Roberta Martinelli Carvalho

Evolution of Postoperative Edema in Alveolar Graft Performed With Bone Morphogenetic Protein (rhBMP-2)

Objective To evaluate the evolution of facial edema in the postoperative period after alveolar graft surgeries performed with collagen membrane soaked with recombinant human bone morphogenetic protein-2 (rhBMP-2) in individuals with cleft lip and palate. Design Longitudinal prospective. Setting Tertiary craniofacial center. Participants One hundred fifty individuals submitted to alveolar graft. Interventions In the preoperative consultation and 4 days after surgery, the individuals were assessed as to age, professional performing the surgery, duration of the procedure, type of cleft, measurement of facial edema, mouth opening, and global evaluation of the postoperative period. Main Outcome Measures Statistical analysis was performed to compare the facial edema and different variables, at a significance level of .05. Results The maximum facial edema occurred between 3 and 4 days postoperatively, was inversely proportional to age and mouth opening, greater for female patients compared with male patients, for incomplete unilateral cleft lip and palate compared with other types of clefts, and for surgeon 1 compared with the other surgeons at some moment postoperatively. The surgeries were longer for complete unilateral and bilateral clefts. The difference was statistically significant for these variables. Conclusions The facial edema was influenced by the rhBMP-2 used in alveolar graft, and trismus was proportional to the intensity of facial edema.

Função canino desempenhada pelo pré-molar

Extraction of the permanent canine surprises many traditional orthodontists who believe that negative functional and unaesthetic results may arise from the procedure. Although esthetics is the major concern of layperson people, the occlusal aims of the orthodontic treatment are esthetics, occlusal function and periodontal health, with or without canines. The current paper describes the possibility of extracting the canine instead of the premolar in an orthodontic treatment with teeth extraction. In such a situation, which is not easily accepted by orthodontists and patients, the canine is eliminated but not its cusp function in lateral mandibular movements, thus maintaining the gnathologic functional concepts.

Outcomes of Alveolar Graft With Rhbmp-2 in CLP: Influence of Cleft Type and Width, Canine Eruption, and Surgeon

Objective: To evaluate the influence of cleft type and width, canine eruption stage, and surgeon on the outcomes of alveolar graft with rhBMP-2. Design: Cross-sectional. Setting: Tertiary craniofacial center. Participants: Ninety individuals submitted to alveolar graft in late mixed or early permanent dentition. Interventions: The 90 individuals (mean age: 16.8 years) were submitted to alveolar graft with rhBMP-2. Periapical radiographs were obtained before and 6 months after surgery. Surgeries were performed by 4 experienced maxillofacial surgeons. The alveolar grafts were assigned as success or failure by 3 blinded raters based on the modified Bergland and Chelsea scales. Permanent canines adjacent to the defect were assigned as erupted and not erupted. The greatest cleft width was measured on preoperative periapical radiographs. Main Outcome Measures: The influence of 4 independent variables (cleft type, cleft width, canine eruption phase, and surgeon) on the outcome of alveolar graft was analyzed by multivariate logistic regression (P < .05). Results: All independent variables presented significant influence on alveolar graft outcome. The subgroup of unerupted maxillary canines demonstrated better outcomes than erupted canines (P = .001). The group with cleft lip and alveolus (CL/A) demonstrated better outcomes than complete cleft lip and palate (CLP; P < .001). The greater the alveolar cleft width, the less favorable were the graft outcomes (P = .027). The surgeon also had a significant influence on the surgery success (P = .003 and .001). Conclusion: The type and width of CLP, the eruption of permanent canines, and the surgeon influenced the outcome of alveolar graft surgeries performed with rhBMP-2.