Claudio Ferreira Nóia

Prospective Clinical Assessment of Morbidity After Chin Bone Harvest

AbstractThe aim of this prospective research was to assess soft tissue morbidity in the symphyseal region after bone graft harvesting. Thirty patients, with average age 45 years, underwent symphyseal bone graft harvesting followed up for a period of 12 months. Follow-up involved neurosensory testing of 2-point discrimination, static light touch, brush directional stroke, pinprick, and thermal discrimination to cold and hot; the statistical analysis was performed using McNemar test and Friedman test with P < 0.05. The results showed that 50% of patients had postoperative morbidity in the first month after surgery showing statistical positive relation with surgery (P < 0.05); at 6 months, this situation diminished to 23%, and at the end of the monitoring period (1 year); the neurosensory tests revealed no persistent morbidity. In conclusion, all neurosensory tests revealed high morbidity in the first month with total resolutions at 1-year follow-up; however, this complication associated to surgery is indispensable to discharge the patient properly.

In vitro resistance of titanium and resorbable (poly L-co-DL lactic acid) osteosynthesis in mandibular body fracture.

This study was a comparative evaluation of the bending resistance of metallic and resorbable plates and screws in a mandibular body fracture model. Forty polyurethane synthetic hemimandibles were used; a vertical linear cut was made between the second and first premolars. These 40 hemimandibles were divided into four groups of 10 and were fixed with titanium plates and screws or resorbable plates and screws, with monocortical screws in the upper sector and bicortical screws in the lower sector. Bending resistance tests were done on a universal testing machine with a linear displacement speed of 1mm/min, a cell load of 500 N, and a load cell on the lower central incisor or on the lower second premolar. Results were analyzed using the Students t-test, with the significance level set at 5%. No statistically significant differences were observed between the groups studied, either in the analysis of the osteosynthesis materials or related to the load-bearing points. The variables of displacement and peak load did not present any significant differences. In this in vitro model of a mandibular body fracture, the mechanical behaviour of a resorbable osteosynthesis was similar to that of a titanium osteosynthesis.

Segmental osteotomy with interpositional bone grafting in the posterior maxillary region

Tooth loss is followed by a natural bone resorption process that often leads to defects in the alveolar ridge, making the installation of dental implants unfeasible. Correction of such bone defects, especially loss of height of the ridge or associated loss of thickness, is a great challenge to dental surgeons. The technique of segmental osteotomy accompanied by interpositional bone grafting has been shown to be a viable option for addressing the problem. This report describes a successful application of the technique in the treatment of vertical dimension deficiency in the posterior maxillary region. Four months after graft surgery, 3 implants were successfully placed in accordance with the original reverse planning.

Estudio Radiográfico Prospectivo de la Reparación Ósea en Sínfisis Mandibular Posterior a la Remoción Ósea de Mentón

El retiro de hueso de sinfisis mandibular ha sido utilizado ampliamente para diferentes procedimientos reconstructivos maxilofaciales. El objetivo de esta investigacion fue establecer la existencia de la reparacion osea en el defecto creado en sinfisis debido al retiro de hueso. Treinta pacientes (22 mujeres, 8 hombres) de entre 21 y 65 anos fueron operados para retirar hueso de menton que fue posteriormente aplicado en reconstruccion osea alveolar; las cirugias fueron realizadas por dos cirujanos maxilofaciales y los pacientes fueron evaluados con telerradiografias en la etapa preoperatoria, postoperatoria inmediata (PIn) y postoperatoria tardia (PTar), donde se realizaron medidas horizontales y verticales del defecto oseo; los valores fueron estudiados con la prueba t de Student con valor de p<0,05. Luego del retiro oseo se observo un defecto vertical promedio de 12,80±1,99 y horizontal de 8,33±1,77; luego de un ano, se obtuvo una disminucion de 32,8% en el sentido vertical y 50,3% horizontal, presentando significancia estadistica en relacion al PIn. Se concluye que existe reparacion osea del defecto originado en sinfisis siendo proximo al 30%-50% en la evaluacion de un ano posterior a la cirugia.

Uso de Enxerto Ósseo Autógeno nas Reconstruções da Cavidade Bucal. Análise Retrospectiva de 07 Anos

Resumo Actualmente existe uma grande demanda de pacientes que necessitam de tratamentos com implantes dentarios osseointegraveis, entretanto esta situacao e muitas vezes dificultada por alteracoes no rebordo alveolar desdentado, o que pode tornar a instalacao do implante mais complicada. Os enxertos osseos autogenos sao nos dias actuais os tratamentos de escolha para aqueles pacientes com volume de osso insuficiente e que desejam receber implantes osseointegraveis. Sendo assim, o objectivo deste trabalho foi analisar retrospectivamente o uso de enxerto osseo autogeno em pacientes tratados pela area de Cirurgia Buco-Maxilo-Facial da Faculdade de Odontologia de Piracicaba, da Universidade Estadual de Campinas no periodo de Junho de 2001 a Julho de 2008. Os resultados mostram que as areas doadoras intrabucais foram utilizadas em 95,1% dos casos, sendo que a tuberosidade maxilar foi empregada em 39,8% dos casos, o ramo ascendente em 31,4% e a sinfise mandibular em 28,8% dos casos. O enxerto em bloco “onlay” foi a tecnica mais usualmente empregada (53,7%), seguida pelo enxerto com osso particulado (36,6%) e pelo levantamento de seio maxilar (9,7%). Em conclusao, sempre que possivel devemos optar por areas doadoras intrabucais, e no presente trabalho essas areas doadoras foram as mais comummente empregadas, sendo a tuberosidade maxilar a mais utilizada.

Influencia del Diámetro y Longitud de Implantes en la Pérdida Tardía de Implantes Dentales

El objetivo de esta investigacion fue describir la influencia del diametro y largo de los implantes en la perdida tardia del implante. Se diseno un estudio retrospectivo para estudiar 375 pacientes que habian sido sometidos a rehabilitacion oral sobre implantes durante un periodo de 11 anos; se incluyeron en el estudio todos aquellos documentos debidamente completados y con estudios radiograficos preoperatorios, posterior a la instalacion del implante y posterior a la instalacion de la protesis. Los implantes fueron clasificados de acuerdo al diametro como estrecho, regular y ancho y de acuerdo al largo como corto, medio y largo; el analisis de datos fue realizado con la prueba Chi Cuadrado con valor de p<0,05. Del total de 939 implantes y se identifico la perdida de 55 implantes posterior a la etapa protesica (5,8%). En base a la perdida, no se logro establecer ninguna relacion estadisticamente significativa con el diametro del dispositivo (p=0,475) y tampoco con el largo del implante (p=0,064). Podemos concluir que el largo y el diametro de implantes dentales no influyen en la perdida tardia del mismo.

Repositioning Implants Through Sandwich Osteotomy with the Interposition of Lyophilized Bovine Bone

The satisfactory positioning of an implant during dental surgery is essential to the success of the treatment. However, accidents can occur during the period of osseointegration, leading to implant movements that hinder or may even prevent prosthetic rehabilitation. Implants can be repositioned through sandwich osteotomy, which has been labeled a versatile, viable and predictable technique in the literature. The aim of the present study was to report a case involving the esthetic displacement of an implant, caused by a sports accident, which was repositioned using sandwich osteotomy, with the interposition of lyophilized bovine bone between the osteotomized segments. In order to adequately perform this repositioning, the authors devised a guide to assist with the positioning process.

Sandwich Osteotomies to Treat Vertical Defects of the Alveolar Ridge.

Purpose: To evaluate the vertical bone gain after osteotomy sandwich. Materials and Methods: Fourteen patients (mean age, 41 years) underwent 17 procedures of osteotomy sandwich. Of these 17 procedures, 15 involved reconstructive surgery and 2 involved the repositioning of implants. The patients were submitted to computed tomography before the surgical procedure and 4 months after the completion of the graft, with measurements taken to assess the vertical gain that had been achieved. Results: The results confirmed a satisfactory vertical gain in all cases (mean, 5.12 mm). The use of autogenous graft or biomaterial particles (in isolation) between the osteotomized segments proved to be viable. Three patients reported postoperative paresthesia, which healed spontaneously after 3 months. One patient exhibited dehiscence due to not following the postoperative recommendations. Forty implants were installed in the grafted regions, and 2 implants were repositioned. Conclusion: The technique of sandwich osteotomy was found to be effective for height gain, and different materials can be used between the osteotomized segments.

Tratamento da Atrofia Vertical Posterior de Mandíbula Através de Osteotomia Sandwich: Série de Casos

1Doutor em CTBMF pela UNICAMP e Diretor do Instituto Braga de Odontologia e Pesquisa (IBOP/SP). 2Doutor em CTBMF pela UNICAMP e Coordenador do curso de aperfeiçoamento em Implantodontia da APCD Piracicaba/SP. 3Mestre em Implantodontia pelo ILAPEO Curitiba e Coordenador da Especialização em Implantodontia CIODONTO/RO. 4Especialista em Implantodontia pela CIODONTO/RO e Professora da Especialização em Implantodontia CIODONTO/RO. 5 Especialista em Implantodontia pela CIODONTO/RO e Professor da Especialização em Implantodontia CIODONTO/RO.

Clinical considerations for optimizing results in bone grafting: Part I

Abstract / Introduction: Due to lack of an ideal bone substitute, which promotes reconstruction of diferent types of bone defects with high predictability, high success rates and preferably without the need for a donor site from the patient, it is known that obtaining results excellent results in bone grafting represents a real challenge to surgeons even nowadays. Objective: hus, the aim of this study was to address some aspects that directly inluence outcomes in bone grafting, namely: defect type, choice of bone substitute, biological limits of surgical techniques and the microarchitecture of grafts, particularly because properly approaching these factors enables clinicians to obtain excellent clinical results.