Osny Ferreira Júnior

Objective: To systematically evaluate reported nasal morphological changes following Le Fort I osteotomy in individuals with cleft lip and palate (CLP). Design: Systematic review. Setting: Not applicable. Participants: Adolescents (>16 years) and adults with nonsyndromic CLP undergoing maxillary orthognathic surgery. Interventions: Le Fort I osteotomy, performed either in isolation or in combination with bilateral sagittal split osteotomy. Main Outcome Measures: Postoperative nasal morphological changes, including alar base width, nasal tip projection, nasal length, and nasolabial angle. Additional synthesized outcomes included alar symmetry and soft tissue response ratios when available. Results: Eight observational studies (one prospective, one cross-sectional, and six retrospective), including 201 individuals with CLP, were analyzed. Risk of bias was high in five studies and moderate in three. Across heterogeneous study designs and assessment methods, Le Fort I osteotomy was associated with improvements in alar symmetry and increases in the nasolabial angle (up to +16.0°). Alar widening (up to 3.0 mm) and variable changes in nasal tip projection, ranging from −2.22 to +2.40 mm, were also reported. Soft tissue responses varied substantially, with the nasal base following approximately 55% to 57% of maxillary advancement, nasal tip response ranging from −0.36 to +0.28 mm/mm of maxillary advancement, and nasolabial angle changes reaching 2.61° per millimeter of advancement. Conclusions: Le Fort I osteotomy is associated with postoperative nasal morphological changes in individuals with CLP. Improvements in alar symmetry and nasolabial angle were reported, although alar widening and variable changes in nasal tip projection and nasal length were also observed. Given methodological heterogeneity and moderate-to-high risk of bias, findings should be interpreted cautiously.

Objetivo: Comparar as medidas transversais da maxila no pré e pós-operatório imediato de cirurgia ortognática em pacientes com e sem enxerto ósseo alveolar (EOA), a fim de avaliar se o grupo com EOA apresenta menor recidiva transversal e maior estabilidade oclusal em relação ao grupo sem EOA. Metodologia: Foram analisados 30 exames de tomografia computadorizada de feixe cônico (TCFC), sendo 15 de pacientes com enxerto ósseo alveolar secundário prévio à cirurgia ortognática e 15 de pacientes sem o procedimento prévio. As medidas transversais da maxila foram registradas nos períodos pré e pós-operatório. Resultados: As variáveis “molar”, “canino” e as diferenças entre os grupos com e sem enxerto não apresentaram significância estatística. Assim, infere-se que a dimensão transversal da maxila não sofre alteração após a osteotomia Le Fort I, independentemente da realização prévia do EOA. Conclusão: Apesar de a literatura indicar maior tendência de recidiva em pacientes com fissura labiopalatina (FLP) sem EOA, neste estudo não foi possível comprovar estatisticamente diferenças entre os grupos em relação à recidiva transversal ou estabilidade oclusal. Novas pesquisas, com amostras maiores, são necessárias para esclarecer a questão.

Objective: To evaluate whether coronectomy is superior to conventional extraction of lower third molars. Materials and methods: The articles were selected according to the PICO criteria in electronic databases. The main outcomes evaluated in the short term were: inferior alveolar nerve injury, pain, dry socket and infection. The main longterm outcome was root migration. Results: 5 studies comparing coronectomy with conventional extraction and with a control period longer than 1 year were included in the study. The longest follow-up time was 3 years and the shortest was 13.5 months. In the studies included in this review, there were 44 cases of inferior alveolar nerve injury in the control group and 25 cases in the coronectomy group. Pain was relatively greater in the conventional extraction group. Root migration was greatest in the first 6 months and stabilized after the first year. Conclusion: Coronectomy is a safe procedure with a lower incidence of postoperative complications and a lower rate of injury to the inferior alveolar nerve, although it is clear that it is not a risk-free technique.

Introduction: Maxillofacial trauma occurs frequently because the face is anatomically exposed, and its bones are fragile. Therefore, understanding the frequency and distribution of facial fracture cases in a population can help establish research priorities for the effective treatment and prevention of these injuries. Objectives: This study aimed to carry out a survey of data contained in the medical records of patients with maxillofacial trauma at the Hospital Docente Universitário Dr. Dario Contreras between 2014 and 2019. Methodology: This is a Descriptive retrospective epidemiological study. In this way, we look for: Identify the type of fracture prevalent in this city, the main etiology and most affected gender and age group. The sample was composed of 6,525 medical records of patients affected by facial trauma were found. The data collected included: age, gender, etiology, anatomical site, and form of treatment. After collecting the data, they were organized and tabulated in an Excel spreadsheet for Windows. The incidence of etiologies was analyzed and correlated with the gender of affected patients. The incidence of fractures was also evaluated according to their anatomical location, and then correlated with the type of treatment. Descriptive Statistics was then performed, with the objective of showing a global view of the prevalence of the collected data, showing its distribution through graphs and tables. Results: The study consisted of 6229 individuals with maxillofacial trauma. Males had the highest incidence (73.69%) in the third decade of life. The main etiologies were traffic accidents (61.59%), followed by aggression (22.62%). Of the total fractures, 70.20% were in the middle third of the face, with the zygomatic bone and nasal bones being the most affected regions. In the mandible, the regions mainly affected were the body and the angle. As for treatment, open reduction and rigid internal fixation represented the form of treatment for most patients. Conclusion: It can be concluded that zygomatic bone fractures were the most prevalent facial fractures in the group of individuals studied, having mainly affected men in the third decade of life, victims of traffic accidents, treated mainly with open reduction and stable internal fixation.

No edentulismo, é comum que a região da maxila apresente pouca densidade óssea, devido a pneumatização do seio maxilar e a reabsorção que ocorre no osso alveolar com o tempo. Algumas técnicas são mencionadas na literatura, que possibilitam a reabilitação do paciente e facilitam no momento da inserção de implantes de titânio. Nas quais, podem ser mencionadas a técnica de Summers (realizada através da crista alveolar com osteótomos) e, a técnica pelo acesso de Caldwell Luc (realizada pela lateral com instrumentos rotatórios). Esta pesquisa teve como objetivo selecionar um método optado como referência, entre os tipos de técnicas existentes para ganhar altura óssea e, consequentemente apresentar sucesso na instalação de implantes na região maxilar. Foram selecionados 24 pacientes, dos quais foram operados 26 seios maxilares e realizados 35 acessos ao seio maxilar. Na pesquisa, houve 3 rompimentos da membrana sinusal, cujo estes não foram incluídos na análise, e apenas um caso não obteve resultado satisfatório no ganho de altura óssea. A média do ganho de altura foi de 5,7mm. A técnica escolhida e realizada com os instrumentos rotatórios, pelo rebordo ósseo se mostrou segura e obteve ganho de altura significativo, e viabilizou a reabilitação protética dos pacientes. Ademais, os pacientes evidenciaram mínimo descômodo no trans e pós-operatório.

O enxerto ósseo alveolar é um procedimento bem estabelecido, porém ainda é um desafio, especialmente em pacientes com fissura labiopalatina. O osso ilíaco é frequentemente utilizado como área doadora para a realização de um enxerto ósseo autógeno, mas também pode ser a tíbia, calvária ou ainda o mento. O objetivo do presente artigo é apresentar uma revisão bibliográfica sobre a disponibilidade óssea para enxertos em diferentes sítios doadores. Para isto, nesta revisão, foram examinados 26 estudos obtidos em plataformas de busca online, do período de 2000 a 2024. Os estudos investigaram a disponibilidade óssea para enxertos alveolares em diferentes sítios doadores. Ao abordar essas questões, buscamos alternativas na literatura para o enxerto ósseo alveolar, seja ele comum ou secundário na fissura palatina residual de pacientes com fissura labiopalatina, para que, com este conhecimento, os pacientes tenham um maior bem-estar e opções seguras ao serem submetidos a esse procedimento cirúrgico. Os diferentes sítios doadores as quais abordamos nesta revisão demonstraram excelentes resultados, com boa disponibilidade de osso para utilização em enxertos ósseos em casos onde existam defeitos dos maxilares. A decisão de qual sítio doador será utilizado dependerá do tipo de defeito. Comparando o osso da calota craniana com sítios doadores intraorais, a disponibilidade óssea desta pode ser até 3 vezes maior do que outras, como regiões da mandíbula, e aproximadamente 2 vezes maior quando comparada com a região da sínfise mandibular.

Lower third molars (L3M) are the last teeth to erupt in the oral cavity. Uneruption of these teeth still raises questions about its causes, in the literature (1) genetic factors, (2) dental lamina activity and, mainly, (3) insufficient growth and development of the bone bases are included. While the lack of space theory influenced by mandibular morphology and size of L3M was argued to be the main reason for L3M impaction, there is a limitation in the literature in examining such association using more accurate tomographic analysis obtained from CBCT. This work aimed to evaluate the relationship between mandibular morphology and the eruption of L3M. In this regard, 85 Cone Beam Computed Tomographies (CBCT), with 147 L3M, were selected from the archives of the Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, obtained using an Accuitomo® Morita device and using the Dolphin Imaging 11.9 software. L3M eruption was related to linear measurements of jaw length (Co-Gn), retromolar space dimension (D2R), mesiodistal width of the L3M crowns, mandibular first molars (L1M) and mandibular canines (LC) and the angle mandibular (Ar-Go-Me). Independent samples t-test, chi-square tests and logistic regression were performed adopting a significance level of 5%. The average mandible length of 116.446 mm + 6.415 mm, retromolar space of 11.634 mm + 2.385 mm, mesiodistal size of the L3M of 10.054 mm + 0.941 mm, sum of the mesiodistal widths of the L1M and LC of 15.564 mm + 1.218 mm and mandibular angle of 127.23° + 6.109. There was no statistically significant association between these factors and the eruption. With the results obtained in this study, we conclude that the length and angle of the mandible, teeth size and dimension of the retromolar space are not associated with the L3M eruption.

There is some controversy about the safety of invasive dental treatments in patients on bisphosphonates. The objective of this research was to verify, through the application of a questionnaire, the degree of knowledge that specialist physicians in Geriatrics, Rheumatology, Orthopedics, Gynecology and Oncology have about the interrelationship between the use of bisphosphonates and their effect on the bones of the maxilla and mandible. 100 health professionals were selected, uniformly distributed in five specialties. All were submitted to a questionnaire and the answers were tabulated. The highest indication of bisphosphonates was for osteoporosis 94%, followed by bone metastasis, Paget's disease, hypercalcemia, lytic lesion and bone fracture. As for the class of bisphosphonates, 50% of gynecologists, 78% of orthopedists, 94% of geriatricians and 100% of oncologists and rheumatologists answered that they prescribe the nitrogen class. Regarding the route of administration, geriatricians, gynecologists, orthopedists and rheumatologists prefer the oral route and only oncologists reported a preference for the parenteral route. The risk of osteonecrosis of the jaw related to the use of bisphosphonates is accepted by most physicians interviewed. All respondents refer all patients who have complications in the oral cavity resulting from the use of bisphosphonates to the dentist, however, they still do not indicate regular visits to the dentist before the onset of complications. We consider that there should be greater communication between the doctor and the dentist in cases where the patient uses bisphosphonates before and during treatment to minimize the severity of injuries involving the maxilla and mandible bones.

During dental appointments, patients often present anxiety and exacerbated fear, especially in surgical procedures. These reactions can promote systemic alterations, such as elevated blood pressure, fainting, and convulsions. The aim of this study was to evaluate the level of anxiety of patients during the lower third molar extraction procedure, seeking indicative parameters of possible complications and, at the same time, contributing to a safe and less uncomfortable procedure for the patient. Forty patients needing extraction of the lower third molar were selected. The study had an evaluator to monitor the systemic variables: blood pressure, oxygen saturation, respiratory and heart rate - while the same surgeon performed the surgical procedures, always using the same surgical technique for all patients. At the anamnesis and at the end of the surgery, the patients answered a visual analogue scale (VAS) questionnaire on anxiety. The results showed that for the four variables observed during the surgery, only the oxygen saturation did not present a statistically significant variation during the procedure. All the others showed changes, mainly during the use of the high-speed engine. We concluded that anxiety, fear and stress showed influences on systemic factors during the extraction procedure. It shows the importance of careful anamnesis and the knowledge of patient systemic diseases before starting any surgery to prevent risks or complications.

The maxillary sinuses are the largest of the paranasal sinuses. They consist of pneumatized bilateral cavities, lined by respiratory mucosa, identical to the nasal mucosa, consisting of pseudostratified epithelium, with hair cells and goblet cells, producing mucus. Radiographically, the maxillary sinus is seen as a radiolucent area, ovoid or rounded, with a well-defined contour, delimited by a continuous radiopaque line or with small interruptions and radiolucency similar to that of the orbit. When a change in the maxillary sinus is suspected, images of the sinus are usually found, the presence of septa, thickening of the mucosa, or polyps. Sinusitis is the main pathology of the maxillary sinus, being of multifactorial etiology, and may be due to anatomical, environmental factors or viral, bacterial, or fungal infections. The diagnosis of sinusitis is clinical, but it can be confirmed by imaging exams such as panoramic radiography or cone beam computed tomography (CBCT). Case Presentation: In this case of a 21-year-old patient treated by the FOB-USP Surgery team, due to the proximity of the third molar to the maxillary sinus, a cone-beam scan was performed in which bubbles were noted on the surface of the maxillary sinus content. The image is compatible with sinusitis however, the presence of bubbles is a very unusual image in this type of alteration of the maxillary sinus. Conclusions: CT images with fluid levels and bubbles on their surface, although uncommon in dental practice, are characteristic of acute sinusitis and the dentist must have this knowledge for the correct diagnosis of maxillary sinusitis.