João Paulo Bonardi

Bone regeneration with recombinant human bone morphogenetic protein 2: a systematic review

AimThe aim of this work was to perform a systematic literature review on the clinical application of rhBMP-2 in bone reconstruction prior to placing implants.Materials and MethodsA PUBMED search was made about the subject and nine clinical trials were selected according to strict inclusion criteria.ResultsOverall success rates of bone regeneration with rhBMP-2 was 81.4% and success of implants placed was 87.4%. Most frequent adverse events were pain, edema and erythema.ConclusionIt was concluded that the treatment with rhBMP-2 foi satisfactory in most cases and the placement of dental implants in the bone regenerated with rhBMP-2 is feasible.

Late mandibular fracture occurring in the postoperative period after third molar removal: systematic review and analysis of 124 cases

Factors associated with the diagnosis, aetiology, and treatment of mandibular fractures occurring during the postoperative period following the removal of a lower third molar are discussed. The following databases were searched using specific key words: PubMed/MEDLINE, LILACS, Embase, and Scopus. The search yielded 124 cases. Sex, age, side, tooth position and angulation, bone impaction, relationship between the tooth and the inferior alveolar nerve, local pathological conditions, aetiology of the fracture, symptomatology, and time between surgery and fracture, as well as any displacement of the fracture and the treatment of the fracture, were evaluated. Data were tabulated and the χ2 statistical test was applied (P<0.05). Male patients aged >35 years, with teeth in positions II/III and B/C, complete bony impaction, and local bone-like alterations, were found to have a higher frequency of fracture and pericoronitis (P<0.05). Late fractures generally occurred between the second and fourth postoperative weeks (P<0.05). They were generally not displaced and the typical treatment was the non-surgical approach (P<0.05). It is concluded that the risk of mandibular fracture after extraction is associated with excessive ostectomy and/or local alterations. At-risk patients should be thoroughly briefed on the importance of a proper postoperative diet.

Comparison between piezoelectric surgery and conventional saw in sagittal split osteotomies: a systematic review

A systematic review of the advantages and disadvantages of piezoelectric surgery in comparison with conventional saws for sagittal split osteotomy (SSO) was performed. Relevant studies published in the last 10 years were identified through a search of the PubMed/MEDLINE, Science Direct, and Embase databases and assessed against predetermined eligibility criteria. The initial search resulted in 1736 articles. After applying the inclusion and exclusion criteria, 12 articles remained. A total of 799 patients with an average age of 27.5 years underwent SSO performed using a saw or ultrasonic device. Results showed that it took longer to perform the osteotomies using an ultrasonic device than using a conventional saw. At ≥6 months of follow-up, neurosensory disturbance was seen in 4.7% of patients who underwent piezoelectric surgery versus 61.6% of patients who underwent surgery in which a conventional saw was used. It was found that the use of piezoelectric surgery in SSO leads to the best outcome regarding neurosensory disturbance when compared to conventional saws (P=0.04) at ≥6 months of follow-up. Further studies are required for the evaluation of the other clinical parameters assessed.

Rare presentation of adenomatoid odontogenic tumor in a pediatric patient: a case report

The adenomatoid odontogenic tumor (AOT) is a painless benign tumor with slow growth, usually asymptomatic. It has three variants: follicular, extrafollicular, and peripheral. In the follicular type, the tumor is associated with an impacted tooth, and maxillary canines are the most frequently affected. Association with primary teeth is very rare. Treatment consists essentially in a total lesion enucleation. The objective of this paper is to present the clinical case of a 7-year-old female patient with an adenomatoid odontogenic tumor associated with the crown of the left lower deciduous canine (73), dislodging it to the mandibular base and consequently shifting and also impacting the permanent lower canine (33). The lesion was treated with careful enucleation, preserving the permanent canine, which then had its eruption path released favoring its migration to an ideal position.

Traumatic Dysgeusia, an Unusual Complication of Facial Trauma: A Case Report.

The chemical senses of taste and smell are important to human life, because they play an important role in detecting potential environmental hazards. Humans can identify countless different flavors by the simultaneous perception of taste and smell. Reports of sensory loss after craniocerebral trauma began to appear in the medical literature in the middle 1800s. Dysgeusia associated with head injuries is rare and its reported incidence is 0.4 to 0.5%. This report describes the clinical case of a 32-year-old man with Le Fort I and III fractures treated with surgical reduction and fixation. The patient presented with dysgeusia after slight improvement of his preoperative anosmia. The prognosis is favorable and the treatment is prospective.

Unsuccessful Treatment of Atrophic Mandible Fracture by Use of Improper Materials.

Fractures of atrophic mandibles are present on the day by day of buccomaxillofacial surgeons. Mandible atrophy occurs due to tooth loss, which over time induces bone resorption leading to a fragile and susceptible to fracture structure. This paper reports the case of a patient victim of face trauma resulting in atrophic mandible fracture with treatment failure through the use of shared load miniplate. Therefore, a new treatment was performed with miniplate of system 2.4 along with bone graft. After 6 months, the patient was rehabilitated with implant-supported prosthesis installation. It is concluded that for successful treatment of atrophic mandible fractures, the use of rigid plates is necessary, allowing an excellent rehabilitation of the stomatognathic system.

Lower third molar displaced to lateral pharyngeal space after mandibular angle fracture: a case report

The removal of displaced dental elements from deep anatomical spaces is a condition that requires the knowledge of the region and skills to perform the procedure. The lateral pharyngeal space contains important structures such as the internal carotid artery and close proximity with the cranium basis. The aim of this paper is to report a clinical case of a lower third molar displaced to the lateral pharyngeal space after a mandibular angle fracture and its treatment by surgical intervention. The tooth was removed under general anesthesia by direct approach and the fracture was reduced and fixed with a plate and screws. This case report illustrates the importance of an immediate procedure to avoiding severe complications and further damage to important anatomical structures.

Supernumerary Teeth in Nonsyndrome Patient

enough requiring any treatment, only proservation until full remission. A 38-year-old female patient with facial trauma was victim of falling from the own height. On clinical and radiographic examination, no suggestible features of facial fractures were observed. Regarding signs and symptoms, the patient reported slight algia in the region of right temporomandibular joint when chewing, besides flushing and sweating in auriculotemporal region when feeding, 2 weeks after trauma. The maneuver to detect transpiration was performed through Minor starch–iodine test, firstly using iodine 1% solution applied to the skin, which after dried was coated with a starch layer. Chewing gum was offered to the patient in order to stimulate salivation. After the beginning of mastication, the sweating initiated, mixing with skin iodine, thus producing a darkened color in the damp region by the action of iodine with the starch (Fig. 1A and B). Because it is a facial contusion with no mandibular fracture associated, conservative treatment was elected and after remission of joint pain 2 months after the starch–iodine test, there was also a sweating cessation with total remission of Frey syndrome. Unfortunately, there is still no treatment of choice for this morbidity. Among the treatment options for Frey syndrome, at the time of this writing, less invasive therapy is the botulinum toxin injection type A, although some studies evaluated in a systematic review showed no presented conclusive results regarding their effects in this disorder. Another available therapy for this syndrome is the physical barrier placement (autologous or xenogeneous materials) between the cheek skin and the parotid bed, offering multiple-layer physical barriers and sufficient tissue volume to alleviate the established gustatory sweating and cosmetic defects. However, it is very important to know that several patients are resolved only with long-term follow-up without any intervention. Therefore, before some invasive treatment of Frey syndrome is established, firstly should wait by the spontaneous remission possibility of signals and symptoms.

Removal of Compound Odontoma With Piezosurgery Technique

Department of Surgery and Integrated Clinic Aracatuba Dental School University Estadual Paulista (UNESP)

Comparative study of volumetric changes and trabecular microarchitecture in human maxillary sinus bone augmentation with bioactive glass and autogenous bone graft: a prospective and randomized assessment

The aim of this study was to compare the volumetric changes and the new bone microarchitecture in human maxillary sinuses augmented with bioactive glass (Biogran) alone, bioactive glass combined with autogenous bone graft (1:1), or autogenous bone graft alone. Twelve maxillary sinuses were grafted with bioactive glass (group 1), nine with bioactive glass mixed with autogenous bone graft 1:1 (group 2), and 12 with autogenous bone graft (group 3). Patients underwent cone beam computed tomography 15days after the procedure to determine the initial volume of the graft (T1) and again 6 months later (T2). Biopsies were obtained at the time of dental implant placement and were subjected to micro-computed tomography. The volumetric change was 44.2% in group 1, 37.9% in group 2, and 45.7% in group 3 (P>0.05). The trabecular microarchitecture results showed that the materials used in groups 1 and 2 were good bone substitutes. However, the addition of 50% bioactive glass to autogenous bone graft improved the microarchitecture of the graft. Furthermore, the results for volumetric changes indicated that bioactive glass, its association with autogenous bone graft in a 1:1 ratio, and autogenous bone graft alone have similar resorption.