Dissertations / Theses: 'Mandibular ramu'

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Pozzer, Leandro Souza 1986. "Análise mecânica da influência de dois desenhos de osteotomia sagital do ramo mandibular fixados com mini-placas e parafusos de titânio para diferentes posições mandibulares." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289444.

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Orientador: José Ricardo de Albergaria-Barbosa
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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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

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Cabral-Andrade, Valdir 1985. "Análise fotoelástica de influência de dois desenhos de osteotomia sagital do ramo mandibular fixados com miniplacas e parafusos de titânio para diferentes avanços mandibulares." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289418.

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Orientador: José Ricardo de Albergaria Barbosa
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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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

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Baccarin, Leandro Stocco 1978. "Análise de corpos de prova mandibulares utilizados para avaliação de sistema de fixação óssea = Analysis of mandibular test specimens used to assess a bone fixation system." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310497.

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Orientador: Luis Augusto Passeri
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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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

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Carreño, Luna Luis Daniel. "Recuperación de la sensibilidad en el territorio inervado por el nervio alveolar inferior, posterior a la osteotomía sagital de rama mandibular bilateral. Estudio longitudinal a 6 meses." Tesis, Universidad de Chile, 2014. http://www.repositorio.uchile.cl/handle/2250/130147.

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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.

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Cabral-Andrade, Valdir 1985. "Avaliação comparativa por meio de testes mecânicos, análise extensométrica e fotoelástica da influência da realização ou não da osteotomia da base nas osteotomias sagitais dos ramos mandibulares." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289445.

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Orientador: José Ricardo de Albergaria-Barbosa
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba.
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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

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Lima, Cristina Jardelino de 1985. "Análise mecânica e fotoelástica de parafusos canulados e parafusos convencionais para fixação de osteotomias sagitais : estudo comparativo." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/288758.

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Orientador: Roger William Fernandes Moreira
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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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

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Santos, Zarina Tatia Barbosa Vieira dos 1989. "Avaliação mecânica entre quatro métodos de fixação interna funcionalmente estável em dois desenhos de osteotomia sagital do ramo mandibular = Mechanical evaluation of four fixation techniques in two different sagittal split ramus osteotomies." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289410.

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Orientador: Jose Ricardo de Albergaria Barbosa
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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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

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TOMMASATO, GRAZIA. "THE REGENERATION OF EDENTULOUS ATROPHIC RIDGES: PROS, CONS, AND EFFECTIVENESS OF THREE DIFFERENT SURGICAL OPTIONS." Doctoral thesis, Università degli Studi di Milano, 2021. http://hdl.handle.net/2434/804105.

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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.

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Oliveira, Leandro Benetti de. "Avaliação mecânica de seis formas de fixação interna da osteotomia sagital do ramo mandibular, em movimento de avanço com rotação anti-horária /." Araraquara, 2016. http://hdl.handle.net/11449/143495.

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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.
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Oliveira, Leandro Benetti de [UNESP]. "Avaliação mecânica de seis formas de fixação interna da osteotomia sagital do ramo mandibular, em movimento de avanço com rotação anti-horária." Universidade Estadual Paulista (UNESP), 2016. http://hdl.handle.net/11449/143495.

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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.

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Gondim, Ricardo Franklin. "Canal mandibular e osteotomia sagital bilateral da mandíbula : uma análise topográfica." reponame:Repositório Institucional da UFC, 2015. http://www.repositorio.ufc.br/handle/riufc/13618.

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GONDIM, Ricardo Franklin. Canal mandibular e osteotomia sagital bilateral da mandíbula : uma análise topográfica. 2015. 71 f. Dissertação (Mestrado em Odontologia) - Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará, Fortaleza, 2015.
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A bilateral sagittal split osteotomy of the mandible (BSSO) is performed for correction of dentofacial deformities and can be used to make forward and retract movements and for changes in the occlusal plane. In an attempt to protect the inferior alveolar nerve, the surgeon makes the osteotomy so that there is no exposure of such a structure at the time of separation of the segments. Despite having facial differences and the relationship of occlusion, Class I, II and III patients are subject to the same surgical technique without changes to adapt to the peculiarities of each case. The mandibular canal ratio analysis with the design of the BSSO can provide important information to enable the professional to set standards and osteotomy levels for each type of malocclusion. Objective: To analyze bilaterally, using cone beam computed tomography (CBCT), the topography of the mandibular canal of a sample of patients undergoing orthognathic surgery. Methods: 444 CBCT in the preoperative phase who underwent orthognathic surgery with the use of the BSSO from 2009 to 2014 were analysed according the inclusion and exclusion criteria, of which 213 were studied. The classification of patients according to malocclusion was based on the mesiodistal relationship of the upper and lower canines, using intraoral photos. Points located in the mandibular foramen, the anterior border of the mandible, distal second molar and interproximal first and second lower molar bilaterally served as a reference to perform the measurements. The software Dolphin Imanging 3D ®, version 11.7 was used for the measurements. Data analysis were performed with the Statistical Packcage software for the Social Sciences®, version 17.0 with a 95% confidence interval. In statistical associations were used the Kolmogorov-Smirnov normality tests, Mann-Whitney, Wilcoxon or Kruskal-Wallis. Results: Patients class III had bilateral reduction in bone height in the regions of anterior border of the mandibular branch, distal second molar and between the molars. Also had bilateral reduced bone thickness in the anterior border of the mandibular ramus. Class II patients showed increased thickness of the base jaw. As the distance of the second molar in relation to the mandibular lingula, class II patients had lower height, and class III patients had greater height. Conclusion: The mandibular canal showed topographical differences between the types of malocclusion, suggesting the need to differentiate the depth and the thickness of the bone cuts. Future studies with individualized osteotomies for the types of malocclusion are required to verify the clinical application of the findings of this research.
A osteotomia sagital bilateral da mandíbula (OSBM) é utilizada para correção de deformidades dentofaciais, podendo ser utilizada para realizar movimentos de avanço, de recuo e para modificações no plano oclusal. Na tentativa de proteger o nervo alveolar inferior, o cirurgião procura realizar a osteotomia de forma que não haja a exposição de tal estrutura no momento da separação dos segmentos. Apesar de apresentarem diferenças faciais e na relação da chave de oclusão, os pacientes classe I, II e III são submetidos a mesma técnica cirúrgica sem alterações que se adaptem às peculiaridades de cada caso. A análise da relação do canal mandibular com o desenho da OSBM tem a possibilidade de fornecer informações importantes para que o profissional possa definir padrões e níveis de osteotomia para cada tipo de má-oclusão. Objetivo: Analisar bilateralmente, com o uso de tomografias computadorizadas de feixe cônico (TCFC), a topografia do canal mandibular de uma amostra de pacientes submetidos à cirurgia ortognática. Material e Método: 444 TCFC na fase pré-operatória de pacientes que foram submetidos à cirurgia ortognática com o emprego da OSBM no período de 2009 a 2014 foram submetidas aos critérios de inclusão e de exclusão, das quais, 213 compuseram a amostra pesquisada. A classificação dos pacientes quanto à má-oclusão foi baseada na relação mésio-distal dos caninos superiores e inferiores, utilizando fotos intra-orais. Pontos localizados no forame mandibular, borda anterior do ramo mandibular, distal de segundo molar inferior e interproximal de primeiro e segundo molar inferior bilateralmente serviram de referência para realizar as mensurações. O software Dolphin Imanging 3D®, versão 11.7 foi utilizado para realizar as medidas. A análise dos dados foi realizada com o software Statistical Packcage for the Social Sciences®, versão 17.0 com intervalo de confiança de 95%. Nas associações estatísticas foram usados os testes de normalidade de Kolmogorov-Smirnov, de Mann-Whitney, Wilcoxon ou Kruskall-Wallis. Resultados: Pacientes classe III apresentaram redução bilateral da altura óssea nas regiões de borda anterior do ramo mandibular, distal de segundo molar e entre os molares inferiores. Também apresentaram redução bilateral da espessura óssea na região da borda anterior do ramo mandibular. Pacientes classe II apresentaram aumento da espessura da base da mandíbula. Quanto à distância do segundo molar em relação à língula mandibular, pacientes classe II apresentaram menor altura, e pacientes classe III apresentaram maior altura. Conclusão: O canal mandibular apresentou diferenças topográficas entre os tipos de má-oclusão, sugerindo a necessidade de diferenciar a profundidade e a espessura dos cortes ósseos. Estudos futuros com osteotomias individualizadas para os tipos de má-oclusão são necessários para verificar a aplicação clínica dos achados dessa pesquisa.

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Rosenquist, Bo. "Displacement of the segments after oblique sliding osteotomy of the mandibular rami." Malmö : Department of Oral Surgery and Oral Medicine, School of Dentistry, University of Lund, 1988. http://catalog.hathitrust.org/api/volumes/oclc/18102588.html.

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Oliveira, Marcelo Vinicius de 1963. "Análise morfométrica mandibular por meio de tomografia volumétrica visando a melhor forma de fixação interna da osteotomia sagital do ramo mandibular." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289421.

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Orientador: José Ricardo de Albergaria Barbosa
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: A osteotomia sagital do ramo mandibular (OSRM) como descrito por Obwegeser e Dal-Pont é atualmente um procedimento comum e de sucesso na cirurgia oral e maxilo-facial no tratamento de certas discrepâncias mandibulares. Em cirurgia ortognática, entre muitas diferentes propostas de osteotomia para correções de deformidades dento-faciais na mandíbula, é evidente que a osteotomia sagital da mandíbula (OSRM) é a mais utilizada pelos cirurgiões buco-maxilo-faciais. Este fato, devido a várias razões, principalmente a estabilidade alcançada pelo contato osso grande entre os segmentos, sem a necessidade de enxerto ósseo, função mandibular precoce; estabilidade no tratamento em longo prazo e fixação fácil. Diferentes métodos para fixação interna foram utilizados para permitir a mobilização precoce e funções após a OSRM. A introdução dispositivos de fixação interna, como miniplacas e parafusos diminui substancialmente a duração do bloqueio maxilo-mandibular ou mesmo o elimina completamente. A espessura da cortical óssea mandibular tem demonstrado ser um dos muitos fatores que levam a falha de afrouxamento de parafuso e, conseqüentemente, o poder de fixação do parafuso. Mensurações da morfologia mandibular utilizando métodos convencionais têm sido relatadas na literatura. Até o momento, apenas um estudo foi publicado em que analisa a espessura do osso cortical no ramo mandibular relacionando-a com fixação interna na osteotomia sagital do ramo mandibular. O objetivo deste estudo foi quantificar a espessura do osso cortical do ramo mandibular para determinar as condições relacionadas com a osteotomia sagital do ramo e colocação de parafusos. A amostra foi composta por 44 pacientes de pacientes, com idades variando de 46 a 52 (idade média de 49 anos). Tomografias computadorizada Cone-Beam foram realizadas fazendo três cortes; na área de terceiro molar (seção A), posterior 5mm (seção B) e 5 milímetros posterior a este último (seção C). Foram realizadas as medidas das corticais em nível superior e inferior relacionada com o canal mandibular além das medições relacionadas com a largura total da mandíbula. Coeficiente de correlação intra classe com p <0,05 foi usado. O resultado mostrou que as corticais vestibular e lingual não apresentaram diferenças estatísticas e seu menor valor foi 1,5 milímetros para cada um. Corticais ósseas superior e inferior não apresentaram diferenças e a largura total da mandíbula foi entre 15,9 milímetros a 8,5 milímetros na região anterior, entre os 17,4 milímetros a 12,8 milímetros na área intermediária e 18mm de 8,8 milímetros na região posterior. A distância superiormente ao canal mandibular apresentou um desvio padrão mínimo com uma média de 8,5 milímetros na região anterior, 10,6 milímetros para a região intermediária e 12,5 milímetros na região posterior. Em conclusão, a espessura cortical do ramo mandibular é particularmente forte e oferece um bom ancoradouro para SSRO osteossíntese com parafusos de fixação independente do tipo de disposição
Abstract: The sagittal split ramus osteotomy (SSRO) as described by Obwegeser and DaiPont is now a standard, common and successful procedure in oral and maxillofacial surgery for the treatment for certain mandibular discrepancies. In orthognathic surgery, among many different designs proposed osteotomy for correction of dentalfacial deformities in the jaw, it is clear that the sagittal osteotomy of the mandibular (OSRM) is the most commonly used by surgeons maxillofacial. This fact due to several reasons, mainly the stability achieved by the large bone contact between the segments, without the need for bone grafts, early jaw function; stability in long-term treatment and easy fixation. Different methods for internal fixation have been used to allow early mobilization and functions after the common use of the SSRO. The introduction of modern devices for internal fixation such as miniplates or lag screws substantially shortens the duration of intermaxillary fixation (IMF) or even obviates it completely. Cortical bone thickness has been shown to be one of many factors affecting screw pullout strength and, consequently, the holding power of the screw. Measurement of mandibular ramus morphology using conventional methods has been reported in the literature28, but surgeons have found that further investigatio of the anatomical relationship is needed. To date, only one study have been publi hed in which the thickness of cortical bone at the mandibular ramus relates to stable internal fixation of SSRO. The objective of this study was to quantify the cortical bone thickness of the mandibular ramus to determine conditions related to sagittal split ramus osteotomy and placement of screws. The patient sample comprised 44 patients, ages ranging. from 46 to 52 (mean age, 49 years). The cone beam computed tomography were periormed and realized three cuts in third molar area (section A), 5 mm posterior (section B) and 5mm posterior to the latter (section C). Was executed measurement in cortical areas of superior and inferior level related to mandibular canal and measurement related to total width of mandible. Intra class Correlation Coefficient with p<0.05 was used. The result showed that buccal and lingual cortical zone was not present sta1istical differences and his minor value was 1.5mm for each one. Superior and inferior cortical bone was not present differences and the total width of mandible was between 15.9mm to 8.5mm in the anterior area, between 17.4mm to 12.8mm in the meddle area and 18mm to 8.8 mm in the posterior area. The distance superiorly to mandible canal presented a minimal standard deviation with a mean of 8.5mm in the anterior region, 10.6 mm for meddle region and 12.5mm in the posterior region. In conclusion, the cortical thickness of the mandibular ramus is particularly strong and offers a good anchorage for SSRO using osteosynthesis screws independently of disposition fixation type
Doutorado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Doutor em Clínica Odontológica

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14

Mello, Marina de Almeida Barbosa. "Comparação da anatomia transversal de mandíbula de indivíduos classe III com e sem fissura labiopalatina por meio de tomografia de feixe cônico." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/25/25151/tde-16082017-182640/.

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A relação entre a anatomia mandibular e a ocorrência de fratura indesejada de mandíbula na osteotomia sagital é alvo de estudos. A literatura mostra a existência de diferentes conformações anatômicas da mandíbula, porém não há estudos nessa área direcionados a indivíduos com fissura labiopalatina. Também não há na literatura estudos que mostrem as diferenças morfológicas da mandíbula relacionadas a secção transversal entre primeiro e segundo molar e sua relação com implicações na cirurgia ortognática. O objetivo do presente estudo foi avaliar a morfologia da região entre primeiro e segundo molar inferior e classificar a prevalência dos tipos mandibulares dentro de cada grupo. Foram realizadas análises e medições das reformatações das tomografias da região de molares, bilateralmente, de indivíduos Classe III, com fissura labiopalatina unilateral (Grupo FLP) submetidos à cirurgia ortognática para recuo mandibular no Hospital de Reabilitação de Anomalias Craniofaciais e de indivíduos Classe III, sem fissura (Grupo Controle) do banco de dados do Departamento de Cirurgia e Estomatologia da Faculdade de Odontologia de Bauru. Foram realizadas duas medidas lineares e uma medida angular. As hemimandíbulas foram classificadas segundo a profundidade da fossa mandibular em: Tipo a - 0 e 1mm; Tipo b - 1,1 e 2mm; Tipo c - 2,1 e 3mm; Tipo d - maior que 3,1mm. Foram analisadas 200 hemimandíbulas no Grupo FLP e 100 no Grupo Controle. Os resultados mostraram que não houve diferença entre os grupos quanto a classificação das mandíbulas segunda a profundidade da fossa, sendo o grupo b o mais prevalente, mas houve diferença em relação a angulação e a altura da mandíbula . Também foi notada uma relação entre a altura da mandíbula e a sua angulação em ambos os grupos. Assim, pode ser observada a grande variação morfológica dessa região, tanto para o grupo com fissura labiopalatina, quanto para o grupo controle.
The relationship between a mandibular anatomy and an occurrence of an undesirable jaw fracture in a sagittal osteotomy is the subject of the studies. The literature shows an existence of different anatomical conformations of the mandible, but there are no studies on the area directed to individuals with cleft lip and palate. There are not in the literature, studies that show a prevalence of mandibular types and the relation of these anatomical variations with orthognathic surgery implications. The objective of the present study was evaluate the morphology of the region between the first and second lower molars and analyze the prevalence of mandibular types within each sample group. Analyzes and measurements of the CT scans were performed bilaterally on Class III patients with unilateral cleft lip and palate (CLP Group) submitted to orthognathic surgery for mandibular retreatment at the Hospital for Rehabilitation of Craniofacial Anomalies and Class III individuals, without Fissure (Control Group) of the database of the Department of Stomatology of the Faculty of Dentistry of Bauru. Two linear measurements and one angular measurement were performed. The half of mandibles were classified according to the depth of the mandibular fossa in: Type a - 0 and 1mm; Type b - 1.1 and 2mm; Type c - 2.1 and 3 mm; Type d - greater than 3.1mm. Two hundred half of mandibles were analyzed in the CLP Group and 100 in the Control Group. The results showed that there was no difference between the groups regarding the classification of the mandibles according to the depth of the fossa, being group b the most prevalent, but there was difference in relation to the angulation and the height of the mandible. It was also noted a relationship between the height of the mandible and its angulation in both groups. Thus, the great anatomical variation of this region can be observed, both for the group with fissure and for the group without fissure.

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15

Moraes, Rogerio Bonfante. "Efeitos do bloqueador de canais de cálcio amlodipina na reparação óssea em defeito cirúrgico no ramo mandibular de ratos." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/23/23149/tde-24102009-114756/.

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Os anti-hipertensivos bloqueadores de canais de cálcio, por interferirem no transporte de cálcio através das membranas celulares, podem afetar muitos processos metabólicos, incluindo o metabolismo ósseo. O objetivo deste estudo foi avaliar, de forma radiográfica, histológica e bioquímica, os efeitos do bloqueador de canais de cálcio amlodipina no processo de reparo de um defeito ósseo, simulando fratura, no ramo mandibular de ratos. Foram utilizados 50 ratos machos Wistar, que foram submetidos ao mesmo procedimento cirúrgico unilateral simulando fratura mandibular, e distribuídos em dois grupos de 25 animais: grupo experimental, que receberam amlodipina, via oral, na dosagem de 0,04 mg / rato / dia, iniciando 12 dias antes do procedimento e continuando até o sacrifício; grupo controle, que permaneceu não tratado. Os animais foram sacrificados nos períodos de 1, 7, 14, 30 e 90 dias pós-operatórios. Foram realizados testes bioquímicos de fosfatase alcalina e cálcio séricos. Exame radiográfico foi obtido para mensuração da área radiolúcida do defeito ósseo. O estudo histológico compreendeu a análise descritiva do processo de reparo ósseo e a avaliação histomorfométrica da quantidade de osso neoformado. Os valores numéricos foram submetidos a análises estatísticas. A análise radiográfica demonstrou maior área radiolúcida no interior do defeito ósseo para o grupo experimental, nos períodos de 14 (p=0,016), 30 (p=0,009) e 90 (p=0,028) dias. Na análise histológica não se observaram atrasos no processo de reparo ósseo para ambos os grupos. Porém, na análise histomorfométrica, o grupo da amlodipina apresentou redução significante do volume de osso neoformado nos períodos de 7 e 14 dias (p=0,049), não havendo diferenças significativas no período de 30 dias. Houve redução significante nos níveis de fosfatase alcalina para o grupo da amlodipina nos períodos iniciais (p=0,049). Não houve alterações para os níveis de cálcio sérico. Concluiu-se que o uso crônico da amlodipina prejudicou a neoformação óssea no processo de reparo do defeito cirúrgico no ramo mandibular de ratos, porém não impediu a consolidação da fratura.
Antihypertensive, calcium channel blockers, which interfere on calcium transport across the cell membrane, may affect many metabolic processes, including bone metabolism. The aim of this study was to evaluate by radiographic, histologic and biochemical analyses the effects of calcium channel blocker amlodipine on bone healing of a defect simulating a fracture in mandibular ramus of rats. Fifty male Wistar rats were used, and submitted to the same unilateral surgical procedure simulating a mandibular fracture, distributed into two groups of 25 animals: experimental group, which received oral doses of 0.04 mg / rat / day starting 12 days before of procedure and continuing until sacrifice; control group, which remained untreated. Animals were sacrificed at 1, 7, 14, 30 and 90 days postoperatively. Blood biochemical tests of alkaline phosphatase and serum calcium were made. Radiographic examination was obtained in order to mensurate the radiolucent area of bone defect. Histological study comprised descriptive analysis of bone healing and histomorphometric analysis of the amount of newly formed bone. Numerical values were submitted to statistical analyses. Radiographic analysis showed larger radiolucent area into bone defect to the experimental group at the periods of 14 (p=0.016), 30 (p=0.009) and 90 (p=0.028) days. In the histological analysis there was no delay in the bone repair stages in both groups. However, in the histomorphometric analysis, the experimental group presented significative lowering of newly formed bone volume at 7 and 14 days periods (p=0.049), with no significant differences at 30 days period. There was significative decrease of alkaline phosphatase levels in experimental group in the initial periods (p=0.049). There was no change in the serum calcium levels. It was concluded that chronic use of amlodipine compromised bone neoformation in the repairing process of surgical defect in the mandibular ramus of rats, but no precluded occurrence of fracture consolidation.

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16

Cunha, Giovanni. "Influência da anatomia óssea no padrão de separação da osteotomia sagital do ramo mandibular /." Araraquara, 2018. http://hdl.handle.net/11449/153297.

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Orientador: Marisa Aparecida Cabrini Gabrielli
Resumo: Este estudo avaliou o padrão da separação da osteotomia sagital do ramo mandibular, sob o aspecto lingual e a influência da espessura óssea correlacionando a esse padrão. Para tanto, foram selecionadas tomografias pré e pós-operatórias de 31 pacientes com deformidade dento-esquelética facial que haviam sido submetidos a tratamento ortodôntico-cirúrgico para correção de deformidade facial dento-esquelética. As tomografias foram analisadas utilizando o software Dolphin 3D 11.8. Foram avaliadas 62 osteotomias sagitais do ramo mandibular (OSRM). Nos exames tomográficos pré-operatórios foram consideradas 4 medidas de espessura no sentido vestíbulo lingual, em áreas pré determinadas da osteotomia: Região A - 1,5mm acima da língula mandibular, Região B - 1mm distante da borda anterior de ramo (Região A e B na altura da osteotomia medial), Região C - 5mm distalmente ao segundo molar e 5mm a partir da borda superior (região retromolar) Região D - região de entre as raízes distal e mesial do 1º e 2º molares inferiores, distando 5 mm da base inferior da mandíbula. Nos exames pós-operatórios, foi analisado o padrão de fratura gerada, classificado em padrão I, II, III ou IV, conforme classificação de Plooij et al. Os dados coletados foram analisados pelo teste estatístico de Kruskal-Wallis seguido do pós-teste de Dunn. Foram encontradas 35 fraturas com padrão tipo I; 01 fratura padrão tipo II; 19 do padrão tipo III e 07 fraturas de padrão tipo IV. O padrão I obteve as maiores médias de es... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: This study evaluates the split pattern after sagittal split ramus osteotomy and its correlation with the bone thickness. Pre and postoperative computed tomographies of 31 patients submitted to orthognathic surgery for corrections of dentofacial deformities were used in the study. Dicom images were analyzed using the software Dolphin 3D 11.8. In the preoperative tomographies 4 thickness measurements were considered: A - 1.5 mm above the lingula. B - 1mm from the anterior border of the ramus (A and B points at the height of the medial osteotomy cut). C - 5mm distally to the second molar and 5mm from the upper border of the mandible (retromolar region) D - In the region between the mesial and distal roots of the first and second mandibular molars. In the postoperative tomographies the exams were analyzed and classified according to the fracture pattern described in the literature, where I (true Hunsuk), II (posterior cortical of the branch), III (through the mandibular canal) and IV (bad split). The data were analyzed by the Kruskal-Wallis test followed by the Dunn post-test. Results showed 35 type I fractures, 01 type II fracture, 19 type III fractures and 07 type IV fractures. Type I presented the highest thickness average values for the four considered measurements, whereas type IV presented the lowest values for all measurements. The variable bone thickness was statistically significant only for point A, when the types I and IV were compared. Results allowed to conclude that... (Complete abstract click electronic access below)
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17

Salmen, Fued Samir [UNESP]. "Comparação entre iniciar a cirurgia pela mandíbula ou pela maxila na correção do excesso maxilar vertical: estudo retrospectivo." Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/148865.

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O objetivo deste estudo retrospectivo foi avaliar a precisão de procedimentos bimaxilares realizados para correção de excesso maxilar vertical, quando a cirurgia é iniciada pelo reposicionamento mandibular ou pelo reposicionamento maxilar. Foram incluídos no estudo 32 prontuários de pacientes, divididos em dois grupos de dezesseis. O primeiro grupo (Grupo 1) de pacientes foi submetido a cirurgia bimaxilar com a sequência clássica do procedimento, no qual a maxila foi reposicionada primeiro que a mandíbula. O segundo grupo (Grupo 2) de pacientes sofreu alteração desta sequência, na qual a mandíbula foi reposicionada primeiro que a maxila. A mensuração para determinar a precisão do reposicionamento dos maxilares foi realizada por sobreposição, pela base do crânio, os traçados obtidos de uma telerradiografia lateral realizada com, no máximo, 30 dias de pós-operatório e os traçados de planejamento. A análise estatística foi realizada utilizando o teste t pareado para verificar a diferença entre os valores previstos e os obtidos em cada grupo. O teste t de Student para amostras independentes foi utilizado para comparar o erro de previsão entre os dois grupos. Na amostra estudada, ambas as sequências operatórias permitiram precisão satisfatória. O erro de previsão para as variáveis incisal do incisivo superior (IIS), Ponto A e cúspide mesiovestibular do molar inferior (6i Oclusal), no sentido vertical, foi maior para o Grupo 2, quando comparado ao Grupo 1. O erro de previsão no sentido vertical para o Pogônio (P) foi menor quando a cirurgia foi iniciada pela mandíbula. Em conclusão, embora ambas as sequências cirúrgicas possam ser utilizadas, iniciar a cirurgia pela mandíbula provocou maior imprecisão em relação ao traçado preditivo do que iniciar a cirurgia pela maxila. A sequência clássica, reposicionando a maxila primeiro, resultou em maior precisão no reposicionamento vertical do ponto A, bem como da incisal do incisivo superior e, portanto, da maxila, do ponto de vista estético. Iniciar a cirurgia pela mandíbula permitiu maior precisão na posição vertical do pogônio.
This study aims to evaluate the precision of bimaxillary surgery performed to correct vertical maxillary excess, when the procedure is sequenced by mandibular surgery first or maxillary surgery first. Thirty-two patients were included in this retrospective study, divided into two groups. The first group was composed by patients who received bimaxillary surgery following the classic sequence of repositioning the maxilla first. In the second group patients received bimaxillary surgery by operating the mandible first. The data were tabulated and statistically analyzed. Precision of the maxillo-mandibular repositioning was measured by superimposing, through the cranial base, digital postoperative tracings taken at a maximum of 30 days after surgery to the prediction tracings. The paired t test was used to determine the difference between predicted and obtained values for each group. The Student’s t test for independent samples was applied to compare the prediction error between groups. In this sample, both surgical sequences provided adequate clinical accuracy. The classical sequence, repositioning the maxilla first, resulted in greater accuracy of A point, lower first molar and incisor edge vertical position. Repositioning the mandible first allowed greater precision in the vertical position of pogonion. In conclusion, although both surgical sequences may be used, repositioning the mandible first will result in greater imprecision in relation to the predictive tracing, than repositioning the maxilla first. The classical sequence resulted in greater accuracy in the vertical position of the maxilla, which is key for esthetics. Repositioning the mandible first allowed greater accuracy for the vertical position of pogonion.

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18

Salmen, Fued Samir. "Comparação entre iniciar a cirurgia pela mandíbula ou pela maxila na correção do excesso maxilar vertical : estudo retrospectivo /." Araraquara, 2017. http://hdl.handle.net/11449/148865.

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Orientador: Mario Francisco Real [UNESP] Gabrielli
Resumo: O objetivo deste estudo retrospectivo foi avaliar a precisão de procedimentos bimaxilares realizados para correção de excesso maxilar vertical, quando a cirurgia é iniciada pelo reposicionamento mandibular ou pelo reposicionamento maxilar. Foram incluídos no estudo 32 prontuários de pacientes, divididos em dois grupos de dezesseis. O primeiro grupo (Grupo 1) de pacientes foi submetido a cirurgia bimaxilar com a sequência clássica do procedimento, no qual a maxila foi reposicionada primeiro que a mandíbula. O segundo grupo (Grupo 2) de pacientes sofreu alteração desta sequência, na qual a mandíbula foi reposicionada primeiro que a maxila. A mensuração para determinar a precisão do reposicionamento dos maxilares foi realizada por sobreposição, pela base do crânio, os traçados obtidos de uma telerradiografia lateral realizada com, no máximo, 30 dias de pós-operatório e os traçados de planejamento. A análise estatística foi realizada utilizando o teste t pareado para verificar a diferença entre os valores previstos e os obtidos em cada grupo. O teste t de Student para amostras independentes foi utilizado para comparar o erro de previsão entre os dois grupos. Na amostra estudada, ambas as sequências operatórias permitiram precisão satisfatória. O erro de previsão para as variáveis incisal do incisivo superior (IIS), Ponto A e cúspide mesiovestibular do molar inferior (6i Oclusal), no sentido vertical, foi maior para o Grupo 2, quando comparado ao Grupo 1. O erro de previsão no sen... (Resumo completo, clicar acesso eletrônico abaixo)
This study aims to evaluate the precision of bimaxillary surgery performed to correct vertical maxillary excess, when the procedure is sequenced by mandibular surgery first or maxillary surgery first. Thirty-two patients were included in this retrospective study, divided into two groups. The first group was composed by patients who received bimaxillary surgery following the classic sequence of repositioning the maxilla first. In the second group patients received bimaxillary surgery by operating the mandible first. The data were tabulated and statistically analyzed. Precision of the maxillo-mandibular repositioning was measured by superimposing, through the cranial base, digital postoperative tracings taken at a maximum of 30 days after surgery to the prediction tracings. The paired t test was used to determine the difference between predicted and obtained values for each group. The Student's t test for independent samples was applied to compare the prediction error between groups. In this sample, both surgical sequences provided adequate clinical accuracy. The classical sequence, repositioning the maxilla first, resulted in greater accuracy of A point, lower first molar and incisor edge vertical position. Repositioning the mandible first allowed greater precision in the vertical position of pogonion. In conclusion, although both surgical sequences may be used, repositioning the mandible first will result in greater imprecision in relation to the predictive tracing, than repositioning the maxilla first. The classical sequence resulted in greater accuracy in the vertical position of the maxilla, which is key for esthetics. Repositioning the mandible first allowed...(Complete abstract electronic access below)
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19

Iamashita, Heric Yukio. "Estudo biomecanico de tres tecnicas diferentes de fixações metalicas utilizadas em osteotomia sagital do ramo mandibular." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/290201.

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Orientadores: Valfrido Antonio Pereira Filho, Luis Augusto Passeri
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Estudos têm proposto diversas técnicas e métodos de fixação interna rígida (FIR) no sentido de se obter maior estabilidade dos segmentos ósseos e mínimo deslocamento condilar após osteotomia sagital do ramo mandibular (OSRM). Desta forma, o presente estudo teve por objetivo avaliar por meio de ensaio mecânico de compressão em hemimandíbulas sintéticas, três diferentes tipos de fixações utilizadas na OSRM em movimento de avanço de 5 mm. Foram utilizadas 30 hemimandíbulas, divididas em 3 grupos com 10 hemimandíbulas em cada. O grupo 1 foi fixado com três parafusos posicionais de 15 mm do sistema 2,0 mm dispostos bicorticalmente na posição de L invertido e com angulação de inserção de 90°; no Grupo 2 a fixação foi realizada com placa de 4 furos do sistema 2,0 mm e 4 parafusos monocorticais de 6 mm de comprimento disposto sobre a região do canal mandibular, e o Grupo 3 a fixação consistiu de uma placa sagital ajustável do sistema 2,0 mm e 8 parafusos de 6,0 mm de comprimento também localizada sobre o canal mandibular. Sendo avaliados quanto à padronização, o sistema de fixação demonstrou semelhança dimensional. As hemimandíbulas foram submetidas a cargas compressivas verticais, por meio de ponta de aplicação de carga em máquina de ensaio universal MTS®, na velocidade de 1 mm/min com deslocamento máximo de 10 mm. Médias e desvios padrão foram obtidos e submetidos à análise de variância a um fator e teste HSD de Tukey com nível de significância de 5%. O Grupo 1 apresentou maiores valores de resistência à força de carga compressiva (p<0,001) sendo superior aos demais grupos. O Grupo 3 demonstrou a menor resistência às forças (p<0,001). Concluiuse que o uso de parafusos bicorticais posicionais em L invertido promove a maior capacidade de resistência às cargas compressivas, sendo que as placas sagitais ajustáveis apresentam-se cerca de 60% menos resistentes do que o Grupo 1.
Abstract: Studies have considered many techniques and methods of rigid internal fixation (RIF) leads to obtain greater stability to the bone segments and minimum displacement of the condyles after performed the sagittal split ramus osteotomy (SSRO). In this way, the purpose of this study was to evaluate by means of mechanical compression testing model with synthetic hemimandibles, three different fixation types used in the SSRO in movement of advance of 5 mm. Thirty hemimandibles, divided in 3 groups with 10 hemimandibles in each group. Group 1 was fixed with three 15 mm positional screws (2.0 mm diameter) bicortically in an inverted-L pattern and with insertion angle of 90°; in Group 2 the fixation was carried through with four-hole straight plate and four 6 mm monocortical screws made located on the region of the mandibular canal, and Group 3 the fixation is consisted of an adjustable sagittal plate and eight 6 mm screws also placed on the mandibular canal. Evaluated for dimensional standardization, the fixation system had demonstrated dimensional similarity. Hemimandibles had been exposed to the vertical compressive loads, by means of tip of load application in a MTS® mechanical testing unit, in the speed of 1 mm/min with maximum displacement of 10 mm. Averages and standard deviations had been obtained and submitted to the analysis of variance to a factor and have tested for HSD of Tukey test with a 5% level of significance. Group 1 presented greaters values of resistance to the compressive loads (p< 0.001) showed superior to the other groups. Group 3 demonstrated the lesser resistance to the loading forces (p< 0.001). It was concluded that the use of positional bicortical screws in inverted-L pattern promotes the higher capacities of resistance to compressive loads, moreover, the adjustable sagittal plates are presented about less resistant 60% that the Group 1.
Mestrado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Mestre em Clínica Odontológica

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20

Costa, Paula Bonfim Almeida. "Avaliação tomográfica do ramo mandibular de indivíduos com diferentes padrões esqueléticos: Contribuição à técnica da osteotomia sagital." Faculdade de Odontologia, 2012. http://repositorio.ufba.br/ri/handle/ri/23420.

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Objetivo: O objetivo deste estudo foi determinar a distância de fusão das corticais látero-mediais do ramo mandibular, superior e posterior à língula, em pacientes com diferentes padrões esqueléticos. Metodologia: Foram utilizadas imagens tomográficas de 120 indivíduos, de ambos os gêneros, na faixa etária entre 18 e 46 anos. A mensuração da distância de fusão das corticais látero-mediais do ramo mandibular foi realizada após a reconstrução tridimensional e multiplanar de um dos lados da mandíbula, utilizando como ponto de referência a junção superior da língula com a face medial do ramo, denominado de ponto “Z”. No corte axial, foi mensurado o término posterior da substância esponjosa, ou seja, a distância de fusão das corticais látero-mediais do ramo mandibular posterior à língula, a partir do ponto Z. E no corte coronal, foi determinado o término superior da substância esponjosa, ou seja, a distância de fusão das corticais látero-mediais do ramo mandibular superior à língula, a partir do ponto Z. A determinação do padrão esquelético no sentido ântero-posterior foi realizada com base na associação dos valores de ANB e WITS, e o padrão esquelético no sentido vertical foi determinado através do ângulo GoGn-SN, ambos mensurados no escanograma dos indivíduos. Resultados: Das 120 imagens tomográficas avaliadas, 60 eram de indivíduos ortognatas, 38 de retrognatas e 22 de prognatas. A média da distância de fusão das corticais látero-mediais do ramo mandibular superior à língula, a partir do ponto Z, foi de 8,23mm, 8,05mm e 5,23mm, no grupo de indivíduos ortognatas, retronatas e prognatas, respectivamente. Em relação à média da distância de fusão das corticais posterior à língula, a partir do ponto Z, foram encontrados os seguintes valores: 10,94mm, 10,39 e 6,29mm, para os ortognatas, retrognatas e prognatas, respectivamente. O teste paramétrico ANOVA revelou que há relação estatisticamente significante entre a distância de fusão das corticais superior e posterior à língula e os diferentes padrões esqueléticos no sentido ântero-posterior (p < 0,001). De acordo com o teste a posteriori de Bonferroni, não houve diferença estatisticamente significante entre os valores encontrados nos padrões ortognata e retrognata. Mas observou-se diferença estatisticamente significante entre os padrões ortognata e prognata, e entre os padrões retrognata e prognata, tanto para a distância de fusão superior, quanto posterior à língula. Em relação ao padrão esquelético no sentido vertical, o teste de correlação de Pearson revelou que há correlação entre o ângulo GoGn-SN e a distância de fusão das corticais superior à língula (r = -0,340; p < 0,01), e também há correlação entre o ângulo GoGn-SN e a distância de fusão posterior à língula (r = -0,318; p < 0,01). Conclusão: A distância de fusão entre as corticais látero-mediais do ramo mandibular superior e posterior à língula é menor nos indivíduos prognatas, quando comparado com os ortognatas e retrognatas, entretanto, não houve diferença estatisticamente significante entre os ortognatas e retrognatas. Há correlação negativa entre o padrão esquelético no sentido vertical (ângulo GoGn-SN) e a distância de fusão das corticais superior e posterior à língula.
Purpose: The purpose of this study was to determine the distance of the point of fusion between lateral and medial cortical plates of the mandibular ramus, above and posterior to the mandibular lingula, in patients with different skeletal patterns. Methodology: It was utilized computed tomography images from 120 individuals of both genders, aged 18 to 46 years. The distance of fusion between lateral and medial cortical plates ramus was measurement after three-dimensional and multiplanar reconstruction of one side of mandibular ramus, using as reference the point top of the lingula with the medial side of mandibular ramus (Point "Z"). In the axial view, was measured the rear end of the cancellous bone, or the distance of fusion between lateral and medial cortical plates ramus, posterior the mandibular lingula, from the point “Z”. In the coronal view, was measured the upper end of the cancellous bone, or the distance of fusion between lateral and medial cortical plates ramus, above the mandibular lingula, from the point “Z”. The determination of anteroposterior skeletal pattern was performed based on the association of values related to ANB and WITS, and the vertical skeletal pattern was based on GoGn-SN angle, both measured in the scout. Results: 60 out of 120 analyzed images were related to individuals with orthognathia, 38 were related to individuals with retrognathia, and 22 related to individuals with prognathism. The average distance of fusion between lateral and medial cortical plates ramus, above the mandibular lingula, from the point “Z”, were 8,23 mm, 8,05 mm and 5,23 mm, in individuals with orthognathia, retrognathia and prognathism, respectively. In relation to the average distance of fusion between lateral and medial cortical plates ramus, posterior the mandibular lingula, from the point “Z”, were 10,94 mm, 10,39 mm and 6,29 mm, in individuals with orthognathia, retrognathia and prognathism, respectively. The parametric test ANOVA revealed that there was a statistically significant relationship between the distance of fusion between lateral and medial cortical plates ramus, above and posterior the mandibular lingula, and the different anteroposterior skeletal patterns (p < 0,001). According to the a posteriori Bonferroni test, there was no statistically significant difference between the values found in individuals with orthognathia and retrognathia. But there was a statistically significant difference between the individuals with orthognathia and prognathism, and between individuals with retrognathia and prognathism, both for the distance of fusion above and posterior the mandibular lingula. Regarding the vertical skeletal pattern, the Pearson correlation test revealed a correlation between the GoGn-SN angle and the distance of fusion between lateral and medial cortical plates ramus above the lingula (r = -0,340; p < 0,01), and correlation between the GoGn-SN angle and the distance of fusion posterior the mandibular lingula (r = -0,318; p < 0,01). Conclusion: The distance of fusion between lateral and medial cortical plates ramus above and posterior the mandibular lingula is smaller in individuals with prognathism compared with individuals with orthognathia and retrognathia, however, there was no statistically significant difference between individuals with orthognathia and retrognathia. There is a negative correlation between the vertical skeletal pattern (GoGn-SN angle) and the distance of fusion of cortical plates ramus above and posterior the mandibular lingula

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Parellada, Insa Héctor. "Localización del foramen mandibular: estudio anatómico mediante tomografía computarizada (TC)." Doctoral thesis, Universitat Internacional de Catalunya, 2012. http://hdl.handle.net/10803/83928.

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Para la mayoría de tratamientos dentales, es efectiva la utilización de técnicas anestésicas de tipo infiltrativo, consiguiendo el bloqueo efectivo del estímulo doloroso en todos los dientes de la arcada superior y del grupo incisivo, canino y premolar de la arcada inferior. Sin embargo, en la zona posterior de la mandíbula, donde se presenta una cortical más gruesa y, además, el nervio alveolar inferior discurre incluido en el grosor del cuerpo de la mandíbula, la técnica anestésica infiltrativa resulta controvertida. En estos casos, el bloqueo del Nervio Alveolar Inferior de tipo troncular se convierte en una maniobra aconsejable para una correcta praxis odontológica. La técnica anestésica convencional se basa en la localización “probable” de la língula a partir de una serie de referencias intra y extraorales para poder ubicar, así, la zona perilocal al foramen mandibular –la más próxima a la entrada del nervio alveolar inferior al canal mandibular- donde se depositará la solución anestésica. Sin embargo, dada la variabilidad individual del foramen mandibular, a pesar de las referencias empleadas para localizar la zona de inoculación de la solución anestésica, el bloqueo puede fracasar o retardarse. Por ello, es importante disponer de métodos y técnicas que nos permitan determinar la ubicación del agujero mandibular de una forma “individualizada” y este ha sido el objetivo principal de nuestro estudio

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Angulo, Asunción Joseph Arnulfo. "Regeneración ósea guiada con injerto en bloque de rama mandibular en maxilar atrófico para tratamiento con implantes dentales." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2021. https://hdl.handle.net/20.500.12672/16511.

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La regeneración ósea guiada (ROG) es un procedimiento quirúrgico cuyo fundamento biológico busca excluir de forma mecánica a todas las células no osteogénicas de los tejidos alrededor de un defecto óseo y así evitar que crezcan, lo que permite que las células osteoprogenitoras derivadas del hueso puedan repoblar la zona del daño óseo. Se presenta el caso clínico de la paciente de iniciales CRTQ de 57 años quién al acudir a la consulta refirió como motivo el querer reponer las piezas dentales del sector anterior, perdidas anteriormente, manifestó que quería someterse a un tratamiento de prótesis fija sin puentes para evitar desgastar sus dientes sanos. Se observó ausencia de varias piezas dentales debido a caries y endodoncias realizadas que fracasaron, lo cual comprometía la función y estética dental. Luego de evaluar los exámenes clínicos, radiográficos y tomográficos la paciente fue diagnosticada con edentulismo parcial en maxilar superior clase Kennedy IV modificación 1 y en maxilar inferior clase Kennedy I. En cuanto al diagnóstico periodontal: Deficiencias de tejido duro y blando debido la atrofia ósea severa en la zona anterior de la maxila lo cual descartaba la posibilidad de colocar implantes dentales en esa zona de la maxila. La paciente fue sometida a una regeneración ósea guiada con dos injertos en bloque obtenidos de la rama mandibular derecha. Resultados: Luego de 6 meses de la intervención quirúrgica, se logró obtener el ancho óseo necesario para poder colocar 3 implantes dentales. Conclusiones: Los resultados sugirieron que el procedimiento de regeneración ósea guiada con injerto en bloque es predecible cuando se respetan los principios biológicos. El injerto en bloque obtenido de rama mandibular presenta menor reabsorción en el tiempo y reduce la morbilidad del paciente. El tiempo de espera para la integración del injerto en bloque es de 4 a 6 meses.

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Giongo, Caroline Comis. "Estimulação transcraniana com corrente contínua na recupração sensorial de pacientes com parestesia do ramo mandibular (V3) : estudo piloto." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/128930.

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A estimulação transcraniana com corrente contínua (ETCC) vem sendo utilizada na reabilitação de diversas patologias que envolvem a disfunção do sistema sensitiva. Apesar disso, a opção para tratamento de parestesias do ramo mandibular nunca foi empregada. Este estudo piloto teve como objetivo avaliar os efeitos da ETCC em pacientes com queixa de parestesia em ramos do nervo mandibular. Seis pacientes com parestesia referida na topografia do ramo alveolar inferior (uni ou bilateral), com sintomas iniciados após cirurgia bucomaxilofacial, receberam 10 sessões de ETCC (2 mA, 20 min). A avaliação sensitiva composta pelo teste de sensibilidade tátil com o estesiômetro Semmes-Weinstein e pelo teste térmico com solução spray -50° C foi realizada previamente ao tratamento e após a quinta e a décima estimulação, em 24 pontos na topografia de inervação do ramo em estudo. Houve melhora significativa na sensibilidade no teste tátil nas regiões hipoestésicas, com a terceira avaliação significativamente diferente da primeira (p-valor= 0,0015), mas não diferente da segunda (p-valor=0,1932). No teste térmico os participantes reconheceram mais pontos gelados com o passar das avaliações (p-valor=0,05). A aplicação de ETCC pareceu melhorar a sensibilidade tátil e térmica, assim como alívio das parestesias decorrentes de cirurgia bucomaxilofacial.
Transcranial direct current stimulation (tDCS) has been used in the rehabilitation of various diseases that involve dysfunction of the sensory system. However, the option for treating the mandibular branch paresthesia has not been already employed. This pilot study aimed to evaluate the effects of tDCS in patients with paresthesia in branches of the mandibular nerve. Six patients had paresthesia of inferior alveolar nerve (unilateral or bilateral) and symptoms that began after maxillofacial surgery. They received 10 sessions of tDCS (2 mA, 20 min). The sensory evaluation was conducted prior to the treatment, after the fifth and after the tenth application in 24 points in the branch innervation of topography study. The evaluation was composed by tactile sensitivity test with the Semmes-Weinstein esthesiometer and thermal test with spray solution -50 ° C. There was significant improvement in the sensitivity during the tactile test in hypoesthesia regions, with the third evaluation significantly different from the first (p-value = 0.0015), but not different from the second evaluation (p-value = 0.1932). In the thermal test, the participants recognized a larger number of cold areas in the course of ratings (p-value = 0.05). The use of tDCS seemed to improve the tactile and thermal sensitivity of paresthesia, as well as the relief of paresthesias caused by oral and maxillofacial surgery.

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Mäckelmann, Julia. "Röntgenologischer Symmetrievergleich der Rami mandibulae sowie der Kondylen bei Kindern und Jugendlichen mit juveniler idiopathischer Arthritis (JIA) /." Hamburg, 2008. http://opac.nebis.ch/cgi-bin/showAbstract.pl?sys=000254046.

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Assis, Gleysson Matias de. "An?lise mec?nica da resist?ncia da fixa??o na osteotomia sagital do ramo ap?s diferentes movimentos de avan?o mandibular: estudo in vitro." PROGRAMA DE P?S-GRADUA??O EM SA?DE COLETIVA, 2017. https://repositorio.ufrn.br/jspui/handle/123456789/22637.

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O objetivo deste trabalho foi de avaliar, atrav?s de um ensaio mec?nico, a resist?ncia da fixa??o na osteotomia sagital do ramo mandibular (OSRM) em tr?s diferentes movimentos de avan?o mandibular, bem como a influ?ncia do movimento associado a rota??o hor?rio do plano mandibular, utilizando miniplacas (4 e 6 elos) e parafusos com 6 mm de comprimento, do sistema 2.0 mm (Egimplan? ). Dois tipos de avan?os foram empregados (6 e 12 mm), utilizando hemimand?bulas de poliuretano com OSRM padronizadas de f?brica, divididos em 5 grupos: G1(Teste 1) - avan?o linear de 6 mm/ 1 placa e 4 parafusos; G2 (Teste 2) - avan?o linear de 12 mm/1 placa e 4 parafusos; G3 (Teste 3)- avan?o linear de 12 mm /2 placas e 8 parafusos; G4 (Teste 4) - avan?o de 12 mm, associado a rota??o hor?ria do plano mandibular(15?) / 1 placa e 4 parafusos; G5 (Teste 5) - avan?o de 12 mm, associado a rota??o hor?rio do plano mandibular(15?)/2 placas e 8 parafusos. As hemimand?bulas foram submetidas a uma carga compressiva vertical na regi?o de primeiro molar e a for?a aplicada, em Newtons, foi registrada nos deslocamentos de 1mm, 5 mm e 10 mm, como tamb?m a for?a m?xima aplicada entre 1 e 10 mm. Utilizando um intervalo de confian?a de 95%, as m?dias de for?a foram obtidas e os grupos foram comparados entre si. Os testes estat?sticos utilizados foram o Kruskal-Wallis* para a an?lise de todos os grupos e o de Mann-Whitney** para o comparativo de dois grupos em separado. Os resultados mostraram que o grupo G3 apresentou m?dias de for?a maiores (p < 0,001*), sendo, portanto, o mais resistente entre os grupos. Quando foi utilizado apenas 1 placa para a fixa??o da hemimandibula, no avan?o de 12 mm, a realiza??o da rota??o hor?ria foi mais resistente do que no movimento linear, nos deslocamentos de 1, 5 e 10 mm (p< 0,05**), n?o resultando em diferen?a estat?stica apenas no deslocamento m?ximo (p= 0,112**). Em um grande avan?o (12mm) houve uma perda de resist?ncia importante na fixa??o, sendo necess?rio compensar essa situa??o com uso de mais fixa??o e a rota??o hor?rio nesses casos tamb?m acrescentaram resist?ncia na OSRM, apenas nos casos em que se utiliza uma ?nica placa.
The objective of this study was to evaluate by means of mechanical testing the fixation strength in sagittal split ramus osteotomy (SSRO) for three different movements of mandibular advancement, as well as the influence of movement associated with clockwise rotation of the mandibular plane, using miniplates (4 and 6 holes) and 6-mm screws of the 2.0 mm system (Engimplan?). Two types of advancement were employed (6 and 12 mm) using polyurethane hemimandibles with factory-standardized SSO, divided into five groups: G1 (test 1) ? linear advancement of 6 mm/1 plate and 4 screws; G2 (test 2) ? linear advancement of 12 mm/1 plate and 4 screws; G3 (test 3) ? linear advancement of 12 mm/2 plates and 8 screws; G4 (test 4) ? advancement of 12 mm associated with clockwise rotation of the mandibular plane (15?)/1 plate and 4 screws; G5 (test 5) ? advancement of 12 mm associated with clockwise rotation of the mandibular plane (15?)/2 plates and 8 screws. The hemimandibles were submitted to a vertical compressive load in the region of the first molar and the force applied (in Newton) was recorded for displacements of 1, 5 and 10 mm, as was the maximum force applied between 1 and 10 mm. Using a 95% confidence interval, the mean force values were obtained and compared between groups. The Kruskal-Wallis* test was used for analysis of all groups and the Mann-Whitney** test for the comparison of two groups. The results showed higher mean force values for G3 (p < 0.001*), which was therefore the treatment that provided the greatest strength. When only 1 plate was used for fixation of the hemimandible, in the advancement of 12 mm, clockwise rotation resulted in a greater fixation strength than the linear movement for displacements of 1, 5 and 10 mm (p < 0.05**), with no significant difference being observed only for the maximum displacement (p = 0.112**). Important loss of strength in fixation was observed for the large advancement (12 mm) and it was necessary to compensate this situation with the use of more fixation. Clockwise rotation added strength to the SSO only in cases in which a single plate was used.

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Brasileiro, Bernardo Ferreira. "Avaliação biomecanica in vitro de tecnicas de fixação rigida metalica para osteotomia sagital do ramo mandibular em movimentos de avanço e recuo." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289676.

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Orientador: Luis Augusto Passeri
Tese doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Um melhor entendimento biomecânico da fixação interna rígida (FIR) na osteotomia sagital dos ramos mandibulares (OSRM) pode ser baseado em pesquisas com o intuito de investigar sua função in vitro antes da aplicação clínica. Assim, este trabalho teve como objetivo avaliar comparativamente a resistência de três diferentes técnicas de FIR em réplicas de hemimandíbulas humanas de poliuretano simulando a OSRM para movimentos de 5 mm em avanço e recuo. As técnicas de FIR incluíram uma miniplaca ponte com 4 furos e 4 parafusos monocorticais (grupo miniplaca), uma miniplaca com 4 furos e 4 parafusos monocorticais mais um parafuso bicortical posicional (grupo híbrido) e 3 parafusos bicortical posicionais em configuração em ¿L¿ invertido (grupo ¿L¿ invertido). Os parafusos e as miniplacas utilizados eram de titânio e pertencentes ao sistema de 2,0 mm. Estes foram avaliados quanto à padronização dimensional por meio do coeficiente de variação, que evidenciou alta semelhança macroscópica. As hemimandíbulas foram submetidas a testes de carregamento linear vertical e lateral por uma unidade de testes mecânicos Instron 4411 para registro da carga de pico aos deslocamentos de 1 mm, 3 mm, 5 mm e 10 mm. Médias e desvio padrão foram avaliados aplicando-se a Análise de Variância e o teste de Tukey em nível de significância de 5%. O grupo miniplaca apresentou menores valores de carga de pico ao deslocamento (p<0,01) quando comparada com as outras técnicas de fixação considerando-se igual tipo de movimento e direção de carga. O grupo ¿L¿ invertido foi ainda superior em resistência (p<0,01) ao grupo híbrido em movimento de avanço e com aplicação de carga verticalmente. Concluiu-se que a utilização da técnica de FIR para a OSRM baseada em 3 parafusos bicorticais em ¿L¿ invertido foi a mais estável, e que a colocação de um parafuso bicortical pode otimizar significativamente a resistência da fixação com miniplacas e parafusos monocorticais
Abstract: A better understanding of the biomechanics of sagittal split ramus osteotomy (SSRO) rigid internal fixation (RIF) can be based on research aiming to evaluate its function in vitro before clinical application. Thus, the goal of this investigation was to evaluate comparatively the resistance of three different RIF techniques applied to polyurethane synthetic hemi-mandible replicas simulating the SSRO for 5 mm advancement and setback. RIF techniques included a 4-hole miniplate and 4 monocortical screws (miniplate group), a 4-hole plate and 4 monocortical screws with one additional bicortical positional screw (hybrid group), and 3 bicortical positional screws in a traditional inverted-L pattern (inverted-L group). Screws and miniplates were made of titanium and from 2.0 mm system. These were analyzed according to dimensional standardization by a coefficient of variation, which revealed high macroscopic similarity. The hemi-mandibles were submitted lateral and vertical loading tests in an Instron 4411 mechanical testing unit for recording of peak loading at 1 mm, 3 mm, 5 mm and 10 mm of displacement. Means and standard deviation were analyzed using Analysis of Variance and Tukey test with a 5% level of significance. Miniplate group showed lower load peak scores (p<.01) when compared to the others fixation techniques regarding equal type of movement and force direction. Inverted-L group demonstrated higher resistance (p<.01) than hybrid group during advancement and with application of vertical load. It was concluded the RIF technique for SSRO based on 3 bicortical screws in the inverted-L pattern was the most stable, and the installation of a bicortical screw may significantly optimize the resistance of the miniplate and monocortical screws fixation
Doutorado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Doutor em Clínica Odontológica

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Santos, Victor Diniz Borborema dos. "Influ?ncia da altera??o do plano oclusal: magnitude do movimento e tipo de osteoss?ntese na resist?ncia mec?nica da fixa??o na osteotomia sagital do ramo mandibular: estudo in vitro." PROGRAMA DE P?S-GRADUA??O EM SA?DE COLETIVA, 2017. https://repositorio.ufrn.br/jspui/handle/123456789/24086.

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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES)
O objetivo deste trabalho foi avaliar, atrav?s de um ensaio biomec?nico a resist?ncia da fixa??o na osteotomia sagital do ramo mandibular (OSRM) em dois tipos de avan?os (6 e 12 mm), associados ou n?o a rota??o do plano oclusal, utilizando placas e parafusos do sistema 2.0 mm. Foram utilizadas hemimand?bulas de poliuretano, com OSRM padronizadas, divididos em 7 grupos: Avan?o linear de 6 mm / 1 placa e 4 parafusos (G1); avan?o linear de 12 mm/1 placa e 4 parafusos (G2); avan?o linear de 12 mm /2 placas e 8 parafusos (G3); avan?o de 12 mm, associado a rota??o hor?ria do plano oclusal / 1 placa e 4 parafusos (G4); avan?o de 12 mm, associado a rota??o hor?rio do plano oclusal/2 placas e 8 parafusos (G5); avan?o de 12 mm, associado ao giro anti-hor?rio do plano oclusal / 1 placa e 4 parafusos (G6); - avan?o de 12 mm, associado ao giro anti-hor?rio do plano oclusal/2 placas e 8 parafusos (G7). As hemimand?bulas foram submetidas a uma carga compressiva vertical na regi?o de primeiro molar e a for?a aplicada, em Newtons, foi registrada nos deslocamentos de 1mm, 5 mm e 10 mm, bem como tamb?m a for?a m?xima. Utilizando um intervalo de confian?a de 95%, as medianas de for?a foram obtidas e os grupos foram comparados entre si. Os testes estat?sticos utilizados foram o Kruskal-Wallis* para a an?lise de todos os grupos e o de Mann-Whitney** para o comparativo de dois grupos separadamente. Os resultados mostraram que, segundo o teste de Kruskall-Wallis houve diferen?as entre os grupos. Ficou demonstrado que o aumento da magnitude do avan?o mandibular diminuiu a resist?ncia da osteoss?ntese na OSRM quando se utilizou um ?nico dispositivo de fixa??o. A inser??o de uma placa adicional em grandes avan?os (G3, G5 e G7), aumentou significativamente a resist?ncia do m?todo de osteoss?ntese de uma maneira geral, quando comparada aos demais grupos. Em grandes avan?os com modifica??o do plano oclusal fixados com uma ?nica placa (G4 e G6), houve um aumento significativo da resist?ncia da fixa??o apenas no movimento de rota??o hor?ria. A rota??o anti-hor?ria do plano oclusal foi significativamente mais resistente que a hor?ria, quando se utilizou 2 placas na estabiliza??o da OSRM.
The aim of this study was to evaluate the resistance of fixation in the sagittal osteotomy of the mandibular ramus (OSRM) when performing great advances (12 mm), as well as the influence of the movement associated with the anticlockwise/clockwise rotation of the occlusal plane , Using plates and screws of the 2.0 mm system. Two types of advances were used (6 and 12 mm) using polyurethane hemimandibulars, with standardized OSRM, divided into 7 groups: G1 - linear advance of 6 mm / 1 plate and 4 screws; G2 - linear advance of 12 mm / 1 plate and 4 screws; G3 - linear advance of 12 mm / 2 plates and 8 screws; G4 - 12 mm advance, associated with clockwise rotation of the occlusal plane (15 ?) / 1 plate and 4 screws; G5 - 12 mm advance, associated with clockwise rotation of the occlusal plane (15 ?) / 2 plates and 8 screws; G6 - 12 mm advance, associated with anticlockwise rotation of the occlusal plane (15 ?) / 1 plate and 4 screws; G7 - 12 mm advance, associated with the counterclockwise rotation of the plane (15 ?) / 2 plates and 8 screws. The hemimandibules were submitted to a vertical compressive load in the first molar region and the applied force in Newtons was recorded in the displacements of 1mm, 5mm and 10mm, as well as the maximum force applied between 1 and 10mm. Using a 95% confidence interval, the means of strength were obtained and the groups were compared to each other. The statistical tests used were Kruskal-Wallis for the analysis of all groups and the Mann-Whitney test for comparison of two groups separately. The results showed that, according to the Kruskall-Wallis test, there were differences between groups. When only 1 plate was used for the fixation of the hemimandibula, at the 12 mm advance, the clockwise rotation was more resistant than in the linear movement, at the displacements of 1, 5 and 10 mm (p <0.05 **), Not resulting in statistical difference only in the maximum displacement (p = 0.112 **). In a large advance (12mm) there was a significant loss of resistance in the FIR, being necessary to compensate this situation with use of more fixation and the clockwise/counterclockwise rotation in these cases also added resistance in the OSRM, only in cases where a single plate is used. The counter-clockwise turn proved to be less sturdy than the clockwise rotation when fixed with one plate and more resistant when fixed with 2 plates. Both situations presented statistical significance with p <0.05. In view of these findings, it was concluded that regardless of movement, the fixation with 2 plates considerably increases the resistance to applied force.

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Casagrande, Liliane Cristina Onofre. "Estudo dos pontos anat?micos de refer?ncia para osteotomia sagital do ramo mandibular com tomografia computadorizada de feixe c?nico e software Dolphin*." Pontif?cia Universidade Cat?lica do Rio Grande do Sul, 2017. http://tede2.pucrs.br/tede2/handle/tede/7553.

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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES
The sagittal split ramus osteotomy is widely used for the surgical correction of den-tofacial deformities. The techniques historical development began with Hugo Obwer-geser in 1957. The relentless proposals for alterations of the sagittal split ramus oste-otomy technique originated with the intention of administering and minimizing the var-ious trans and pos-operative complications that happened during the performance of this procedure. As this is a technique usually employed with young healthy patients, the rates of complications must be controlled and the possible factors of confusion must be detected and corrected. The present study had the purpose of identifying mandibular anatomical points, using cone beam computed tomography, and ana-lise their relation with areas and structures that are important for surgical planing, in the exams of patients with retrognathism, prognathism and with a balanced maxillo-mandibular pattern using Dolphin? software. 27 tomographic patient images were dis-tributed into the three groups and were evaluated. Significant statisti-cal diferences were found between the three evaluated deformities and between men and women. However, the mandibular canal had a greater distance to the vestibular cortical plate in the points between the distal root of the first molar and de distal root of the second molar, and was closer to the lingual plate in the region between 1M and 2M, in all three classes.
A osteotomia sagital do ramo mandibular ? amplamente utilizada para a corre??o cir?rgica das deformidades dentais e esquel?ticas. O desenvolvimento hist?rico da t?cnica iniciou com Hugo Obwegeser, em 1957. As incans?veis propostas de altera??o da t?cnica de osteotomia sagital do ramo mandibular se originaram com a inten??o de administrar e minimizar as v?rias complica??es trans e p?s-cir?rgicas encontradas durante a realiza??o desse procedimento. Por se tratar de uma t?cnica usualmente utilizada em pacientes jovens e saud?veis, as taxas de complica??es devem ser controladas e os poss?veis fatores de confus?o devem ser detectados e corrigidos. O presente estudo teve como objetivo identificar pontos anat?micos mandibulares, utilizando tomografias computadorizadas de feixe c?nico (TCFC), e analisar sua rela??o com ?reas e estruturas importantes para o planejamento cir?rgico, em exames de pacientes portadores de oclus?o dent?ria classe I, II ou III utilizando o software Dolphin?. Foram avaliadas as imagens tomogr?ficas de 27 pacientes distribu?dos entre os tr?s grupos. Foram encontradas diferen?as estatisticamente significantes entre as tr?s deformidades avaliadas entre os sexo feminino e masculino. Entretanto, o canal mandibular esteve mais afastado da placa cortical vestibular nos pontos entre a raiz distal do primeiro molar e a raiz distal do segundo molar, e mais pr?ximo da placa lingual na regi?o entre 1M e 2M, nas tr?s classes.

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Guimarães, Filho Rubens. "Comparação da resistencia mecanica a flexão da fixação interna rigida atraves do uso de parafusos metalicos e reabsorviveis na osteotomia sagital do ramo mandibular : estudo in vitro." [s.n.], 2003. http://repositorio.unicamp.br/jspui/handle/REPOSIP/288703.

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Orientador : Renato Mazzonetto
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: O propósito deste trabalho foi avaliar a resistência biomecânica a flexão de dois sistemas utilizados para fixação interna rígida. O estudo foi realizado em 20 hemimandíbulas frescas de carneiro, divididos em 2 grupos com 10 hemimandíbulas em cada. Todas as hemimandíbulas foram submetidas a osteotomia sagital do ramo seguindo-se um avanço de 5 mm. As amostras foram mensuradas para se evitar discrepâncias entre as mesmas. O grupo A foi fixado com três parafusos reabsorvíveis de 2,0 x 12 mm (Sionx Implants®, Tampere, Finlândia), inseridos de modo posicional e na configuração de "L" invertido. O mesmo se sucedeu no grupo S, onde foram utilizados parafusos metálicos (Osteomed® CO. Addison, Texas - Estados Unidos), com as mesmas dimensões e forma. Os resultados demonstraram não haver diferenças estatisticamente significantes entre os grupos testados. O sistema reabsorvível testado demonstrou ser uma alternativa viável quando comparado ao sistema metálico
Abstract: The purpose of this study was to evaluate the flexion biomechanical resistance of two internal rigid fixation systems. The study which were mechanically tested in twenty sheep's hemimandibles, divided in two groups of ten in each. All mandibles were subjected to a ramus sagittal split osteotomy, followed by an advancement of 5 mm. The samples were measured to avoid discrepancies between them. Group A were fixed by three reabsorbable screws of 2.0 X 12 mm (Bionx Implants®, Tampere, Finland), inserted in positional way and disposed in inverted "L". The same happened in-group B, which were used metallic screws (Osteomed® CO. Addison, Texas - USA), with the same dimensions and design. The results showed no significant statistical difference between the groups. The reabsorbable system tested proved to be a viable alternative when compared to the metallic one
Doutorado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Doutor em Clínica Odontológica

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Salomone, Raquel. "Regeneração do ramo mandibular do nervo facial de ratos após a implantação de células multipotentes do estroma mesenquimal indiferenciadas e diferenciadas in vitro que apresentam fenótipo de células de Schwann." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5143/tde-26112012-112234/.

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INTRODUÇÃO: O nervo facial desempenha um papel importante em diversas funções fisiológicas no organismo, no entanto, distúrbios funcionais desse nervo podem também afetar a psique do indivíduo, provocando mudanças significativas na autoimagem, interferindo no rendimento profissional e piorando a qualidade de vida. Lesões graves do nervo facial (neurotmeses) mesmo quando tratadas precocemente apresentam resultados funcionais pobres. Com a recente descoberta das células-tronco, as células multipotentes do estroma mesenquimal indiferenciadas (CMEMi) ou diferenciadas em células com fenótipo de células de Schwann (CMEMd) podem ser uma alternativa melhor para o tratamento de lesões graves do nervo facial. OBJETIVOS: Avaliar a melhora funcional e histológica do ramo mandibular do nervo facial após neurotmese e implantação das CMEMi e CMEMd. MÉTODOS: Em 48 ratos Wistar realizou-se a neurotmese do ramo mandibular direito do nervo facial com a formação de um hiato de 3mm e a tubulização (conduíte de silicone) da região do nervo lesada. Foram criados quatro grupos de acordo com o método de reparo: conduíte de silicone vazio (grupo A, grupo controle); conduíte de silicone com gel acelular (grupo B); conduíte de silicone com gel acelular e CMEMi (grupo C), e conduíte de silicone com gel acelular e CMEMd (grupo D). Um quinto grupo, grupo N, foi criado a partir de segmentos do nervo normal para a avaliação histológica. Os resultados funcionais foram avaliados com o estudo de condução nervosa e os histológicos por avaliação qualitativa e quantitativa dos segmentos proximais e distais. RESULTADOS: Na avaliação funcional, após 6 semanas, os grupos C e D apresentaram amplitudes maiores que os grupos A e B (p<0,001). O grupo C apresentou duração menor que os grupos A, B e D (p<0,001). Na avaliação qualitativa dos segmentos proximais, houve pouca diferença entre os grupos, já nos segmentos distais, as diferenças dos grupos A e B em relação aos grupos C e D foram bem evidentes, no entanto, em ambos os segmentos, o grupo C foi o que mais se aproximou do nervo normal. Na avaliação histológica quantitativa do segmento proximal, não houve diferença no número total e na densidade axonal entre os grupos (p0,169), somente nos diâmetros axonais dos grupos A e B quando comparados ao nervo normal (p<0,001). No segmento distal, o número e a densidade axonal do grupo C foram maiores que os do grupo A e B (p=0,001) e iguais as do grupo D (p=0,711), porém, em todos os grupos, número e a densidade axonal foram menores que do grupo N (p0,003). Não houve diferença na média dos diâmetros entre os grupos operados (p0,007), somente quando comparados com o grupo N (p<0,001). CONCLUSÕES: As CMEMi assim como as CMEMd beneficiaram a regeneração do ramo mandibular do nervo facial de ratos Wistar, contudo, as CMEMi apresentaram resultados funcionais e histológicos melhores que as CMEMd
INTRODUCTION: Facial nerve performs an important function in different physiological activities in the organism, however, functional disturbances of such nerve may also attack a persons mind, causing expressive changes in their self-image, interfering in professional life and aggravating their quality of life. Severe lesions in the facial nerve (neurotmesis) present poor functional results even when early treated. With recent discovering of the stem cells, undifferentiated multipotent stem cell (uMSC) from mesenchymal stroma or differentiated to Schwann cell-like (dMSC) can be a better perspective to treat severe lesion of the facial nerve. OBJECTIVES: The objective of this study is to evaluate the functional and histological improvement of the mandibular branch after neurotmesis and implantation of the uMSC and dMSC. METHODS: The neurotmesis of the right mandibular branch of the facial nerve with a 3mm gap formation and tubulization (silicone tubing) of the wounded nerve area was performed in 48 Wistar rats. Four groups were divided according to the restoration method: empty silicone tubing (group A, control group); silicone tubing with non-cell gel (group B); silicone tubing with non-cell gel and uMSC (group C) and silicone tubing with non-cell gel and dMSC (group D). A fifth group (N) was created from the normal nerve segments to perform histological evaluation. The nerve conduction study evaluated the functional results; quantity and quality evaluation of the distal and proximal segment evaluated the histological results. RESULTS: After six weeks, regarding functional evaluation, groups C and D presented larger amplitude than groups A and B (p<0.001). Group C presented lesser duration than groups A, B and D (p<0.001). There was little difference among the groups in the quality evaluation of the proximal segments; on the other hand, the differences in groups A and B in relation to groups C and D were quite expressive in the distal segments. However, group C, in both segments, was the one that came closer to the normal nerve. Regarding quantity histological evaluation of the proximal segment, there was no difference in the total number and in the axonal density among the groups (p0.169); there was difference only in the axonal diameters in groups A and B when compared to normal nerve (p<0,001). Regarding distal segment, axonal density and number, in group C, were higher than in group A and B (p=0.001) and the same as in group D (p=0,711), but number and axonal density were lesser than in group N (p0,003). There was no difference in the diameter average among the operated groups (p0.007), when only compared to group N (p<0.001). CONCLUSION: Both uMSC and dMSC benefited regeneration of the mandibular branch of the facial nerve in Wistar rats, although uMSC presented better functional and histological results

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Pereira, Larissa Vilela. "Regeneração do ramo mandibular do nervo facial de ratos após transplante de células-tronco multipotentes de polpa dentária indiferenciadas: comparação com células-tronco multipotentes do estroma mesenquimal de medula óssea indiferenciadas e diferenciadas em Schwann-like." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5143/tde-12092018-102412/.

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INTRODUÇÃO: As lesões traumáticas graves do nervo facial, relativamente frequentes no cotidiano do otorrinolaringologista, mesmo que reparadas com as melhores técnicas microcirúrgicas, apresentam recuperação funcional extremamente limitada acarretando grande impacto na motricidade facial e, consequentemente, na qualidade de vida dos pacientes. OBJETIVOS: Avaliar a recuperação funcional (eletroneuromiografia), histológica (quantitativa e qualitativa) e imunohistoquímica do ramo mandibular do nervo facial de ratos obtidas após autoenxerto combinado a transplante de células-tronco multipotentes de polpa dentária indiferenciadas (CTPD). Seguiu-se comparação com os resultados anteriormente obtidos pelos mesmos pesquisadores e utilizando mesma técnica cirúrgica após transplante de células-tronco de medula óssea indiferenciadas (CTMOi) e diferenciadas em Schwann-like (CTMOd). Realizou-se autoenxerto no ramo mandibular do nervo facial de ratos para reparo de GAP de 5mm provocado por duas neurotmeses sequenciais, reimplantação do próprio fragmento retirado, sendo o mesmo envolvido por tubo de ácido poliglicólico (Grupo A) e preenchido com gel acelular de lâmina basal purificada, com transplante de CTPD (grupo B). Após seis semanas, os animais foram sacrificados e as análises realizadas. RESULTADOS: Observou-se que, seis semanas após a cirurgia, os animais do grupo tratado com células-tronco apresentaram valores médios de amplitude do potencial de ação muscular composto (PAMC) (CTPD 3,79±1,74mV; CTMOd 2,7±0,53mV; CTMOi 1,81±0,77mV) estatisticamente superiores ao grupo controle (0,75±0,46mV, p < 0,001). Os diâmetros axonais médios, também, foram significativamente maiores nos grupos tratados com células-tronco (CTPD 3,04±0,49?m; CTMOd 3,5±0,16?m; CTMOi 3,15±0,32?m) do que no grupo controle (2,13±0,07?m), com valor de p < 0,001. A densidade axonal foi estatisticamente superior no grupo controle (0,021±0,003axônios/um2) quando comparada aos grupos tratados (CTPD 0,014±0,004 axônios/um2; CTMOd 0,017±0,003axônios/?m2; CTMOi 0,015±0,002axônios/um2, p=0,004).Ao ensaio de imunofluorescência, no grupo tratado com CTPD, observou-se células positivas para lamina humana A/C e para S100, evidenciando, assim, a presença de células humanas com fenótipo de Schwann no segmento distal do nervo analisado. No grupo tratado com CTMOi houve marcação em beta-galactosidade, mas não em S100, confirmando a presença de células exógenas, porém não diferenciadas em Schwann. Já no grupo tratado com CTMOd demonstrou a presença de células exógenas com fenótipo de Schwann ao observar a comarcação pelos marcadores beta-galactosidase e S100, mantendo, assim, o mesmo fenótipo do observado in vitro. CONCLUSÃO: Conclui-se que, segundo critérios funcionais e histológicos, a regeneração do ramo mandibular do nervo facial de ratos foi superior quando associada ao transplante de CTPD comparativamente ao controle. O grupo tratado com CTPD apresentou melhores resultados funcionais e parâmetros histológicos similares aos obtidos com CTMOi e CTMOd. Nos três grupos tratados com células-tronco, as células exógenas foram observadas após 6 semanas de experimento, com evidência de integração ao tecido neural e evidência de diferenciação in vivo para o fenótipo de Schwann apenas no grupo tratado com CTPD
INTRODUCTION: Traumatic lesions of the facial nerve, relatively frequent of the daily routine of the otorhinolaryngologist, even if when repaired with the best microsurgical techniques, have limited functional recovery causing great impact on facial motricity, consequently, on patients\' quality of life. OBJECTIVES: The purpose of this study was to evaluate the functional and histological recovery (quantitative and qualitative) and immunohistochemistry of the mandibular branch of the facial nerve of rats obtained after autograft combined with transplantation of multipotent undifferentiated dental pulp stem cells (DPSC). We compared the results obtained previously by the same researchers and using the same surgical technique after transplantation of undifferentiated bone marrow stem cells (uBMSC) and differentiated to Schwann cell-like (dBMSC). METHODS: A 5mm gap in the mandibular branch of the facial nerve was perfomed by two sequencial neurotmesis, followed by autograft with reimplantation of the removed fragment itself, tubulization with a polyglycolic acid tube (Group A) and transplantation with DPSC (group B). After six weeks, the animals were sacrificed and analyzes performed. RESULTS: Six weeks after surgery, the animals in the stem cells group had mean values of the amplitude of the compound muscle action potential (CMAP) (DPSC 3.79±1.74mV; dBMSC 2.7±0,53mV; uBMSC 1.81±0.77mV) statistically higher than the control group (0.75±0.46mV, p < 0.001). Medium axon diameters were also significantly higher in the stem cells treated groups (DPSC 3.04±0.49um, dBMSC 3.5±0.16um, uBMSC 3.15± 0.32um) than in the control group (2.13±0.07um), with a value of p < 0.001. The axonal density was statistically higher in the control group (0.021±0.003axons/um2) when compared to the treated groups (DPSC 0.014±0.004 axons/?m2, dBMSC 0.017±0.003 axons/?m2, uBMSC 0.015±0.002 axons/um2, p=0.004). In the immunofluorescence assay, cells positive for human laminA/C and for S100 were observed in the DPSC-treated group, thus evidencing the presence of human cells with Schwann cells phenotype in the distal segment of the nerve analyzed. In the group treated with uBMSC there was beta- galactosidase, but not in S100, confirming the presence of exogenous but undifferentiated cells. In the group treated with dBMSC, the presence of exogenous cells with Schwann cells phenotype was observed by observing the comarcation by beta-galactosidase and S100 markers, thus maintaining the same phenotype as that observed in vitro. CONCLUSION: According to functional and histological criteria, the regeneration of the mandibular branch of the facial nerve of rats was superior when associated with the DPSC transplant compared to the control. The DPSC treated group had better functional results and histological parameters similar to those obtained with uBMSC and dBMSC. In the stem cells-treated groups, exogenous cells were observed after 6 weeks of experiment with evidence of neural tissue integration and evidence of in vivo differentiation for the Schwann cells phenotype only in the DPSC-treated group

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Marchiori, Érica Cristina 1982. "Neuropathic pain following sagittal split ramus osteotomy of the mandible = prevalence, risk factors and clinical course = Dor neuropática após osteotomia sagital dos ramos mandibulares : prevalência, fatores de risco e curso clínico." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/288761.

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Orientador: Roger William Fernandes Moreira
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Objetivos: Avaliar a prevalência, fatores de risco e curso clínico da dor neuropática (DN) após osteotomia sagital dos ramos mandibulares (OSRM) em uma grande amostra de pacientes. Materiais e Métodos: Estudo retrospectivo realizado em dois centros médicos do Hospital Kaiser Permanente da Norte da Califórnia, no período de janeiro de 2007 até setembro de 2012, nos pacientes submetidos à OSRM. Fatores demográficos, clínicos e cirúrgicos foram identificados nos prontuários dos pacientes, bem como comorbidades associadas. A prevalência, sinais e sintomas, características da dor e a resposta ao tratamento nos pacientes afetados foram analisados. Resultados: Os autores identificaram 1.778 pacientes que foram submetidos à OSRM e, destes, 107 foram excluídos de acordo com critérios pré-definidos. A média de idade dos pacientes (1.671) foi de 24 anos (intervalo interquartil de 19 a 35 anos) e 62,4% eram do gênero feminino. Sete pacientes desenvolveram DN após OSRM, cuja prevalência foi de 0,42%. Todos eles eram mulheres, cuja média de idade foi de 48 anos. Os fatores de risco para o desenvolvimento de DN após OSRM incluíram: idade superior a 40 anos (p = 0.0098), depressão (p = 0.0100), e gênero feminino (p = 0.0497). O inicio da DN ocorreu em uma média de 30 dias de pós-operatório (18 a 56 dias), com média de duração de 52 dias (30 a 69,5 dias). Todos os pacientes responderam favoravelmente à medicações anticonvulsivantes (n = 6) ou antidepressivas tricíclicas (n = 1), além de nenhum dos pacientes ter desenvolvido dor crônica pós-cirúrgica. Conclusões: A dor de origem neuropática é uma complicação infrequente após OSRM, acometendo 1 a cada 238 pacientes nesta amostra. A curta duração e a reposta favorável às medicações empregadas reforça esse achado. Os resultados dessa investigação chamam a atenção para a necessidade de futuros estudos prospectivos para melhor compreensão da DN pós-operatória
Abstract: Purpose: To estimate the prevalence of, risk factors for, and clinical course of neuropathic pain (NPP) after sagittal split ramus osteotomy (SSRO) of the mandible in a large cohort of patients. Materials and Methods: A retrospective cohort of all patients who underwent SSRO at 2 medical centers within Kaiser Permanente Northern California from January 2007 through September 2012 was assembled. Demographic, clinical, and surgical factors were collected from medical records and relevant comorbidities were identified. The prevalence of NPP in the cohort was calculated and the clinical signs, symptoms, temporal characteristics and treatment response in affected patients were noted. Results: The authors identified 1.778 patients who underwent SSRO and excluded 107 patients according to predefined criteria. The remaining 1.671 patients had a median age of 24 years (interquartile range from19 to 35 years) and 62.4% were women. Seven patients developed NPP after SSRO, which was an overall prevalence of 0.42%. All patients with NPP in this cohort were women and had a median age of 48 years. The risk factors for developing NPP after this surgery were age over 40 years (p = 0.0098), depression (p = 0.0100), and female gender (p = 0.0497). NPP developed an average of 30 days postoperatively (range, 18 to 56 days) and persisted for a median duration of 52 days (range, 30 to 69.5 days). All patients responded favorably to anticonvulsant (n = 6) or tricyclic (n = 1) medications, and no patients developed chronic postsurgical pain. Conclusions: NPP was an infrequent complication after SSRO, occurring in 1 of 238 patients in this cohort. The short duration and positive response to medication are reassuring findings. The results of this investigation highlight the need for prospective studies to further understand the spectrum of postoperative NPP
Doutorado
Cirurgia e Traumatologia Buco-Maxilo-Faciais
Doutora em Clínica Odontológica

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Silva, Fátima Cristiana Ferreira da. "Ramo Mandibular Humano como Indicador do Sexo em Adultos." Master's thesis, 2017. https://repositorio-aberto.up.pt/handle/10216/107266.

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Silva, Fátima Cristiana Ferreira da. "Ramo Mandibular Humano como Indicador do Sexo em Adultos." Dissertação, 2017. https://repositorio-aberto.up.pt/handle/10216/107266.

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Yang, Chenjung, and 楊承融. "Biomechanical Analysis Of Fixation Type Of The Mandibular Ramus Fracture." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/63172210350351788991.

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碩士
義守大學
生物醫學工程學系
100
Mandible fractures are the most common injuries of motorcycle injuries. Although wearing a helmet may prevent from head injury, the mandible often has insufficient protection. Miniplate system was usually applied for mandible fracture to restore its original function. Because it was difficult to harvest cadaveric mandible, porcine or sawbone mandible were selected as alternatives but the structure and mechanical properties still varied from human beings. Finite element method became a popular approach, which could save the cost of experiment and simulate the conditions that experiment could not achieve. Thus,this study investigated fixation types of mandible ramus fracture using finite element method. Four different types of plate system, three kinds of plate thickness and three screw diameters were tested. Equivalent stress and displacement of fracture site were observed to evaluate the fixation ability and main effect plot was illustrated to determine the relative importance of the factors. The results showed that all factors have statistically significant in mandible cortical stress. The diameter of the screw was the most important factor in cancellous stress. The displacement of the fracture site was dominated by the types of bone plate.

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Chen, Chun-Ming, and 陳俊明. "Stability after modified vertical ramus osteotomy for correction of mandibular prognathism." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/72016756926864147548.

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碩士
高雄醫學大學
牙醫學研究所
89
Mandibular prognathism is characterized by excessive mandibular growth, which may compromise the masticatory function and facial appearance, and this may distort the personality of the patient. Surgical correction of mandibular prognathism will generally improve both the masticatory function and dentofacial aesthetics. This study was undertaken to examine the factors that might be responsible for skeletal stability occurring during one to two years postoperative mandibular setback. Forty-four patients, treated for absolute mandibular prognathism by modified intraoral bilateral vertical ramus osteotomy, were evaluated cephalometrically at least 1-year postoperatively. A set of 7 standardized lateral cephalograms were obtained from each subject, i.e., preoperative (T1) and immediately postoperative (T2), prior to removing the maxillomandibular fixation (T3), 3 months (T4), 6 months (T5), 1-year (T6) and 2-years postoperative (T7). There were 20 patients who underwent a 2-year follow-up with cephalograms. The mean setback of the menton was 12.3mm in the horizontal direction and 0.8mm downward in the vertical direction. Relapse was defined as forward movement of the menton during the 2-year postoperative period. The average movement for 1-year follow-up (12 of 20 patients) in the horizontal direction was as follows; 4 with 2.1mm (16% = 2.1/13.1) in forward movement and 8 with 1.6mm (12.4% = 1.6/12.9) in backward movement. The average movement during the 1-year follow-up (12 of 20 patients) in the vertical direction was 7 patients with 1.5mm in upward movement and 8 with 0.7mm in downward movement. The average movement during the 2-year follow-up (20 patients) in the horizontal direction was as follows; 14 with 2mm (16.3% = 2/12.3) in forward movement and 5 with 1.4mm (12.1% = 1.4/11.6) in backward movement. The average movement during the 2-year follow-up (20 patients) in the vertical direction was as follows; 11 patients with 1.7mm in upward movement and 8 with 1.2mm in downward movement. The variables included vertical and horizontal Me (T21) distance, Rp-Cut (distance between osteotomy point and the most posterior point of inferior ramus)(T1), and area of the pterygomasseteric sling (Rp-Cut-H ×V-T1) The multiple regression showed that the vertical amount of setback (T21) that predicated the vertical relapse (T72) was significant, whereas no significant correlations were noted between the variables and horizontal relapse (T72). In patients whose distal segments were still in the backward group 2-years postoperaviely, their osteotomy positions were anterior to the forward group. This tell us: the more anterior osteotomy position the more acceptable capacity of the pterygomasseteric sling will be created and this allow the distal segment to setback more without distend the pterygomasseteric sling. These results suggest that this technique can provide greater acceptable capacity for larger amount of distal segment setback and is feasible for the correction of severe mandibular prognathism. Key Words: Postoperative Stability, Mandibular Prognathism Modified Intraoral Vertical Ramus Osteotomy

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Carneiro, Bárbara Maria Marques. "Estimativa forense da idade através da análise radiográfica do ramo mandibular." Master's thesis, 2015. https://repositorio-aberto.up.pt/handle/10216/79202.

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Carneiro, Bárbara Maria Marques. "Estimativa forense da idade através da análise radiográfica do ramo mandibular." Dissertação, 2015. https://repositorio-aberto.up.pt/handle/10216/79202.

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Geldenhuys, Barry. "Bilateral sagittal spilt mandibular ramus osteotomy: The influence of stripping the medial pterygoid muscle on proximal segment control for mandibular advancement procedures." Thesis, 2014.

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Department of Maxillofacial and Oral Surgery, 2013
One of the goals during surgical repositioning of the mandible is to ensure a correct condyle-fossa relationship and to maintain the position of the proximal segment at the time of placement of rigid fixation. During setback procedures, accurate control of the proximal segment is influenced by the medial pterygoid muscle and stylomandibular ligament. These structures are therefore stripped from the medial surface of the mandibular angle during surgery. The aim of this study was to investigate the influence of the muscle attachment on proximal segment control in mandibular advancement surgery. Clockwise or counterclockwise rotations of the proximal segment during surgery of two groups of patients were compared. In one group, the medial pterygoid muscle was stripped during surgery while in the other group the medial pterygoid muscle was left attached. The second group formed part of the historical development phase of the surgical technique for mandibular advancement procedures.

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Beukes, Jacques. "The anatomical dimensions of the mandibular ramus and the presence of third molars: its effect on the sagittal split ramus osteotomy." Thesis, 2012. http://hdl.handle.net/10539/11457.

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Yang, Chieh, and 楊潔. "Frontal and lateral profile changes following mandibular setback surgery with modified intraoral vertical ramus osteotomy." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/76052529562100790975.

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碩士
高雄醫學大學
牙醫學系碩士班
105
Abstract Purpose: Orthodontic treatment combined orthognathic surgery would be the most adequate treatment for the patients with severe Class III skeletal discrepancy, it would not only improve the patients’ profile and also correct their occlusal function. The predictive data about the changes of facial profile and surrounding soft tissue would be an assist in drafting the treatment plan and communication with the patients. This retrospective study using cephalometric radiography combined to evaluate the changes of hard and soft tissue in lower face and commisures of the lips, before and after mandiblular setback using modified intraoral vertical ramus osteotomy (modified IVRO). Material and method: Thirty-one patients (17 females and 14 males; mean age：20.1 years) with mandibular prognathism receiving mandibular setback using modified IVRO were recruited in our institution. Lateral and postero - anterior cephalograms were taken respectively at T1: within a month before surgery; and T2 : longer than 1 year after surgery . All the radiographies with good quality to identify the landmarks of the hard and soft tissues in lower faces and soft tissues around the lips Result: The soft and hard tissue landmarks of the mandible had backward movements along with the setback surgery of mandible in the horizontal direction. The setback ratios of soft tissue/hard tissue, ΔSLI/ΔB, ΔPog’/ΔPog and ΔMe’ /ΔMe were approached to 1 respectively, especial for the ΔMe’ /ΔMe (1.01). Additionally, the lip commisures had backward, downward and medial movement after mandibular setback surgery, and the backward amount of the lip commisures was almost half of that of the mandibular hard and soft tissue. Conclusion: The relationship between the corresponding soft tissue and hard tissue, and the changes of lip commisures after the setback of the mandible with modified IVRO would be a reliable reference basis to establish the treatment plan and patient communication.

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Chen, Hsin-Ju, and 陳歆如. "Soft tissue profile and cheek line changes following mandibular setback with modified intraoral vertical ramus osteotomy." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/28508722601956293404.

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碩士
高雄醫學大學
牙醫學系碩士班
104
Purpose： For the patients with severe Class III skeletal discrepancy , orthodontic treatment combined with orthognathic surgery would be the best choice of treatment. A useful data predicting about the changes of facial proﬁle and surrounding soft tissue would be a great help in setting up a treatment plan and communication with the patients. This retrospective study was an analysis of the changes of the facial proﬁle and surrounding soft tissue after mandiblular setback using modified intraoral vertical ramus osteotomy (modified IVRO). Material and method： Thirty- three patients (20 females and 13 males; mean age：20.6 years) with mandibular prognathism being had mandibular setback using modified IVRO were recruited. Lateral cephalograms were taken at T0: within a month before surgery; T1: 1~2 day(s) after surgery; T2 : longer than 1 year after surgery . All the radiographics had good quality to analyze the changes of the hard tissue, soft tissue profile and cheek line. Result： After the mandibular setback, soft tissue and hard tissue landmark of the mandible had a backward movement along with the mandible in the horizontal direction. The setback ratios of ΔPog’/ΔPog, and ΔMlf /ΔB and ΔLi /ΔL1 were approached to 1, especillay the ΔMlf /ΔB. Additionally, the cheek line in the lateral view had forward movement about 1.22mm (T2-T0). Statisticaly significant difference was noted (p=0.001) Conclusion： The relationship between the corresponding soft tissue and hard tissue after the setback of the mandible with modified IVRO would be a useful information for prediction and establishing treatment plan.

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Silva, Alessandro Costa da. "Correlação tomográfica e topográfica do trajeto anatómico do nervo alveolar inferior e a osteotomia sagital do ramo mandibular." Master's thesis, 2020. http://hdl.handle.net/10400.14/31281.

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Introdução: Este estudo teve por objetivo avaliar a correlação topográfica do trajeto do nervo alveolar inferior com o seu posicionamento intraoperatório após separação dos cotos osteotomizados na osteotomia sagital do ramo mandibular em pacientes com deformidade dentofacial. Materiais e Métodos: Um estudo prospectivo e de secção transversal foi conduzido através da análise de 20 indivíduos portadores de deformidades dentofaciais que foram submetidos a osteotomias sagitais do ramo mandibular bilateralmente. As análises consistiram em medidas da distância do nervo alveolar inferior a córtex óssea lingual e bucal, a mensuração da espessura mandibular, grau de densidade óssea mandibular (unidades de Hounsfield) e a proporção de osso cortical e medular em três locais diferentes. Durante o período intraoperatório, foi analisado o segmento ao qual o nervo permaneceu aderido após a realização da osteotomia sagital do ramo sagital mandibular, e esses dados foram correlacionados. Resultados: A distância medida do canal mandibular à superfície interna do osso cortical vestibular mostrou um valor médio de 2,6 mm no ponto “A” quando o nervo permaneceu aderido ao segmento distal e valor médio de 0,7 mm quando o nervo foi aderido no segmento proximal . Quanto à espessura, o valor médio foi de 11,2 mm no ponto “A”, quando o nervo aderiu nos segmentos distais e 9,8 mm no ponto “A”, quando aderido no segmento proximal. Após a avaliação tomográfica de 40 hemi-mandíbulas, observou-se que houve uma relação significante (p<0,05) entre a espessura do corpo mandibular, e a distância do trajeto do nervo alveolar inferior à córtex vestibular e lingual com a possibilidade de seu encarceramento intra-operatório durante a osteotomia sagital do ramo mandibular. Conclusão: Este estudo concluiu que mandibulas que apresentavam o corpo mandibular estrreito e com a distância do trajeto do nervo alveolar inferior a superfície interna das corticais linguais e vestibulares menores que dois milímetros aumentavam significativamente o risco do encarceramento do nervo alveolar inferior durante a osteotomia sagital do ramo mandibular.
Introduction: This research evaluated the topographic correlation, through computed tomography (CT Scan), of the trajectory of the inferior alveolar nerve with its intraoperative positioning after mandibular sagittal split osteotomy in patients with dentofacial deformities. Material and Methods: A prospective cross-sectional research was carried out through the analysis of twenty CT scans of individuals with dentofacial deformities who underwent mandibular bilateral sagittal split osteotomy (BSSO). The analyzes consisted of measurements of the distance from the inferior alveolar nerve to the lingual and buccal bone cortex, the mandibular thickness measurement, the degree of mandibular bone density (Hounsfield units) and the proportion of cortical and medullary bone in three different locations. During the intraoperative period, the segment to which the nerve remained adhered after performing mandibular sagittal split ramus osteotomy was analyzed, and these data were correlated. Results: The distance measured from the mandibular canal to the internal surface of the buccal cortical bone showed a mean value of 2.6 mm at point “A” when the nerve remained adhered the distal segment and mean value of 0.7 mm when the nerve were adhered in proximal segment. As for the thickness the mean value was 11.2 mm at point “A”, when the nerve adhered in distal segments and 9.8 mm at point “A”, when adhered in proximal segment. In the 40 osteotomies evaluated, the mandibular thickness, distance from the mandibular canal to the buccal cortical bone and distance from the mandibular canal to the lingual cortical bone were observed to be significantly related to the intraoperative position of the inferior alveolar nerve (p<0,05). Conclusion: This study concluded that mandibles that presented a narrow mandibular body and with a reduced distance of the inferior alveolar nerve trajectory to the internal surface of the lingual and vestibular cortical bone less than two millimeters have significantly increased the risk of nerve entrapment during mandibular sagittal split ramus osteotomies.

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44

Oettle, Anna Catherina. "Effects of dental loss and senescence on aspects of adult mandibular morphology in South Africans." Thesis, 2015. http://hdl.handle.net/2263/45986.

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Changes occur to the mandible with dental loss and senescence. However, the influence that these changes have on sex and ancestry estimations remains unclear. The purpose of this study was to investigate the influence of dental loss and senescence on changes in mandibular morphology. The outcome has implications for both forensic anthropology and restorative dentistry. The study sample consisted of 717 mandibles consisting of both male and female South Africans of African (SAA) and European ancestry (SAE). To minimise the effects of variation in dentition amongst sex-ancestry groups, the sample included individuals with a spectrum of tooth loss patterns, namely efficient and inefficient occlusions as well as no occlusions. Dentition was considered efficient when the remaining teeth in occlusion were evenly distributed between the sides. Linear measurements as well as geometric morphometric shape analyses were performed. Shape analyses of the complete mandible were performed on models from digitised landmarks by using a MicroScribe G2. Detailed shape analyses of the ramus and chin area as well as measurements of the cortical thickness at specific sites were executed on images generated by cone beam computed tomography (CBCT). A comprehensive assessment of changes in shape, size and cortical thickness of the mandible with age and dental loss were made. Shape and size differences of the mandible were evaluated for discriminant abilities between sex and ancestry groups. Although most dimensions decreased with tooth loss, the greatest impact was noted in the loss of alveolar bone. The mandibular angle increased minimally in size when a few teeth were lost, but recovered to some extent with further tooth loss. The cortical thicknesses at the mental foramen lingually as well as in the midline in females, were relatively spared with tooth loss. Male individuals of SAA were often the most resilient to tooth loss. In general external linear dimensions were maintained with age despite tooth loss. Conversely, measurements of cortical bone thickness decreased slightly, but could have been influenced by dental loss. The shape of the chin and gonial area was more affected by aging in SAE. The sex and ancestry discriminant ability of the linear dimensions when considered collectively approximated 90%, in general improving further when tooth loss was taken into account. All linear measurements were smaller in females and in general tooth loss accentuated sex differences. SAA exhibited greater dimensions, apart from maximum ramus height, bigonial breadth and cortical thickness at the gonion. The mental tubercles were more prominent than the pogonion in SAE (square chin) and vice versa in individuals of SAA (pointed chin). The gonial area in individuals of African ancestry was broad and more convex and the gonial eversion more prominent with a more upright ramus. Discriminant qualities of the gonial shape for sex in individuals of African ancestry reached 90% within dentition groups. Ramus flexure and chin shape were not found to be useful in sex estimation. In conclusion, this research elucidated the effects of tooth loss and senescence on the morphology of the mandible for the forensic anthropological setting.
Thesis (PhD)--University of Pretoria, 2015.
tm2015
Anatomy
PhD
Unrestricted

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45

Gallardi, Robin. "A Determination of the Accuracy of Cone Beam Computed Tomography and Digital Orthopantomography for the Determination of Bone Quantity in the Mandibular Ramus." Thesis, 2013. http://hdl.handle.net/1807/42844.

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Objective: The purpose of this study was to compare the accuracy of cone beam CT (CBCT) imaging with digital orthopantomograms for determining bone quantity in the mandibular ramus. Methods: Twenty-nine cadaveric mandibles marked bilaterally with three fiducial markers were imaged using both CBCT and digital orthopantomography. After sectioning, four cross sectional measurements were made on the specimens and on the CBCT images. Two corresponding linear measurements were made on the orthopantomograms. Statistical analysis was used to compare the CBCT and orthopantomogram measurements with measurements from the anatomic specimens. Results: CBCT measurements were found to significantly differ from those made on the anatomic specimens (P<0.05). Linear measurements from the orthopantomograms varied by 15.9 percent compared to the anatomic specimens. Conclusion: CBCT and orthopantomogram measurements were significantly different from those of the anatomic specimens suggesting inaccuracies in the radiographic technology or a lack of precision in landmark identification.

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Huang, Chun Yuan, and 黃俊源. "Comparison of the Mandibular Canal in Patients with Normal Jaw Relation, Retrognathism and Prognathism: Relevance to the Sagittal Split Ramus Osteotomy." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/j988b6.

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碩士
長庚大學
顱顏口腔醫學研究所
104
Background/Purpose: The purpose of this study was to determine the position of the mandibular canal in relation to the buccal cortical bone in Chinese patients with the three dentofacial relationships: normal dentition, retrognathism, and prognathism. Methods: Cone-beam computed tomography and lateral cephalograms of patients with normal dentation, retrognathism, and prognathism (n = 32 each group) were reviewed. Measurements of the shortest distance from the outer/buccal edge of the mandibular canal to the inner surface of the buccal cortex, and the distance from the lingula of the ramus to the distal root of the first molar were recorded. One-way ANOVA was performed to compare the three groups. Results: No significant difference was observed between the three groups in the distribution of contact or fusion of the mandibular canal, or in the course of the mandibular canal on the right or left side. When the shortest distance at the lingula on the left side was > 2.1 mm, no instances of contact or fusion were observed. On the right side, 100% of the patients had no contact or fusion when the shortest distance was > 2.7 mm at the lingual. The mandibular canal was nearest the cortical bone at the point halfway between the lingula and the anterior ramus border. Conclusions: The shortest distance from the outer/buccal edge of the mandibular canal to the inner surface of the buccal cortex, measured at the lingual, can predict contact or fusion. During sagittal split ramus osteotomy, surgeons should be very careful at the point halfway between the lingula and the anterior ramus border where the mandibular canal is nearest the cortical bone.

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Wu, Buor-Chang, and 吳伯璋. "Gonial Region Changes After Modified Vertical Ramus Osteotomy for Correction of Mandibular Prognathism and Its Relation to the Stability of the Mandible." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/96228669382938460459.

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碩士
高雄醫學大學
牙醫學研究所
89
Mandibular prognathism due to excessive growth of mandible, varies in facial characteristics and incidences amoung the different ethnic proups. People who are seeking management of mandibular prognathism are usually disturbed by prominent lower third of the face, poor chewing function and psychological factors. In Taiwan, the high incidences and more severely dentofacial deformity in mandibular prognathism was noted and the problem could only be solved by combined orthodontic treatment and surgery. The purpose of this study was to investigate the changes in gonial region and the factors contributing to skeletal stability in mandibular prognathism treated by modified intraoral vertical ramus osteotomy. Thirty-two patients( 9 males and 23 females ), treated for absolute mandibular prognathism by modified intraoral vertical ramus osteotomy, were evaluated cephalometrically at least two-years postoperatively. A set of three standardized lateral cephalograms were obtained from each subject, i.e., preoperative (A), immediately postoperative (B1) and two-years postoperatively (B6). Some cephalometric landmarks were used for evaluating the positional and angular change postoperatively. The results showed that (1). In stability, during the postoperative period, the Me moved forward with 1.9mm in 22 patients( group I ) whose mean setback of Me was 13.96mm, and the relapse was 13.61%. In other group, the Me moved backward with 2.46mm in 10 patients( group II ) whose mean setback of Me was 11.31mm, and the backward instability rate was 21.75%( 2.46/11.31). (2). The Go moved backward with 1.35mm and upward with 1.90mm in group I, the gonial angle increased for 3.69°, and angle between palatal plane and mandibular plane was increased for 5.00°; In group II, the Go moved backward with 1.85mm and upward with 3.32mm , the gonial angle increased for 4.06°, and angle between palatal plane and mandibular plane was increased for 5.22°. Both in group I and II, there was a tread for clockwise rotation of mandibular corpus. The length of pterygomasseteric sling was mild increased due to the backward movement of Go. (3). The displacement of condylar process( forward or backward ) didn’t influence the stability, but the condyle could not return to its original position completely. The position of condyle may be controlled by bone remodeling. (4). The results of multiple regression showed that the postoperative stability was only correlated with amount of mandibular setback, and rotation of mandibualr corpus and amount of displacement of condyle could not influence the stability. The amount of Go backward movement depends on two factors, one is the position of osteotomy site in distal segment, and the other is the position of osteotomy site in distal segment immediately postoperative. The more horizontal distance between Go and osteotomy site, the less tread of posterior movement of Go postoperatively. When the distal segment setback to ideal position of occlusion and the osteotomy site was behind to Go, the more distance between osteotomy site and Go, the more tread of posterior movement of Go postoperatively. But when the osteotomy site was before to Go, we found that the horizontal position of Go postoperatively was unchanged nearly. The pterygomasseteric sling could be lengthened and distorted under the limitation and it has potential to recover the original length and position if the stretch was larger then the upper limitation. In our study, there was no relationship between the stability and positional change of Go postoperatively. But in group II, we found the distance between the Rp and osteotomy site was larger then amount of mandibular setback. We suspected that the backward movement of Me was caused by loosening the pterygomasseteric sling or other else. It needs more study cases for further examination.

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48

Nieblerová, Jiřina. "Zhodnocení stability osteosyntézy po sagitální osteotomii větve dolní čelisti." Doctoral thesis, 2012. http://www.nusl.cz/ntk/nusl-309843.

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Orthognatic surgery deals with congenital and acquired dentoalveolar or skeletal deformities of the face. An unfavourable downward rotation of a mandible and posterior vertical maxillary excess cause an anterior open bite, which is characterized by excessive anterior facial height in the lower third, a gap between the incisors in maximal occlusion and a large mandibular angle. Osteotomy (mainly Le Fort I osteotomy or bilateral sagittal split osteotomy of the mandibular ramus - BSSO), ostectomy or distraction osteogenesis are performed to correct the orthognatic deformities. Osteosynthetic materials based on titanium or bioresorbable materials are used in the form of miniplates with monocortical screws, or bicortical screws are utilized to fix the bony fragments. Stability of the new jaws position is the main criterion for success. Relapse causes a loss of occlusion and consequently functional and aesthetic disorders. Relapse consists of skeletal and dental factors. Skeletal relapse is usually divided into early and long-term relapse. BSSO with counter-clockwise (CCW) rotation of the occlusal plane alone was traditionally considered to be the least stable treatment method. Some authors suggest the use of two miniplates on each side of the osteotomy, but we have not found scientific proof of the...

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"Comparação da resistencia mecanica a flexão da fixação interna rigida atraves do uso de parafusos metalicos e reabsorviveis na osteotomia sagital do ramo mandibular : estudo in vitro." Tese, Biblioteca Digital da Unicamp, 2003. http://libdigi.unicamp.br/document/?code=vtls000293697.

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Chen, Chun-Ming, and 陳俊明. "The research of vertical ramus osteotomy in treatment of mandibular prognathismPart I: Postoperative changes in pharyngeal airway space, tongue dimension, hyoid, and head positions Part II: Intraoperative blood loss, postoperative pain, and sequelae." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/19179595154413200956.

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Abstract:

博士
高雄醫學大學
牙醫學系博士班
104
The research of vertical ramus osteotomy in treatment of mandibular prognathism Part I: Postoperative changes in pharyngeal airway space, tongue dimension, hyoid, and head positions Purpose: To determine the correlation between the pharyngeal airway space and head posture mandibular setback surgery for mandibular prognathism. Materials and Methods: Serial lateral cephalograms of 37 patients (26 women ; 11 men) with mandibular prognathism who underwent intraoral vertical ramus osteotomy (IVRO) were evaluated before (T1), immediately (T2), between 6 weeks and 3 months (T3), and more than 1 year (T4) after surgery. Paired t-tests and Pearson’s correlation analysis were used to evaluate the postoperative changes in all cephalometric parameters, including the mandible, hyoid, head posture (craniocervical angle), and pharyngeal airway space. Results: The mandible and hyoid bone were set back by 12.8 mm and 4.9 respectively, at T2. Furthermore, the hyoid bone showed significant inferior movement of 10.7 mm, with an 8 mm increase in the depth. The upper oropharyngeal airway (UOP) shortened by 4.1 mm, the lower oropharyngeal airway (LOP) by 1.7 mm, the laryngopharyngeal airway by 2 mm. The craniocervical angle showed a significant increase of 2.8 ∘UOP and LOP showed a significant correlation with the craniocervical angle at T2 and T4. Conclusion: Our findings conclude that the oropharyngeal airway space is significantly decreased and correlated with a change in the head posture after mandibular setback surgery. Part II: Intraoperative blood loss, postoperative pain and sequelae Purpose: To investigate the factors affecting intraoperative hemorrhage and postoperative sequelae after orthognathic surgery. Materials and Methods: Eighty patients with mandibular prognathism underwent surgical mandibular setback with intraoral vertical ramus osteotomy (IVRO). The correlation between the blood loss volume and postoperative Visual Analogue Scale (VAS) with the gender, age, and operating time was assessed using the t-test and Spearman rank correlation coefficient. The correlation between the magnitude of mandibular setback with the presence of lip sensation was also assessed. Results: The mean operating time and the mean blood loss volume for men and women were 249.52 min and 229.39 min, and 104.03 mL and 86.12 mL, respectively. The mean VAS in men and women was 3.21 and 2.93, and 1.79 and 1.32 respectively on the first and second postoperative days. There is no gender difference in the operating time, blood loss, VAS, and lip numbness. The magnitude of mandibular setback was not correlated with immediate and long-term postoperative lip numbness. Conclusion: There are no gender differences in the intraoperative hemorrhage and postoperative sequelae (pain, and lip numbness). In addition, symptom wasn’t significantly correlated with the amount of mandibular setback.

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