André Vajgel

A New Approach for Reconstruction of a Severely Atrophic Mandible

PURPOSE The purpose of this study is to report a case of a patient with a severely atrophic mandible (less than 5 mm) who was treated without bone graft using short implants and internal rigid fixation. PATIENT AND METHODS A 61-year-old woman was referred to a private clinic in the city of Recife (Brazil) with a severely resorbed mandible (less than 5 mm). The patient reported a history of nearly 15 years of complete edentulism and consecutive treatment failures. Cone beam tomography was performed and severe atrophy was confirmed, revealing total bilateral exposed inferior alveolar nerves. There was a high risk of pathologic mandible fracture, since bone density in critical areas was very low. Treatment of choice was the placement of 4 Shorty (3.75 x 5.5 mm) implants (Nobel Biocare, Göteborg, Sweden) at the symphysis for immediate functional reasons and a 2.0-mm large profile Unilock bone plate (Synthes Maxillofacial, Paoli, PA) to reinforce the mandible. A rapid prototype model was made to help precontour the plate, enabling the insertion of the plate through the transoral approach. RESULTS A week after surgery, a Brånemark prosthesis protocol was performed and the patient was satisfied with the result. At 29 months after surgery, the patient was still satisfied and had excellent function without complications. CONCLUSIONS Because of the reported advances in implantology and internal rigid fixation, more patients would be able to improve their severe dental condition without the use of more invasive techniques.

Comparative Finite Element Analysis of the Biomechanical Stability of 2.0 Fixation Plates in Atrophic Mandibular Fractures

PURPOSE The objective of the present study was to conduct a computational, laboratory-based comparison of the biomechanical stability of 2.0 fixation locking plates with different profiles in Class III atrophic mandibular fractures using 3-dimensional finite element analysis. MATERIALS AND METHODS Three-dimensional finite element models simulating Class III atrophic mandibular fractures were constructed. The models were divided into 4 groups according to plate thickness (1.0, 1.5, 2.0, and 2.5 mm). Fractures were simulated in left mandibular bodies, and 3 locking screws were used on each side of each fracture for fixation. Bite forces of approximately 63 N were simulated in the incisor and molar regions of the mandibles in finite element models. RESULTS The level of compressive strain on the bone around the screw was within the physiological limit. No significant difference was observed in the displacement of bone segments in the fracture region. Von Mises stress was higher during simulated bites in the molar region for plates with thicknesses of 1.0 mm. Plate tension values were below the level required for permanent deformation or fracture in all models. The 2.5-mm-thick plate presented better biomechanical performance than all other plates. The 2.0-mm-thick plate also showed satisfactory results and adequate safety limits. CONCLUSION Large-profile (2.0-mm-thick) locking plates showed better biomechanical performance than did 1.0- and 1.5-mm-thick plates and can be considered an alternative reconstruction plate for the treatment of Class III atrophic mandibular fractures.

Recurrence rate following treatment for primary multicystic ameloblastoma: systematic review and meta-analysis.

Opinions regarding the treatment of multicystic ameloblastoma are divergent due to its benign nature and the high rate of recurrence if not adequately excised. The aim of the present study was to perform a systematic review of the literature for a qualitative and quantitative assessment of studies addressing primary multicystic ameloblastoma with regard to treatment and recurrence. Searches were conducted of the Ovid Medline and Embase databases for articles published up to January 2014. Based on predefined eligibility criteria, studies were selected in a two-stage screening process conducted by two independent reviewers. Quality assessment of the selected articles was performed using the modified criteria of the Agency for Healthcare Research and Quality. The meta-analysis was performed using Review Manager (RevMan) software. Statistical heterogeneity was investigated by performing a χ(2) test at the 5% significance level (P<0.05) and determining I(2). The relative risk of recurrence was 3.15-fold greater (95% confidence interval 1.98-5.00) when conservative treatment was performed on primary multicystic ameloblastoma in comparison to radical treatment (P<0.00001 for treatment effect; I(2)=0% and P=0.48 for heterogeneity). The findings justify the treatment of primary multicystic ameloblastoma with bone resection.

Hemodynamic Changes Comparing Lidocaine HCl With Epinephrine and Articaine HCl With Epinephrine

Background The aim of the present study was to analyze hemodynamic changes after the administration of either 2% lidocaine with epinephrine 1:100,000 (L100) or 4% articaine with epinephrine 1:200,000 (A200) in the surgical removal of symmetrically positioned lower third molars. Methods A prospective, randomized, double-blind, clinical trial was carried out involving 43 patients. Each patient underwent 2 surgeries on different occasions—one under local anesthesia with L100 and the other with A200. The following parameters were assessed at 4 different times: systolic, diastolic, and mean blood pressure; heart rate; oxygen saturation; rate pressure product (RPP); and pressure rate quotient (PRQ). Results No hypertensive peak was observed in systolic, diastolic, and mean blood pressure at any evaluation time. Moreover, the type of anesthetic solution did not affect diastolic blood pressure, oxygen saturation or PRQ during the surgeries. Statistically significant differences between groups were detected with regard to heart rate and RPP (P < 0.05). Conclusions The epinephrine concentration (1:100,000 or 1:200,000) and local anesthetic solutions used (2% lidocaine or 4% articaine) influenced hemodynamic parameters without perceptible clinical changes in healthy patients undergoing lower third molar removal.

Ameloblastoma in the Northeast region of Brazil: A review of 112 cases

Context: Ameloblastomas are benign tumors of the jaws with locally invasive capacity. Aim: The aim of this study was to review 112 cases of ameloblastoma seen over an 18-year period (1992-2009) at the Pernambuco Dental School, University of Pernambuco and at Federal University of Sergipe, in the northeast region of Brazil. Materials and Methods: The following data were selected for analysis: age, gender, race, site distribution, radiographic appearance, association with an impacted tooth, size, presence of symptoms, clinicopathologic subtypes and recurrence. Settings and Design: In this retrospective study, Pearsons χ2 test and t-test were employed. The critical level of significance was set at P < 0.05. Results: The mean age of the patients at presentation was 35.1 ± 16.8 years with a slight female preference. The peak prevalence was in the 11- to 20-year age group and declined with increasing age. Total 75 patients were black and 37 were white, for a 2:1 black: white ratio. The location of the ameloblastomas showed a marked predominance in the mandible (84.8%) and 69% of the cases presented with a multilocular radiographic appearance. The tumor was associated with an embedded tooth in 14 cases (12.7%): nine unilocular and five multilocular ameloblastomas. The maximum radiological extension of the lesions on panoramic radiographs was 0.5-20 cm (mean ± SD: 5.2 ± 3.3 cm) and most cases were symptom-free (75.9%). Solid/multicystic ameloblastoma was the most common clinicopathologic subtype. There was an association between the clinicopathologic subtypes and radiographic appearance (P < 0.001). Recurrence was observed in 13.3% of cases. Conclusion: We propose that racial factors may have strong influence on the incidence of ameloblastomas in the northeast region of Brazil, since most people have African descent. Data related to gender, location, radiographic appearance, size, symptoms, clinicopathologic subtypes and recurrence were similar to previous studies conducted in various parts of the world.

Treatment of condylar fractures with an intraoral approach using an angulated screwdriver: Results of a multicentre study

BACKGROUND This multicentre study aimed to investigate long-term radiographic and functional results following the treatment of condylar fractures using an angulated screwdriver system and open rigid internal fixation with an intraoral surgical approach. METHODS Twenty-nine patients with a total of 32 condylar fractures were evaluated. The patients were investigated prospectively based on the following variables: age, sex, aetiology, side, location and classification of the fracture, degree of displacement, associated fractures, surgical approach, oral health status, type of osteosynthesis plate, duration of surgery, mouth-opening, complications, and duration of follow-up. RESULTS The fractures were classified as subcondylar (n = 25) or condylar neck (n = 7). Mean patient age was 36.38 ± 16.60 years. The median duration of postoperative follow-up was 24.39 ± 13.94 months. No joint noise, weakness of the facial nerve, joint pain, or muscle pain was observed. An additional retromandibular approach was necessary to enable the treatment of one subcondylar fracture with medial displacement. CONCLUSION Subcondylar or condylar neck fractures with medial or lateral displacement can be treated using an intraoral approach with satisfactory results with the advantages of the absence of visible scarring, the avoidance of facial nerve injury, and the ability to obtain rapid access to the fracture.

Nevoid Basal Cell Carcinoma Syndrome: A Long-Term Study in a Family.

We present a family case series with 10 individuals having nevoid basal cell carcinoma syndrome (NBCCS) with a 10-year follow-up. All articles published in the literature between 1967 and 2011 on familial Gorlin-Goltz syndrome in any language were surveyed to determine the mapping of cases per country of occurrence of this disease. All patients in the present series were presented with calcification of the falx cerebri, mild hypertelorism, and frontal bossing. Odontogenic keratocystic tumors, palmar and plantar pits, and multiple basal cell carcinomas occurred in 90, 40, and 20%, respectively, of the patients. One of the patients died of skin cancer. Diagnosis of odontogenic keratocyst tumors was confirmed by histopathological examination. NBCCS is a rare autosomal dominant cancer predisposition syndrome; it is important to recognize it when a patient has multiple odontogenic keratocyst tumors because life-long monitoring is essential for patient management.