A expansão rápida da maxila cirurgicamente assistida tornou-se amplamente utilizada e muito aceitável no tratamento da deficiência maxilar de pacientes adolescentes e adultos. Diversas técnicas cirúrgicas foram propostas ao longo dos anos com o objetivo de solucionar este problema de forma eficiente, com estabilidade dos resultados e baixa morbidade. Controvérsias em relação ao procedimento cirúrgico persistem, principalmente relacionadas a quais osteotomias devem ser realizadas para se obter bons resultados. O objetivo deste trabalho foi avaliar os resultados da expansão ortocirúrgica da maxila realizando osteotomias nas paredes laterais da maxila e na sutura palatina mediana. Foram selecionados dezessete pacientes adultos portadores de deficiência transversa maxilar, com média de idade de 24 anos e 8 meses; todos foram submetidos a exames de tomografia computadorizada convencional e moldagens maxilares previamente ao procedimento cirúrgico e após três meses, no mínimo, do término de ativação e estabilização do aparelho expansor. As medidas do pós-cirúrgico foram confrontadas com as do pré-cirúrgico e os resultados foram comparados e analisados estatisticamente. Foi obtida a expansão desejada clinicamente em todos os pacientes. No entanto, a quantidade de expansão na região de molares foi estatisticamente maior nas áreas referentes aos dentes, enquanto que os resultados obtidos referentes aos caninos se mostraram similares nas três regiões maxilares avaliadas. Quando comparadas às regiões de caninos e molares entre si, a expansão intercaninos foi maior na altura dos forames palatinos e o inverso ocorreu nas regiões de processo alveolar e dentária, nas quais a expansão intermolar foi maior. / Several surgical techniques have been proposed over the years for the treatment of maxillary deficiency aiming at correcting it efficiently, with long-lasting results and low morbidity. Surgically assisted rapid maxillary expansion has found wide acceptance for the treatment of maxillary deficiency in both adolescents and adults. Controversy still remains regarding particularly to which osteotomies are to be done in order to achieve satisfactory outcomes. The author reports on the results of the ortho-surgical maxillary expansion with osteotomies of the maxillary lateral walls and midpalatal suture. Seventeen adults with transverse maxillary deficiency had conventional CT scans and maxillary dental models prior to the operation and also after at least three months from the complete activation and stabilization of the expansion device. The measurements made before and after the operation as well as the final results were assessed and statistical analysis performed. All nineteen patients had the amount of expansion which had been planned. However, the amount of expansion in the molar region was shown to be statistically larger at the teeth while the results at the canines was similar in the three maxillary regions. When comparing the canine and molar regions, the intercanine expansion was greater at the palate foramina region and the opposite was observed with greater intermolar expansion within the regions of the alveolar process and dental.

<p>In two prospective, clinical studies the stability of implants and prosthetic constructions were evaluated after three years of loading. In the first study, the implant and the bridge stability of 39 patients with 1-stage bone grafts, were compared to a reference-group of 37 patients who did not need bone grafts. In the second study, 40 patients were randomised to have either 1-stage sinus inlay bloc grafts or 2-stage sinus inlay particulated grafts. </p><p>Implant success in Paper 1, was 75.3% in the study group and 93.1% in the reference group. In Paper 2 implant survival in the 1-stage group was 77.7% and 86.5% in the 2-stage group. Bruxism and post-operative complications, such as unexpected pain, dehiscence and infection were found to be associated with the later loss of implants. </p><p>The volumes of onlay block and inlay particulated bone grafts, after 6 months as evaluated by computed tomography showed the decrease of 49.5% and 47% respectively, although there was a wide range in both groups. </p><p>Using of cutting torque measurements during the placement of implants in grafted and non-grafted jaw bone, showed a significant inverse correlation to the commonly used clinical estimation of jaw bone quality, acc. to Lekholm & Zarb. Significantly lower torque values were recorded in grafted regions when compared to non-grafted. </p><p>It was shown that autogenous bone grafts and implants to the edentulous maxilla, after early high failure rates, showed stable and predictable results after three years. Bruxism was found to be significantly associated with implant failures and initially reduced biomechanical properties was seen in the grafted bone. </p>

In two prospective, clinical studies the stability of implants and prosthetic constructions were evaluated after three years of loading. In the first study, the implant and the bridge stability of 39 patients with 1-stage bone grafts, were compared to a reference-group of 37 patients who did not need bone grafts. In the second study, 40 patients were randomised to have either 1-stage sinus inlay bloc grafts or 2-stage sinus inlay particulated grafts. Implant success in Paper 1, was 75.3% in the study group and 93.1% in the reference group. In Paper 2 implant survival in the 1-stage group was 77.7% and 86.5% in the 2-stage group. Bruxism and post-operative complications, such as unexpected pain, dehiscence and infection were found to be associated with the later loss of implants. The volumes of onlay block and inlay particulated bone grafts, after 6 months as evaluated by computed tomography showed the decrease of 49.5% and 47% respectively, although there was a wide range in both groups. Using of cutting torque measurements during the placement of implants in grafted and non-grafted jaw bone, showed a significant inverse correlation to the commonly used clinical estimation of jaw bone quality, acc. to Lekholm &amp; Zarb. Significantly lower torque values were recorded in grafted regions when compared to non-grafted. It was shown that autogenous bone grafts and implants to the edentulous maxilla, after early high failure rates, showed stable and predictable results after three years. Bruxism was found to be significantly associated with implant failures and initially reduced biomechanical properties was seen in the grafted bone.

Bone grafts and titanium implants are commonly used for surgical/prosthetic rehabilitation of the atrophic edentulous maxilla. The factors which influence bone graft healing and implant integration are not sufficiently understood. The aim of this dissertation was to evaluate autogenous bone grafting and delayed placement of titanium endosteal implants for reconstruction of the atrophic maxilla, including the effects of different patient factors on bone graft healing and integration of titanium implants into grafted bone. A total of 46 patients with severe maxillary atrophy received onlay- (n=35) or interpositional bone grafts (n=11) and 6 mo. later received 341 titanium endosteal implants. All bone grafts were harvested from the iliac crest. All patients received fixed dental bridges and were followed clinically and with radiographical examinations for 3 yr. In Papers I and II, a total of 68 titanium microimplants were placed and retrieved from the bone grafts at various time points for histological analysis of the bone graft-implant interface. Integration was better after 6 mo. healing than placement in conjunction with bone grafting. Implant integration was similar for the two bone-grafting techniques. In Papers III and IV, originally including 29 patients and 222 implants, implant stability was measured with resonance frequency analysis (RFA) at placement, abutment connection, after 6 mo. of loading (III) and after 3 yr. of loading (IV). Ten non-grafted patients measured at the same time points were used as controls (III). RFA showed equal implant stability in grafted bone vs. non-grafted bone (III). Stability did not change from the 6-mo. to the 3-yr. control. Cumulative survival was 90% after 3 yr. (21 implants failed). Thirteen implants were lost prior to loading and 8 during functional loading. The group of failed implants showed a lower primary RFA stability than those that remained stable for 3 yr. All patients received and maintained a fixed dental bridge throughout the study. In Paper V, the graft volume changes (GVC) during the 6-mo. healing period prior to implant placement were studied in 30 patients using computerized tomography. Blood samples were taken from 25 patients in conjunction with bone grafting and were analysed for 13 haematological factors. Bone mineral density (BMD) was measured in 21 patients. Biopsies of the bone grafts were analysed for bone volume fraction (BVF). GVC (loss) was correlated with decreased BMD of the lumbar vertebrae L2-L4. There was no correlation between the haematological factors and GVC. Implant failure was not correlated with BMD, BVF or GVC. This dissertation shows that surgical/prosthetic rehabilitation of the atrophic edentulous maxilla with autogenous iliac crest bone grafts and delayed placement of titanium implants after 6 mo. of graft healing is effective, reproducible and functional. RFA at placement may be able to predict later implant failure.

Thesis (M.S.)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed Oct. 31, 2007). Includes bibliographical references (p. 42-45).

Thesis--University of Oklahoma. / Includes bibliographical references (leaves 111-115).

Made available in DSpace on 2016-08-03T16:31:05Z (GMT). No. of bitstreams: 1 Tatiana Sumie.pdf: 1948093 bytes, checksum: 4f13df329a1650a660e7ff88dd133508 (MD5) Previous issue date: 2006-03-08 / This current study aims at cephalometrically evaluating the skeletal,dental, and soft tissues sagittal and vertical alterations in patients who underwent surgically assisted rapid maxilla expansion. The sample comprised 17 teleradiographs in lateral norm of 17 Brazilian adult subjects, being 6 male subjects and 11 female subjects, with average age of 24 years and 1 month, presenting a severe transverse deficiency of the maxilla. Teleradiographs were taken at the beginning of treatment (T1), after SARME (T2), and after three months in retention with the disjunctive appliance (T3). According to the analysis and discussion of the results achieved, it was seen a clock-wise rotation of both the maxilla and mandible, presenting, as consequence, an increase of the AFAI. After three months in retention therapy, there was a relapse of this behavior. It was also seen an extrusion of the upper incisors, in which was kept during the retention period. During retention, there was also a retrusion of the upper incisors. As for the upper molars, there was an extrusion after expansion, followed by a minor relapse when compared to the effect of the expansion achieved. There was no alteration of the soft tissues regarding the nasal thickness. And, there was a retrusion of the upper and lower lips, and the soft pogonion, following the skeletal part. There was an increase of the nasolabial angle. / O presente estudo teve como objetivos avaliar cefalometricamente as alterações esqueléticas, dentárias e de tecidos moles, no sentido sagital e vertical em pacientes submetidos à expansão rápida da maxila assistida cirurgicamente. A amostra constituiu-se de 51 telerradiografias em norma lateral de 17 pacientes adultos, brasileiros, sendo 6 do sexo masculino e 11 do sexo feminino, com idade média de 24 anos e 1 mês e severa deficiência transversa da maxila. As telerradiografias foram obtidas no início do tratamento (T1), após o procedimento de ERMAC (T2), e após três meses de contenção com o próprio aparelho disjuntor (T3). A partir da análise e discussão dos resultados, observouse rotação da maxila e da mandíbula no sentido horário, havendo, como conseqüência, aumento da AFAI. Após 3 meses de contenção, houve recidiva considerando-se o aumento da AFAI. Houve extrusão dos incisivos superiores, na qual foi mantida no período de contenção. Durante a contenção, houve também retrusão dos incisivos superiores. Considerando-se aos molares superiores, houve extrusão após a expansão, acompanhada de uma recidiva com menor magnitude quando comparada ao efeito da expansão obtida. Não houve alteração dos tecidos moles quanto a espessura nasal e houve retrusão do lábio superior, lábio inferior e pogônio mole, acompanhando a parte esquelética. Houve aumento do ângulo nasolabial.

A expansão rápida da maxila cirurgicamente assistida tornou-se amplamente utilizada e muito aceitável no tratamento da deficiência maxilar de pacientes adolescentes e adultos. Diversas técnicas cirúrgicas foram propostas ao longo dos anos com o objetivo de solucionar este problema de forma eficiente, com estabilidade dos resultados e baixa morbidade. Controvérsias em relação ao procedimento cirúrgico persistem, principalmente relacionadas a quais osteotomias devem ser realizadas para se obter bons resultados. O objetivo deste trabalho foi avaliar os resultados da expansão ortocirúrgica da maxila realizando osteotomias nas paredes laterais da maxila e na sutura palatina mediana. Foram selecionados dezessete pacientes adultos portadores de deficiência transversa maxilar, com média de idade de 24 anos e 8 meses; todos foram submetidos a exames de tomografia computadorizada convencional e moldagens maxilares previamente ao procedimento cirúrgico e após três meses, no mínimo, do término de ativação e estabilização do aparelho expansor. As medidas do pós-cirúrgico foram confrontadas com as do pré-cirúrgico e os resultados foram comparados e analisados estatisticamente. Foi obtida a expansão desejada clinicamente em todos os pacientes. No entanto, a quantidade de expansão na região de molares foi estatisticamente maior nas áreas referentes aos dentes, enquanto que os resultados obtidos referentes aos caninos se mostraram similares nas três regiões maxilares avaliadas. Quando comparadas às regiões de caninos e molares entre si, a expansão intercaninos foi maior na altura dos forames palatinos e o inverso ocorreu nas regiões de processo alveolar e dentária, nas quais a expansão intermolar foi maior. / Several surgical techniques have been proposed over the years for the treatment of maxillary deficiency aiming at correcting it efficiently, with long-lasting results and low morbidity. Surgically assisted rapid maxillary expansion has found wide acceptance for the treatment of maxillary deficiency in both adolescents and adults. Controversy still remains regarding particularly to which osteotomies are to be done in order to achieve satisfactory outcomes. The author reports on the results of the ortho-surgical maxillary expansion with osteotomies of the maxillary lateral walls and midpalatal suture. Seventeen adults with transverse maxillary deficiency had conventional CT scans and maxillary dental models prior to the operation and also after at least three months from the complete activation and stabilization of the expansion device. The measurements made before and after the operation as well as the final results were assessed and statistical analysis performed. All nineteen patients had the amount of expansion which had been planned. However, the amount of expansion in the molar region was shown to be statistically larger at the teeth while the results at the canines was similar in the three maxillary regions. When comparing the canine and molar regions, the intercanine expansion was greater at the palate foramina region and the opposite was observed with greater intermolar expansion within the regions of the alveolar process and dental.

A reabilitação da região anterior com próteses sobre implantes é um procedimento complexo pela quantidade de fatores que devem ser controlados. Nos casos em que o paciente apresenta estruturas anatômicas ou deficiências ósseas na região da prémaxila, que impeçam o ideal posicionamento de todos os implantes possíveis, o clínico deverá escolher entre um planejamento com prótese em cantilever ou fixa convencional. O sucesso clínico de reabilitação com implantes está relacionado, principalmente, pelo modo com que as tensões mecânicas são transferidas do implante para o osso circundante, sem gerar tensões que possam colocar em risco a longevidade dos implantes e próteses. Assim, o objetivo deste estudo foi avaliar, por meio de análise de elementos finitos, a distribuição de cargas em planejamento com implantes na região anterior da maxila em diferentes posições (incisivo central e lateral), conexões (cone morse e hexágono externo), diâmetros (4mm e 3,75mm), comprimentos (8,5mm e 10mm) e material restaurador (metalocerâmica e resina acrílica). Um modelo de maxila foi obtida a partir de um banco de dados e transformada em um modelo tridimensional por meio do software Invesalius v.3.0. O modelo da maxila foi simplificado e considerada a espessura de 2mm de osso cortical. Os modelos dos implantes utilizados foram fornecidos pela empresa em formato virtual. Foram criados modelos de prótese em cantilever com implantes de 4mm de diâmetro na região dos incisivos centrais e prótese fixa convencional com implantes de 3,75mm de diâmetro na região dos incisivos laterais, ambos com conexões de hexágono externo e cone morse, com comprimentos de 8,5 e 10 mm e restaurações em resina acrílica e metalocerâmicas. Os modelos foram simulados aplicando uma carga oblíqua estática de 150 N em 45º em relação ao longo eixo do implante, distribuída no cíngulo dos quatro incisivos, sendo 37,5 N em cada elemento dental. Os implantes, componentes protéticos, copings e subestrutura metálica foram analisados com tensão equivalente Von Mises, porém as tensões perimplantares no osso cortical e na região apical do osso trabecular, foram analisadas por tensões máxima e mínima principais e deformações máxima e mínima principais. O deslocamento também foi considerado em ambos os tipos de restaurações e a análise geral foi feita em todos os modelos tanto qualitativa quanto quantitativamente. Na análise foi observado que a tensão máxima e mínima principal ocorreu sempre no osso cortical, identificando maiores valores na tensão por compressão. Além disso, o planejamento, seja prótese em cantilever ou fixa convencional, comprimento e sistema de conexão, influíram nas tensões do osso cortical, mas não nas deformações do trabecular. As variáveis que mostraram menores tensões principais na estrutura óssea perimplantar foram: prótese em cantilever, conexão cone morse, implantes com comprimento de 8,5mm e restaurações metalocerâmicas. Com relação à tensão equivalente Von Mises, a conexão cone morse apresentou concentração das tensões máximas na união entre o pescoço do implante e pilar, enquanto o hexágono externo concentrou as tensões na subestrutura metálica, plataforma do pilar e roscas do implante. Os modelos em resina acrílica exibiram os maiores valores de deslocamento. Finalmente, todos os modelos apresentaram valores de tensão e deformação dentro dos limites fisiológicos. / Anterior region rehabilitation thorugh implant-supported prosthesis is a complex procedure by the amount of critical factors that must be controlled. In some cases, when patient has bone defects or anatomic structures in the premaxilla, which avoid the ideal number of implant placement, the clinical must choose between a plan with cantilever or conventional fixed prosthesis. The clinical success with implant rehabilitation is mainly related to the way that mechanical stresses are transferred from the implant to surrounding bone without creating overload that will endanger the long life of implants and prostheses. The aim of this study was to assess through finite element analyses the load distribution in planning with implants located at maxilla anterior region with different positions (central and lateral incisor), connection (external hexagon and morse taper), diameter (4mm and 3.75mm), lengths (8.5mm and 10mm), and restorative material (metalloceramic and acrylic resin). A maxilla image was obtained from a database and converted into a three-dimensional model through InVesalius software v.3.0. The model was simplified and considered a cortical bone thickness of 2mm. Implant models were provided by the company in a virtual file. Models with 4mm in diameter cantilever prosthesis at the central incisor area and 3.75mm in diameter conventional fixed prosthesis at the lateral incisor were developed. Both kinds of models had external hexagon and morse taper connections, lengths of 8.5 and 10mm and metalloceramic and acrylic resin restorations. The models were loaded with 150 N at an angle of 45º to the long axis of implant, at the cingulum area and with a magnitude of the force applied on each unit of 37.5 N. Implants, abutments, copings and metallic substructures were analyzed through Von Mises equivalent stress. However, stresses of perimplantar bone, cortical and trabecular bone were analyzed through maximum and minimum principal stresses, and maximum and minimum principal strains. Also, total deformation was regarded in both kinds of restorations and a general analysis was performed on all models qualitatively and quantitatively. The analyses showed that maximum and minimum principal stresses were identified in all models on cortical bone, observing the higher compression stress values. Moreover, the planning, cantilever or conventional fixed prosthesis, length and connection system influenced the principal stresses on cortical bone but not the strains on trabecular bone. The factors that exhibited the lowest principals stresses in peri-implant bone structure were: cantilever prosthesis, morse taper connection, implant length of 8,5mm and metal-ceramic restoration. Regarding Von Mises equivalent stress, morse taper connection showed a maximum concentration stresses located in the joint between the implant neck and abutment, while external hexagon exhibited stress concentration in the metallic structure, abutment and implant screws. The models with acrylic resin restorations showed the highest total deformation. Finally, all stresses and strains observed were found within physiological limits.

O seio maxilar apresenta formato distinto e volume variável entre as pessoas e seu assoalho pode ser encontrado em íntimo contato com as raízes dos dentes posteriores, podendo haver protrusão dessas raízes em seu interior. Tal proximidade é de grande relevância frente aos casos de comunicação bucossinusal em potencial ou pela possibilidade de desenvolvimento de um quadro infeccioso de origem odontogênica, em que esse pode vir a se estender para o interior do seio maxilar. Existe uma ausência de trabalhos na literatura acerca da relação estabelecida entre dentes posteriores e o seio maxilar em pessoas com fissura labiopalatina. O objetivo do presente estudo foi identificar e comparar a relação entre o assoalho do seio maxilar e os ápices radiculares dos dentes posteriores em imagens de tomografia computadorizada de feixe cônico em pessoas sem fissura labiopalatina e com fissura transforame incisivo unilateral e bilateral. Foram avaliados 100 indivíduos sem anomalias craniofaciais e 112 com fissura transforame incisivo unilateral ou bilateral, não sindrômicos, utilizando o programa i-CAT® Vision, onde a relação estabelecida pelas estruturas foi convencionada sendo, tipo 0 ou ausência de contato entre as estruturas, tipo 1 ou relação de íntimo contato entre as estruturas sem protrusão radicular no interior do seio maxilar e tipo 2 ou relação de íntimo contato entre as estruturas com protrusão radicular no interior do seio maxilar. Foi utilizado o teste do qui-quadrado para comparar os achados entre os grupos estudados, considerando valor estatisticamente significante quando p&#x2264; 0,05. Foi avaliada a relação do assoalho do seio maxilar com 1679 dentes, totalizando 3664 raízes onde 1883 (51,3%) foram classificadas como tipo 0, 1456 (39,7%) tipo 1 e 325 (8,8%) do tipo 2. Houve diferença estatisticamente significante para a raiz palatina do dente 18 entre os grupos com fissura unilateral e bilateral (p = 0,011), para a raiz mesiovestibular do dente 18 entre os grupos sem fissura e fissura bilateral (p = 0,046), bem como entre os grupos com fissura unilateral e bilateral (p = 0,016) e para a raiz vestibular do dente 24 entre os grupos sem fissura e com fissura bilateral (p = 0,001). Pessoas com fissura transforame incisivo unilateral e bilateral tendem a apresentar maior ocorrência da raiz vestibular do dente 24 (p = 0,027) e mesiovestibular do dente 16 (p = 0,047) em proximidade com o seio maxilar quando comparadas às pessoas sem fissura. Pessoas com fissura transforame incisivo bilateral tendem a apresentar uma maior ocorrência de proximidade com o seio maxilar das raízes vestibular do dente 24 (p = 0,001) e mesiovestibular do dente 18 (p = 0,046) quando comparados às pessoas sem fissura. A avaliação das raízes dos dentes posteriores por meio de imagens de tomografia computadorizada de feixe cônico e sua relação com o seio maxilar oferecem detalhamento e precisão, contribuindo assim para a elaboração de um diagnóstico e plano de tratamento que visam minimizar os riscos de acidentes e complicações. / The maxillary sinus has a remarkable feature and a variable volume among people where the inferior wall may be found in an intimate relation with the posterior teeth roots protruding or not inside the antrum. This proximity is of great relevance considering a potential oroantral communication or the spreading of an odontogenic infection into the maxillary sinus. There is a lack of evidence into the literature regarding the relationship between posterior teeth roots and the maxillary sinus in non-syndromic complete cleft lip and palate patients. This study aimed to evaluate and compare cone beam computed tomography images regarding the relationship between the posterior teeth roots and the maxillary sinus floor in non-cleft lip and palate patients and non-syndromic complete unilateral and bilateral cleft lip and palate patients. Images were interpreted using the i-CAT® Vision software including 100 noncleft patients and 112 presenting non-syndromic complete unilateral and bilateral cleft lip and palate. The relationship between teeth roots and the maxillary sinus floor was established as type 0 or no contact between these structures, type 1 or close contact without root protrusion into the sinus and type 2 or close contact with root protrusion into the sinus. The chi-square test, considering a statistically significant value where p&#x2264;0,05, was used to compare data between different groups. The sample included 1679 teeth and 3664 roots where 1883 (51,3%) were classified as type 0, 1456 (39,7%) as type 1 and 325 (8,8%) as type 2. There were statistically significant differences for tooth 18 palatine root between both complete cleft lip and palate groups (p = 0,011), for tooth 18 mesiobuccal root between noncleft and the bilateral groups (p = 0,046) and between both complete cleft lip and palate groups (p = 0,016) and for tooth 24 buccal root between non-cleft and the bilateral group (p = 0,001). Complete unilateral and bilateral cleft lip and palate patients presented a higher occurrence when compared with the non-cleft group of the tooth 24 buccal root (p = 0,027) and the tooth 16 mesiobuccal root (p = 0,047) in proximity with the maxillary sinus. Complete bilateral cleft lip and palate patients had a higher occurrence when compared with the non-cleft group of the tooth 24 buccal root (p = 0,001) and the tooth 18 mesiobuccal root (p = 0,046) in proximity with the sinus floor. The posterior teeth roots relationship with the maxillary sinus floor is better depicted and accurate by cone beam computed tomography images that may collaborated for a diagnosis and treatment planning that reduces the risks.