Sabrina Ferreira

Scientific evidence on the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in oral and maxillofacial surgery

PurposeThis study aimed to identify the main indications for the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for bone repair and maintenance in the maxilla and mandible through a review of clinical trials evaluating the viability of using rhBMP-2 to delay the installation of dental implants, thus allowing satisfactory bone formation and long-term osseointegration.MethodsLiterature search of the PubMed/Medline databases was performed using the following MeSH index terms—“bone morphogenetic protein 2” and “dentistry”. Only clinical trials necessarily published in English, related to dentistry, and focused on bone reconstruction in critical defects, post-extraction alveoli, increasing the atrophic alveolar ridge, or surgery for maxillary sinus elevation were included, regardless of the age, sex, ethnicity, associated morbidities, or period of publication.ResultsOf the 17 studies identified based on the search filters, 2 were excluded. Therefore, 15 studies were finally included in this review.ConclusionsBased on the results of our review, we concluded that the use of rhBMP-2 for the preservation of the alveolar ridge after tooth extraction or for increasing the local defects is safe and viable. The use of rhBMP-2/Bio-Oss® for the elevation of the maxillary sinus membrane is unnecessary; however, it can improve and accelerate the maturation process in cases of guided bone regeneration in peri-implant defects. Compounds comprising rhBMP-2, allogenic bone, and plasma-rich platelet (PRP) can act as autograft substitutes in mandibular critical defects.

The Primary Closure Approach of Dog Bite Injuries of the Nose

The nose holds an outstanding position on the face, acquiring great importance within the context of facial aesthetics. Because of the functional, psychological, and social aspects of trauma in a society increasingly demanding about aesthetics, treatment institution must reduce, as accurate as possible, the sequelae that hinder social integration. This clinical report relates an immediate nasal reconstruction of a complex animal bite wound. A 7-year-old patient was victim of a dog bite with avulsion of the left nasal ala and part of the ipsilateral nasal tip. The treatment was immediate nasal reconstruction with auricular composite graft. After 1 year of follow-up, the shape of nasal ala was stable, and the color was consistent with the surrounding tissue. The 2 nasal sides exhibited satisfactory symmetry when evaluated. It can be concluded that the composite graft derived from the auricular helix is a safe option for reconstruction of nasal ala defects with compromised margins in pediatric patients when conditions of reimplantation do not exist.

Reconstruction of extensive frontal fracture with titanium mesh.

When local flap options are not available or suitable, the best choice of regional reconstruction method is the forehead flap. The skin of the forehead has perfect color and tissue match with the nose, lips, as well as the medial canthal and malar regions. Paramedian forehead flap is widely accepted as the workhorse flap for nasal reconstruction. The paramedian forehead flap is an axial flap that is perfused by the supratrochlear artery as major and the supraorbital artery as minor pedicle. Vertical paramedian flap length is limited with hairline. Obliquely oriented flap can be used to increase the length. In our case, local flaps from the malar region were not reliable because of a previously performed surgery. We preferred deepithelialized modification of paramedian forehead flap instead of standard fashion because of the thickness heterogeneity of the cavity. The distal portion of the flap was folded to fill the deeper caudal part of the defect. The fullthickness skin graft obtained from the flap was used to cover the defect. Thus, the cavitary defect was filled and no additional morbidity was formed for skin graft harvesting. Being a 2-stage procedure is the most important disadvantage of forehead flap. The perfect color and tissue match with the infraorbital region makes this disadvantage negligible. With our modification, a cavitary infraorbital defect could be reconstructed, preserving the contour of the cheek and also achieving color and tissue match. Cemil Ozerk Demiralp, MD Department of Plastic Reconstructive and Aesthetic Surgery Ataturk Training and Research Hospital Ankara, Turkey

Central giant cell granuloma in pediatric maxilla: surgical management

Central giant cell granuloma (CGCG) is an intraosseous lesion consisting of fibrous cellular tissue that contains multiple foci of hemorrhage, multinucleated giant cells, and occasional trabeculae of woven bone. An 8-year-old boy presented himself complaining of a painless swelling in the left maxilla that had started 1 year. Computed tomography (CT) scan confirmed a poorly defined multilocular radiolucent lesion in the left maxilla crossing the midline. The patient underwent enucleation through an intraoral approach of the lesion. The biopsy revealed multinucleated giant cells in a fibrous stroma. A CT was taken approximately 1 year postoperatively. There was no clinical or radiographic evidence of recurrence. Therefore, surgical treatment of CGCG can be performed, trying to preserve the surrounding anatomic structures, which can be maintained in case the lesion does not show an aggressive clinical behavior, avoiding large surgical defects which are undesirable in children.

Effect of topical application of chlorhexidine and metronidazole on the tissue repair of palatal wounds of rats: a clinical and histomorphometric study

OBJECTIVE This study investigated the effect of topical application of 2% chlorhexidine (GCl) and metronidazole (Gme) pastes for the repair of palatal wounds in rats. STUDY DESIGN A 4-mm diameter wound was created on the palates of 27 rats separated randomly into 3 groups of 9 animals each, according to the treatment received: GNa (Control: natrosol), GCl, and GMe. The animals were euthanized after 3, 6, and 10 days, and wound closure was clinically and histomorphometrically assessed. RESULTS Clinical evaluation showed a statistically significant difference in tissue repair with GCl and GMe compared with GNa. In histomorphometric analysis, the highest values in the areas of the epithelium and keratin were observed for GCl and GMe; however, compared with Gna, no statistically significant differences were observed. CONCLUSIONS GCl and GMe pastes showed promising results with regard to tissue repair from a clinical point of view. Histologically, premature closure of wounds was noted in most specimens on day 6. Although no statistically significant differences were observed among the experimental groups with regard to histometry of the epithelium and keratin, the highest means were observed for GCl.

Compound Odontoma in a Pediatric Patient With Aspects Similar to Complex Odontoma.

Division of Oral and Maxillofacial Surgery Department of Surgery and Integrated Clinic Aracatuba Dental School Univ. Estadual Paulista Julio de Mesquita Filho (UNESP)

Unilateral Condylar Hyperplasia: A Treatment Strategy

Condylar hyperplasia (CH) is a pathologic condition that causes overdevelopment of the condylar head and neck as well as the mandible. Slowly progressive unilateral enlargement of the head and the neck of the condyle causes crossbite malocclusion, facial asymmetry, and shifting of the midpoint of the chin to the unaffected side. The etiology and the pathogenesis of CH remain uncertain. The diagnosis is made by clinical and radiologic examinations and bone scintigraph. A difference in uptake of 10% or more between condyles is regarded as indicative of CH, and the affected condyles had a relative uptake of 55% or more. When the diagnosis of active CH is established, the treatment consists of removal of the growth center by a partial condylectomy. The authors present the case of a 46-year-old male patient with right active type II CH or hemimandibular hyperplasia who underwent a high condylectomy.

Unerupted lower third molar extractions and their risks for mandibular fracture.

As every surgical procedure extraction of third molars can result in several complications, among them the mandibular angle fracture. Predisposing factors for fracture should be analyzed during and after the surgery. This paper aims to discuss the predisposing factors to the occurrence of mandibular angle fractures during and after the procedure for third molars extraction, as well as surgical principles to avoid this complication.

Large Dentigerous Cyst Associated to Maxillary Canine

Dentigerous cysts are defined as a cyst originated by separation of the follicle of dental crown of a tooth unerupted. Although most dentigerous cysts are considered developmental cysts, some cases seem to have an inflammatory origin. The aim of this study was to show a case of an 8-year-old patient, male, presenting a lesion in maxilla with large proportions. Computed tomography scans showed a hypodense image, well-defined, associated to unerupted teeth. The case was treated by enucleation of the lesion under local anesthesia. Histopathological examination confirmed the diagnostic suspicious of dentigerous cyst. Currently, 3-year follow-up period showed no signs of recurrence, and it was observed eruption of the teeth associated to the lesion. This case highlights the importance of the association between clinical and radiographic analysis together to the surgical findings, aiming the best treatment for the patient.

Surgical treatment of severe frontal bone fracture.

AbstractCraniofacial trauma can lead to several complications. The combined fractures of anterior and posterior walls of the frontal bone are almost always followed by lesions in nasofrontal orifices and disruption of nasofrontal ostia or ducts, a significant factor for the development of early and late complications after sinus fractures. This article reports a case of trauma patient, who underwent neurological evaluation and at first showed good general condition. Computed tomography noted fracture of the anterior and posterior walls of the frontal sinus and small foci of pneumocephalus in the cerebral cortex. The patient was monitored periodically and 9 days after trauma showed increased areas of pneumocephalus in prefrontal cortex, cerebrospinal fluid draining, and large dura mater lesion, with signs of necrosis and inflammation (meningitis). The necrotic tissues were removed, and dura mater was repaired through the approximation with resorbable wire polyglactin 910 5-0, oxidized cellulose application, and bonding with human fibrin sealant (fibrinogen, thrombin, and calcium chloride). Sinusectomy, frontal sinus, and nasofrontal duct obliteration with pedicled pericranium flap were performed. Tomographically, a reanatomization was noted in frontal region, and a 12-month follow-up showed no complication. The use of fibrin glue to repair dura mater lacerations, as well as the pedicle pericranium flap for frontal sinus and nasofrontal duct obliteration, is an efficient method for treating fractures of the frontal bone.