Academic literature on the topic 'Mandibular ramu'

Objetivou-se investigar a aplicabilidade de medidas mandibulares para estimativa do sexo em crânios secos humanos de duas coleções osteológicas brasileiras. Este foi um estudo do tipo diagnóstico, cego, com 471 mandíbulas de 215 mulheres e 256 homens. As variáveis ​​consideradas foram: largura bigonial; largura bicondilar; largura do processo condilar direito/esquerdo; largura do coronóide; distância entre os forames mandibulares; distância entre os forames mentais; distância entre os forames espinhais geniais e os forames mandibulares direito/esquerdo; altura do processo coronóide direito e esquerdo; altura do ramo mandibular direito/esquerdo; espessura mandibular direita/esquerda; espessura mandibular anterior; largura máxima do ramo mandibular direito/esquerdo; largura mínima do ramo mandibular direito/esquerdo; comprimento mandibular; e o ângulo mandibular. A análise discriminante foi realizada para verificar as associações em relação ao sexo, tanto para as medidas individuais quanto para o total. A análise estatística indicou que todas as variáveis ​​apresentaram associação significativa com o sexo. Quando aplicado a homens e mulheres, o método stepwise classificou corretamente 77,50% e 80,20% dos casos, respectivamente, com percentual total de concordância de 78,70%. A altura do ramo mandibular esquerdo (74,80%) e a largura bigonial (77,60%) foram as variáveis ​​com maiores taxas de concordância entre homens e mulheres, respectivamente. Equações foram geradas a partir da análise discriminante para cada variável e uma fórmula única para as seis variáveis ​​que apresentaram maior preferência por sexo. Todas as medidas mandibulares foram estatisticamente diferentes entre os sexos, sugerindo que a mandíbula desempenha um papel importante na antropologia forense como fonte de informação quantitativa para estimativa do sexo.

(1) Background: Medial sigmoid depression (MSD) of the mandibular ramus is an anatomical variation that resembles non-odontogenic cystic lesion. (2) Aim: The aim of this systematic review was to survey the literature to identify the relevant journal publications, reveal their scientific impact in terms of citations and compare the reported prevalence of MSD. (3) Materials and methods: PubMed, Google Scholar, Scopus and Web of Science were queried to identify relevant publications. The search string was: “medial depression of mandibular ramus” OR “medial depression of the mandibular ramus” OR “medial depression of the mandibular rami” OR “medial depression of mandibular rami” OR “medial sigmoid depression”. (4) Results: Eight studies were identified. Dry mandibles and patient dental panoramic radiographs were evaluated in four and seven of the eight studies, respectively. The prevalence of MSD varied from 20.2% to 82.0%. In male and female patients, the prevalence was 18.3–76.0% and 22.0–64.0%, respectively. MSD tended to occur bilaterally and most prevalent in patients with Angle’s Class II occlusion. The semilunar and triangular shapes were more common than teardrop and circular shapes. The most cited study had 12 citations. (5) Conclusions: MSD was a seldom investigated and cited anatomical variation that was not uncommon. Its recognition should be further promoted.

Objective. The study aimed to investigate and measure the anatomical relationship between the mandibular lingula (Li) and skeletal patterns using cone-beam computed tomography (CBCT). Materials and Methods. In total, 72 participants (23 men and 49 women) were categorized into three groups according to their skeletal patterns (specifically, the A point–nasion–B point (ANB]) angle) as follows: Class I (0° < ANB < 4°), Class II (ANB ≥ 4°), and Class III (ANB ≤ 0°). The CBCT images of 144 rami were collected, and the distance from the Li to the external oblique ridge (Li-EOR), internal oblique ridge (Li-IOR), posterior border of the ramus (Li-PBR), inferior border of the ramus (Li-IBR), sigmoid notch (Li-Sm), and mandibular foramen (Li-MF) was examined. The Li-hMF (horizontal distance from the Li to the MF) and Li-vMF (vertical distance from the Li to the MF) were measured. The comparisons of gender, side (right and left), and skeletal patterns were then evaluated by statistical analysis. Results. The values of the Li-EOR and Li-PBR (19.99 mm and 15.93 mm, respectively) were significantly higher in men than in women (18.85 mm and 14.89 mm, respectively). Moreover, the Li-IBR was higher in men (32.91 mm) than in women (30.40 mm). Both sides (right and left) and skeletal patterns demonstrated that the Li-EOR, Li-IOR, and Li-PBR were not significantly different. Pearson’s correlation test reported a strong correlation between the Li-EOR and Li-IOR (r=0.610). Conclusion. The distances from mandibula lingula to the external oblique ridge, posterior border of ramus, and inferior border of ramus were significantly longer in men than in women. Similarly, both horizontal and vertical distances from the lingula to the mandibular foramen were significantly longer in men than in women. Therefore, the results demonstrated that the Li was longer and more protruding in men than in women. With respect to the horizontal distance from the mandibular lingula to the mandibular foramen, of the three types of the skeletal system (Class I, Class II, and Class III), Class III was the significantly largest.

Mandibular step body osteotomy has been out of favour since more stable ramus osteotomies were refined and used for jaw deformities. Mandibular body osteotomy still has certain indications for which it is preferable over ramus osteotomies. Mandibular body osteotomy is best suited to correct prognathism caused by mandibular body excess with a retained tooth or in presence of extraction space, with good posterior occlusion, when ramus osteotomies and setback will lead to loss of the last tooth and non-obtuse gonial angle. Other indications are apertognathia, mandibu­lar asymmetry and small advancements of the anterior mandible. Here we present a case 24 year male with a skeletal class III malocclusion managed with an intra­oral mandibular step osteotomy and setback of 8 mm. One-year followup has shown minimum neurosensory and odontogenic complications associated with mandibular step osteotomy and very high satisfaction among the patient. We also present a brief review of the indications, modifi­cations and refinement of the technique and summarize current published clinical usage. This is a very stable osteotomy with favourable fracture pattern and does not involve stripping or change in position of muscles of mastication thereby ensures long term stability and minimal risk of relapse. This surgery also has minimal effect on airway narrowing compared to the ramus osteotomy setback. For some specific indications not suited to a sagittal split ramus osteotomy, mandibular body step osteotomy still has relevance and usage.

El foramen mandibular es un importante hito anatómico. Para procedimientos como el bloqueo alveolar inferior del nervio, el tratamiento con implantes y osteotomías mandibulares, un profundo conocimiento de la ubicación del foramen mandibular (MF) y el foramen mandibular accesorio (AMF) es un requisito previo. Hay pocas referencias en la literatura con respecto a la localización anatómica exacta del foramen mandibular. Por lo tanto, el presente estudio tuvo como objetivo identificar la ubicación exacta de la MF y la incidencia de la AMF alrededor MF en una población india. Sesenta (60) mandíbulas humanas adultas fueron estudiadas para determinar la distancia del LV de la los anteriores, bordes posteriores de la rama mandibular, maxilar inferior categoría y el ángulo de la mandíbula. AMF todo el MF también fueron estudiados por su presencia y números. La distancia media de MF del borde anterior de rama mandibular fue 15,72 ±2,92 mm(lado derecho), 16,23 ±2,88 mm(lado izquierdo), de borde posterior fue 13,29 ±1,74 mm(lado derecho) y 12,73 ±2,04 mm(a la izquierda lado). La MF se encuentra 22,70 ±3 mm(lado derecho) y 22, 27 ± 2,62 mm(lado izquierdo) de la muesca mandibular. La distancia de MF de ángulo de la mandíbula fue 21,54 ±2,92 mm(lado derecho) y 21,13 ±3.43 mm(lado izquierdo). AMF estuvieron presentes en el 16, 66% de las mandíbulas. En 10% de las mandíbulas una sola AMF estaba presente y en el 6,66% hubo dos agujeros presentes. La ubicación del MF y AMF es importante para evitar compli-caciones como hemorragia y parestesia durante los procedimientos quirúrgicos orales y también para los radioterapeutas en la planificación de la radioterapia. The mandibular foramen is an important anatomical land mark. For procedures like inferior alveolar nerve block, implant treatment and mandibular osteotomies, a thorough knowledge of the location of the mandibular foramen (MF) and accessory mandibular foramina (AMFs) is a prerequisite. There are few references in the literature regarding the exact anatomical location of the mandibular foramen. Therefore, the present study was aimed to identify the precise location of the MF and the incidence of AMFs around MF in an Indian population. Sixty (60) adult human mandibles were studied to determine the distance of the MF from the anterior, posterior borders of the mandibular ramus, mandibular notch and angle of the mandible. AMFs around the MF were also studied for their presence and numbers. The average distance of MF from the anterior border of mandibular ramus was 15.72 ±2.92 mm(right side), 16.23 ±2.88 mm(left side), from posterior border was 13.29 ±1.74 mm(right side) and 12.73 ±2.04 mm(left side).The MF was located 22.70 ±3 mm(right side) and 22.27 ±2.62 mm(left side) from mandibular notch. The distance of MF from angle of mandible was 21.54 ±2.92 mm(right side) and 21.13 ±3.43 mm(left side). AMFs were present in 16.66% of mandibles. In 10% mandibles a single AMF was present and in 6.66 % double foramina were present. Location of MF and AMF is important to avoid complications like hemorrhage and paresthesia during oral surgical procedures and also for radiotherapists in planning radiation therapy.

Gigi dikatakan impaksi ektopik apabila mengalami malposisi yang disebabkan oleh faktor kongenital atau mengalami perubahan posisi yang disertai dengan kondisi patologis. Kondisi patologis yang sering menyertai gigi impaksi ektopik adalah kista dentigerous. Tujuan dari studi pustaka ini adalah untuk memaparkan odontektomi pada kasus molar ketiga ektopik yangdisertai dengan kista dentigerous. Operasi ini adalah untuk menghilangkan faktor penyebab terjadinya kista dentigerous serta membersihkan lesi kista agar tidak berkembang semakin membesar. Pasien laki-laki 38 tahun mengeluhkan adanya sedikitbenjolan pada pipi sebelah kanan namun tanpa disertai rasa sakit. Benjolan dirasakan mulai muncul dalam satu tahun terakhir.Hasil pemeriksaan radiografik menunjukkan gigi molar ketiga mandibula kanan berada pada sudut angulus mandibula disertaiadanya gambaran radiolusen pada mahkotanya didiagnosa sebagai impaksi ektopik gigi molar ketiga mandibula kanan disertaikista dentigerous. Tindakan operasi odontektomi dan enukleasi kista dentigerous dilakukan secara ekstraoral dengananastesiumum, pemilihan metode pengambilan ekstraoral karena posisi gigi yang telah berubah jauh dari posisi normal gigimolar ketiga mandibula. Telah dilakukan pengambilan gigi molar ketiga mandibula yang impaksi ektopik dan enukleasi kistadentigerous secara ekstraoral, karena posisi gigi impaksi yang ektopik di ramus mandibula. Pengambilan gigi impaksi secaraekstraoral sangat jarang sekali dilakukan, namun jika posisi gigi berada jauh sekali dari posisi normal maka pendekatanekstraoral merupakan metode operasi yang akan mempermudah proses pengambilan gigi dan enukleasi kista serta dapatmeminimalkan hilangnya tulang mandibula yang sehat. ABSTRACT: Odontectomy of Ectopic Third Molar Associated with Dentigerous Cyst in Submandibular Region. Ectopic impacted tooth has been defined as malpositioned tooth caused by congenital factor or malpositioned tooth associated with pathologic condition. Pathologic condition associated with ectopic impacted tooth is dentigerous cyst. The purpose of this operation is to eliminate the causes of the dentigerous cyst and to raise cyst lesions that do not develop as they grow. A 38-year-old male patient complained of a painless slight swelling on his right cheek which occurred in the last one year. The radiograph examination shows an ectopic right mandibular third molar at the posterior border of the right angle of mandible, with an associated coronal radiolucency diagnosed as ectopic impacted right mandibular third molar associated with dentigerous cyst. The tooth and the cyst were removed surgically under general anesthetic via an extra-oral approach due to an extreme malposition of the tooth. The ectopic impacted right mandibular third molar and associated dentigerous cyst had been removed and enucleated surgically via extra-oral approach because the location of the ectopic impacted tooth was in the ramus of mandible. Extra-oral removal of ectopic mandibular third molar is very rare, however this approach will facilitate an easy removal and enucleation of an extremely malpositioned mandibular third molar associated with dentigerous cyst and minimize a loss of healthy mandibular bone.

Pendahuluan: Ameloblastoma adalah tumor invasif lokal dengan insidensi kekambuhan yang tinggi jika tidak dieksisi sepenuhnya. Mandibulektomi segmental sebagai pilihan tatalaksana yang dapat menyebabkan deformitas dan asimetri pada wajah, serta masalah pengunyahan. Pemulihan defek setelah reseksi mandibula menimbulkan masalah yang cukup berat. Tujuan laporan kasus ini untuk melaporkan hasil rekontruksi menggunakan cangkok tulang non-vaskularisasi mandibulektomi segmental pada pasien dengan ameloblastoma mandibula. Laporan kasus: Pria berusia 33 tahun datang ke Poliklinik Rawat Jalan Bagian Bedah Mulut dan Maksilofasial RS Persahabatan dengan keluhan utama pembengkakan mandibula yang perlahan bertambah dan tidak nyeri sejak enam tahun lalu. Pemeriksaan ekstra oral tampak asimetri wajah, bukaan mulut tidak ada limitasi, tidak teraba pembesaran kelenjar getah bening regio leher. Pemeriksaan intraoral didapatkan adanya benjolan regio mandibula kiri dengan batas tegas, konsistensi padat, permukaan tampak trauma oklusi gigi antagonis, immobile, dan terdapat nyeri tekan. Gambaran radiologis menunjukan lesi radiolusen multilokuler menyerupai honeycomb pada corpus mandibula kiri meluas ke regio ramus mandibula kiri. Pemeriksaan biopsi menunjukkan hasil ameloblastoma tipe folikuler pada mandibula kiri dan dilakukan mandibulektomi segmental dengan rekonstruksi cangkok tulang fibula non-vaskularisasi. Sembilan bulan setelah operasi, cangkok tulang non-vaskularisasi tidak menunjukkan komplikasi intraoral dengan bekas luka submandibular ekstraoral baik. Simpulan: Cangkok tulang fibula non-vaskular dapat dipertimbangkan sebagai salah satu pilihan untuk rekonstruksi setelah mandibulektomi segmental pada pasien ameloblastoma.Kata kunci: Mandibulektomi segmental, cangkok fibula non-vaskularisasi, ameloblastoma folikuler. ABSTRACTIntroduction: Ameloblastoma is a locally invasive tumour with a high incidence of recurrence if not completely excised. Segmental mandibulectomy as a treatment option that can cause facial deformities and asymmetry and mastication problem. Recovery of the defect after mandibular resection presents a severe problem. This case report was aimed to report the results of reconstruction using a segmental non-vascularised mandibulectomy bone graft in a patient with mandibular ameloblastoma. Case report: A 33-year-old male came to the Outpatient Polyclinic of the Oral and Maxillofacial Surgery Division of Persahabatan General Hospital with the chief complaint of mandibular inflammation, which was slowly increasing yet painless since six years prior. Extraoral examination showed facial asymmetry, no limitation in mouth opening, no palpable enlargement of lymph nodes in the neck region. Intraoral examination revealed a lump in the left mandibular region with firm borders, solid consistency. The surface appears to be traumatic occlusion of the antagonist tooth, immobile, and tenderness was found. Radiological features showed a multilocular, honeycomb-like radiolucent lesion on the left mandibular body extending into the left mandibular ramus region. A biopsy showed follicular ameloblastoma in the left mandible, and a segmental mandibulectomy was performed with non-vascular fibular bone graft reconstruction. Nine months after surgery, non-vascular bone grafts showed no intraoral complications with either extraoral submandibular scar. Conclusion: Non-vascular fibular bone graft can be considered an option for reconstruction after segmental mandibulectomy in ameloblastoma patients. Keywords: Segmental mandibulectomy, non-vascularised fibula graft, follicular ameloblastoma.

Abstract: Introduction: The precise knowledge of the position of canalis mandibulae and foramen mandibulae is important for surgical and endodontic interventions on the mandible. Aim: The aim of the study is to examine the position of these anatomical landmarks in different vertical facial types. Method: In the panorama radiograph of 26 normodivergent, 26 hypodivergent and 28 hyperdivergent arthritis (total of 1360 measurements) we measured the distance between the canalis mandibulae and interdental septums, the apex of the lateral teeth, the mandibular base, the goniac angle, and the steepness of the canal and the distance the foramen mandibulae to the anterior and posterior margin of the ramus. Results: ANOVA and t-test statistical analysis showed that the foramen mandibulae is farer from the posterior margin of the ramus in hipodivergent facial types, in hyperdivergent facial types the canalis mandibulae was closer to the root apex of posterior teeth and in hypodivergent types to the base of the mandible. In normal and hyperdivergent individuals, the canalis mandibulae runs steeper and in the course of running it is increasingly distanced from the tangent to the base of the mandible. Conclusion: The position of the canalis mandibulae and the foramen mandibulae showed significant differences in the different vertical facial types. Orv Hetil. 2017; 158(46): 1841–1847.

BACKGROUND: In medical literature, there are few studies provided a precise and detailed description of the facial nerve rami and its branches. AIM: Identify several practical anatomic landmarks related to the facial nerve main trunk and its rami. METHODS: A descriptive study, 30 cadavers in the anatomy department of UPNT from October 2012 to April 2015. RESULTS: The average distance from the mandibular angle to the division of the facial nerve is 40.8 mm, and is 86.6% from range 36 – 50 mm. There is 86.7% case in which the facial nerve is in the lateral of the retromandibular vein, and there is a significant difference about both sides. Eighty percent of the case has the superior and inferior ramus in the lateral to the retromandibular vein. There are 2 cases in which the superior ramus makes the circle of the vein. Eighty percent of the facial nerve is in the lateral to the external carotid artery. CONCLUSION: The distance from the mandibular to the division of the facial nerve is longer. The relationship between the superior/inferior ramus and the retromandibular vein maybe not the same in both sides. In some cases, it makes the circle of the vein to cause some complication in the parotid gland surgery.

Quando o canal mandibular apresenta segundo ramo, é chamado de bifurcado. Embora a bifurcação do canal mandibular seja considerada uma rara variação, deve ser cuidadosamente avaliada. Usualmente, o canal mandibular surge nas ortopantomografias como um túnel encerrado no osso, delimitado por bordos radiopacos, que se estende desde o forame mandibular até ao forame mentoniano, localizando-se normalmente diretamente por baixo dos ápices radiculares dos dentes mandibulares. Através do presente trabalho, foram esclarecidos conceitos, riscos e particularidades do canal mandibular bifurcado. A base de dados utilizada para a temática foi Google Acadêmico e SciELO, sendo usados os descritores em ciências da saúde (DeCS): “Mandíbula” “Canal Mandibular” e “Variação Anatomica”. Ao concluir o trabalho foi possível perceber a importância de se conhecer as variações do canal mandibular, pois reconhecer as estruturas anormais possibilita a prevenção de possíveis complicações que, em determinados casos, podem trazer consequências fatais durante os tratamentos na região mandibular.

Orientador: José Ricardo de Albergaria-Barbosa
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
Made available in DSpace on 2018-08-23T17:12:16Z (GMT). No. of bitstreams: 1 Pozzer_LeandroSouza_M.pdf: 2724015 bytes, checksum: 92ed84ee2d65fa61c35646c90bce649e (MD5) Previous issue date: 2013
Resumo: O objetivo nesta pesquisa foi analisar a resistência mecânica de duas diferentes osteotomias sagitais do ramo mandibular (OSRM) em mandíbulas de resina de poliuretano. O grupo I - osteotomia angulada proposta por Epker (1977) e o grupo II - osteotomia linear sem ângulos proposta por Farrel & Tucker (2011) fixadas com uma mini-placa de titânio com 4 furos do sistema de 2,0 mm com quatro parafusos de 5 mm variando a posição mandibular, sendo com 0 milímetros e com avanço de 3mm e 7 milímetros. O grupo I e II foram subdivididos em três subgrupos: IA/IIA (sem avanço); IB/IIB (com 3 milímetros de avanço) e IC/IIC (com 7 milímetros de avanço). As réplicas de hemi mandíbulas de poliuretano foram testadas em uma máquina de ensaio universal para carregamento linear (Instron, modelo 4411) para obter a carga de pico e o deslocamento de pico obtidos pelo Software Bluehill. Foi realizado o teste t para amostras não pareadas, considerando distribuição normal com desvio padrão semelhante entre os grupos de estudo (p <0,05). Os deslocamentos dos segmentos foram maiores em todos os subgrupos II antes da falha do sistema (p <0,05). Os deslocamentos do grupo IIA, IIB e IIC foram mais elevados do que o grupo IA, IB e IC (p<0,05). Finalmente, pode-se concluir que a OSRM mais linear (grupo II) tem comportamento mecânico melhor do que a OSRM angulada (grupo I)
Abstract: The aim of this research was to analyze the strength of two different sagittal ramus osteotomies (OSRM) in polyurethane resin mandibles. Group I - angled osteotomy proposed by Epker (1977) and group II - linear osteotomy without angles proposed by Farrel & Tucker (2011) with a fixed titanium plates with 4-hole system with four 2.0mm screws 5mm varying the mandibular position, from 0mm and 3mm and 7mm advancement. Group I and II were divided into three subgroups: IA / IIA (without advance); IB / IIB (with 3mm of advance) and IC / IIC (with 7 mm of advance). Replicas of polyurethane hemi mandibles were tested in a universal testing machine for linear loading (Instron Model 4411) for peak load and peak displacement before system failure noted by Bluehill Software. The t test for unpaired samples, considering the normal distribution with a standard deviation similar between the study groups (p <.05). The displacements of the segments were higher in all subgroups II before the system failure (p <0.05). The displacements of Group IIA, IIB and IIC were higher than Group IA, IB and IC (p <0.05). Finally, it can be concluded that the more linear OSRM (group II) has better mechanical behavior than the angled OSRM (group I)
Mestrado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Mestre em Clínica Odontológica

Orientador: José Ricardo de Albergaria Barbosa
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
Made available in DSpace on 2018-08-24T02:13:32Z (GMT). No. of bitstreams: 1 Cabral-Andrade_Valdir_D.pdf: 2148738 bytes, checksum: d487fa80b30b5bbfc43cc5658a9ccca6 (MD5) Previous issue date: 2013
Resumo: O objetivo deste estudo foi avaliar dois desenhos diferentes de osteotomias sagitais do ramo mandibular, comparando a distribuição de tensões, utilizando como metodologia o teste fotoelástico. Para o teste de fotoelasticidade foi utilizada uma amostra composta de 06 hemimandibulas confeccionadas em resina fotoelástica, sendo o Grupo I representando a osteotomia angulada proposta por Epker (1977) e o Grupo II pela osteotomia linear sem angulos idealizada por Farrel & Tucker (2011). Os grupos I e II foram subdivididos em três subgrupos: IA/IIA (sem avanço); IB/IIB (com 3 milímetros de avanço) e IC/IIC (com 7 milímetros de avanço). Cada tipo de desenho de osteotomia sagital do ramo mandibular recebeu a mesma fixação, com uma miniplaca de titânio com 4 furos do sistema de 2,0 mm com quatro parafusos de 5 mm, sendo submetidas à incidência de carga linear a uma velocidade de deslocamento de 1mm/min. Na a análise fotoelástica, a osteotomia não angulada apresentou melhor padrão de distribuição de tensões. As tensões se concentraram ao redor do sistema de fixação na osteotomia convencional enquanto que na osteotomia não angulada as tensões não se concentraram somente ao redor do sistema de fixação, também para regiões de maior resistência do substrato, como a linha obliqua e base da mandíbula.
Abstract: The aim of this study was to evaluate two different designs of sagittal split ramus osteotomy, evaluating the stress distribution, using photoelastic test methodology. To photoelastic test used a sample of 06 hemimandibles made of photoelastic resin, with group I representing angled osteotomy proposed by Epker BN (1977) and group II by linear osteotomy without angles idealized by Farrel & Tucker (2011). Group I and II were divided into three subgroups: IA / IIA (without advance); IB / IIB (with 3mm forward) and IC / IIC (with 7 mm foward). Each type of drawing sagittal split osteotomy of the mandibular branch received the same internal fixation with a titanium plates with 4-hole system with four 2.0 mm screws of 5 mm length, with mandibular position ranging from 0 mm and an advancement of 3 mm and 7 mm in which were subjected to linear loading at a speed of 1mm/min. The results of photoelastic analysis demonstrated that not angled osteotomy showed better distribution of strain pattern. The fringes concentrated around the fixing system in the conventional osteotomy while the osteotomy is no angled strains appear not only to be concentrated around the fixation system, but to regions of higher resistance of the substrate as the base and the oblique line jaw.
Doutorado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Doutor em Clínica Odontológica

Orientador: Luis Augusto Passeri
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-21T21:56:10Z (GMT). No. of bitstreams: 1 Baccarin_LeandroStocco_M.pdf: 2096681 bytes, checksum: 04979b5f15938f19353542ca48c4d46d (MD5) Previous issue date: 2013
Resumo: Objetivo: O objetivo deste trabalho é avaliar, por meio de testes biomecânicos, se materiais sintéticos diferentes, empregados para a confecção de corpos de prova apresentam comportamento biomecânico diferente, em comparação aos demais, ao simular in vitro a resistência ao carregamento de um método de fixação consagrado para OSRM. Material: 30 réplicas de hemimandíbulas humana, sintéticas e padronizadas, com OSRM, divididas em três grupos de 10 amostras cada: Grupo A - plástico ABS, Grupo B - Poliamida, e Grupo C - Poliuretano. Estas foram fixadas por três parafusos bicorticais posicionais (16 mm de comprimento, sistema 2.0 mm), em disposição "L" invertido, utilizando-se guias de perfuração e avanço de 5 mm. Métodos: Cada amostra foi submetida ao carregamento linear vertical e os valores de resistência ao carregamento registrado em 1, 3, 5, 7 e 10 mm de deslocamento. As médias e desvio padrão foram comparados, empregando-se análise de variância (p<0.05) e pelo teste Tukey. Resultados: Notou-se uma tendência de menores valores no grupo B em relação aos grupos A e C. Nos deslocamentos 3 e 5 mm, houve uma diferença entre os grupos A e C para o grupo B (p<0.05). Nos deslocamentos 7 e 10 mm houve diferença entre os 3 grupos sendo os maiores valores encontrados no grupo C e os menores no grupo B (p<0.05). Conclusões: Levando-se em consideração os resultados obtidos e o comportamento de cada material utilizado como substrato, podemos considerar que ocorreram diferenças significativas entre os materiais, quando comparados entre si
Abstract: Purpose: The aim of this study was to assess through biomechanical testing if different synthetic materials used to fabricate test specimens have a different biomechanical behavior in comparison with other materials when simulating in vitro load resistance of a fixation method established for SSRO. Material: Thirty synthetic and standardized human hemimandible replicas with SSRO were divided into three groups of 10 samples each. Group A - ABS plastic; Group B - Polyamide and Group C - Polyurethane. These were fixated with three bicortical position screws (16 mm in length, 2.0mm system) in an inverted L pattern using perforation guide and 5 mm advancement. Methods: Each sample was submitted to linear vertical load and load strength values were recorded at 1, 3, 5, 7 and 10 mm of displacement. The means and standard deviation were compared using the Analysis of Variance (p<0.05) and the Tukey's test. Results: A tendency for lower values was observed in Group B in comparison with Groups A and C. At 3 and 5 mm of displacement, a difference between Groups A and C was found in comparison with Group B (p<0.05). At 7 and 10 mm of displacement a difference was found among the 3 groups, in which Group C showed the highest values and Group B the lowest (p<0.05). Conclusions: Taking into consideration the results obtained and the behavior of each material used as a substrate, significant differences occurred among the materials when compared among them
Mestrado
Fisiopatologia Cirúrgica
Mestre em Ciências

Trabajo de Investigación Requisito para optar al Título de Cirujano Dentista
Introducción: Se han descrito múltiples reportes que indican alteración a nivel neurosensitivo del territorio inervado por el nervio alveolar inferior (NAI) tras el daño provocado a este último durante la osteotomía sagital de rama mandibular bilateral (OSRMB), y que afecta a casi el 100% de los pacientes durante el postoperatorio inmediato. Según estudios dicha alteración se evidencia hasta los 6, 12 y 24 meses inclusive. El principal objetivo de este estudio es determinar si la sensibilidad del territorio inervado por el NAI se recupera en un 60% luego de 6 meses posterior a la OSRMB. Materiales y métodos: Estudio longitudinal observacional descriptivo de incidencia, incluyó 27 pacientes, sometidos a cirugía ortognática durante 1 año en el Hospital Clínico San Borja Arriarán, de ambos géneros, entre 16 y 50 años, ASA I, diagnosticados como dismorfosis dentofacial (DDF) clase II o III. Se estudió parte del área inervada por el NAI correspondiente al mentón y labio inferior por medio de una proyección cuadrangular en la región. Este rectángulo se dividió en 8 partes iguales. Se creó una escala de hipoestesia con valores cualitativos asignados por números del 1 al 5, siendo 1 anestesia total (0% de recuperación) a 5 sensibilidad normal (100% de recuperación), que se correlacionaron a un test de sensibilidad utilizando monofilamentos tipo Von Frey calibrados a 0.01, 0.02 y 0.1 mg. Cada monofilamento se aplicó una vez en cada zona del rectángulo y se evaluó la respuesta a los 1, 3 y 6 meses. Se encuestó a los pacientes para evaluar desde el punto de vista subjetivo, su percepción en relación a la pérdida y recuperación de la sensibilidad. Resultados: La recuperación de la sensibilidad alcanzó un promedio de 55,3% a los 6 meses, encontrándose diferencias significativas (p<0,05) entre géneros 8 (mujeres: 60%; hombres: 46,3%) y entre DDF (clase II: 56,6%; clase III: 60%). La encuesta refleja un proceso de recuperación paulatina hacia los 6 meses. Conclusiones: La recuperación de la sensibilidad fue ascendente durante los 6 meses alcanzando un 26,7% al primer mes, un 42,4% a los 3 meses y un 55,3% a los 6 meses. Las mujeres y los pacientes sometidos a OSRMB + GO presentaron mayor porcentaje de recuperación que los hombres y pacientes sometido a OLFI + OSRMB + GO durante los 6 meses post quirúrgicos.

Orientador: José Ricardo de Albergaria-Barbosa
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba.
Made available in DSpace on 2018-08-20T01:39:48Z (GMT). No. of bitstreams: 1 Cabral-Andrade_Valdir_M.pdf: 2554505 bytes, checksum: 59b3398b4be124c9a3c5db0bc28f73f2 (MD5) Previous issue date: 2012
Resumo: O objetivo deste estudo foi avaliar a influência da osteotomia da base mandibular nas osteotomias sagitais do ramo, comparando como ela modifica a resistência mecânica dos sistemas de fixação, bem como a distribuição de tensões, utilizando como metodologia os testes mecânicos, extensiométricos e de fotoelasticidade. Para os testes mecânico e extensométrico, foi utilizada uma amostra composta de 20 hemimandíbulas confeccionadas em poliuretano, sendo 10 hemimandíbulas para cada tipo de osteotomia fixadas com parafusos bicorticais posicionais em L invertido, as quais foram submetidas à incidência de carga analisada por extensometria até a falha do sistema de fixação através de teste de carregamento linear a uma velocidade de 1mm/min. Para o teste mecânico, não existiu diferença em termos de carga e deslocamento final. Para a análise extensométrica, não existiu diferença estatisticamente significante entre os parafusos 1 e 3 entre as amostras, somente para o parafuso 2. No caso da análise fotoelástica, a osteotomia da base mostrou apresentar melhor padrão de distribuição de tensões. Apesar dessas diferenças estatísticas, clinicamente elas não devem influenciar em termos de resistência mecânica, podendo ambas ser utilizadas dependendo do caso e da preferência de cada profissional
Abstract: The aim of this study was to evaluate the osteotomy of the inferior border of the mandible, comparing the mechanical resistance of the fixation system, as the tension distribuition, using the mechanical, extensiometric and photoelastic methodology. For the mechanical and extensiometic analysis, a sample of 20 polyurethane hemimandibles were made, 10 hemimandible for each type of osteotomy, fixed with positional bicortical screws in inverted L configuration, that were submitted to linear loading with a displacement of 1 mm/min until the fixation failure, with extensiometric analysis. The mechanical tests found no difference for final loading and displacement. For the extensiometric analysis, there was no statistical difference between the screws 1 and 3, just for the screw 2. In the photoelastic analysis, the osteotomy of the inferior border of the mandible presented better stress distribution pattern. Despite those differences in the in vitro tests, the inferior border osteotomy probably does not have clinical influence in the resistance and it should be done depending on the case and the preference of the professional
Mestrado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Mestre em Clínica Odontológica

Orientador: Roger William Fernandes Moreira
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
Made available in DSpace on 2018-08-25T11:23:33Z (GMT). No. of bitstreams: 1 Lima_CristinaJardelinode_D.pdf: 804320 bytes, checksum: f36d67c8b410aafe2f3664c02eb674ca (MD5) Previous issue date: 2014
Resumo: O objetivo do presente estudo foi comparar, por meio de testes mecânicos e fotoelásticos, o desempenho de parafusos canulados em relação a parafusos convencionais, ambos do sistema 2,3 mm, utilizados na fixação de osteotomia sagital do ramo mandibular. Dez réplicas de mandíbulas humanas fabricadas em poliuretano e uma em resina fotoelástica (Nacional, Jaú, SP, Brazil) foram utilizadas em cada grupo e fixadas em L invertido. Foram realizados testes de carregamento linear vertical em uma máquina de ensaio universal (Instron Corporation, Norwood, MA). O teste Shapiro-Wilk foi realizado para verificar a presença de normalidade entre os resultados (p<0,05), em seguida o teste T foi utilizado para verificar a diferença entre as médias. O teste fotoelástico foi realizado, com o auxílio de um polariscópio plano. A avaliação dos dados do teste fotoelástico foi qualitativa e descritiva. Os resultados mecânicos obtidos demonstraram diferença entre os grupos apenas no deslocamento de 1mm, no qual o parafuso canulado provou ser mais estável. Os resultados da análise fotoelástica revelaram maior tensão entre os parafusos superior anterior e inferior, sendo o parafuso posterior superior o que sofreu menor carga de estresse, o teste revelou ainda franjas de tensão na região de ramo mandibular no grupo convencional. De acordo com os resultados do presente estudo foi possível concluir que os parafusos canulados cônicos apresentaram melhor desempenho nos testes mecânicos em 1 mm de deslocamento e nos testes fotoelásticos, sendo uma opção viável para a fixação da osteotomia sagital do ramo mandibular
Abstract: The aim of the present study was to use mechanical and photoelastic tests to compare the performance of cannulated-screws with that of solid-core screws in sagittal split osteotomy fixation. Ten polyurethane mandibles, with a prefabricated sagittal split ramus osteotomy, were fixed with the inverted L technique and allocated to the following groups: CSG Group, fixed with three 2.3-canullated-screws and SCSG Group, fixed with three 2.3-solid-core-screws. Vertical linear loading tests were performed. The differences between mean values were analysed using the T test for independent samples. The photoelastic test was carried out using a polariscope. The results revealed that there were only differences between the two groups at 1 mm of displacement, at which point the cannulated-screw exhibited more resistance. The photoelastic test confirmed higher stress concentration close to the mandibular branch in the solid-core group. Cannulated-screws performed better than solid-core screws in photoelastic tests and in a mechanical test at 1 mm displacement
Doutorado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Doutor em Clínica Odontológica

Orientador: Jose Ricardo de Albergaria Barbosa
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
Made available in DSpace on 2018-08-27T22:57:52Z (GMT). No. of bitstreams: 1 Santos_ZarinaTatiaBarbosaVieirados_M.pdf: 1096819 bytes, checksum: 2006f7be54ec5deb54b18701da9dca26 (MD5) Previous issue date: 2015
Resumo: Objetivo: Avaliar a resistência mecânica de quatro métodos de fixação interna funcionalmente estável (FIFE) em dois desenhos de osteotomia sagital do ramo mandibular (OSRM), quando submetidos ao carregamento linear. Materiais e Métodos: Dois modelos de osteotomia foram feitos em hemimandíbulas de poliuretano e divididos em dois grupos, ambos com 20 amostras: Grupo I - osteotomia angular e grupo II - osteotomia linear. Depois de um avanço de 5 mm do segmento distal, os segmentos ósseos foram fixados com diferentes sistemas de placa/parafuso de 2,0 mm, estabelecendo os sub-grupos: (A), uma placa reta convencional de 4 furos, (B), uma placa reta convencional de 4 furos associado a um parafuso bicortical, (C), uma placa reta com travamento de 4 furos, (D), uma placa reta com travamento de 4 furos associado a um parafuso bicortical. As amostras, foram então, submetidas ao carregamento linear a uma velocidade de 1 mm/min, até alcançar a carga de pico e falha do sistema. Resultados: Pelo teste de Tukey, o grupo de uma placa convencional associado a um parafuso bicortical mostrou ter uma carga superior a 3 mm de deslocamento (87,42 ± 4,86 N) estatisticamente significativa em comparação com o de uma placa convencional com parafusos monocorticais (p <0,01) e uma placa com travamento com parafusos mocorticais (p <0,01). O grupo de uma placa de travamento associado a um parafuso bicortical mostrou ter uma carga superior a 3 mm de deslocamento (72,47 ± 4,86 N) estatisticamente significativa em comparação com o de uma placa convencional com parafusos monocorticais (p = 0,02) e uma placa com travamento com parafusos mocorticais (p = 0,01). Não houve diferença estatisticamente significativa entre os grupos: uma placa convencional com parafusos monocorticais e uma placa com travamento com parafusos mocorticais (p = 0,65); uma placa convencional associado a um parafuso bicortical e uma placa com travamento associado a parafuso bicortical (p = 0,15). A osteotomia angular apresentou maior resistência mecânica em 3 mm de deslocamento do que a linear. No entanto, o único grupo que apresentou diferença estatisticamente significante foi o grupo A (p = 0,05). Conclusão: não houve diferença entre o sistema de fixação placa/parafuso convencional e com travamento; a adição de um parafuso bicortical na região retromolar promoveu uma melhor estabilização dos sistemas de fixação. A OSRM angular apresentou melhor resistência mecânica
Abstract: Purpose: Evaluate the mechanical resistance of four different osteosynthesis in two different design of sagittal split ramus osteotomy (SSRO) when submitted to vertical forces. Materials and Methods: Two osteotomy models were made on polyurethane hemimandibles. Group I - angled osteotomy and group II - linear osteotomy, both with 20 specimes. After 5-mm advancement of the distal segment, the bone segments were fixed by different osteosynthesis methods using 2.0-mm plate/screw systems, establishing sub-groups: A, one 4-hole conventional straight plate, B, one 4-hole conventional plate and one bicortical screw, C, one 4-hole locking straight plate, D, one 4-hole locking straight plate and 1 bicortical screw. The samples were then subjected to a linear load at a speed of 1 mm/min until reaching peak load and system failure. Results: A Tukey post-hoc test revealed that the group of one conventional plate with bicortical screws showed higher load (87.42 ±4.86 N ) with statistically significantly compared to one conventional plate with monocortical screws (p<0.01 ) and one locking plate with mocortical screws (p<0.01). The group of one locking plate with bicortical screws showed higher load (72.47 ±4.86 N ) with statistically significantly compared to one conventional plate with monocortical screws (p=0.02) and one locking plate with mocortical screws (p=0.01). There was not a statistically significant difference between groups: one conventional plate with monocortical screws and one locking plate with mocortical screws (p=0.65); one conventional plate with bicortical screws and one locking plate with bicortical screws (p=0.15). The osteotomy with angle showed higher mechanical resistance than linear. However, the only group that showed statistically significant differences was the group A (p=0.05). Conclusion: no statistical differences were detected between locking and standard system, the placement of 2.0-mm¿diameter bicortical screws in the retromolar region, promoted a better stabilization of bone segments. The angular SSRO offers the best mechanical resistance
Mestrado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Mestra em Clínica Odontológica

INTRODUCTION During the three-year doctoral period, the candidate developed 3 research projects which, although different, are all related to one of the most controversial topics of advanced implant dentistry which include procedures to make it possible the use of dental implants also in case of severely atrophic edentulous ridges. During the last decade, a variety of surgical procedures have been proposed, each of them with specific indications, contraindications, advantages and disadvantages. Despite the publication of numerous systematic reviews and meta-analyses focused on this fascinating topic, much controversy is still present between clinicians and researches. The aims of the PhD candidate have been to focus on three main areas related to the correction of severely atrophic edentulous ridges in order to: 1) update the present knowledge on this particular field thank to a systematic analysis of the available literature; and 2) develop three different research projects specifically dedicated to regeneration/reconstruction procedures. More in detail, one line of research was focused on the evaluation of medium to long-term results of dental implants placed in severely atrophic jaws reconstructed with autogenous calvarial bone blocks covered with bovine bone mineral and collagen membranes. Seventy-two patients and 330 implants were involved in this retrospective study with a mean follow-up after implant loading of 8 years, ranging from 3 to 19 years. The second project, similar in structure to the previous one, was designed to evaluate retrospectively the medium and long-term results (with a mean follow-up of 10 years) of implants placed in atrophic edentulous ridges grafted with autogenous mandibular blocks covered with bovine bone mineral and collagen membranes. Seventy-five patients, 82 sites, and 182 implants were involved in this study. The third line of research allowed the candidate to design a prospective study which involved edentulous and atrophic patients treated with guided bone regeneration using CAD-CAM customized titanium meshes. The effectiveness of digitally customized titanium meshes in association with autologous bone particles and bovine bone mineral for the regeneration of atrophic edentulous sites, and the survival rate of implants placed in the reconstructed areas were evaluated. A histomorphometric analysis of mandibular regenerated bone were also performed. Forty-one patients, 53 sites, and 106 implants were involved in this study and the follow-up of implants before and after loading ranged from 2 to 23 months (mean: 11 months), and from 1 to 15 months (mean: 6 months), respectively. This latter research is of particular interest, as the literature supporting this particular technique is scarce, and available data are difficult to be compared, because they have been collected in a non- systematic way and mainly retrospectively. In all these studies, a dedicated questionnaire, adapted from the OHIP-14 survey, was performed to evaluate patients’ satisfaction (patient reported outcome measurements – PROMs) as regards the treatment received. It was therefore possible to elaborate a discussion of the results on two different levels: the first associated to the specific regenerative / reconstructive technique; the second allowed a comparison among the different treatment solutions. AIMS The aim of the first and second project, two retrospective longitudinal cohort studies, is to present the medium to long-term outcome of bone reconstructions with calvarium or mandibular grafts , respectively by evaluating: a) complication rate of the reconstructive procedure; b) bone resorption before implant placement; c) peri-implant bone resorption; d) implant-related complications; e) implant survival rate; and, f) patient’s satisfaction inquired with a dedicated questionnaire. The aims of the third project, a prospective, single-arm clinical study, are to evaluate: a) the effectiveness of digitally customized titanium meshes in association with autologous bone particles and BBM and covered with collagen membranes for the regeneration of atrophic edentulous sites; b) the survival rate of implants placed in the regenerated areas and, c) PROMs inquired with a dedicated questionnaire. MATERIALS & METHODS Project 1 – calvarium From 1998 to 2014, 72 patients presenting with severe bone defects were reconstructed with autogenous calvarial bone blocks covered with bovine bone mineral granules and collagen membranes. Four to 9 months later, 330 implants were placed and loaded 3 to 9 months later. The follow-up ranged from 3 to 19 years (mean: 8.1 years). Project 2 – ramus from 1997 to 2015, 75 patients presenting with bone defects of the jaws were grafted with autogenous mandibular bone blocks. One-hundred-eighty-two implants were placed 4 to 12 months later and loaded 3 to 10 months later: the mean follow-up was 10 years (range: 3-16 years). Project 3 – GBR with Ti-mesh 41 patients, presenting with 53 atrophic sites were enrolled between 2018 and 2019. GBR was obtained with titanium meshes filled with autogenous bone chips and bovine bone mineral (BBM). After a mean of 7 months (range: 5-12 months), meshes were removed and 106 implants placed. After a mean of 3.5 months (range: 2-5 months), implants were uncovered and prosthetic restorations started. RESULTS Project 1 – calvarium No patients developed severe complications, such as complete loss or resorption of the grafts. A dehiscence occurred in 6 patients, which developed a mild graft resorption. The mean peri-implant bone resorption before implant placement was 0.13 mm (SD ± 0.71). All patients received the planned number of implants. Three patients were lost during the follow-up. The survival rate of implants at the end of the observation period was 98.5%. The mean peri-implant bone resorption ranged from 0.00 mm to 4.87 mm (mean: 1.11 mm). Finally, 90% of the patients were very satisfied as regards the treatment received. Project 2 – ramus Post-operative recovery was uneventful in the majority of patients. An early dehiscence occurred in three patients, but with no significant bone loss, while 3 experienced temporary paresthesia. The mean vertical and horizontal bone resorption before implant placement was 0.18 mm (standard deviation (SD)=0.43) and 0.15 mm (SD=0.42), respectively. The mean peri-implant bone loss ± standard deviation was 1.06±1.19 (range 0.00 to 5.05) at patient level, and 1.11±1.26 (range 0.00 to 5.20) at implant level. Two implants in 2 patients lost integration and were removed; 10 implants in 7 patients developed peri-implantitis, but healed after surgical treatment. The cumulative implant survival and success rates were 98.11% and 85.16%, respectively. PROMs were very positive: 95.5% of patients would have undergone the procedure again. Project 3 – GBR with Ti-mesh out of 53 sites, 11 underwent mesh exposure: 8 of them were followed by uneventful integration of the graft, while 3 by partial bone loss. The mean vertical and horizontal bone gain after reconstruction was 4.78±1.88mm (range 1.00 to 8.90mm), and 6.35±2.10mm (range 2.14 to 11.48 mm), respectively. At the time of implant placement, mean changes of initial bone gain were -0.39±0.64mm (range -3.1 to +0.80mm), and -0.49±0.83mm (range –3.7 to +0.4mm), in the vertical and horizontal dimensions, respectively. Reduction of bone volume was significantly higher (P<0.001 for both dimensions) in the exposed sites. At histologic analysis, mesh appeared well osseointegrated, except that in sites where membrane exposure occurred. In all sites, newly formed tissue resulted highly mineralized, well-organized and formed by 35.88% of new lamellar bone, 16.42% of woven bone, 10.88% of osteoid matrix, 14.10% of grafted remnants and 22.72% of medullary spaces. Blood vessels were the 4 % of the tissue.The mean follow-up of implants after loading was 10.6±6.5months (range: 2 to 26months). The survival rate of implants was 100%. PROMs were very positive: 92.5% of patients would have undergone the procedure again. DISCUSSION These three projects have offered, on one side, a relevant opportunity to evaluate the short, medium, and long-term outcomes of both reconstructions with autogenous bone blocks and guided bone regeneration with an innovative, customized, titanium mesh. On the other side, “intrinsic” methodologic limits have appeared during the development of this PhD thesis, such as: o heterogeneity of patient samples and type of defects; o retrospective and prospective type of study; o duration of the observation period; o presence/absence of evaluation of bone gain and with different methods; o different methods used to evaluate bone resorption before implant placement. Despite these limits, results from these three researches offered relevant information as regards the behaviour of the transplanted /regenerated bone as well as the behaviour of peri-implant bone over time. Although the three projects significantly differ among them as regards details in the reconstructive procedures, it must be underlined that many aspects are in common. Therefore, to reduce redundancies it has been decided to write a “unified” discussion which will make it possible a direct comparison of pros, cons, indications and contra-indications of each of them. More in detail, each of the following issues will be discussed reporting and comparing obtained from each study: 1. bone gain; 2. complication rate of the reconstructive procedure; 3. bone resorption before implant placement; 4. peri-implant bone resorption; 5. survival rate of implants and implant-related complications; 6. patient’s satisfaction inquired with a dedicated questionnaire. CONCLUSION Despite the descriptive nature of the first two retrospective longitudinal cohort studies and the variability of the selected patients (including different patients anamnesis, defects locations, defect morphologies, and prosthetic rehabilitations), medium- to long-term results seem to confirm the efficacy of reconstruction of atrophic ridges using autogenous bone blocks taken from both the calvarium and the mandibular ramus covered by a protective layer of bovine bone mineral and stabilized by a collagen membrane. The use of autogenous calvarial grafts may be prefer in case of severely deficient edentulous ridges, when the ramus can offer an insufficient quantity of bone. The low postoperative morbidity, the stability over time of the augmented bone, the high survival rate of implants placed in a prosthetically driven way, leading to very satisfactory prosthetic restorations, confirmed the long-term reliability of these procedures. Preliminary results of the third prospective study, on the other hand, despite the limited number of patients, implants, short follow-up, and the non-negligible incidence of Ti-mesh exposures, seem to demonstrate that CAD-CAM customized Ti-meshes may represent a reliable GBR option for the correction severely atrophic edentulous ridges in terms of vertical bone gain, limited peri-implant bone resorption and survival rate of implants. It is however worth noting that if on one hand it is possible to simplify the reconstructive procedure thanks to the customization of Ti-meshes, on the other hand surgeons have to face the non-negligible incidence of Ti-mesh exposures and the higher complexity of their removal at the time of implant placement. Therefore, studies involving a higher sample of patients and with longer follow-ups are necessary. PROMs seem to validate the use of all the regenerative and reconstructive procedures, with high value of patient’ satisfaction.

Orientador: Marisa Aparecida Cabrini Gabrielli
Banca: Luis Geraldo Vaz
Banca: Eduardo Hochuli Vieira
Banca: Alexandre Elias Trivelato
Banca: Luciana Asprino
Resumo: Este estudo avaliou a resistência ao deslocamento vertical de seis métodos de fixação interna estáveis utilizados na osteotomia sagital do ramo mandibular (OSRM) no movimento de avanço mandibular com rotação anti-horária. Foram utilizadas sessenta hemimandíbulas sintéticas, divididas em seis grupos de 10 hemimandíbulas, todas fixadas com sistema de fixação 2,0 mm da seguinte forma: Grupo I - 1 miniplaca reta de quatro furos e quatro parafusos monocorticais de 6,0 mm; Grupo II - 1 miniplaca reta de seis furos e seis parafusos monocorticais de 6,0 mm; Grupo III - 2 miniplacas retas de quatro furos e oito parafusos monocorticais de 6,0 mm; Grupo IV - 1 placa grade de oito furos e oito parafusos monocorticais de 6,0 mm; Grupo V - 1 miniplaca reta de quatro furos com quatro parafusos monocorticais de 6,0 mm e um parafuso bicortical 2,0 x 12 mm; Grupo VI - 1 miniplaca reta de quatro furos, locking e quatro parafusos monocorticais de 6,0 mm locking. O teste mecânico foi realizado por meio da aplicação de uma força linear na região entre o primeiro pré-molar e canino, em uma máquina de ensaios mecânicos (EMIC- DL2000) com célula de carga de 10 kilogramas Newton (kN). As cargas para o deslocamento de 1, 3 e 5 mm foram registados em Newton (N) e os dados foram transmitidos para um computador. Os resultados foram avaliados utilizando a análise de variância ANOVA (p <0,001) e teste de Tukey para comparação entre os grupos. O sistema de fixação testado nas três condições de deslocamento m... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: This study evaluated the resistance to vertical displacement of six stable fixation methods for the sagittal split ramus osteotomy (SSRO) in the mandibular advancement with counterclockwise rotation. Sixty synthetic hemimandibles were used. They were divided into six groups of 10 hemimandibles, all hemimandibles were fixed with 2.0 mm system as follows: Group I - fixation with a straight four-hole miniplate and four monocortical screws 6.0 mm; Group II - a straight six-hole miniplate and six monocortical screws 6.0 mm; Group III - two straight four-hole miniplates and eight monocortical screws 6.0 mm; Group IV - an eight-hole (grid plate) and eight monocortical screws 6.0 mm; Group V - a four-hole straight miniplate with four monocortical screws 6.0 mm and 2.0 x 12 mm bicortical screw; Group VI - a straight four-hole locking miniplate and four monocortical screws locking 6.0 mm. Biomechanical evaluation was performed by applying a linear force in the region between the canine and first premolar, using a mechanical testing machine (EMIC- DL2000) with loading cell of 10 kN. The loads at 1, 3 and 5 mm of displacement were recorded in N and the data were transmitted from the load cell to a computer. Results were analyzed using the variance analysis ANOVA (p < 0.001) and Tukey post-test for comparison between the groups. For the three displacement conditions fixation with two straight 2.0 mm plates and with the grid plate presented higher load values.
Doutor

Submitted by LEANDRO BENETTI DE OLIVEIRA null (le_benetti@yahoo.com.br) on 2016-08-30T13:45:31Z No. of bitstreams: 1 TESE - Leandro Benetti de Oliveira.pdf: 2195790 bytes, checksum: 21bf2ac77d2bdf1976aedf77850b0e7f (MD5)
Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-08-31T13:10:40Z (GMT) No. of bitstreams: 1 oliveira_lb_dr_arafo.pdf: 2195790 bytes, checksum: 21bf2ac77d2bdf1976aedf77850b0e7f (MD5)
Made available in DSpace on 2016-08-31T13:10:40Z (GMT). No. of bitstreams: 1 oliveira_lb_dr_arafo.pdf: 2195790 bytes, checksum: 21bf2ac77d2bdf1976aedf77850b0e7f (MD5) Previous issue date: 2016-07-29
Este estudo avaliou a resistência ao deslocamento vertical de seis métodos de fixação interna estáveis utilizados na osteotomia sagital do ramo mandibular (OSRM) no movimento de avanço mandibular com rotação anti-horária. Foram utilizadas sessenta hemimandíbulas sintéticas, divididas em seis grupos de 10 hemimandíbulas, todas fixadas com sistema de fixação 2,0 mm da seguinte forma: Grupo I - 1 miniplaca reta de quatro furos e quatro parafusos monocorticais de 6,0 mm; Grupo II – 1 miniplaca reta de seis furos e seis parafusos monocorticais de 6,0 mm; Grupo III - 2 miniplacas retas de quatro furos e oito parafusos monocorticais de 6,0 mm; Grupo IV - 1 placa grade de oito furos e oito parafusos monocorticais de 6,0 mm; Grupo V - 1 miniplaca reta de quatro furos com quatro parafusos monocorticais de 6,0 mm e um parafuso bicortical 2,0 x 12 mm; Grupo VI – 1 miniplaca reta de quatro furos, locking e quatro parafusos monocorticais de 6,0 mm locking. O teste mecânico foi realizado por meio da aplicação de uma força linear na região entre o primeiro pré-molar e canino, em uma máquina de ensaios mecânicos (EMIC- DL2000) com célula de carga de 10 kilogramas Newton (kN). As cargas para o deslocamento de 1, 3 e 5 mm foram registados em Newton (N) e os dados foram transmitidos para um computador. Os resultados foram avaliados utilizando a análise de variância ANOVA (p <0,001) e teste de Tukey para comparação entre os grupos. O sistema de fixação testado nas três condições de deslocamento mostrou que os grupos com duas miniplacas retas de 2,0 mm e placa grade apresentaram valores de carga mais elevados.
This study evaluated the resistance to vertical displacement of six stable fixation methods for the sagittal split ramus osteotomy (SSRO) in the mandibular advancement with counterclockwise rotation. Sixty synthetic hemimandibles were used. They were divided into six groups of 10 hemimandibles, all hemimandibles were fixed with 2.0 mm system as follows: Group I – fixation with a straight four-hole miniplate and four monocortical screws 6.0 mm; Group II – a straight six-hole miniplate and six monocortical screws 6.0 mm; Group III – two straight four-hole miniplates and eight monocortical screws 6.0 mm; Group IV – an eight-hole (grid plate) and eight monocortical screws 6.0 mm; Group V – a four-hole straight miniplate with four monocortical screws 6.0 mm and 2.0 x 12 mm bicortical screw; Group VI – a straight four-hole locking miniplate and four monocortical screws locking 6.0 mm. Biomechanical evaluation was performed by applying a linear force in the region between the canine and first premolar, using a mechanical testing machine (EMIC- DL2000) with loading cell of 10 kN. The loads at 1, 3 and 5 mm of displacement were recorded in N and the data were transmitted from the load cell to a computer. Results were analyzed using the variance analysis ANOVA (p < 0.001) and Tukey post-test for comparison between the groups. For the three displacement conditions fixation with two straight 2.0 mm plates and with the grid plate presented higher load values.

AbstractMandible, a horseshoe shaped bone of the facial skeleton, is one of the sturdy bones in humans. Prominent chin is a unique feature of anatomically modern man in comparison with his anthropological ancestors. The simian shelf has reduced to two genial tubercles to which two muscles are attached. The neck of the condyle has narrowed and acts as a buffer to budge by fracture if there is a severe force on the prominent chin. These evolutionary changes facilitated increased space for the tongue as men started articulation. It articulates with the temporal bone by two inter-dependent Temporo-mandibular joints. Mandible is important in both function and aesthetics.Mandible can be cut into multiple pieces and re-arranged and fixed to achieve aesthetic and functional changes. Facial bones have a tremendous capacity to regenerate and heal provided proper blood supply is ensured to the cut segments. Ostoetomies of the mandible can be done on ramus, body, chin, dento-alveolar region, inferior border, etc. Most of these procedures are done intraorally. Technological advancements have aided orthognathic surgery at large. This chapter envisages to elaborate different techniques of osteotomy of mandible.

The parotid gland consists of two lobes: superficial and deep with regard to its relation with the facial nerve. It is wrapped around the mandibular ramus and secretes saliva through the parotid (Stensen's) duct. It is a paired organ, weighing 15-30g each. Its superficial lobe overlies the lateral surface of the masseter muscle and is bounded superiorly by the zygomatic arch, while its deep lobe is located in the pre-styloid compartment of the parapharyngeal space between the mastoid process posteriorly, ramus of mandible anteriorly, and external auditory meatus superiorly. Medially, the gland reaches to the styloid process. Inferiorly, the parotid tail extends down to the anteromedial margin of sternocleido-mastoid muscle. Several structures run through the parotid gland, namely, terminal segment of external carotid artery, retro-mandibular vein, parotid lymph nodes, and facial nerve, which soon gives two divisions (temporo-facial and cervico-facial) that give off five branches inside the gland radiating forwards. This chapter explores the surgical anatomy of the parotid gland.

There are three paired major salivary glands of the head and neck, all named according to their location and each contributing to saliva and enzyme production via their respective ducts to assist with mastication and digestion. At rest, the lion’s share (60%) of saliva production is from the submandibular glands. On stimulation, the parotid contribution increases from 20% to 50%. There are up to 1000 minor salivary glands found within the submucosa of the oral cavity – 1-2mm in size and predominantly mucous in nature. The parotid glands are irregular shaped masses of lobulated tissue situated on the side of the face, reaching from the zygomatic arch superiorly to the upper part of the neck inferiorly where they overly the posterior belly of digastric and upper sternocleidomastoid muscle. Anteriorly, the gland lies between the posterior border of the mandibular ramus before continuing below the external acoustic meatus towards the mastoid process posteriorly.

Introducao: ameloblastoma trata-se de um tumor odontogenico benigno que afeta na maioria das vezes ele e encontrado na parte posterior da mandibula. Ele e localmente invasivo e decorrente de restos epiteliais do orgao do esmalte. Objetivo: relatar o tratamento cirurgico de remocao de ameloblastoma no servico de cirurgia e traumatologia da Universidade Federal de Uberlandia (UFU) Relato de caso: paciente de 33 anos, compareceu na UFU com o relato de que a tres meses antes realizou exame de radiografia panoramica, na qual foi evidenciado lesao radiolucida em corpo e ramo mandibular direito. Com a biopsia incisional e que no laudo foi diagnostico o ameloblastoma multicistico em corpo e ramo mandibular direito. Foi realizado o tratamento foi optado por fazer uma resseccao marginal. Discussao: Homens e mulheres sao igualmente afetados, e ele costuma ser encontrado prevalentemente em adultos jovens, em tal caso encontra-se em uma mulher. O melhor tratamento para diminuir as chances de recidiva e a resseccao. Conclusao: O ameloblastoma tem o seu crescimento lento e assintomatico, o reconhecimento previo da doenca pode evitar tratamentos invasivos e fornecer melhor prognostico para o paciente. ,

Introdução: As neoplasias na cavidade oral representam cerca de 5% de todas as neoformações encontradas em caninos e felinos. O termo melanoma é utilizado quando há uma neoplasia maligna dos melanócitos. Os melanomas amelanóticos são aqueles em que não há pigmentação. Objetivo: O presente trabalho tem como objetivo relatar o caso de um felino fêmea, sem raça definida, de 8 anos com uma neoplasia no ramo mandibular direito, identificada em um estudo radiográfico e, posteriormente, diagnosticada como melanoma amelanótico, pelo exame histopatológico. O paciente apresentava perda de peso e variações no apetite. Ao exame físico notou-se a presença de uma massa em cavidade oral no ramo mandibular direito, além disso o paciente apresentava sialorréia leve e as mucosas pálidas. Foi indicado uma radiografia de crânio, o qual mostrou um aumento de tecidos moles concomitante com áreas de lise óssea no ramo mandibular direito, discreta proliferação no periósteo na porção ventral do ramo e deslocamento dorsal do molar inferior. Materiais e Métodos: Os tratamentos de eleição foram a eletroquimioterapia e posteriormente uma cirurgia de excisão do neoplasma. O diagnóstico definitivo de neoplasias de células pouco diferenciadas é feito com o auxílio dos exames histopatológico e imunohistoquímico. Resultados: Ocorreu a coleta do material para o exame histopatológico, o qual mostrou fragmentos apresentando neoplasia maligna invadindo difusamente a submucosa e o tecido muscular adjacente. O diagnóstico definitivo foi de melanoma amelanótico. Após alguns meses, a paciente retornou com a queixa inicial de prostração, à análise física notou-se feridas na região onde houvera a excisão da neoplasia, levando a suspeita de uma possível recidiva tumoral. Solicitou-se uma nova radiografia de crânio, que apontou perda de densidade óssea no ramo mandibular direito, área onde havia, anteriormente, o melanoma. Após diagnóstico de confirmação e devido a complicações no quadro clínico do paciente, e o possível prognóstico desfavorável foi realizada a eutanásia. Conclusão: Por ser extremamente raro na cavidade oral de felinos, os dados quanto à predisposição de melanoma nessa espécie são escassos, portanto, o presente relato corrobora para novos estudos quanto à patogenia e comportamento desse tipo de neoplasia.