João Luiz Carlini

Use of Allogeneic Bone Graft in Maxillary Reconstruction for Installation of Dental Implants

The aim of this study is to evaluate the efficacy of the application of allogenous bone at the maxillomandibular reconstructions for future rehabilitation with dental implants. The patients were submitted to reconstruction of maxilla, using allogeneic bone grafts, in 3 different techniques: onlay grafts for lateral ridge augmentation, onlay and particulate bone for sinus lift grafting, and particulate alone for sinus lift grafts. Clinical and radiographic control was done at the postoperative phase for at least 8 months, until the patient could be submitted to the installation of dental implants. The results showed success in the majority of the cases, and dental implants could be installed. This can be considered an excellent alternative when compared with the use of autogenous grafts; because handling is easier, there is a great amount of material available and a possibility of using local anesthesia, and consequently there is a reduction of patient morbidity.

Surgical Repositioning of the Premaxilla With Bone Graft in 50 Bilateral Cleft Lip and Palate Patients

PURPOSE The aim of this study was to evaluate a modified surgical technique for premaxilla repositioning with concomitant autogenous bone grafting in bilateral trans-foramen cleft lip and palate patients. PATIENTS AND METHODS The study included 50 bilateral trans-foramen cleft lip and palate patients. Bone graft was harvested from the mandibular symphysis in 24 patients. Whenever more grafting was necessary, the iliac crest bone was used as the donor site (26 patients). The premaxilla was displaced by rupturing the bone and the palatine mucosa, and repositioned in a more adequate position using a surgical guide. The premaxilla and the grafts were fixed with miniplates and screws or screws only. The surgical guide was kept in place for 2 months, whereas the miniplates and screws were removed after 6 months, together with the complete bilateral lip and nose repair. Follow-up examinations were performed at 3, 6, and 12 months by means of periapical and occlusal radiographs, and by clinical examination. Thereafter, the patients were referred for completion of the orthodontic treatment. RESULTS Overall, in 48 cases (96%) the treatment achieved total graft integration, with complete closure of the bucconasal and palatal fistulas, and premaxilla stability (either at first surgery or after reoperation). In the remaining 2 patients (4%), the treatment failed, due to necrosis of the premaxilla. CONCLUSIONS The procedure is complex and involves risk. However, the patients social inclusion, especially at the addressed age group, is the best benefit achieved.

Enxerto autógeno de crista ilíaca na reconstrução do processo alveolar em portadores de fissura labiopalatina: estudo de 30 casos

The reconstruction of alveolar process in cleft lip palate patients is mandatory to enable the eruption and movement of permanent teeth through the clefted area by orthodontic procedure, beside the establisment of aesthetics with prostetic procedure by osteointegrated implants. Considering that autogenous bone grafts provide a high reabsortion level determining a reduction of orthodontic movement or making impossible to place implants, to minimize this problem, we developed a protocol by which the bone (anterior iliac crest) is mixed with alloplastic material (hydroxyapatite) to keep the bone matrix framework, reducing the absotion degree at the clefted area. We selected 30 patients at the Centro de Atendimento Integral ao Fissurado Labio-Palatino (Center of Integral Care of Cleft Lip and Palate Patients), in Curitiba, Parana (from 1997 to 1999). The patients were divided in two groups: at the first one, we utilized grated autogenous iliac crest and in the last one, the same bone combined with bio-reabsorbable hydroxyapatite. After 6 months, we compared for both procedures, the results through digital periapical X ray, concerning the height of the alveolar bone of the adjacent teeth, and 4 limiting lines for bone reconstruction as follow: line 1 was drawn at the cervical region of the adjacent tooth to the less distorted cleft and lines 2,3 and 4, parallel to line 1, being 3mm apart from each other. It was successfull considered the grafts whose greatest concavity was between lines 1 and 2 (space A) and for grafts between lines 2 and 3 (space B) or 3 and 4 (space C), surgical failure. The control group (grated bone) had 46,7% of the patients in space A while the study group (bone plus alloplastic material) 80% of patients in this space, being the determining factor of sucess the patient age.

Diagnóstico e tratamento das assimetrias dentofaciais

Facial asymmetry is a common human characteristic, which is not notice by the patients themselves many times, not even by those who live with them. The facial asymmetry becomes important when the patient itself relates some alteration. Professional evaluation should be required in order to establish the etiology, through efficient methods of diagnosis. The facial asymmetry can be caused by genetic factors, as found in patients with hemifacial microsomia, or by trauma and pathologies. The treatment for the facial asymmetry has the purpose to bring a satisfactory esthetic result and mainly functional and oclusal stability. The treatment plan is elaborated following the etiology, severity, age and affected areas, correcting the deformity installed or avoiding its progress. The purpose of this study is to review the literature about the etiology, methods of diagnosis and treatment of facials asymmetries, exemplifying with clinical cases the different types of treatment.

Social integration and inclusion after pre-maxilla surgical repositioning in patients with bilateral cleft palate and lip

UNLABELLED Bilateral alveolar process fissure causes important functional and aesthetical limitations and thus difficulties in terms of social and family integration and interaction for these patients. AIM (A) to assess motivations and expectations Treatment-wise and (B) to assess social inclusion and integration brought about by the surgery. MATERIALS AND METHODS retrospective observational study involving 50 participants recruited among the patients submitted to the pre-maxilla repositioning procedure from January of 2003 to July of 2005 at the Centro de Atendimento Integral ao Fissurado Lábio-Palatal in Curitiba (CAIF), Paraná, and an assessment questionnaire was used. RESULTS as far as the care protocol is concerned, results show a 90% success rate of surgeries. As to surgical and personal satisfaction rates are concerned, 76% sought treatment for personal satisfaction reasons and 86% reported having had more self-confidence after the surgery. CONCLUSIONS Most of the patients submitted to the maxilla repositioning saw surgery as a continuation of the care previously given, with the expectation of better looks and self-confidence and, 96% of them were pleased with the results attained, which facilitated their social inclusion and re-integration.

O impacto na qualidade de vida após o reposicionamento cirúrgico da pré-maxila em portadores de fissura lábio palatal bilateral - estudo de 50 casos

ABSTRACT BACKGROUND: To describe the assistance protocol, at the Center for Integral Assistance of Cleft Lip and Palate Patients (CAIF); to assess the expectations and motivations in respect to treatment; to evaluate the social integration and inclusion obtained through the procedure. METHODS: a retrospective study with all the 50 patients recruited among those submitted to the procedure of premaxilla repositioning, at the period from January 2003 to july 2005, at the Center for Integral Assistance of Cleft Lip and Palate Patients (CAIF), Parana. A questionnaire was applied. RESULTS: regarding the assistance protocol, the results showed success in 90% of surgeries. Concerning surgical and social integration expectations, it was showed that 76% looked after surgery for personal satisfaction reasons and, 86% related better self trust after surgery. CONCLUSION: the surgical protocol of premaxilla repositioning is a viable technique for the treatment of patients with bilateral cleft of the alveolar process; the majority of patients submitted to premaxilla repositioning perceived the treatment as continuity of the care received, participated due to medical indication, expecting improvement at personal aspect and in self trust and, 96% of them, related satisfaction with results, which facilitates integration and social inclusion.

Reconstrução do seio maxilar atrófico com enxerto autólogo de crista ilíaca: avaliação por tomografia computadorizada e radiografia panorâmica

OBJETIVOS: As dificuldades para a utilizacao de implantes dentarios osteointegrados em pacientes portadores de atrofia do seio maxilar justificaram o emprego de enxerto autologo nao vascularizado de crista iliaca isolado ou associado a hidroxiapatita (HA) em 14 pacientes submetidos a 25 procedimentos no Hospital das Nacoes, Curitiba, Parana, portadores de atrofia do sinus maxilar. O objetivo foi avaliar comparativamente a precisao da tomografia computadorizada e da radiografia panorâmica, atraves da quantificacao da neoformacao ossea nesta estrutura. METODOS: Foram selecionadas pacientes edentados, com altura ossea residual do rebordo gengival ao soalho do seio maxilar menor que 5mm. O enxerto medular de crista iliaca fragmentada isolado ou misturado com HA foi colocado atraves da parede lateral no soalho atrofico da cuba maxilar por via submucosa. A avaliacao quantitativa e qualitativa foi feita atraves da radiografia panorâmica e tomografia computadorizada, sendo utilizado na analise estatistica a distribuicao t de Student (prevalencia de 0,05) para analise das variâncias, considerado que a leitura dos laudos radiologicos foi feita por dois especialistas, medindo a distância entre os pontos inferiores e superiores do enxerto no soalho do seio maxilar. RESULTADOS: Tivemos um ganho medio de 14,8mm em todos os procedimentos, com um erro maior que 3mm em 16 procedimentos (64%) e incorporacao satisfatoria do enxerto osseo suficiente para futuro implante dentario. CONCLUSOES: A tomografia computadorizada foi o metodo de escolha na avaliacao qualitativa e quantitativa da incorporacao de enxerto autologo nao vascularizado em seio maxilar atrofico.

Pedicle Tongue Flap for Palatal Fistula Closure

Background:Palatal fistulae are common sequels that appear in patients after surgical procedures in the palate. Considering the difficulty to achieve an effective treatment, there are many techniques to surgically manage fistulae, that is, the pedicle tongue flap. Objective:Being so, the main goal of this paper is to report cases of patients with palatal fistulae, from different etiologies, treated with anterior pedicle tongue flap. Patients:Eleven patients, 8 male and 3 female, mean age of 32 years old with palatal fistulae surgically treated with anterior dorsal tongue flaps. No flap was completely lost. There was 1 partial loss and 1 residual buconasal communication. The most common complaints of the patients were difficulty to perform oral hygiene and mild pain. Conclusion:The use of anterior pedicle tongue flap for closing palatal fistulae demonstrates to be a safe procedure with high success rates (81% in this paper) when correctly indicated.

A inclusão e a integração social pós-reposicionamento cirúrgico da pré-maxila em portadores de fissura lábio palatal bilateral

Bilateral alveolar process fissure causes important functional and aesthetical limitations and thus difficulties in terms of social and family integration an...

Correção das deficiências transversas e ântero-posteriores da maxila em pacientes adultos

AIM: The purpose of this article is to evaluate the correction of anteroposterior and transverse maxillary deficiency in adult patients with the use of facial mask and surgically assisted RME (SARME). METHODS: Reverse traction of the maxilla was applied to 10 subjects through a facial mask after a SARME. All individuals presented a Class III skeletal malocclusion. Cephalometric tracings were used to access the amount of anterior maxillary displacement during treatment. RESULTS AND CONCLUSION: The association of these procedures promoted transverse correction and anterior displacement of the maxilla. This approach avoided a two step correction - one for SARME and other for maxillary advancement, reducing morbidity and costs of treatment.AIM: The purpose of this article is to evaluate the correction of anteroposterior and transverse maxillary deficiency in adult patients with the use of facial mask and surgically assisted RME (SARME). METHODS: Reverse traction of the maxilla was applied to 10 subjects through a facial mask after a SARME. All individuals presented a Class III skeletal malocclusion. Cephalometric tracings were used to access the amount of anterior maxillary displacement during treatment. RESULTS AND CONCLUSION: The association of these procedures promoted transverse correction and anterior displacement of the maxilla. This approach avoided a two step correction - one for SARME and other for maxillary advancement, reducing morbidity and costs of treatment.