Jose Ricardo de Albergaria-Barbosa

Bisphosphonate-Related Osteonecrosis of the Jaw: A Review of the Literature

Bisphosphonates (BPs) are a class of drugs used to treat osteoporosis and malignant bone metastasis. BPs show high binding capacity to the bone matrix, especially in sites of active bone metabolism. The American Society for Bone and Mineral Research defines BRONJ as “an area of exposed bone in the maxillofacial region that has not healed within 8 weeks after identification by a healthcare provider in a patient who is receiving or has been exposed to a bisphosphonate and has not had radiation therapy to the craniofacial region.” Bisphosphonate-related osteonecrosis of the jaw (BRONJ) can adversely affect quality of life, as it may produce significant morbidity. The American Association of Oral and Maxillofacial Surgeons (AAOMS) considers as vitally important that information on BRONJ be disseminated to other dental and medical specialties. The purpose of this work is to offer a perspective on how dentists should manage patients on BPs, to show the benefits of accurately diagnosing BRONJ, and to present diagnostic aids and treatments strategies for the condition.

Maxillary Sinus Floor Augmentation Using Blood Without Graft Material. Preliminary Results in 10 Patients

PURPOSE The maxillary sinus lift is recognized and stable, and there have been different innovations to optimize the technique. The aim of this study was to investigate the maxillary sinus lift technique with the use of a blood clot and without the use of a bone graft. MATERIALS AND METHODS Ten patients were recruited for a unilateral sinus lift; patients without sinus pathology or other contraindication were selected. The maxillary sinus was accessed conventionally under local anesthesia followed by an osteotomy and a 1-cm(2) bony window access. The sinus membrane was detached and the window was repositioned above and stabilized with a 12- or 14-mm osteosynthesis screw introduced through the alveolar ridge. Dental implants were installed in the second surgical stage. Standardized panoramic radiographic checks were performed at every stage. RESULTS Seven completely edentulous patients and 3 partially dentate patients were treated surgically. From the first to the second surgery, a bone gain of 2.37 mm was obtained, although loss of bone height was observed in 1 completely edentulous patient. In 7 patients, it was not possible to install the implants owing to insufficient bone height or inadequate bone quality. CONCLUSION The protocol used in this investigation failed in the bone increase required for implant installation.

Mandibular fractures in a group of Brazilian subjects under 18 years of age: A epidemiological analysis

OBJECTIVE This study showed a retrospective analysis of the etiology, incidence and treatment of maxillofacial injuries in a pediatric and adolescent population of the State of Sao Paulo. METHODS We analyzed 2986 medical records of victims of facial trauma under 18 years, treated between 1999 and 2008 by the Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, University of Campinas, Sao Paulo - Brazil. During this period, 757 patients under 18 were victims of maxillofacial trauma, of which, 112 patients had 139 lines of fracture in the mandible. The most affected age group were male adolescents. RESULTS The bicycle accidents constituted the main etiology (34.82%). The conservative treatment was used in 51% of cases, and 49% received surgical treatment. Only 5 cases of postoperative complications were identified. CONCLUSION The incidence of trauma and mandible fractures in pediatric and adolescent patients was high in the area of study. Bicycle accidents and falls being the main etiological factors. The group of adolescents was most affected. The conservative and surgical treatment was used almost in the same proportion.

Accidental impaction of a unilateral removable partial denture: A clinical report.

VOLUME 82 NUMBER 3 Several studies have shown that swallowing or aspiration of a removable partial denture (RPD) is not uncommon.1-6 It occurs more frequently in the elderly or mentally ill population,7 and represents a serious medical situation. The complications arising from swallowed removable prostheses include, but are not limited to, laceration, perforation, and hemorrhage of the esophagus and gastrointestinal tract, which can in turn cause peritonitis, septicemia, or result in foreign body granulomas; abscess formation, fistulas, or even penetration into the kidneys.2,8-10 When a RPD is ingested, immediate medical intervention is required to prevent complications. This clinical report describes the treatment of a patient who swallowed a unilateral RPD.

Mineralized Tissue Formation Associated With 2 Different Dental Implant Designs: Histomorphometric Analyses Performed in Dogs

The clinical success of dental implants might be associated with such factors as installation technique, implant shape, size, material, and screw threads. Therefore, the aim of this study is to analyze mineralized tissue formation on the screw threads of conical and cylindrical dental implants. This study includes 7 beagle dogs that had the lower premolars extracted. Three months after bone and soft tissue repair, 2 different designs of dental implants (1 conical and 1 cylindrical) were installed in each hemimandible using a nonsubmerged technique. Both implants when installed had different shape and thread, as revealed by scanning electron microscopy. Six weeks after implant installation, animals were killed and submitted to histomorphometric analysis. Cervical, middle, and apical areas were analyzed. Statistical analysis was carried out using Student t test at a significance level of P < .05. Statistically significant differences were not found between the conical and cylindrical implants. The conical implants presented fewer threads, a smaller area, and more bone formation when compared with the cylindrical ones, without significant differences (P  =  .1226). The highest values concerning bone formation were observed for the cervical area (P  =  .4005), and the lowest for the apical area (P  =  .1899); however, no statistically significant difference was observed. In conclusion, no statistically significant difference was observed in thread bone formation between the cylindrical and conical implant designs when placed using the nonsubmerged technique.

Therapeutic response of benzodiazepine, orphenadrine citrate and occlusal splint association in TMD pain

ABSTRACT Loss of function, muscle inflammation, and pain are some of the signs and symptoms of temporomandibular dysfunction (TMD). Pharmacological strategies to minimize the clinical manifestation of these disorders often focus on blocking or inhibiting the pain-causing symptom. Resources such as muscle-relaxants, anxiety-relief drugs, and splint therapy are often used to reduce muscular hyper-activity related to TMD muscle pain. This study compares the effect of a randomly ordered association of occlusal splint therapy (S), nonsteroid anti-inflammatory with a muscle-relaxant drug (orphenadrine citrate) (O), and an anxiety-relief drug (benzodiazepine) (B), to ease painful TMD muscle symptoms. Clinical and anamnestic analyses were recorded in accordance with the Helkimo TMD index and applied before and after treatments. Twenty-one group two Helkimo TMD adult female patients were treated, all of whom were subjected to the three random therapeutic associations proposed: SBO, BOS, and OSB. The same operator applied the three specific associations over a period of 21 days in the proposed sequence, seven days for each therapy. The results show that all the groups presented the best results in terms of relief from pain after the therapeutic association (28.5% showed a decrease and 47.6% showed an absence of symptoms). No significant difference was observed among association therapeutic protocols.

Accuracy in the Diagnosis of the Mental Nerve Loop: A Comparative Study Between Panoramic Radiography and Cone Beam Computed Tomography

Dental implant and chin osteotomy are executed on the mandible body and the mental nerve is an important anatomical limit. The aim of this research was to know the position of the mental nerve loop comparing result in panoramic radiography and cone beam computed tomography. We analyzed 94 hemimandibles and the patient sample comprised female and male subjects of ages ranging from 18 to 52 years (mean age, 35 years) selected randomly from the database of patients at the Division of Oral Radiology at Piracicaba Dental School State University of Campinas; the anterior loop (AL) of the mental nerve was evaluated regarding the presence or absence, which was classified as rectilinear or curvilinear and measurement of its length was obtained. The observations were made in the digital panoramic radiography (PR) and the cone beam computed tomography (CBCT) according to a routine technique. The frequencies of the AL identified through PR and CBCT were different: in PR the loop was identified in 42.6% of cases, and only 12.8% were bilateral. In contrast, the AL was detected in 29.8% of the samples using CBCT, with 6.4% being bilateral; Statistical comparison between PR and CBCT showed that the PR led to false-positive diagnosis of the AL in this sample. According to the results of this study, the frequency of AL is low. Thus, it can be assumed that it is not a common condition in this population.

Regeneración Ósea en Defectos Críticos Tratados con Matriz Ósea Bovina Inorgánica Aplicada con dos Diferentes Vehículos

Multiples materiales se han utilizado en la reconstruccion osea; la matriz osea bovina ha sido ampliamente estudiada y aun existen investigaciones que identifican su capacidad de contribuir en la formacion osea. El objetivo de esta investigacion fue establecer la reparacion osea en defectos criticos de calotas de perros rellenados con matriz osea bovina inorganica transportada con carboxi-metil-celulosa. Se diseno un estudio experimental en 6 perros donde se realizaron 3 defectos de 8mm de diametro en los parietales de cada animal; el defecto fue rellenado aleatoriamente con hueso autogeno particulado (grupo I), matriz osea bovina inorganica con suero fisiologico al 0,9% (grupo II) y matriz osea bovina con carboxi-metil-celulosa (grupo III). Se realizo el sacrificio de los animales a la tercera y sexta semana momento en el que se realizaron los estudios radiograficos de los defectos tratados y los estudios histologicos de rutina con tinciones de hematoxilina-eosina. No se observo procesos infecciosos vinculados a los materiales injertados. En el grupo del hueso autogeno se observo una adecuada aposicion osea en la tercera y sexta semana junto a una relacion correcta con la imagen radiografica; en el grupo II se observo etapas de formacion osea y permanencia de los fragmentos de hueso injertado; en el grupo III se observo infiltrado inflamatorio en los dos periodos de sacrificio, abundante tejido conectivo y bajo nivel de formacion osea. Las radiografias de los grupos II y III mostraron signos de formacion osea que en la histologia eran solo remanentes del material injertado. Se concluye que la matriz osea bovina inorganica es compatible con el tejido oseo y que puede contribuir a la formacion osea aunque el empleo de la carboxi-metil-celulosa, como vehiculo, podria obstaculizar la regeneracion osea.

Reparación Ósea Utilizando Sulfato de Calcio en Defectos Óseos de Tibia de Conejos

La regeneracion osea en reconstruccion del proceso alveolar junto al uso de implantes oseointegrables son ampliamente utilizados, existiendo una amplia variabilidad de productos. El objetivo de esta investigacion es estudiar la reparacion osea asociada a un sustituto oseo a base de sulfato de calcio cubierto con membrana biologica en defectos creados en tibia de conejos. Se seleccionaron 12 conejos de entre 3 y 6 meses para ser intervenidos; de acuerdo a protocolos de anestesia ya conocidos se realizo la tecnica con acceso a ambas tibias donde se realizaron 2 defectos de 2,6 mm de diametro; se formaron cuatro grupos siendo el grupo I de relleno con coagulo sanguineo, grupo II relleno con coagulo cubierto con membrana de colageno, grupo III relleno con sulfato de calcio y grupo IV relleno con sulfato de calcio cubierto con membrana biologica. Se realizo la eutanasia a los 21 y 42 dias y posteriormente se procedio a procesar y analizar laminas histologicas con tincion de hematoxilina y eosina. Se realizo la histomorfometria comparativa analizando los datos con prueba ANOVA y prueba de Turkey considerando un valor de p<0,05 para significancia estadistica. Los resultados demostraron que todos los defectos mostraron patrones regulares de reparacion osea; los grupos rellenados con coagulo mostraron formacion osea estadisticamente menor que el presentado por los defectos rellenos con el sulfato de calcio, aunque estos ultimos presentaron mayores indicadores de presencia de proceso inflamatorio; el grupo IV fue el que presento los mejores niveles de reparacion osea a los 21 y 42 dias. Se concluye que la reparacion osea en defectos menores es viable de ser realizada con este biomaterial y que la cobertura con membrana de colageno puede ser util en la regeneracion osea guiada.

Photoelastic Analysis of Fixed Partial Prosthesis Crown Height and Implant Length on Distribution of Stress in Two Dental Implant Systems

The aim of this study was to evaluate by photoelastic analysis stress distribution on short and long implants of two dental implant systems with 2-unit implant-supported fixed partial prostheses of 8 mm and 13 mm heights. Sixteen photoelastic models were divided into 4 groups: I: long implant (5 × 11 mm) (Neodent), II: long implant (5 × 11 mm) (Bicon), III: short implant (5 × 6 mm) (Neodent), and IV: short implants (5 × 6 mm) (Bicon). The models were positioned in a circular polariscope associated with a cell load and static axial (0.5 Kgf) and nonaxial load (15°, 0.5 Kgf) were applied to each group for both prosthetic crown heights. Three-way ANOVA was used to compare the factors implant length, crown height, and implant system (α = 0.05). The results showed that implant length was a statistically significant factor for both axial and nonaxial loading. The 13 mm prosthetic crown did not result in statistically significant differences in stress distribution between the implant systems and implant lengths studied, regardless of load type (P > 0.05). It can be concluded that short implants showed higher stress levels than long implants. Implant system and length was not relevant factors when prosthetic crown height were increased.