A expansão da maxila cirurgicamente assistida (EMCA) é um procedimento cirúrgico indicado para a correção da atresia maxilar em pacientes que já atingiram a maturação óssea. Os efeitos da EMCA são observados não só nos arcos dentários, maxilas e mandíbula, mas também na cavidade nasal, já que o septo nasal encontra-se localizado no centro do assoalho nasal, apoiado sobre a sutura palatina mediana. O objetivo deste estudo foi identificar a posição do septo nasal antes e após a separação cirúrgica das maxilas e avaliar sua influência na movimentação da maxila do lado que foi deslocado. Foram avaliadas 56 tomografias computadorizadas de feixe cônico (TCFC) adquiridas no tomográfo i-CAT Classic®, com voxel de 0,3mm, de 14 indivíduos submetidos à EMCA nos períodos préoperatório e pós-operatório de 15, 60 e 180 dias. Inicialmente, as imagens pósoperatórias foram visualizadas nas reformatações multiplanares, para identificar a qual maxila, direita ou esquerda, o septo nasal permaneceu ligado após a EMCA. Numa segunda etapa, foram realizadas medidas lineares nas imagens correspondentes aos períodos pré e pósoperatórios. Essas medidas foram realizadas na reformatação axial imediatamente acima do aparelho expansor, de forma padronizada para cada paciente, e consistiram da distância entre uma linha de referência central, que passava na espinha nasal anterior e no centro do forame incisivo, dividindo o paciente em lado direito e esquerdo, até os caninos e molares direitos e esquerdos. O índice kappa intraexaminador foi > 0,9. Para comparar as diferenças entre as médias dos dois grupos (lado ligado ao septo nasal e não ligado ao septo nasal) foi utilizado o teste t. Em 78,6% dos pacientes o septo nasal permaneceu ligado à maxila esquerda e em 21,4%, ligado à maxila direita. Em relação às medidas lineares, tanto na região de caninos como na região de molares, observouse que, no período pré-operatório, não havia diferença entre os lados direito e esquerdo. Após a EMCA, houve diferença estatisticamente significante (p<0,05), observando que houve menor movimentação da maxila a qual o septo nasal permaneceu ligado. Portanto, podese concluir que a expansão maxilar ocorre de forma assimétrica, pois a maxila que permanece ligada ao septo nasal, após a EMCA, movimenta-se menos do que a maxila não ligada ao septo nasal. / The Surgically assisted rapid palatal expansion (SARPE) is a surgical procedure indicated for the correction of maxillary constriction in adult patients. The effects of EMCA are observed not only in dental, maxillary, and mandibular arches, but also in the nasal cavity, since the septum is located in the center of the nasal floor and rests on the median palatine suture. The purpose of this study the position of the nasal septum before and after surgical separation of the maxillary, was to identify and evaluate their influence on the movement of the jaw which remained attached. Fifty six cone beam computed tomography (CBCT) scanner acquired i-CAT Classic, with 0.3 mm voxel. Fourteen individuals submitted to SARPE in the preoperative and postoperative periods of 15, 60, and 180 days which were evaluated. Initially, postoperative images were visualized using multiplanar reformatting to identify which jaw, right or left, the nasal septum remained bound after the SARPE. In a second step, linear measurements in the images corresponding to the pre- and postoperative periods were performed. These measurements were performed in the axial immediately above the expander reformatting, standardized form for each patient, and consisted of the distance from a central reference line, passing the anterior nasal spine and the center of the incisive foramen, dividing the patient\'s right side and left to the canines and molars on the right and left. The intraobserver kappa index was > 0.9. To compare the differences between the means of two groups (side connected to the nasal septum and not connected to the nasal septum) a t test was used. In 78.6% of patients, the nasal septum remained attached to the left maxilla and 21.4% on right jaw. Regarding linear measurements, both in the region of canines as in the molar region, it was observed that, in the preoperative period, there was no difference between the right and left sides. After the SARPE, a statistically significant difference (p < 0.05) was observed, noting that there was less movement of the maxilla which the nasal septum remained connected. Therefore, it can be concluded that the expansion jaw is asymmetrical because the jaw remains on the nasal septum after SARPE and moves less than maxilla not connected to the nasal septum.

Introdução: O diabetes mellitus (DM) é uma doença crônica caracterizada pela hiperglicemia associada a diversas alterações sistêmicas e uma das suas complicações é o processo de reparo ósseo comprometido. Entretanto, ainda não há estudos utilizando análises celulares e biomoleculares que avaliem o processo de reparo ósseo desta desordem metabólica quando associada à expansão rápida da maxila (ERM). Objetivo: O objetivo deste estudo foi avaliar a remodelação óssea e sinalização osteogênica durante a aplicação de mecânica ortodôntica para ERM em ratos diabéticos tipo1- induzidos. Material e Métodos: Cento e cinquenta ratos Wistar, machos, foram divididos aleatoriamente em seis grupos de estudo. Grupos: controle (C, n=30), veículo (V, n=15), diabetes mellitus tipo 1 induzido com estreptozotocina (D, n=30), controle submetido à ERM (Cd, n=30), veículo submetido à ERM (Vd, n=15) e diabetes mellitus tipo 1 induzido com estreptozotocina submetido à ERM (Dd, n=30). Os animais foram eutanasiados aos 3, 7 e 10 dias após ERM . Análises histológicas, mudanças no padrão de expressão gênica e proteica de osteoprotegerina, (OPG), RANK, RANKL, osteonectina (ONC), osteocalcina (OCC), sialoproteína óssea (BSP), osteopontina (OPN) e proteína morfogenética óssea 2 (BMP2), assim como as mudanças no peso corporal, na ingestão de água na glicemia foram avaliadas. A análise da expressão gênica e proteica foram realizadas por qRT-PCR e Western Blotting, respectivamente. Os dados foram submetidos ao teste estatístico ANOVA de duas vias e pós-teste de Tukey (&alpha;= 0,05). Resultados: Histologicamente no grupo Dd foi notado maior reabsorção óssea, com diversas áreas em degradação com ausência de osteoblastos, intensa atividade de reabsorção óssea solapante, presença de osteoclastos, células inflamatórias associada ao comprometimento da formação óssea quando comparado aos grupos D e Cd. Estes resultados foram confirmados também nos achados moleculares, uma vez que algumas sinalização gênicas e proteicas relacionadas a osteogênese foram reduzidas, ao passo que a sinalização osteoclastogênica foi estimulada, principalmente no período inicial de reparo ósseo. No grupo D, o processo de formação ósseo estava atrasado comparado ao grupo C, devido a alteração da expressão dos genes e proteínas que regulam o catabolismo e anabolismo ósseo, haja vista que havia maior presença de tecido ósseo imaturo e maior quantidade de áreas de remodelação ativa até o período mais tardio de estudo. No grupo Cd foi observado remodelação óssea, caracterizada por um tecido desorganizado na região da sutura palatina mediana, com intensas áreas inflamatórias, hemorrágicas e reabsortivas comparado ao grupo C. Contudo, até o período de 10 dias pós abertura da sutura, não foi possível observar o completo preenchimento do gap sutural por tecido ósseo. Estes resultados histológicos foram observados na sinalização de genes e proteínas no grupo Cd, uma vez que estes biomarcadores de formação e reabsorção óssea estavam alterados quando comparados aos grupos C e Dd. Conclusões: O DM alterou a sinalização para o metabolismo ósseo e atrasou o processo de reparo após ERM. Estes resultados reforçam a necessidade de avaliar o status do metabolismo ósseo dos pacientes durante tratamento ortopédico e/ ou ortodôntico, visto que a aplicação destas forças na presença do DM podem promover efeitos indesejáveis. / Background: Diabetes mellitus (DM) is a disease associated with several disorders of health in humans and one of the most important is the jeopardizing of bone formation. However, to the best of our knowledge there is no information about the influence of diabetes on orthodontic and orthopedic treatment at cellular and molecular levels. Objective: The aim of this study was to evaluate bone remodeling process in palatal suture during orthopedic mecanotherapy in rats with type 1-induced diabetes mellitus. Material and Methods: One hundred and fifty Wistar male rats were randomly assigned to six groups. Groups: control (C, n=30), vehicle (B, n=15), type 1-induced diabetes mellitus using streptozotocin (D, n=30), control with RME (C+RME, n=30), vehicle with RME (C+RME, n=15) and type 1-induced diabetes mellitus using streptozotocin with RME (D+RME, n=30). The animals were euthanized at 3, 7 and 10 days after RME. Histologic evaluations, changes in genes and proteins expression of osteoprotegerin (OPG), RANK, RANKL, osteonectin (ONC), osteocalcin (OCC), bone sialoprotein (BSP), osteopontin (OPN) and bone morphognetic protein 2 (BMP2) were evaluated along with the changes in body weight, water intake and glycemic profile. Real-Time RT-PCR and Western Blotting were used to evaluate gene and the protein expression. Data were submitted to statistical analysis using two-way ANOVA followed by Tukey test ( &alpha;= 0,05). Results: On group D+RME it was observed an increased bone resorption, serveral undermining and tissue degradation areas. On the suture gap there were mainly inflammatory and osteoclasts cells associated with compromised bone formation compared to groups D and Cd. These results were observed also in molecular levels, since there were a reduced osteogenesis and an upregulation of osteoclastogenesis, mainly in early period of healing. On group D, bone formation was compromised compared to group C, due to changes on genes and proteins expression which regulates bone metabolism, considering that there was more immature bone and incresead active remodeling areas until late periods. On group Cd it was observed bone remodeling, characterized by desorganized tissue on the gap of midpalatal suture, with intense inflammatory hemorhagic and resorptive areas compared to group C. However until 10 days after RME, on group D the gap was not completely filled with bone tissue. These results were observed on the signaling of molecular biomarkers on group Cd, since they were changed compared to groups C and Dd. Conclusions: DM modify the signaling for bone metabolism and compromise bone repair after RME. During orthopedic and orthodontic treatment is necessary to evaluate metabolism status of subjects, since the application of these forces have been shown to promote undesirable effects mostly when associated with DM.

Introdução: O diabetes mellitus (DM) é uma doença crônica caracterizada pela hiperglicemia associada a diversas alterações sistêmicas e uma das suas complicações é o processo de reparo ósseo comprometido. Entretanto, ainda não há estudos utilizando análises celulares e biomoleculares que avaliem o processo de reparo ósseo desta desordem metabólica quando associada à expansão rápida da maxila (ERM). Objetivo: O objetivo deste estudo foi avaliar a remodelação óssea e sinalização osteogênica durante a aplicação de mecânica ortodôntica para ERM em ratos diabéticos tipo1- induzidos. Material e Métodos: Cento e cinquenta ratos Wistar, machos, foram divididos aleatoriamente em seis grupos de estudo. Grupos: controle (C, n=30), veículo (V, n=15), diabetes mellitus tipo 1 induzido com estreptozotocina (D, n=30), controle submetido à ERM (Cd, n=30), veículo submetido à ERM (Vd, n=15) e diabetes mellitus tipo 1 induzido com estreptozotocina submetido à ERM (Dd, n=30). Os animais foram eutanasiados aos 3, 7 e 10 dias após ERM . Análises histológicas, mudanças no padrão de expressão gênica e proteica de osteoprotegerina, (OPG), RANK, RANKL, osteonectina (ONC), osteocalcina (OCC), sialoproteína óssea (BSP), osteopontina (OPN) e proteína morfogenética óssea 2 (BMP2), assim como as mudanças no peso corporal, na ingestão de água na glicemia foram avaliadas. A análise da expressão gênica e proteica foram realizadas por qRT-PCR e Western Blotting, respectivamente. Os dados foram submetidos ao teste estatístico ANOVA de duas vias e pós-teste de Tukey (&alpha;= 0,05). Resultados: Histologicamente no grupo Dd foi notado maior reabsorção óssea, com diversas áreas em degradação com ausência de osteoblastos, intensa atividade de reabsorção óssea solapante, presença de osteoclastos, células inflamatórias associada ao comprometimento da formação óssea quando comparado aos grupos D e Cd. Estes resultados foram confirmados também nos achados moleculares, uma vez que algumas sinalização gênicas e proteicas relacionadas a osteogênese foram reduzidas, ao passo que a sinalização osteoclastogênica foi estimulada, principalmente no período inicial de reparo ósseo. No grupo D, o processo de formação ósseo estava atrasado comparado ao grupo C, devido a alteração da expressão dos genes e proteínas que regulam o catabolismo e anabolismo ósseo, haja vista que havia maior presença de tecido ósseo imaturo e maior quantidade de áreas de remodelação ativa até o período mais tardio de estudo. No grupo Cd foi observado remodelação óssea, caracterizada por um tecido desorganizado na região da sutura palatina mediana, com intensas áreas inflamatórias, hemorrágicas e reabsortivas comparado ao grupo C. Contudo, até o período de 10 dias pós abertura da sutura, não foi possível observar o completo preenchimento do gap sutural por tecido ósseo. Estes resultados histológicos foram observados na sinalização de genes e proteínas no grupo Cd, uma vez que estes biomarcadores de formação e reabsorção óssea estavam alterados quando comparados aos grupos C e Dd. Conclusões: O DM alterou a sinalização para o metabolismo ósseo e atrasou o processo de reparo após ERM. Estes resultados reforçam a necessidade de avaliar o status do metabolismo ósseo dos pacientes durante tratamento ortopédico e/ ou ortodôntico, visto que a aplicação destas forças na presença do DM podem promover efeitos indesejáveis. / Background: Diabetes mellitus (DM) is a disease associated with several disorders of health in humans and one of the most important is the jeopardizing of bone formation. However, to the best of our knowledge there is no information about the influence of diabetes on orthodontic and orthopedic treatment at cellular and molecular levels. Objective: The aim of this study was to evaluate bone remodeling process in palatal suture during orthopedic mecanotherapy in rats with type 1-induced diabetes mellitus. Material and Methods: One hundred and fifty Wistar male rats were randomly assigned to six groups. Groups: control (C, n=30), vehicle (B, n=15), type 1-induced diabetes mellitus using streptozotocin (D, n=30), control with RME (C+RME, n=30), vehicle with RME (C+RME, n=15) and type 1-induced diabetes mellitus using streptozotocin with RME (D+RME, n=30). The animals were euthanized at 3, 7 and 10 days after RME. Histologic evaluations, changes in genes and proteins expression of osteoprotegerin (OPG), RANK, RANKL, osteonectin (ONC), osteocalcin (OCC), bone sialoprotein (BSP), osteopontin (OPN) and bone morphognetic protein 2 (BMP2) were evaluated along with the changes in body weight, water intake and glycemic profile. Real-Time RT-PCR and Western Blotting were used to evaluate gene and the protein expression. Data were submitted to statistical analysis using two-way ANOVA followed by Tukey test ( &alpha;= 0,05). Results: On group D+RME it was observed an increased bone resorption, serveral undermining and tissue degradation areas. On the suture gap there were mainly inflammatory and osteoclasts cells associated with compromised bone formation compared to groups D and Cd. These results were observed also in molecular levels, since there were a reduced osteogenesis and an upregulation of osteoclastogenesis, mainly in early period of healing. On group D, bone formation was compromised compared to group C, due to changes on genes and proteins expression which regulates bone metabolism, considering that there was more immature bone and incresead active remodeling areas until late periods. On group Cd it was observed bone remodeling, characterized by desorganized tissue on the gap of midpalatal suture, with intense inflammatory hemorhagic and resorptive areas compared to group C. However until 10 days after RME, on group D the gap was not completely filled with bone tissue. These results were observed on the signaling of molecular biomarkers on group Cd, since they were changed compared to groups C and Dd. Conclusions: DM modify the signaling for bone metabolism and compromise bone repair after RME. During orthopedic and orthodontic treatment is necessary to evaluate metabolism status of subjects, since the application of these forces have been shown to promote undesirable effects mostly when associated with DM.

O aparelho propulsor mandibular é utilizado na odontologia para modular o crescimento da cartilagem condilar, por meio de forças geradas pela alteração postural da musculatura. Neste estudo foi avaliado o papel de integrinas ligantes de fibronectina (FN) na transdução das forças mecânicas geradas pelo aparelho, em ratos. Por meio de imuno-histoquímica e PCR em tempo real verificou-se que, in vivo, o uso do aparelho modulou a expressão das subunidades <font face=\"symbol\">1, <font face=\"symbol\">5, e <font face=\"symbol\">v de integrinas, FN e PCNA, um marcador de proliferação celular. In vitro, forças distensivas cíclicas aplicadas sobre células da cartilagem condilar aumentaram a expressão de mRNA para FN, fatores de crescimento IGF-I e IGF-II e PCNA. A adição do peptídeo GRGDSP, que bloqueia a ligação de algumas integrinas à FN, inibiu todos os efeitos, exceto na expressão de IGF-II. Esses resultados sugerem que integrinas ligantes de FN desempenham papel importante na mecano-transdução neste sistema e contribuem para o entendimento das bases moleculares envolvidas na ortopedia funcional dos maxilares / The mandibular propulsor appliance is widely used in dentistry to modulate the growth of the condylar cartilage, through forces generated by postural changes in the orofacial musculature. The aim of this study was to evaluate the role of fibronectin (FN)-binding integrins in the transduction of mechanical forces generated by the appliance in rats. By immunohistochemistry and real time PCR it was observed that, in vivo, the appliance´s use modulated the expression of the integrin subunits <font face=\"symbol\">1, <font face=\"symbol>\"5, and <font face=\"symbol\">v, FN and PCNA, a cell proliferation marker. In vitro, the application of cyclic distension forces on condylar cartilage cells increased the expression of FN, IGF-I, IGF-II and PCNA mRNA. Addition of the peptide GRGDSP, which blocks the binding of some integrins to FN, inhibited all the effects except the increase in IGF-II mRNA. These results suggest that FN-binding integrins play an important role in mechanotransduction in this system, contributing to the understanding of the molecular basis involved in maxillary functional orthopedic therapy.

Made available in DSpace on 2014-07-29T15:25:17Z (GMT). No. of bitstreams: 1 TESE CLEOMAR D RODRIGUES -Cisto Ret Mucoso Seio Maxilar.pdf: 1752210 bytes, checksum: 164b291567764c89587221e7d462d819 (MD5) Previous issue date: 2011-05-31 / Objective: To detect the mucous retention cyst of maxillary sinus (MRCMS) through panoramic radiography and cone beam computed tomography (CBCT). Methods: Six thousand panoramic radiographs were selected from digital database for diagnostic analysis of MRCMS. We detected suggestive images of MRCMS in 185 radiographs of patients who were located and invited to return to control. Thirty patients returned for the realization of panoramic radiography for control between 6 and 46 months. Given the presence of MRCMS by radiographic control we performed the CBCT for a better evaluation of the maxillary sinus. Cysts were measured and compared through the images of two methods. The Wilcoxon, Spearman and Kolmorogov-Smirnov tests were used for statistical analysis. The level of significance was set at 5%. Results: There was statistically significant difference between the methods for detection of MRCMS (p <0.05); 23 MRCMS detected by panoramic radiography control were confirmed by CBCT, however, 5 MRCMS detected in CBCT images were not identified by panoramic radiographs. Eight MRCMS detected by X-ray control were not confirmed by CBCT. The discrepancy of extent of MRCMS between images of initial panoramic radiographs and control ones for the CBCT were not statistically significant (p = 0.617 and p = 0.626, respectively) as well as the correlation between time and discrepancy of extent of MRCMS (r = -0.16, p = 0.381). Conclusion: The cone beam computed tomography examination provides more accurate detection of MRCMS than panoramic radiography / Objetivos: Detectar o cisto de retenção mucoso do seio maxilar (CRMSM) por meio da radiografia panorâmica e tomografia computadorizada de feixe cônico (TCFC). Metodologia: Seis mil radiografias panorâmicas foram selecionadas do banco digital de dados para análise de diagnóstico de CRMSM. Foram detectadas imagens sugestivas de CRMSM em 185 radiografias, cujos pacientes foram localizados e convidados a retornar para controle. Trinta indivíduos retornaram para a realização de radiografia panorâmica para controle entre 6 e 46 meses. Constatada a presença do CRMSM pelo controle radiográfico realizava-se a TCFC, para uma melhor avaliação do seio maxilar. Cistos foram mensurados e comparados por meio das imagens dos dois métodos. Os testes de Wilcoxon, de Spearman e Kolmorogov-Smirnov foram utilizados para análise estatística. O Nível de significância estabelecido foi de 5%. Resultados: Foi observada diferença estatisticamente significante entre os métodos para detecção dos CRMSM (p<0,05); 23 CRMSM diagnosticados por meio da radiografia panorâmica controle foram confirmados por TCFC, no entanto, 5 CRMSM detectados em TCFC não foram identificados pelas imagens de radiografias panorâmicas. Oito CRMSM detectados pelo controle radiográfico não foram confirmados pela TCFC. A discrepância da extensão do CRMSM entre as imagens das radiografias panorâmicas inicial e controle e da panorâmica controle e TCFC não foram estatisticamente significantes (p=0,617 e p=0,626, respectivamente), bem como a correlação entre tempo e a discrepância da extensão dos CRMSM (r= -0,16 e p= 0,381). Conclusão: O exame por tomografia computadorizada do feixe cônico apresentou maior potencial de detecção de CRMSM que a radiografia panorâmica.

O osso alógeno fresco congelado e o Bio-Oss® (OBM) são materiais conhecidos como substitutos ao osso autógeno em cirurgias de levantamento de seio maxilar. O objetivo deste estudo foi avaliar clínica, histológica e histomorfometricamente o processo de reparo de enxertos alógenos com e sem a utilização de OBM, utilizados em técnicas de levantamento de seio maxilar em humanos. Neste estudo do tipo prospectivo, randomizado, tipo série de casos, comparativo, foram operados 34 seios maxilares de pacientes de ambos os sexos, que apresentavam um rebordo ósseo residual com altura máxima de 5 mm na região de seios maxilares para reconstrução em altura para cirurgias de levantamento de seio maxilar prévia à reabilitação por implantes. Os pacientes foram divididos em a) Grupo Controle: Dezessete (17) seios maxilares enxertados somente com a utilização de osso alógeno e b) Grupo Teste: 17 seios maxilares reabilitados com osso alógeno e OBM, na proporção de 2:1. Seis meses após a enxertia, no momento da instalação dos implantes, amostras ósseas foram coletadas por meio de trefinas para análise histológica e histomorfométrica. Os dados da investigação foram submetidos ao teste t de Student para amostras independentes empregado para comparações entre os dois grupos, Mann-Whitney e testes de correlação foram aplicados. 29 pacientes com uma média de idade de 51,32 anos (± 6,44), foram divididos em grupos controle (17) e teste (12), sendo 34 seios avaliados no total. Não houve diferença estatística entre os grupos com relação à idade (p = 0,23) e ao gênero (p = 0,56). Mediana do torque de inserção dos implantes foi de 32N para o grupo controle, e 45N para o grupo teste (p < 0,0001). Taxa de sucesso no grupo controle foi de 93,02% e 100% no grupo teste. Análise histológica apresentou no grupo controle osso alógeno residual com lacunas osteocíticas vazias e padrão lamelar; osso neoformado com lacunas osteocíticas com osteócitos viáveis e padrão imaturo; osteoblastos em íntimo contato matriz osteóide, formando pontes entre os blocos de osso alógeno e osso neoformado; osteoclastos em proximidade às áreas remodelação óssea; ausência de sinais de infiltrado inflamatório; tecido conjuntivo; e no grupo teste, todos os ítens acima e osso bovino mineral. Histomorfometria: material enxertado remanescente (p = 0,74); osso alógeno remanescente (35.78% ± 6.21% grupo controle, 19.72% ± 10.42% grupo teste; p < 0,0001); OBM remanescente no grupo teste (14,78% ± 8,67); osso neoformado (11.94% ± 1.71% grupo controle, 25.79% ± 8.76% grupo teste; p < 0,001); osso total (47.72% ± 5.6% grupo controle, 58.96% ± 8.1% grupo teste; p < 0,001); tecido conjuntivo (52.27% ± 5.6% grupo controle, 41.45% ± 8.4% grupo teste; p < 0,01). Adicionar OBM ao osso alógeno em cirurgias de levantamento de seio maxilar mostrou-se uma técnica de enxertia eficaz para a instalação de implantes. Resultou em maior torque de inserção, porcentagens maiores de osso neoformado e osso total, permitindo a instalação de implantes e reabilitação protética funcional. / Allograft fresh frozen bone and Bio-Oss are knows as autogenous bone materials substitutes in maxillary sinus lifting. The aim of this study was to evaluate clinical, histological and histomorphometrically the process of repair with and without the association of BBM in maxillary sinus augmentation. In this prospective, randomized, comparative case series study, 34 maxillary sinuses were augmented, which had a residual bone ridge with a maximum height of 5 mm in maxillary sinus reconstruction region at the time for surgery of maxillary sinus prior to rehabilitation by implants. Patients were divided into a) control group: seventeen (17) grafted maxillary sinuses with only allograft bone and b) test group: 17 maxillary sinuses rehabilitated with allograft bone and BBM in a 2:1 ratio. Six months after grafting, at time of implant placement, bone samples were collected using a trephine burr for histological and histomorphometrical analysis. The research data were subjected to Student\'s t test for independent samples used for comparisons between two groups, Mann - Whitney and correlation tests were applied. 29 patients with a mean age of 51.32 years (± 6.44), were divided into control group (17) and test (12), with 34 maxillary sinuses evaluated in total. There was no statistical difference between the groups regarding to age (p = 0.23) and gender (p = 0.56). Median insertion torque of the implants was 32N for the control group and 45N for the test group (p < 0.0001). Survival rate in the control group was 93.02% and 100% in the test group. Histological analysis showed, at the control group, residual allograft bone with empty osteocytic lacunae and lamellar pattern; newly formed bone with osteocytic lacunae with viable osteocytes and immature pattern; osteoblasts in close contact with osteoid matrix, forming bridges between the blocks of allograft bone and new bone formation; osteoclasts in bone remodeling surrounding areas; no evidence of inflammatory infiltrate; connective tissue; and in the test group, all the items above and bovine bone mineral. Histomorphometry: graft remaining material (p = 0.74); remaining allogenous bone (35.78% ± 06.21% control group, 19.72% ± 10:42% test group, p < 0.0001); BBM remaining in the test group (14.78% ± 8.67); newly formed bone (11.94% ± 1.71% control group, 25.79% ± 8.76% test group, p < 0.001); total bone (47.72% ± 5.6% control group, 58.96% ± 8.1% test group, p < 0.001); connective tissue (52.27% ± 5.6% control group, 41.45% ± 8.4% test group, p < 0.01). Adding bovine bone mineral to allogenous bone in maxillary sinus surgery proved to be an effective technique of grafting for implant placement. It resulted in higher insertion torque, higher percentages of new bone formation and total bone, allowing installation of implants and functional loading.

Objectif : Récemment, un nouvel appareil issu de la technologie du Forsus™ et visant à corriger les malocclusions de classe III a été mis sur le marché et se popularise dans la pratique orthodontique : le Tandem Forsus Maxillary Corrector (TFMC). L’objectif de la présente étude est de mesurer les effets squelettiques, l’influence réelle sur la croissance, et les effets dento-alvéolaires du port du TFMC. Matériel et méthodes : 14 patients présentant une malocclusion de classe III (âge moyen de 9 ans 6 mois) traités par le même orthodontiste ont participé à cette étude prospective. Le groupe consiste en 10 garçons et 4 filles. Le Tandem Forsus Maxillary Corrector est porté de 12 à 14 heures par jour jusqu’à l’obtention d’une surcorrection du surplomb horizontal et une relation dentaire de classe I. Le traitement est généralement d’une durée de 8 à 9 mois. Des radiographies céphalométriques latérales prises avant (T1) et après (T2) le traitement ont été analysées afin de déterminer les changements dentaires et squelettiques. Les résultats ont été comparés à un groupe contrôle composé de 42 enfants provenant du Centre de croissance de l’Université de Montréal. Les radiographies ont été tracées et analysées de manière aveugle à l’aide du logiciel Dolphin Imaging (ver 11.0, Patterson Dental, Chatsworth, California). L’erreur sur la méthode a été évaluée avec la formule de Dahlberg, le coefficient de corrélation intra-classe et l’indice de Bland-Altman. L’effet du traitement a été évalué à l’aide du test t pour échantillons appariés. L’effet de la croissance pour le groupe contrôle a été calculé à l’aide d’un test t pour échantillons indépendants. Résultats : L’utilisation du TFMC produit un mouvement antérieur et une rotation antihoraire du maxillaire. De plus, il procline les incisives supérieures et rétrocline les incisives inférieures. Une rotation antihoraire du plan occlusal contribue aussi à la correction de la malocclusion de classe III. Par contre, le TFMC ne semble pas avoir pour effet de restreindre la croissance mandibulaire. Conclusion : La présente étude tend à démontrer que le port de l’appareil TFMC a un effet orthopédique et dento-alvéolaire significatif lors du traitement correctif des malocclusions modérées de classe III. / Aim: Recently, a new appliance used to correct class III malocclusions, equipped with the Forsus™ technology, has been marketed and is gaining popularity in orthodontic practice: the Tandem Forsus Maxillary Corrector (TFMC). The purpose of the present study is to measure the skeletal and dento-alveolar effects, and the true influence on growth of the TFMC. Materials and Methods: A prospective study was done with 14 growing children (mean age of 9 years 6 months) who had a class III malocclusion and were treated with the TFMC by the same orthodontist. The group consisted of 10 boys and 4 girls. The «Tandem Forsus Maxillary Corrector» was worn 12 to 14 hours a day until a positive overjet and a class I dental relationship was obtained. For each patient, lateral cephalograms taken before (T1) and after (T2) the treatment were analyzed to determine skeletal and dental changes resulting from treatment. These results were compared to a control group randomly selected from the Growth Center of the University of Montreal. The cephalograms were traced and analyzed with the software Dolphin Imaging (ver 11.0, Patterson Dental, Chatsworth, California). Consistency and repeatability of measurements was evaluated with the intraclass correlation, the Dahlberg formula and the Bland-Altman test. The effect of treatment was evaluated with a paired T-test. The effect of growth for the control group was calculated with an unpaired T-test. Results: Use of the TFMC results in an anterior movement and a counterclockwise rotation of the maxilla. The upper incisors proclined and the lower incisors retroclined. A counterclockwise rotation of the occlusal plane also contributed to the correction of the class III malocclusion. Furthermore, the TFMC does not seem to restrain mandibular growth. Conclusion: The TFMC appliance seems to have a significant orthopedic and dento-alveolar effect when correcting a moderate class III malocclusion.

Introduction : Cette étude vise à évaluer la stabilité de la chirurgie LeFort I multisegmentaire à moyen (fin du traitement orthodontique) et à long termes dans les trois plans de l'espace (transversal, antéro-postérieur et vertical). Matériel et méthodes : L'échantillon étudié est composé de 31 patients traités en clinique privée, ayant eu une chirurgie LeFort I multisegmentaire en deux, trois ou quatre morceaux, et ayant terminé leur traitement orthodontique. Parmi eux, 17 patients ayant terminé leur traitement orthodontique depuis plus de deux ans (moyenne de trois ans post-traitement) ont permis d'évaluer la stabilité de la procédure chirurgicale à long terme. La collecte des données a été réalisée sur des modèles et des radiographies céphalométriques latérales pris à des temps précis tout au long du traitement orthodontique, ainsi que pendant la période de contention. Concernant l'analyse statistique, des T-tests et des corrélations de Pearson ont été utilisés. Le test de Bland-Altman et le coefficient de corrélation intra-classe ont permis d'analyser les fiabilités intra-examinateur et inter-examinateurs. Résultats : Une récidive transverse significative, mais très faible cliniquement, est constatée aux niveaux prémolaires et molaires entre la chirurgie et la fin du traitement orthodontique. Elle est corrélée avec l’expansion totale réalisée. Cette récidive transverse est non significative suite au traitement orthodontique. Aucune corrélation statistiquement significative n'est mise en évidence entre le nombre de segments et la récidive transverse postchirurgicale. Une variation de certaines mesures antéro-postérieures et verticales statistiquement significative, mais faible cliniquement, est notée entre la chirurgie et la fin du traitement orthodontique (avancement et impaction postérieure). Pour les mesures antéro-postérieures et verticales, aucun changement n'est statistiquement significatif suite au traitement orthodontique. Conclusion : Pour l'échantillon étudié, la stabilité de l'ostéotomie de type LeFort I multisegmentaire est très bonne, dans les trois plans de l'espace étudiés. / Introduction : The aim of this study was to evaluate the medium and long term stability of segmented LeFort I surgery in all three planes of space (transverse, sagittal and vertical). Materials and methods : The sample consisted of 31 private practice patients that received a two, three, or four-piece segmented LeFort I surgery and who had finished their orthodontic treatment. Study models and cephalometric radiographs were analyzed before treatment, before surgery, after surgery, and at the end of the orthodontic treatment for the 31 patients as well as a minumum two years into retention for 17 patients (mean of 3 years post-treatment). T-tests and Pearson correlation tests were used. Intra and inter-examiner reliability were verified with Bland Altman and intraclass coefficient tests. Results : A statistically significant transverse relapse was seen at the premolars and molars between surgery and the end of orthodontic treatment, that has little clinical significance. The relapse is correlated with the effective expansion. There was no significant relapse after orthodontic treatment was completed. There was no correlation between the amount of relapse observed and the amount of segments. Statistically significant changes were measured in the post surgical phase for maxillary advancement and impaction cases, but were shown to be of limited clinical significance. After removal of fixed appliances, no significant changes were noted. Conclusion : Multisegmented Lefort I surgery appears to have good stability in all three planes of space in the studied sample.

Aims: This study uses radiological and clinical evaluations of the healing of endosseous titanium implants presented with different surface characteristics in the clinical situation (paper I-III) and experimentally to describe the early bone healing in maxillary sinus membrane elevation with and without the use of grafting material (paper IV). Material and methods: In paper I, 136 patients were treated with 394 dental implants – 199 were oxidized titanium implants (Nobel Biocare TiUnite) and 195 were turned titanium surface implants (Nobel Biocare Mark III). Implant survival rates were retrospectively investigated after a minimum of five months after functional loading of the implants. At the five-year follow-up (paper II), eight patients were deceased and 128 were invited. Twenty-five patients refrained from participating in the study. The remaining 103 patients (287 implants – 133 with a turned surface and 154 with an oxidized surface) were examined after at least five years of functional loading. Clinical examinations of bleeding on probing (BoP) and pocket depth (PD) were performed. Intraoral radiographs were used to assess marginal bone levels (MBLs). In paper III, 28 patients were subjected to autologous bone graft and delayed implant placement, with a total of 92 dental implants. Thirteen patients received 47 implants with a turned surface and 15 patients received 45 implants with an oxidized surface. After a minimum of five years of functional loading, all patients were clinically examined regarding PD and BoP. The MBL was measured in intraoral radiographs. Cone beam computed tomography (CBCT) was used to evaluate the apical bone level (ABL) of the implants and intra-sinus conditions. The experimental study (paper IV) used nine adult male tufted capuchin primates (Cebus apella). Eight animals were subjected to bilateral maxillary sinus membrane elevation using a lateral replaceable bone window technique. One oxidized dental implant was placed in the residual bone of the sinus floor, protruding into the maxillary sinus cavity on both sides. In four animals, one sinus was left without any additional treatment, while the contralateral sinus was filled with autologous bone grafts from the tibia. In two animals, the implants were inserted under the elevated sinus membrane on both sides. In two animals, the sinus membrane was totally removed bilaterally before placement of implants. The animals were euthanized after 10 (n=4) or 45 (n=4) days. One non-operated animal representing pristine tissue conditions served as the control. The maxillary sinuses with implants were retrieved and further processed to prepare light microscopic ground sections or decalcified sections for immunohistochemical analyses. Results: In paper I seven implants were lost in five patients – six in the maxilla and one in the mandible. All failed implants were Mark III turned implants. The overall implant survival rate was 98.2% with a survival rate of 96.4% for implants with turned surface after a minimum of five months after functional loading. In paper II, one additional oxidized implant failed, giving an overall cumulative survival rate of 94.7 and 99.4%, respectively, after at least five years of functional loading. There was no difference for BoP, PD, or MBL between turned and oxidized implants. A total of two implants, three oxidized and one turned, showed a PD &gt; 3 mm, MBL &gt; 4 mm, and BoP. However, none of these were associated with suppurative infection on examination. In paper III no difference was found between the two implants surfaces used in terms of PD, BoP, MBL, or ABL. Pathological reactions to the sinus membrane were seen in four of the patients (14%). Radiographic signs of sinus pathology were not correlated to either survival rate of the implants or any of the investigated parameters. In the experimental paper IV, bone formation started from the bottom of the sinus floor, sprouting into the granulation tissue along the implant surface under the elevated membrane irrespective of time and surgical technique. Bone formation was not seen in direct conjunction with the sinus membrane. A distinct expression of osteopontin was observed in the serous glands of deeper portion of the lamina propria in direct connection with the elevated sinus membrane and close to the implant within all groups. Conclusion: After more than five years of function in non-grafted patients, oxidized implants had a survival rate higher than turned implants, although this was not statistically significant. No difference was found in MBL, PD, or BoP. Grafting of the maxillary sinus floor with intra- orally harvested bone and delayed placement of either turned or oxidized implants resulted in equally high long-term survival rates, MBL, ABL, and BoP. Pathological findings in the maxillary sinus cavity, in terms of sinus membrane health, are few and not correlated to any of the other investigated parameters. In the experimental study bone formation after sinus membrane elevation with or without additional bone grafts started at the sinus floor and sprouted into the elevated space along the implant surface. Removal of the membrane resulted in less bone formation. The sinus membrane did not seem to present osteoinductive potential in sinus membrane elevation procedures.

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Os sistemas de retenção utilizados em próteses totais sobre implante (sobredentaduras) tem sido discutidos ao longo das últimas décadas a fim de se obter uma padronização a respeito do tratamento clínico desses pacientes. Considerando o importante papel da estabilidade das próteses para a eficiência mastigatória, bem como para elaboração do plano de tratamento adequado, o objetivo deste estudo foi avaliar a estabilidade das próteses implantossuportadas e/ou implantorretidas, utilizando para isso um estudo in vitro que simulou a força de mordida. Materiais e Métodos: Foram testadas quatro tipo diferentes de próteses totais: 1) G1 Prótese Total Removível Convencional; 2) G2 - Próteses Total Removível sobre Implantes (Overdenture), retida pelo sistema ERA; 3) G3 Prótese Total Removível sobre Implantes (Overdenture), retida pelo sistema de Barra com clipes e Encaixes - ORCE; e 4) G4 - Prótese Total Fixa sobre Implantes, seguindo o protocolo Brånemark e utilizando o sistema de barras-distais da marca Neodent. Cada grupo foi submetido ao carregamento em pontos específicos, localizados sobre os elementos 16 (F=300N), 26 (F=300N) e na região anterior 11/21(F=100N). A aferição da estabilidade foi feita através da mensuração do deslocamento vertical da prótese durante o a aplicação da força e a distância do local do carregamento, sobre os elementos 16, 26 e na região anterior, nos elementos 11 e 21. Os dados passaram no teste de normalidade de Shapiro-Wilk e foram submetidos à análise de variância ANOVA e à comparação múltipla através do teste de Bonferroni (p<0.05) Resultados: O tipo de sistema utilizado influenciou na movimentação vertical da prótese na região posterior contralateral à aplicação de força, sendo a movimentação vertical G1 > G2 > G3 &#8805; G4. Na movimentação vertical da prótese nos dentes anteriores, quando a força foi aplicada nos dentes posteriores (rotação para posterior), a movimentação vertical foi de G1 > G2 > G3 &#8805; G4. Durante a rotação para posterior, quando a força foi aplicada nos dentes anteriores (rotação para anterior) e a movimentação medida nos dentes posteriores, o comportamento foi de G1 > G2 > G3 > G4. Conclusão: Em duas das três situações testadas não houve diferença estatística entre a movimentação vertical entre o G3 e o G4, sugerindo que a estabilidade da overdenture retida por barra com clipes e encaixes se comportou, em relação a estabilidade, semelhante a prótese fixa sobre implantes. / The retain systems used by the complete dentures have been discussed over the past decades in order to achieve a standardization regarding to the clinical treatment of the patients. Considering the important meaning of the stability of dentures for chewing efficiency and for planning appropriate treatment, the aim of this study was to evaluate the stability of the implant-supported and implant-retained prosthesis, using an in vitro study that simulated the bite force. Materials and Methods: Four different types of dentures were tested: 1) G1 - Conventional Denture; 2) G2 Overdenture retained by the ERA system ; 3) G3 - Overdenture retained by bar system using clipes and fittings; and 4) G4 - Total implant-supported Prosthesis, following the Brånemark protocol and using Neodent`s distal bar. Each group was subjected to loading at specific points, located on the elements 16, 26 (F = 300Ncm) and at the anterior region 11/21 (F = 100Ncm). The measurement of vertical displacement during the test was taken out-lying from the loading area and at the elements 16, 26 and in the anterior region, at the element 11/21. Results: The data was analyzed by Shapiro -Wilk normality Test and than by ANOVA and multiple comparisons using the Bonferroni test. Conclusions: The retention system have influenced the vertical movement of the prosthesis in the posterior region contralateral to force application point, with the vertical movement as G1 > G2 > G3 > G4. In the vertical movement of the prosthesis at anterior point, when the force was applied to the posterior teeth, the vertical movement was G1 > G2 > G3 > G4. When the load was applied to the anterior teeth and movement was measured ate the posterior teeth, the behavior was G1 > G2 > G3 > G4. In two of the three situations simulated, there was no statistical difference between the vertical movement between the G3 and G4, suggesting that the stability of overdentures retained by bar with clips and fittings performed like fixed prosthesis.