Introdução: A mutilação intra-oral, após tratamento de tumores, ocasiona além de deformidades estéticas, perda de função e impacto na qualidade de vida do paciente. Proposição: Avaliar a experiência individual do paciente tratado por lesões benignas e malignas que resultaram em mutilação intra-oral e necessidade de reabilitação complexa maxilo mandibular Material e Método: Através de entrevistas semi estruturadas, à luz da metodologia de análise de conteúdo, proposta por Bardin em 1977, utilizando a pergunta norteadora O que aconteceu na sua vida antes, durante e o que acontecerá depois da lesão/doença que te trouxe aqui, foram entrevistados seis pacientes, como mutilação intra-oral em reabilitação protética maxilo facial. Resultados e Discussão: Após análise, exploração e interpretação dos resultados colhidos em entrevistas semi-estruturadas, que duraram em média 1hora e meia a duas horas cada, foram extraídas duas categorias dos discursos dos sujeitos: Vivendo a mutilação, perdendo os dentes, a comunicação e a socialização e Preservando a esperança de um novo normal, respeitando a doença com a sombra da recidiva. Conclusão: Os dados revelam que o paciente que sofreu mutilação intra-oral após tratamento de tumor, é um sujeito que vive as seqüelas da terapêutica, tem respeito extremo pela doença que o levou àquela condição, tem medo de possíveis recidivas, mas, fundamentalmente, nutre a esperança de retomar sua vida e construir um novo normal. / Introduction: Intra-oral mutilation after treatment of tumors, causes beyond cosmetic deformities, loss of function and impact on quality of life of patients. Proposition: To evaluate the experience of the individual patient treated for benign and malignant lesions that resulted in injury intra-oral and maxillofacial complex rehabilitation needs Methods: Using semi-structured interview, supported of content analysis proposed by Bardin in 1977, using the guiding question \"What happened in your life before, during and what will happen after the injury / illness that brought you here,\" were interviewed six patients, such as mutilation intra-oral maxillo facial prosthetic rehabilitation. Results and Discussion: After analysis, exploration and interpretation of the results collected from semi-structured interviews, which lasted on average 1 hour and a half to two hours each, were extracted from two categories of the speeches: Living mutilation, losing teeth, communication and socialization and preserving the hope of a \"new normal\", respecting the disease in the shadow of recurrence. Conclusion: Our data show that patients who suffered mutilation after intra-oral tumor treatment, is a guy who lives the consequences of therapy, has utmost respect for the disease that led to that condition, afraid of possible relapse, but fundamentally nurtures the hope of resuming their lives and build a \"new normal\".

O objetivo do trabalho foi avaliar a hipótese nula de que pacientes com maloclusão de Classe III esquelética por deficiência do terço médio da face poderiam ser tratados ortopedicamente utilizando mini-implantes ortodônticos convencionais como apoio de elásticos intermaxilares durante a protração da maxila. No grupo mini-implantes (MI) foram selecionados 12 cranças, nas quais foram instalados dois mini-implantes convencionais na região próxima à mesial das raízes dos primeiros molares permanentes e, outros dois na distal das raízes dos caninos inferiores. Foi orientado que as crianças utilizassem elásticos intermaxilares ¼\" médio, durante 24 horas por dia e força de 200g. No grupo máscara facial (MF) foi realizado o protocolo de expansão rápida da maxila e uso de máscara facial em 13 criancças. Todos os participantes estavam em fase de crescimento, e tinham entre 7 e 12 anos de idade. Através dos dados cefalométricos iniciais e finais dos casos foram realizadas análises estatísticas com Teste t de Student e Mann-Whitney para comparação de amostras independentes, Wilcoxon para amostras pareadas, e nível de significância foi de 5%. Foi possível confirmar que ambos os grupos apresentaram melhora no perfil facial com aumento da convexidade facial e correção da sobressaliência negativa na maioria das crianças, mostrando avanço da maxila, pelas superposições cefalométricas, com diferenças entre T0 e T1 significativas nas medidas SNA, ANB, Wits, Co-A, Co-Gn, NAP, A-Npog, overjet e relação molar, além de Sn-linha H, 1-NB para o grupo MI. Não houve diferença significativa estatisticamente intergrupos nas medidas cefalométricas avaliadas, mas o tempo de tratamento foi significante, sendo mais rápido para o grupo MI. Como conclusão geral, a hipótese nula foi aceita, sendo possível afirmar que mini-implantes convencionais associados a elásticos intermaxilares podem ser uma opção para tratamentos de pacientes Classe III com retrusão maxilar, principalmente em casos de falta de colaboração com o uso da máscara facial, e com reduzido grau de intervenção cirúrgica, que é característica do protocolo de instalação dos mini-implantes. / The aim of this study was to test the null hypothesis that patients with Class III skeletal malocclusion due to deficiency of the middle third of the face could be treated orthopedically with the use of conventional orthodontic mini-implants and support of intermaxillary elastics during protraction of the maxilla. In the mini-implants group (MI) with n = 12, two conventional mini-implants were inserted in the region close to the mesial area of the permanent first molar roots and another two, in the distal area of the mandibular canine roots. The children were instructed to use ¼\" medium intermaxillary elastics, throughout almost 24 hours per day and force of 200g. In the facial mask group (MF) with n = 13, the rapid maxillary expansion protocol and facial mask were performed. All participants were in the growth phase, and were between 7 and 12 years of age. Statistical analyzes were performed using the Student\'s t-test and the Mann-Whitney test for comparison of independent samples, Wilcoxon for paired samples, and a significance level of 5% was used for the initial and final cephalometric data. It was possible to confirm that both groups presented improvement in the facial profile with increase of the facial convexity and correction of the negative overjet in the majority of the children. Advancement of the maxilla was shown by means of cephalometric superimpositions, with significant differences between T0 and T1 in the following measurements: SNA, ANB, Wits, Co-A, Co-Gn, NAP, A-Npog, overjet and molar relationship, in addition to Sn-line H, and 1-NB for Group MI. There was no statistically significant intergroup difference in the cephalometric measurements evaluated, but the time of treatment was significant, as it was faster for Group MI. As a general conclusion, the null hypothesis was acepted, because it was possible to affirm that conventional mini-implants associated with intermaxillary elastics could be an option for the treatment of Class III patients with maxillary retrusion, particularly in cases of lack of cooperation with the use of the face mask. In addition, the degree of surgical intervention was reduced, which is characteristic of the protocol for the insertion of mini-implants.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-01-06T14:00:14Z No. of bitstreams: 1 luizmarceloamaralgalvaonunes.pdf: 1165890 bytes, checksum: 617cb8b85316ada8b08107c635bf0730 (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2017-01-31T11:27:08Z (GMT) No. of bitstreams: 1 luizmarceloamaralgalvaonunes.pdf: 1165890 bytes, checksum: 617cb8b85316ada8b08107c635bf0730 (MD5) / Made available in DSpace on 2017-01-31T11:27:08Z (GMT). No. of bitstreams: 1 luizmarceloamaralgalvaonunes.pdf: 1165890 bytes, checksum: 617cb8b85316ada8b08107c635bf0730 (MD5) Previous issue date: 2016-09-06 / A Implantodontia, afim de, proporcionar melhores resultados estéticos e funcionais, tem apresentado inúmeras inovações e tecnologias visando alcançar estes objetivos associado a redução do tempo de tratamento. Contudo pacientes que apresentam a necessidade de cirurgias de reconstruções associadas a enxertos ósseos visando à instalação adequada destes implantes permanecem como desafios. Deste modo, o presente trabalho analisou o enxerto ósseo autógeno em dois diferentes períodos e avaliou os implantes instalados nestes períodos analisados, a pesquisa foi subdividida e descrita nos Capítulos à seguir. CAPITULO I: Análise histológica das características existentes no processo de incorporação e maturação óssea em áreas submetidas à cirurgia de enxerto ósseo em elevação de seio maxilar. Observou-se nos dois períodos analisados, correspondentes do processo de reparo ósseo, que foram semelhantes em ambos períodos. Deste modo, pode-se concluir que o enxerto ósseo autógeno apresenta características semelhantes na fase de incorporação (2 meses) e maturação (6 meses) o que possibilita a manipulação deste tecido na fase mais inicial sem o seu comprometimento. CAPITULO II: O propósito deste capítulo foi avaliar a osseointegração em dois períodos diferentes sendo, incorporação (2 meses) e maturação (6 meses) óssea em áreas submetidas a cirurgia de enxerto ósseo em elevação de seio maxilar e a estabilidade da prótese instalada. Observou-se nos dois períodos analisados, a incorporação óssea (2 meses) e maturação óssea (6 meses), que embora divergentes nas etapas de reparo ósseo, apresentaram resultados semelhantes para a osseointegração e estabilidade da prótese. Deste modo, pode-se concluir que a inserção de implantes osseointegráveis nestas regiões em menor período de reparo, ou seja, na fase de incorporação óssea (2 meses) não compromete a osseointegração nem tão pouco a estabilidade da prótese a longo prazo. A redução do tempo de tratamento de pacientes submetidos a cirurgias de reconstruções com enxerto ósseo em elevação de seio maxilar é possível realizando a instalação dos implantes no período de incorporação óssea. / The implantology in order to provide better aesthetic and functional results, presented numerous innovations and technologies to achieve these goals associated with reduced treatment time. However patients who have the need for reconstructive surgery associated with bone grafts seeking the proper installation of these implants remain as challenges. Thus, this work presents two studies described in the following chapters. Article I: Histological analysis of existing resources in the process of development and maturation in areas prone to bone graft surgery in sinus floor elevation. It was observed in both periods analyzed, bone repair, which were similar in both the periods. Thus, it can be concluded that autogenous grafts has similar characteristics in the incorporation phase (2 months) and mature (6 months), allowing the tissue manipulation in the initial stage without their involvement. Article II: The objective of this chapter was to evaluate the osseointegration in two different periods being, incorporation (2 months) and maturity (6 months) bone in areas subjected to bone graft surgery in sinus floor elevation and stability of the installed prosthesis. It was observed in both study periods, the bone ingrowth (2 months) and maturation (6 months), although at different stages of bone healing that showed similar results for bone integration and stability of the prosthesis. Thus, it can be concluded that the insertion of dental implants in these regions in the shortest repair, namely on bone growth phase (2 months) does not jeopardize the osseointegration or long-term stability of the prosthesis. The reduction in the treatment of patients undergoing reconstructive surgery with bone grafting time in sinus floor elevation is possible to perform the installation of implants in bone growth period.

Die Idealvorstellung eines vollständig digitalisierten Behandlungsalltags rückt mit fortschreitender technologischer und informationeller Entwicklung stetig näher an die Realität. Zu Beginn bestand lediglich die Möglichkeit einer elektronischen Patientenakte, hinzu kamen vielfältige Möglichkeiten der digitalen Bildgebung und wurden schließlich um das Ziel eines vollständigen digitalen Workflows ergänzt. Die Planung der interdisziplinären kieferorthopädischen / kieferchirurgischen Versorgung von Patienten mit Lippen-Kiefer-Gaumen-Spalten (LKGS) wurde bis vor kurzem am Universitätsklinikum Dresden noch hauptsächlich analog durchgeführt. Eine volldigitalisierte Behandlungsplanung unter Einbeziehung aller beteiligten Behandler fand nicht statt. Ziel des Projektes war es deshalb, eine digitale Plattform zur interdisziplinären zahnmedizinischen Versorgung von LKGS-Patienten zu schaffen. Dazu wurde zuerst die bisher erforderliche Abdrucknahme mittels Alginat und die anschließende Herstellung eines Gipsmodells durch einen intraoralen 3D-Scan der Zahnbögen des Patienten abgelöst. Anhand des intraoralen 3D-Scans können nun die erforderlichen Trinkplatten mittels 3D-Druck erstellt werden. Zweiter Schritt war die Anfertigung von 3D-Aufnahmen der Weichteile des Gesichtes mittels eines extraoralen 3D-Scanners. Als dritter Schritt erfolgte die Anfertigung von Digitalen Volumentomografie (DVT)-Aufnahmen zur 3D-Darstellung des Schädelknochens und Kieferskeletts. Nach der Anfertigung wurden diese bildbasierten Datensätze zu einem „digitalen Zwilling“ (virtuelles 3D-Modell aus DVT, intra- und extraoralen 3D-Scan) zusammengefasst, wodurch erstmalig ein umfassendes 3D-Modell des Mund-Kiefer-Raumes einschließlich wichtiger Informationen zum Kiefergelenk und der anliegenden Weichteile entstand. Dieses virtuelle Modell bildet jetzt die Grundlage für die Behandlungsplanung und die Planung der weiteren zahnmedizinischen und medizinischen Versorgung. Es konnte also im Projekt die komplette Digitalisierung der Diagnostik, die Etablierung einer Fusionsplattform und der Datenaustausch zwischen Uniklinik und privater Praxis umgesetzt werden.

The preclinical imaging method micro-CT (microtomography) allows the visualization and quantification of the structure of samples at a resolution of micrometers. Its' importance is increasing globally. In addition to several advantages (non-destructive, the possibility of direct 3D analysis, time efficiency, etc.), micro-CT also has some significant limitations (problematic validation of results, image artifacts, significant influence of image modifications, etc.). This thesis focuses on the application of micro-CT in the field of research and development of metallic and non-metallic materials promoting bone healing with their possible clinical applications. The first part addresses the limitations of micro-CT through several studies. A comparison of pore sizes in biomaterials utilizing scanning electron microscopy (SEM) and micro-CT was performed, and the complications of pore size evaluation were presented. SEM image analysis leads to significantly higher values than micro-CT (approximately three times), which allows for comparison of the studies using only one of these methods. Validation of micro-CT 3D analysis results based on calibration phantoms with complex structure, to date, is not possible. We therefore developed software generating phantom datasets of 3D objects with well-defined...

Purpose Following the introduction of the Regulation (EU) 2017/745 by the European Parliament, any bioactive substance or surgical implant introduced into the human body must be documented. The regulation requires any implant to be traced back to the manufacturer. Lot numbers need to be available for every single medical implant. Also, the manufacturer is required by law to provide implants individually packaged and sterilized. Previously, model tray systems (MOS tray) were used for osteosynthesis in oral and maxillofacial surgery, in which the individual implants could not be registered separately. The new regulation made it impossible to use such processes during surgery anymore and a need for a change in the medical practice surged. We examined a possible solution for the new legislation. The aim of this prospective cohort study is to analyze the MOS tray systems to osteosynthesis materials prepackaged in sets. We record and evaluate parameters such as surgical time and documentation time. We perform a short cost analysis of our clinic. The primary aim is to determine how much time is gained or lost by the mandatory increased patient safety. The secondary aim is to describe change in costs. Methods Patients that underwent standard surgical procedures in the clinic of oral and maxillofacial surgery of the faculty hospital Carl Gustav Carus in Dresden were included. We chose open reduction and internal fixation (ORIF) of anterior mandibular corpus fractures as well as mandibular advancement by means of bilateral sagittal split osteotomies (BSSO) as standardized procedures. Both of these procedures require two osteosynthesis plates and at least four screws for each plate. MOS trays were compared to prepackaged sterilized sets. The sets include a drill bit, two plates, and eight 5-mm screws. A total number of 40 patients were examined. We allocated 20 patients to the ORIF group and the other 20 patients to the BSSO group. Each group was evenly subdivided into a MOS tray group and a prepackaged group. Parameters such as the incision-suture time (IST) as well as the documentation time (DT) by the operating room (OR) staff to complete documentation for the implants are the main focus of investigation. Results For open reduction, the incision-suture time was significantly different in favor of the MOS tray (p < 0.05). There was no difference in the BSSO groups. However, we observed a significantly different (p < 0.01) documentation time advantage for the prepackaged sets in both the ORIF and BSSO groups. On top of that, we find that by using the prepackaged kits, we are able to reduce sterilization costs by €11.53 per size-reduced container. Also, there is also a total cut of costs of €38.90 and €43.70, respectively, per standardized procedure for implant material. Conclusions By law, a change in the method of approaching surgery is necessary. For standardized procedures, the right choice of implants can lead to a reduction of documentation time and costs for implant material, sterilization, as well as utilizing less instruments. This in turn leads to lower costs for perioperative processing as well as provision of state-of-the-art implant quality implementing higher patient security.

O grande desafio da Implantodontia é alcançar resultados a longo prazo com maior preservação dos tecidos ósseos, resposta adequada dos tecidos conjuntivos e manutenção da estabilidade secundária adequada para a retenção de próteses. Estes fatores evitam a perda indesejável tanto do tratamento reabilitador quanto dos tecidos ósseos de suporte. A região extraoral apresenta menores espessuras ósseas em comparação às regiões de maxila e mandíbula, especialmente no osso temporal. Portanto, os seguintes aspectos foram investigados: (i) Análise pelo Método dos Elementos Finitos (FEA) de 16 modelos virtuais, com aplicação de forças estáticas de tensão e compressão nos pontos médios entre os implantes. Três implantes maxilofaciais extraorais foram posicionados no osso temporal, onde um deles foi posicionado sobre o processo mastóide. Este estudo foi totalmente realizado em ambiente computacional. Foram empregados dois tipos de conexões protéticas e intermediários retos de conicidades 20º e 45º, posicionados virtualmente no modelo de osso temporal, com paralelismo entre eles. Foi desenhada uma barra virtual para retenção protética do tipo barra-clipe da prótese auricular. Foram consideradas as melhores configurações aquelas apresentando distribuição uniforme e branda das tensões de von Mises sobre o tecido ósseo adjacente aos implantes. (ii) Confecção de corpos de prova com graus variáveis de pigmentação para (a) melhorar a reprodutibilidade da coloração (b) entender e reduzir o processo de descoloração para melhorar a longevidade das próteses. Um elastômero maxilofacial tipo A foi pigmentado intrinsecamente de acordo com os seis tons da Escala de Fitzpatrick. Uma técnica de pigmentação foi desenvolvida a partir dos resultados obtidos a partir de uma Escala de Fitzpatrick impressa em papel e dos pigmentos intrínsecos de cores primárias. Este dimetil-metilvinil-siloxano reforçado por platina A 223-30 (Factor II, Inc., Lakeside, AZ, USA) apresenta dureza \"Shore-A\" 30. As amostras foram expostas a fotoenvelhecimento acelerado, e sua degradação mapeada com Espectroscopia UV/Vis/NIR. Concluiu-se que: (i) Os implantes com conexão cone Morse plataforma 3.7 tem melhor comportamento biomecânico com intermediários de 45o e altura de 2mm. Sugere-se planejamento cirúrgico visando a instalação a 3 horas para o temporal esquerdo e 9 horas para o temporal direito, mais 6 horas (mastóide). Implantes com conexão cone Morse plataforma 4.0 apresentaram comportamento biomecânico desejável com intermediários de 20o e alturas de 2mm or 4mm. Para implantes com conexão cone Morse plataforma 4.0, sugere-se a instalação a 6-9-12 horas para o temporal direito, e 12-6-3 para o esquerdo, visando comportamento biomecânico adequado. Sugere-se que os implantes extraorais Brånemark hexágono externo com plataforma 4.1 regular ou expandida sejam preferencialmente empregados com intermediários de 20o. (ii) O SiO2 5% pode ser adicionado à preparação do silicone para retardar o desbotamento da prótese maxilofacial. O TiO2 traz mudanças visuais significativas e pode ser considerado como opacificador. / Major challenges in Implantology include: achieving longevity of implants, bone tissue preservation, connective tissue suitable answer and maintenance of secondary stability in order to retain prosthesis. These factors avoid the undesirable loss of both rehabilitation treatment and supporting bone tissues. The extraoral region has less bone depth compared to the maxilla and mandible regions, especially for the temporal bone. Therefore, the following aspects were investigated: (i) Finite Elements Analysis (FEA) of 16 virtual models, with static application of tension and compression forces in medium points between implants. Three extraoral maxillofacial implants were placed on the temporal bone, which one of them was placed on the mastoid process. This study was made entirely in a computational environment. Two prosthetic connection types and straight Intermediários were employed, with conicities of 20º and 45º, placed virtually on the temporal bone model, mutually parallel. A virtual bar for bar-clip prosthetic retention of auricular prosthesis was designed. The best configurations were considered to be the ones presenting uniform and mild von Mises tension distribution over the bone tissue around the implants. (ii) Generation of samples with varying degree of pigmentation to (a) improve the reproducibility of the colouration (b) understand and minimise the discolouration process to improve prosthetics longevity. A maxillofacial elastomer type A was intrinsically pigmented according to the six tones of the Fitzpatrick Scale. A pigmentation technique was developed from spectroscopy outcomes of paper printed Fitzpatrick Scale and the primary colors pigments. This platinum reinforced dimethyl methylvinyl siloxane A 223-30 (Factor II, Inc., Lakeside, AZ, USA) presents \"Shore-A\" hardness 30. The samples were exposed to accelerated photo aging, and their degradation mapped with UV/Vis/NIR Spectroscopy. The effects of exclusion of oxygen and inclusion of nanoparticle fillers during prosthetic formulation were investigated. It was concluded that: (i) Morse taper prosthetic connection 3.7 platform implants, should be employed with 45o abutments with 2mm height. The surgical planning shall be for placement 3 hours for the left temporal bone and 9 hours for the right, and in 6 hours (mastoid). Morse taper prosthetic connection 4.0 platform implants behaved biomechanically desirably with 20o abutments in 2mm or 4mm heights. For the Morse taper connection 4.0 platform implants, their placement shall be in 6-9-12 hours, for the right temporal, and 12-3-6, for the left temporal, in order to achieve proper biomechanical behaviour. The Brånemark extraoral external hexagon implant, with 4.1 platform (normal or expanded) should preferrably be used with 20o abutments. (ii) The SiO2 5% may be added to the silicone preparation in order to slow maxillofacial prosthesis colour fading. The TiO2 brings visually significant changes and may be considered as an opacifier.

O grande desafio da Implantodontia é alcançar resultados a longo prazo com maior preservação dos tecidos ósseos, resposta adequada dos tecidos conjuntivos e manutenção da estabilidade secundária adequada para a retenção de próteses. Estes fatores evitam a perda indesejável tanto do tratamento reabilitador quanto dos tecidos ósseos de suporte. A região extraoral apresenta menores espessuras ósseas em comparação às regiões de maxila e mandíbula, especialmente no osso temporal. Portanto, os seguintes aspectos foram investigados: (i) Análise pelo Método dos Elementos Finitos (FEA) de 16 modelos virtuais, com aplicação de forças estáticas de tensão e compressão nos pontos médios entre os implantes. Três implantes maxilofaciais extraorais foram posicionados no osso temporal, onde um deles foi posicionado sobre o processo mastóide. Este estudo foi totalmente realizado em ambiente computacional. Foram empregados dois tipos de conexões protéticas e intermediários retos de conicidades 20º e 45º, posicionados virtualmente no modelo de osso temporal, com paralelismo entre eles. Foi desenhada uma barra virtual para retenção protética do tipo barra-clipe da prótese auricular. Foram consideradas as melhores configurações aquelas apresentando distribuição uniforme e branda das tensões de von Mises sobre o tecido ósseo adjacente aos implantes. (ii) Confecção de corpos de prova com graus variáveis de pigmentação para (a) melhorar a reprodutibilidade da coloração (b) entender e reduzir o processo de descoloração para melhorar a longevidade das próteses. Um elastômero maxilofacial tipo A foi pigmentado intrinsecamente de acordo com os seis tons da Escala de Fitzpatrick. Uma técnica de pigmentação foi desenvolvida a partir dos resultados obtidos a partir de uma Escala de Fitzpatrick impressa em papel e dos pigmentos intrínsecos de cores primárias. Este dimetil-metilvinil-siloxano reforçado por platina A 223-30 (Factor II, Inc., Lakeside, AZ, USA) apresenta dureza \"Shore-A\" 30. As amostras foram expostas a fotoenvelhecimento acelerado, e sua degradação mapeada com Espectroscopia UV/Vis/NIR. Concluiu-se que: (i) Os implantes com conexão cone Morse plataforma 3.7 tem melhor comportamento biomecânico com intermediários de 45o e altura de 2mm. Sugere-se planejamento cirúrgico visando a instalação a 3 horas para o temporal esquerdo e 9 horas para o temporal direito, mais 6 horas (mastóide). Implantes com conexão cone Morse plataforma 4.0 apresentaram comportamento biomecânico desejável com intermediários de 20o e alturas de 2mm or 4mm. Para implantes com conexão cone Morse plataforma 4.0, sugere-se a instalação a 6-9-12 horas para o temporal direito, e 12-6-3 para o esquerdo, visando comportamento biomecânico adequado. Sugere-se que os implantes extraorais Brånemark hexágono externo com plataforma 4.1 regular ou expandida sejam preferencialmente empregados com intermediários de 20o. (ii) O SiO2 5% pode ser adicionado à preparação do silicone para retardar o desbotamento da prótese maxilofacial. O TiO2 traz mudanças visuais significativas e pode ser considerado como opacificador. / Major challenges in Implantology include: achieving longevity of implants, bone tissue preservation, connective tissue suitable answer and maintenance of secondary stability in order to retain prosthesis. These factors avoid the undesirable loss of both rehabilitation treatment and supporting bone tissues. The extraoral region has less bone depth compared to the maxilla and mandible regions, especially for the temporal bone. Therefore, the following aspects were investigated: (i) Finite Elements Analysis (FEA) of 16 virtual models, with static application of tension and compression forces in medium points between implants. Three extraoral maxillofacial implants were placed on the temporal bone, which one of them was placed on the mastoid process. This study was made entirely in a computational environment. Two prosthetic connection types and straight Intermediários were employed, with conicities of 20º and 45º, placed virtually on the temporal bone model, mutually parallel. A virtual bar for bar-clip prosthetic retention of auricular prosthesis was designed. The best configurations were considered to be the ones presenting uniform and mild von Mises tension distribution over the bone tissue around the implants. (ii) Generation of samples with varying degree of pigmentation to (a) improve the reproducibility of the colouration (b) understand and minimise the discolouration process to improve prosthetics longevity. A maxillofacial elastomer type A was intrinsically pigmented according to the six tones of the Fitzpatrick Scale. A pigmentation technique was developed from spectroscopy outcomes of paper printed Fitzpatrick Scale and the primary colors pigments. This platinum reinforced dimethyl methylvinyl siloxane A 223-30 (Factor II, Inc., Lakeside, AZ, USA) presents \"Shore-A\" hardness 30. The samples were exposed to accelerated photo aging, and their degradation mapped with UV/Vis/NIR Spectroscopy. The effects of exclusion of oxygen and inclusion of nanoparticle fillers during prosthetic formulation were investigated. It was concluded that: (i) Morse taper prosthetic connection 3.7 platform implants, should be employed with 45o abutments with 2mm height. The surgical planning shall be for placement 3 hours for the left temporal bone and 9 hours for the right, and in 6 hours (mastoid). Morse taper prosthetic connection 4.0 platform implants behaved biomechanically desirably with 20o abutments in 2mm or 4mm heights. For the Morse taper connection 4.0 platform implants, their placement shall be in 6-9-12 hours, for the right temporal, and 12-3-6, for the left temporal, in order to achieve proper biomechanical behaviour. The Brånemark extraoral external hexagon implant, with 4.1 platform (normal or expanded) should preferrably be used with 20o abutments. (ii) The SiO2 5% may be added to the silicone preparation in order to slow maxillofacial prosthesis colour fading. The TiO2 brings visually significant changes and may be considered as an opacifier.

<p>Uvod: Kraniofacijalni sistem je svim svojim strukturama razvojno, funkcionalno i anatomski tesno vezan sa strukturama gornjih respiratornih puteva. Tako je svaki poremećaj u jednom od njih često praćen manjim ili većim poremećajem u drugom. Ovaj rad se bavi utvrđivanjem mogućnosti da se prepoznaju neki od orofacijalnih faktora kod dece koji bi mogli da uzrokuju ili povećaju ozbiljnost smetnji u disanju. Od posebnog je značaja činjenica da se većina autora bavi tretiranjem odrasle populacije, dok samo nastajanje poremećaja nije jasno obja&scaron;njeno. Zbog toga je ovaj rad zami&scaron;ljen kao doprinos saznanju o nekim od mnogih međusobno veoma kompleksno isprepletanih funkcionalnih i morfolo&scaron;kih poremećaja koji svi zajedno dovode do ovog potencijalno opasnog, a globalno prisutnog stanja. U ovom istraživanju posebna pažnja se obraća na uticaj poremećenih međuviličnih odnosa u sagitalnoj dimenziji (posteriorni odnos struktura donje vilice) kod dece koja nisu zavr&scaron;ila rast i kod koje se jo&scaron; uvek može terapijski delovati, kao i na sagitalnu uskost gornjih respiratornih puteva. Skeletno II klasa je poremećaj kraniofacijalnog razvoja koji se u dece leči, dok je kod odraslih sa zavr&scaron;enim rastom taj odnos vilica fiksiran. Ispravljanje morfolo&scaron;ke nepravilnosti kod dece koriguje se pravilnim usmeravanjem rasta, i normalizacijom poremećenih funkcija orofacijalne i nathioidne muskulature, &scaron;to se postiže primenom funkcionalnih ortodontskih aparata. Ciljevi i hipoteze: Op&scaron;ti cilj rada je da se doprinese saznanjima o dimenzijama struktura u periodu razvoja koje mogu u kasnijim životnim dobima da doprinesu nastanku smetnji u disanju i nekom od &scaron;irokog spektra poremećaja opisanih kao sindrom opstruktivnog prekida disanja u toku sna, kao i da se sagledaju mogućnosti ranog delovanja na njih. Metode: Ispitivanje je sprovedeno kao kombinacija studije preseka u svom prvom delu I kohortne studije u svom drugom delu, na Klinici za stomatologiju Vojvodine. Studijom je obuhvaćeno 98 ispitanika eksperimentalne grupe koji su ispunjavali kriterijume za uključivanje u studiju, odgovarajućeg uzrasta i kraniofacijalne morfologije (druga skeletna klasa i hiperdivergentan rast), kao i 70 (dve grupe po 35) ispitanika kontrolne grupe odgovarajućeg uzrasta kao reprezent op&scaron;te populacije. Kod svih ispitanika izvr&scaron;ena su standardna rendgenkefalometrijska merenja i utvrđene dimenzije gornjih respiratornih puteva, kao i struktura koje bi mogle da imaju uticaja na njih, jezika i mekog nepca. Dobijene vrednosti su upoređene statistički. Posle godinu dana ortodontskog lečenja malokluzije druge klase, pristupilo se ponovnom merenju istih struktura, upoređivanju sa kontrolnom grupom odgovarajućeg uzrasta, kao i utvrđivanju nastalih promena u odnosu na početni nalaz. Da bi se utvrdio stvarni opseg promena nastalih usled ortodontske terapije, upoređen je stepen promene i kod kontrolne grupe na početku i kraju opservacionog perioda. Rezultati: Utvrđene su sagitalne dimenzije gornjih respiratornih puteva kod ispitanika sa hiperdivergentnom malokluzijom klase II/1. Utvrđene dimenzije su značajno manje kod ispitanika sa klasom II/1 nego kod op&scaron;te populacije, na sva tri posmatrana nivoa, nivou nazofarinksa, nivou orofarinksa i nivou hipofarinksa. Ne postoji statistički značajna međuzavisnost između sagitalnih dimenzija gornjih respiratornih puteva i skeletnih odnosa u sagitalnoj dimenziji. Nakon ortodontskog lečenja funkcionalnim aparatima, kod ispitanika su se dimenzije gornjih disajnih puteva na sva tri posmatrana nivoa povećale. Zaključak: Nalazi potvrđuju da su gornji disajni putevi kod osoba sa hiperdivergentnom klasom II/1 uži nego kod ostatka populacije, kao i da uravnotežavanje njihovih morfofunkcionalnih odlika u toku rasta ortodontskim lečenjem dovodi i do skladnijeg razvoja faringealnih struktura koje izgrađuju gornje disajne puteve.</p> / <p>Introduction: Craniofacial system has all of its structures developmentally, functionally and anatomically closely related to the structures of the upper respiratory tract. Thus, any disturbance<br />in any of them is often accompanied by a disorder in the other. This paper is identifying opportunities to recognize some of the orofacial factors in children that could cause or increase the severity of breathing difficulties. Of particular importance is the fact that most authors deal with treating the adult population, while the mere emergence of the developmental disorder is not clearly explained. Therefore, this paper is conceived as a contribution to the knowledge of some of the many mutually very complex, interwoven functional and morphological disorders that together lead to this potentially dangerous, a globally present situation. In this study, special<br />attention is paid to the influence of irregular intermaxillary relationship in the sagittal dimension (posterior position of lower jaw) in children who have not yet completed growth and in which there still can be a therapeutic act, as well as the sagittal narrowness of the upper respiratory tract. Correcting morphological irregularities in children is acheived by modifying and directing the growth and normalization of disturbed functions of orofacial musculature, by the application of functional orthodontic appliances. Objectives and hypotheses: The overall objective of this paper is to contribute to the knowledge of the structures and dimensions of the structures during the period of development, which may in later stages of life contribute to the occurrence of disturbances in breathing and a wide spectrum of disorders described as obstructive sleep apnoea syndrome, as well as to examine the possibility of affecting them early. Methods: The study was conducted as a combination of cross-sectional study in the first part and cohort study in its second part. It was performed at the Clinic of Dentistry of Vojvodina. The study included 98 experimental group subjects who met the criteria for inclusion in the study, appropriate age and craniofacial morphology (second class and hyperdivergent skeletal growth), and 70 (two groups of 35) of controls, being of corresponding ages. Roentgenocephalometric features and the dimensions of the upper respiratory tract were assessed in all subjects, as well as structures that could influence them, tongue and soft palate. The values obtained were compared statistically. After a year of orthodontic treatment of class II malocclusion, re- measurement of the same structures was performed, as well as the comparison with a control group of corresponding age. Changes in relation to the initial findings were tracked. To determine the actual extent of the changes caused by orthodontic treatment, the degree of change was compared in the control group at the beginning and end of the observation period. Results: The sagittal dimensions of the upper respiratory tract are significantly smaller in patients with Class II/1 than in the general population in all three observed levels, the level of the nasopharynx, oropharynx, and the level of level of hypopharynx. There was no significant interdependence between the sagittal dimension of the upper respiratory tract and skeletal relationships in the sagittal dimension. After orthodontic treatment by the means of functional appliances, the dimensions of the upper airway in all three observed levels increased. Conclusion: The findings confirm that the upper airway in patients with hyperdivergent class II/1 malocclusion is narrower than in the rest of the population, as well as that balancing their morphofunctional facial features during growth by orthodontic treatment leads to the more harmonious development of the pharyngeal structures that make up the upper airways.</p>

Bone regeneration or augmentation is often required prior to or concomitant with implant placement. With the limitations of many existing technologies, a biologically compatible synthetic bone grafting substitute that is osteogenic, bioerodible, and provides spacing-making functionality while acting as a drug delivery vehicle for bioactive molecules could provide an alternative to ‘gold standard’ techniques. In the first part of this work, calcium sulfate (CS) space-making synthetic bone grafts with uniformly embedded poly(β-amino ester) (PBAE) biodegradable hydrogel particles was developed to allow controlled release of bioactive agents. The embedded gel particles’ influence on the physical and chemical characteristics of CS was tested. Namely, the compressive strength and modulus, dissolution, and morphology, were studied. All CS samples dissolved via zero-order surface erosion consistent to one another. Compression testing concluded that the amount, but not size, of embedded gel particles significantly decreased (up to 75%) the overall mechanical strength of the composite. Release studies were conducted to explore this system’s ability to deliver a broad range of drug types and sizes. Lysozyme (model protein for larger growth factors like bone morphogenic protein [BMP]) was loaded into PBAE particles embedded in CS matrix. The release of simvastatin, a small molecule drug capable of up regulating BMP production, was also examined. The release of both lysozyme and simvastatin was governed by dissolution of CS. The second part of this work proposed a bilayered CS implant. The physical and chemical properties were characterized similarly to the CS composites above. Release kinetics of directly loaded simvastatin in either the shell, core, or both were investigated. A sequential release of simvastatin was witnessed giving foresight of the composite’s tunability. The sequential release of an antibacterial, metronidazole, loaded into poly(lactic-co-glycolic acid) (PLGA) particles embedded into the shell along with directly loaded simvastatin either in the shell, core, or both layers was also observed. Through controlled release of bioactive agents, as well as a tunable layered geometry, CS-based implants have the potential to be optimized in order to help streamline the steps required for the healing and regeneration of compromised bone tissue.