Objetivo: Analisar, em indivíduos com mordida cruzada total, a influência da cirurgia ortognática na produção dos diferentes fonemas da língua portuguesa, agrupados quanto ao ponto articulatório. Modelo: Estudo prospectivo, que comparou a fala de sujeitos submetidos à cirurgia ortognática, nas fases pré e pós-cirúrgica. Local: Laboratório de Fisiologia- HRAC/USP. Participantes: 19 homens e 11 mulheres (média de 21 anos) com mordida cruzada total, que apresentavam fissura labiopalatina reparada. Intervenções: Avaliação da fala, antes e, em média, 4 meses após a cirurgia ortognática. Variáveis: Ponto articulatório dos grupos de fonemas bilabiais, labiodentais, linguodentais, alveolares, palatais e velares, sendo considerada presença ou ausência de alteração. Resultados: Houve o predomínio de permanência sem alteração para os grupos de fonemas bilabiais e velares, permanência com alteração para os labiodentais e linguodentais, e melhora para os alveolares. Já, no grupo de fonemas palatais, houve uma maior distribuição entre os resultados, com equilíbrio entre permanência com e sem alteração. Apesar de raros, houveram casos de piora para esses quatro grupos. Conclusão: Em sujeitos com mordida cruzada total, a cirurgia ortognática não exerceu influência nos fonemas bilabiais e velares, corretos na fase pré-cirúrgica; influência positiva foi observada em menos de 1/3 no grupo de fonemas labiodentais, e ao redor de 50% nos linguodentais, alveolares e palatais; influência negativa ocorreu nos quatro grupos, ao redor de 5%. À exceção dos casos de adequação automática de todos os fonemas do grupo e de permanência sem alteração, os demais resultados evidenciaram a necessidade de terapia miofuncional orofacial. / Objective: To evaluate, in individuals with anterior and posterior crossbite, the influence of orthognathic surgery on the production of different Portuguese phonemes grouped as to the place of articulation. Model: Prospective study for comparison of the speech of individuals submitted to orthognathic surgery, before and after surgery. Setting: Physiology Laboratory – HRAC/USP. Participants: 19 males and 11 females (mean age 21 years) with anterior and posterior crossbite with repaired cleft lip and palate. Interventions: Speech evaluation before and about four months after orthognathic surgery. Variables: Place of articulation of the groups of bilabial, labiodental, dental, alveolar, palatal and velar phonemes, considering the presence or absence of alteration. Results: There was predominance of permanence without alteration for the groups of bilabial and velar phonemes, permanence with alteration for the labiodental and dental phonemes, and improvement in the alveolar phonemes. As regards the group of palatal phonemes, there was a greater distribution among the outcomes with balance between permanence with and without alteration. Though rare, there were cases of worsening for these four groups. Conclusion: In subjects with anterior and posterior crossbite, the orthognathic surgery did not yield any influence on the bilabial and velar phonemes, which were correct in the pre-surgical phase; a positive influence was observed in less than 1/3 in the group of labiodental phonemes and close to 50% in the dental, alveolar and palatal phonemes; the negative influence in the four groups was close to 5%. Except for the cases with automatic adaptation of all phonemes in the group and permanence without alteration, the other results indicated the need of orofacial myofunctional therapy.

Aim: To evaluate the ability of a publicly available facial recognition application program interface (API) to calculate similarity scores for pre- and post-surgical photographs of patients undergoing orthognathic surgeries. Our primary objective was to identify which surgical procedure(s) had the greatest effect(s) on similarity score. Methods: Standard treatment progress photographs for 25 retrospectively identified, orthodontic-orthognathic patients were analyzed using the API to calculate similarity scores between the pre- and post-surgical photographs. Photographs from two pre-surgical timepoints were compared as controls. Both relaxed and smiling photographs were included in the study to assess for the added impact of facial pose on similarity score. Surgical procedure(s) performed on each patient, gender, age at time of surgery, and ethnicity were recorded for statistical analysis. Nonparametric Kruskal-Wallis Rank Sum Tests were performed to univariately analyze the relationship between each categorical patient characteristic and each recognition score. Multiple comparison Wilcoxon Rank Sum Tests were performed on the subsequent statistically significant characteristics. P-Values were adjusted for using the Bonferroni correction technique. Results: Patients that had surgery on both jaws had a lower median similarity score, when comparing relaxed expressions before and after surgery, compared to those that had surgery only on the mandible (p = 0.014). It was also found that patients receiving LeFort and bilateral sagittal split osteotomies (BSSO) surgeries had a lower median similarity score compared to those that received only BSSO (p = 0.009). For the score comparing relaxed expressions before surgery versus smiling expressions after surgery, patients receiving two-jaw surgeries had lower scores than those that had surgery on only the mandible (p = 0.028). Patients that received LeFort and BSSO surgeries were also found to have lower similarity scores compared to patients that received only BSSO when comparing pre-surgical relaxed photographs to post-surgical smiling photographs (p = 0.036). Conclusions: Two-jaw surgeries were associated with a statistically significant decrease in similarity score when compared to one-jaw procedures. Pose was also found to be a factor influencing similarity scores, especially when comparing pre-surgical relaxed photographs to post-surgical smiling photographs.

In the field of maxillofacial surgery, the treatment for the recovery of the fracture at condyle region of the mandible has been carried out using Bio-metals such as Titanium, Cobalt, Stainless-Steel because they were considered the standard materials for Implant plate devices for fracture fixation. Using these materials have led to undesired disturbances where the patient must undergo secondary surgery after recovery leading to exposure of the fracture site to the surrounding, metal-ion release into the human system, stress-shielding and interruption during imaging i.e. (Computerized tomography scans). The healing of the mandible requires a delicate and stable fixation procedure for the bone structure to heal. Bio-resorbable materials are the renovation for substituting metals for recovery of the fracture. The main dis-advantage using resorbable plates is absence of mechanical strength and stability. Bio-composites are the innovation for the treatment of the fractures the main study for this thesis is comparing the combination bio-ceramic and bio-resorbable materials using Finite Element Analysis software.

Objectives: (1) To calculate rates for maxillofacial (MF) injury-related visits in emergency departments (EDs) and hospitals in Ontario; (2) To investigate socio-demographic distribution of MF injuries; (3) To identify common causes for MF injuries. Methods: An 8-year retrospective study design was implemented. Two datasets were used: Discharge Abstract Database and National Ambulatory Care Reporting System. Color-coded maps were created using ArcGIS. Results: From 2004 to 2012 in Ontario, 1,457,990 ED visits and 41,057 hospitalizations due to MF injuries were registered. MF injuries are most frequent in males and occur mainly in evenings (7:00 to 9:00 pm) and weekends. Higher rates of MF injury are seen in rural areas and low-income neighborhoods. The leading cause of MF injuries is falls. Conclusion: 3 out of 100 ED visits and 1 out of 200 hospitalizations were caused by MF injury. Male youth and female older people suffered high rates of MF injury.

Objectives: (1) To calculate rates for maxillofacial (MF) injury-related visits in emergency departments (EDs) and hospitals in Ontario; (2) To investigate socio-demographic distribution of MF injuries; (3) To identify common causes for MF injuries. Methods: An 8-year retrospective study design was implemented. Two datasets were used: Discharge Abstract Database and National Ambulatory Care Reporting System. Color-coded maps were created using ArcGIS. Results: From 2004 to 2012 in Ontario, 1,457,990 ED visits and 41,057 hospitalizations due to MF injuries were registered. MF injuries are most frequent in males and occur mainly in evenings (7:00 to 9:00 pm) and weekends. Higher rates of MF injury are seen in rural areas and low-income neighborhoods. The leading cause of MF injuries is falls. Conclusion: 3 out of 100 ED visits and 1 out of 200 hospitalizations were caused by MF injury. Male youth and female older people suffered high rates of MF injury.

As cirurgias ortognáticas são aceitas como alternativa de tratamento para anomalias dento-faciais de diferentes padrões morfológicos e magnitudes de discrepância maxilo-mandibular. Diferentes metodologias foram propostas na literatura para sua realização, a maior parte delas envolvendo múltiplas etapas de planejamento e métodos físicos de transferência deste para o campo operatório, envolvendo guias cirúrgicos físicos dento-suportados, bem como diferentes tipos de cirurgias de modelos ou tecnologias complexas. A análise cefalométrica é indicada para o diagnóstico, planejamento e o acompanhamento do resultado destas cirurgias, podendo ser obtida de forma manual ou por meio de traçado digital. O objetivo deste estudo foi comparar dados obtidos com cefalometria manual e digital, para determinar a existência de diferenças ente as grandezas cefalométricas analisadas. Foram realizados traçados cefalométricos em 38 telerradiografias laterais de pacientes diagnosticados com anomalia dento-facial pelo mesmo cirurgião, utilizando-se ambos os métodos. Os valores aferidos foram comparados utilizando-se o teste tpareado, o qual demonstrou diferença estatística para os ângulos IMPA e PHF.PO (p<0,05). Conclui-se que pode haver diferença nos valores quando utiliza-se um ou outro método, no entanto sugere-se que essas discrepâncias não são clinicamente válidas. Portanto, tanto o método manual como o digital, apresentam vantagens e desvantagens, mas parecem ser confiáveis para realização de diagnóstico e conseguinte planejamento de cirurgia ortognática. / Combined orthognathic surgery are accepted as alternative treatment for dentofacial anomalies with different morphological patterns and magnitudes of maxillo-mandibular discrepancy. Different methods were proposed in the literature for its realization, most of them involving multiple stages of planning and physical methods of transferring this to the operative field, involving surgical guides dental-supported as well as different types of surgeries models or complex technologies. The cephalometric analysis is indicated for the diagnosis, treatment planning and evaluation of the surgical outcome, either by manual or digital tracing. The aim of this study was to compare data obtained from manual and digital cephalometric tracings, evaluatingpossible differences between the methods. Digital and manual cephalometry were performed in 38 lateral cephalometric radiographs of patients previously diagnosed with dentofacial anomalies, and the data was compared using the paired t test. Significant differences were found for the angles PHF.PO and IMPA angles (p <0,05). However the magnitude of the differences was low. The findings reinforce previous data suggesting that there may be differencein measurement values obtained by these methods, however these differences have no clinical impact. Both the manual and digital methods seem to bereliable for diagnosis and treatment planning of skeletal dentofacial anomalies.

Proposição: O presente trabalho propõe o estudo histológico descritivo da aplicação de um campo magnético sepultado, estático e permanente em área de enxerto ósseo alógeno liofilizado e dento-alveolar associada a defeito cirúrgico em mandíbulas de ratos. Metodologia: estudo experimental in vivo, randomizado. Amostra foi composta por 21 ratos, da espécie Rattus novergicus albinus, linhagem Wistar, machos, divididos em três grupos, correspondendo aos tempos experimentais de sete, 21 e 45 dias. Foram realizadas ostectomias associadas a odontossecções, na face lateral externa do corpo mandibular e no ramo ascendente, atingindo transversalmente a raiz do incisivo inferior e os ápices dos molares. Este defeito cirúrgico permitiu a adaptação de dispositivos metálicos magnetizados (grupo teste) e não magnetizados (grupo controle) associados às regiões apicais dos molares e ao coto distal do incisivo inferior, local este onde realizou-se enxertia óssea alógena liofilizada. A intensidade média do campo magnético sepultado e permanente foi de 250 gauss.Resultados: observou-se no grupo teste e controle, nos diferentes tempos experimentais a gradativa integração do enxerto ósseo alógeno liofilizado, a manutenção da vitalidade pulpar dos molares e coto proximal do incisivo inferior, além da contínua erupção do incisivo inferior do rato. Nos grupos teste, principalmente aos 45 dias, constatou-se uma diferenciada e exuberante neoformação óssea centrípeta em direção aos dispositivos metálicos imantados. Conclusão: o campo magnético sepultado in vivo foi capaz de favorecer o processo de cicatrização óssea no defeito cirúrgico criado. / Purpose: The present study provides a descriptive histological analysis of the use of a buried, static and permanent magnetic field in lyophilized bone allografts in a dentoalveolar area associated with surgical defects in rat mandibles. Method: a randomized in vivo experimental study was carried out with 21 male Wistar rats (Rattus norvegicus albinus), which were split into three groups, corresponding to 7, 21 and 45 experimental days. Ostectomies associated with odontotomies were performed on the outer lateral face of the mandibular body and in the ascending branch, cross-sectionally to the root of the lower incisor and to the molar apices. This surgical defect allowed for the use of magnetized (test group) and non-magnetized (control group) metal devices associated with molar apices and with the distal stump of the lower incisor, where the lyophilized bone allograft was performed. The intensity of the buried and permanent magnetic field amounted to 250 gauss. Results: In the test and control groups, there was gradual integration of the lyophilized bone allograft, maintenance of pulp vitality of the molars and of the proximal stump of the lower incisor, in addition to continuous eruption of the lower incisor. In the test groups, especially at 45 days, there was distinct and pronounced centripetal new bone formation in a direction toward the magnetized metal devices. Conclusion: the in vivo buried magnetic field favored bone healing at the site of the surgical defect.

A compreensão dos fenômenos de reparo ósseo representa parte fundamental da odontologia e da cirurgia bucomaxilofacial. Objetivo: O presente trabalho tem como objetivo avaliar a influência da estimulação de campo magnético sepultado sobre o reparo ósseo em calvária de ratos após reconstrução com enxerto ósseo autógeno, implante de hidroxiapatita granulada sintética ou enxerto alógeno de cartilagem, comparados entre si e aos controles sem estimulação magnética. Materiais e métodos: foram utilizados 95 ratos Wistar machos, divididos em grupos constituidos por 5 animais. Foram realizados defeitos ósseos críticos na calvária dos animais, sendo os mesmos imediatamente reconstruídos, isoladamente com, enxerto ósseo autógeno, hidroxiapatita granulada sintética e enxerto alógeno de cartilagem, sob influência ou não de campos magnéticos sepultados. Foram realizadas avaliações aos 15, 30 e 60 dias pós-operatórios. Apenas um grupo não sofreu intervenção cirúrgica (Naive), para fornecer os dados para obtenção da atividade fisiológica das enzimas fosfatase alcalina e fosfatase ácida. Em todos os tempos experimentais foi realizada a quantificação da neoformação óssea por meio da histomorfometria. A avaliação da intensidade de expressão da proteína osteopontina, foi obtida somente aos 60 dias Resultados: a avaliação histomorfométrica evidenciou interação significativa entre grupos e tempos com p=0,008. Aos 60 dias, nos animais que receberam reconstrução com osso autógeno o grupo sob influência do campo magnético apresentou percentual de preenchimento ósseo superior ao grupo sem influência do estímulo magnético. A mensuração da atividade das enzimas fosfatase alcalina e fosfatase ácida evidenciou interação significativa entre grupos e tempos com p=0,02 e p=0,005 respectivamente. Aos 60 dias, todos os grupos apresentaram atividade de ambas enzimas significativamente inferior ao grupo Naive. A análise imunoistoquímica realizada não evidenciou diferença significativa na expressão da enzima osteopontina com a metodologia empregada. Conclusão: o presente trabalho contribuiu para o entendimento da influência do campo magnético sepultado sobre o reparo ósseo em crânio de rato. A partir dos resultados encontrados, novas metodologias podem ser propostas para complementar os resultados obtidos e fortalecer a presente linha de pesquisa. / Objective: the comprehension of the phenomenon of bone repair represents a fundamental part of dentistry and of oral and maxillofacial surgery. The present work has as its objective, to evaluate the influence of a stimulated magnetic field implanted on the calvarial bone of rats after its reconstruction with autogeneous bone graft, synthetic hydroxyapatite crystals or with the insertion of allogeneic cartilage, in comparison to no magnetic stimulation. Materials e methods: 95 Wistar male rats were used, divided into groups with 5 animals in each. The autogeneous bone graft, the synthetic hydroxyapatite crystals and the insertion of allogeneic cartilage were each used separately in the performed interventions of reconstruction with or without the influence of implanted magnetic fields. Evaluations were performed in 15, 30 and 60 days after surgery. Only one group did not suffer surgical intervention (Naïve); this group provided data for the physiological activity of the alkaline and acid phosphatase enzymes. Also, quantification of bone neoformation was obtained through histomorphometry in all experimental time periods, and evaluation of the osteopontin protein expression of intensity in 60 days. Results: the histomorphometry 60-day evaluation, showed evidence of a significant interaction between the groups and the time of p=0,008 on the animals that received reconstruction with autogeneous bone. The group that was influenced by the magnetic field presented a percent of bone reconstruction superior to that of the group which did not receive magnetic stimulation. In 60 days, activity mensuration of the alkaline and acid phosphatase enzymes, showed evidence of significant interaction between the groups and the times of p=0,02 and p=0,005, respectively. In all groups, activity of both enzymes was present and significantly inferior to the Naive group. The immunohistochemistry analysis performed did not show evidence of any significant difference in the oseopontin enzyme expression with the applied methodology. Conclusion: this work contributed to the understanding of the influence that an implanted magnetic field has on bone reconstruction. From the results found, new methodologies can be proposed as a complementary to obtained results and can strengthen the present line of research.

As cirurgias ortognáticas são aceitas como alternativa de tratamento para anomalias dento-faciais de diferentes padrões morfológicos e magnitudes de discrepância maxilo-mandibular. Diferentes metodologias foram propostas na literatura para sua realização, a maior parte delas envolvendo múltiplas etapas de planejamento e métodos físicos de transferência deste para o campo operatório, envolvendo guias cirúrgicos físicos dento-suportados, bem como diferentes tipos de cirurgias de modelos ou tecnologias complexas. A análise cefalométrica é indicada para o diagnóstico, planejamento e o acompanhamento do resultado destas cirurgias, podendo ser obtida de forma manual ou por meio de traçado digital. O objetivo deste estudo foi comparar dados obtidos com cefalometria manual e digital, para determinar a existência de diferenças ente as grandezas cefalométricas analisadas. Foram realizados traçados cefalométricos em 38 telerradiografias laterais de pacientes diagnosticados com anomalia dento-facial pelo mesmo cirurgião, utilizando-se ambos os métodos. Os valores aferidos foram comparados utilizando-se o teste tpareado, o qual demonstrou diferença estatística para os ângulos IMPA e PHF.PO (p<0,05). Conclui-se que pode haver diferença nos valores quando utiliza-se um ou outro método, no entanto sugere-se que essas discrepâncias não são clinicamente válidas. Portanto, tanto o método manual como o digital, apresentam vantagens e desvantagens, mas parecem ser confiáveis para realização de diagnóstico e conseguinte planejamento de cirurgia ortognática. / Combined orthognathic surgery are accepted as alternative treatment for dentofacial anomalies with different morphological patterns and magnitudes of maxillo-mandibular discrepancy. Different methods were proposed in the literature for its realization, most of them involving multiple stages of planning and physical methods of transferring this to the operative field, involving surgical guides dental-supported as well as different types of surgeries models or complex technologies. The cephalometric analysis is indicated for the diagnosis, treatment planning and evaluation of the surgical outcome, either by manual or digital tracing. The aim of this study was to compare data obtained from manual and digital cephalometric tracings, evaluatingpossible differences between the methods. Digital and manual cephalometry were performed in 38 lateral cephalometric radiographs of patients previously diagnosed with dentofacial anomalies, and the data was compared using the paired t test. Significant differences were found for the angles PHF.PO and IMPA angles (p <0,05). However the magnitude of the differences was low. The findings reinforce previous data suggesting that there may be differencein measurement values obtained by these methods, however these differences have no clinical impact. Both the manual and digital methods seem to bereliable for diagnosis and treatment planning of skeletal dentofacial anomalies.

Proposição: O presente trabalho propõe o estudo histológico descritivo da aplicação de um campo magnético sepultado, estático e permanente em área de enxerto ósseo alógeno liofilizado e dento-alveolar associada a defeito cirúrgico em mandíbulas de ratos. Metodologia: estudo experimental in vivo, randomizado. Amostra foi composta por 21 ratos, da espécie Rattus novergicus albinus, linhagem Wistar, machos, divididos em três grupos, correspondendo aos tempos experimentais de sete, 21 e 45 dias. Foram realizadas ostectomias associadas a odontossecções, na face lateral externa do corpo mandibular e no ramo ascendente, atingindo transversalmente a raiz do incisivo inferior e os ápices dos molares. Este defeito cirúrgico permitiu a adaptação de dispositivos metálicos magnetizados (grupo teste) e não magnetizados (grupo controle) associados às regiões apicais dos molares e ao coto distal do incisivo inferior, local este onde realizou-se enxertia óssea alógena liofilizada. A intensidade média do campo magnético sepultado e permanente foi de 250 gauss.Resultados: observou-se no grupo teste e controle, nos diferentes tempos experimentais a gradativa integração do enxerto ósseo alógeno liofilizado, a manutenção da vitalidade pulpar dos molares e coto proximal do incisivo inferior, além da contínua erupção do incisivo inferior do rato. Nos grupos teste, principalmente aos 45 dias, constatou-se uma diferenciada e exuberante neoformação óssea centrípeta em direção aos dispositivos metálicos imantados. Conclusão: o campo magnético sepultado in vivo foi capaz de favorecer o processo de cicatrização óssea no defeito cirúrgico criado. / Purpose: The present study provides a descriptive histological analysis of the use of a buried, static and permanent magnetic field in lyophilized bone allografts in a dentoalveolar area associated with surgical defects in rat mandibles. Method: a randomized in vivo experimental study was carried out with 21 male Wistar rats (Rattus norvegicus albinus), which were split into three groups, corresponding to 7, 21 and 45 experimental days. Ostectomies associated with odontotomies were performed on the outer lateral face of the mandibular body and in the ascending branch, cross-sectionally to the root of the lower incisor and to the molar apices. This surgical defect allowed for the use of magnetized (test group) and non-magnetized (control group) metal devices associated with molar apices and with the distal stump of the lower incisor, where the lyophilized bone allograft was performed. The intensity of the buried and permanent magnetic field amounted to 250 gauss. Results: In the test and control groups, there was gradual integration of the lyophilized bone allograft, maintenance of pulp vitality of the molars and of the proximal stump of the lower incisor, in addition to continuous eruption of the lower incisor. In the test groups, especially at 45 days, there was distinct and pronounced centripetal new bone formation in a direction toward the magnetized metal devices. Conclusion: the in vivo buried magnetic field favored bone healing at the site of the surgical defect.