts fail; presence of arthritic diseases; fibrous or bony ankylosis; tumors involving the TMJ; loss of vertical posterior mandible dimension by other TMJ pathologies; and previous prosthetic joint fail. The use of TMJ prosthesis, when compared to other reconstructive procedures, provides immediate function, reducing the duration of surgery and hospitalization time. Disadvantages of the TMJ prosthesis include high cost, prosthesis failure, functional mandibular movements loss, such as protrusion and laterality, and limited fit of stock prosthesis.

Highlights Camurati-Englemann disease is a rare congenital disorder with physical manifestations. Cranial and Maxillofacial manifestations are common including TMJ hyperplasia. Surgical treatment with bony resection and TMJ prostheses installation. Satisfactory post-operative recovery upon follow-up.