>Magister Scientiae - MSc / Introduction: A common complication of poorly managed mandible fractures is infection. There is a consensus amongst clinicians in treating infected mandible fractures in an immediate setting. The approach includes drainage of the purulent discharge, debridement of the fracture, removal of teeth in the fracture line and immediate fixation. Fixation can be load bearing or load sharing in nature. Although clinicians advocate for the use of a reconstruction load bearing plate, a double miniplate fixation could be an alternative. Aim: The aim is to assess the outcomes of double miniplate osteosynthesis in the immediate management of infected mandible fractures Material and method: A prospective cohort study was conducted. The sample size was 20 (n =20). Infections were treated with an incision and drainage and the fractures fixated with a double miniplate fixation system. Pain scores, fracture union, fracture stability and surgical times were measured. Follow–up visits included one week, six weeks and three months respectively.

Magister Chirurgiae Dentium (MChD) / Introduction: A common complication of poorly managed mandible fractures is infection. There is a consensus amongst clinicians in treating infected mandible fractures in an immediate setting. The approach includes drainage of the purulent discharge, debridement of the fracture, removal of teeth in the fracture line and immediate fixation. Fixation can be load bearing or load sharing in nature. Although clinicians advocate for the use of a reconstruction load bearing plate, a double miniplate fixation could be an alternative. Aim: The aim is to assess the outcomes of double miniplate osteosynthesis in the immediate management of infected mandible fractures Material and method: A prospective cohort study was conducted. The sample size was 20 (n =20). Infections were treated with an incision and drainage and the fractures fixated with a double miniplate fixation system. Pain scores, fracture union, fracture stability and surgical times were measured. Follow–up visits included one week, six weeks and three months respectively. Results: Mandibular angle fractures were most commonly infected. The most common cause of infection were teeth in the line of fracture. The buccal fascial space was the most commonly involved fascial space in regard to spread of infection. Nineteen of the twenty cases attained fracture stability. However, complications commonly encountered were persistent infection and wound dehiscence. Conclusion: Although a limited number of clinical cases were treated, the results correspond with the current literature when an immediate miniplate fixation protocol is used in infected mandible fractures. However, complications encountered in the study included the persistence of infection and wound dehiscence.

Made available in DSpace on 2014-06-11T19:27:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2004-03-26Bitstream added on 2014-06-13T19:15:34Z : No. of bitstreams: 1 nakao_cy_me_arafo.pdf: 287074 bytes, checksum: 7de04a5493221049b259b6b4157ddca4 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A necessidade de recursos para o tratamento da mordida aberta anterior esquelética, em adultos, que apresentam excesso de erupção dentária posterior superior, a deficiência de dados literários e de estudos mais aprofundados sobre o tratamento deste tipo de problema originou o presente estudo.O propósito deste estudo foi o de avaliar o efeito da intrusão dos molares pela técnica de ancoragem com miniplacas de titânio. A amostra de estudo consistiu-se de telerradiografias em norma lateral e a 45 graus, de pacientes adultos com idade entre 13 anos e 5 meses a 29 anos e 8 meses. A seleção da amostra teve como critério de inclusão, pacientes com dentadura permanente, portadores de mordida aberta anterior de pelo menos 1,5 mm e extrusão dos dentes posteriores superiores. Os pacientes foram tratados com força intrusiva aplicada ao segmento posterior bilateralmente, utilizando elástico tissue guard apoiado do tubo do primeiro molar superior ao gancho da miniplaca de titânio. Este procedimento era iniciado quinze dias após a implantação das miniplacas no pilar zigomático da maxila e ativada a cada 15 a 20 dias pela troca do elástico com força de 450 g a 500 g, pelo período de 6 meses. Os dados do estudo mostraram evidências de intrusão verdadeira dos molares superiores com este tipo de tratamento. Pôde ser concluído que as miniplacas de titânio permanecem firmes e estáveis quando utilizadas como ancoragem ortodôntica fixa possibilitando uma intrusão real dos dentes posteriores de pacientes adultos, com resultante alteração na inclinação do plano oclusal no sentido horário e mandibular no sentido anti-horário além de diminuição da altura facial anterior. / The need of resources for the treatment of skeletal anterior open bite in adults with superior posterior dental eruption excess, the lack of information in the literature and elaborate studies about the technique originates this study. The aim of the study was to evaluate the effect of the upper molar intrusion by the titanium miniplates anchorage technique. The sample consisted of lateral and 45 cephalometric radiographs of patients between 13 years and 5 months to 29 years and 8 months of age. The inclusion criteria for selection of the sample was adult patients with permanent dentition, anterior open bite of at least 1,5 mm and extrusion of the posterior upper teeth. The patients were treated with an intrusion force applied to the posterior segment bilaterally by the means of tissue guard elastics tied to the tube of the upper first molars and to the miniplates hooks. This procedure was started fifteen days after the implantation of the miniplates and it was checked each 15 to 20 days for elastic change, with forces varying from 450 to 500 grams/side for six month period. The data collected in the study showed evidence of real upper molar intrusion with this kind of treatment. It was concluded that the titanium miniplates as used as orthodontic anchorage remained firm and stable allowing a real intrusion of the posterior teeth in adult patients, with a resulting change in the inclination of the occlusal plane in the clockwise direction, of the mandibular plane in the counterclockwise direction and in a decrease of the anterior facial height.

Resumo: A necessidade de recursos para o tratamento da mordida aberta anterior esquelética, em adultos, que apresentam excesso de erupção dentária posterior superior, a deficiência de dados literários e de estudos mais aprofundados sobre o tratamento deste tipo de problema originou o presente estudo.O propósito deste estudo foi o de avaliar o efeito da intrusão dos molares pela técnica de ancoragem com miniplacas de titânio. A amostra de estudo consistiu-se de telerradiografias em norma lateral e a 45 graus, de pacientes adultos com idade entre 13 anos e 5 meses a 29 anos e 8 meses. A seleção da amostra teve como critério de inclusão, pacientes com dentadura permanente, portadores de mordida aberta anterior de pelo menos 1,5 mm e extrusão dos dentes posteriores superiores. Os pacientes foram tratados com força intrusiva aplicada ao segmento posterior bilateralmente, utilizando elástico "tissue guard" apoiado do tubo do primeiro molar superior ao gancho da miniplaca de titânio. Este procedimento era iniciado quinze dias após a implantação das miniplacas no pilar zigomático da maxila e ativada a cada 15 a 20 dias pela troca do elástico com força de 450 g a 500 g, pelo período de 6 meses. Os dados do estudo mostraram evidências de intrusão verdadeira dos molares superiores com este tipo de tratamento. Pôde ser concluído que as miniplacas de titânio permanecem firmes e estáveis quando utilizadas como ancoragem ortodôntica fixa possibilitando uma intrusão real dos dentes posteriores de pacientes adultos, com resultante alteração na inclinação do plano oclusal no sentido horário e mandibular no sentido anti-horário além de diminuição da altura facial anterior. / Abstract: The need of resources for the treatment of skeletal anterior open bite in adults with superior posterior dental eruption excess, the lack of information in the literature and elaborate studies about the technique originates this study. The aim of the study was to evaluate the effect of the upper molar intrusion by the titanium miniplates anchorage technique. The sample consisted of lateral and 45 cephalometric radiographs of patients between 13 years and 5 months to 29 years and 8 months of age. The inclusion criteria for selection of the sample was adult patients with permanent dentition, anterior open bite of at least 1,5 mm and extrusion of the posterior upper teeth. The patients were treated with an intrusion force applied to the posterior segment bilaterally by the means of "tissue guard" elastics tied to the tube of the upper first molars and to the miniplates hooks. This procedure was started fifteen days after the implantation of the miniplates and it was checked each 15 to 20 days for elastic change, with forces varying from 450 to 500 grams/side for six month period. The data collected in the study showed evidence of real upper molar intrusion with this kind of treatment. It was concluded that the titanium miniplates as used as orthodontic anchorage remained firm and stable allowing a real intrusion of the posterior teeth in adult patients, with a resulting change in the inclination of the occlusal plane in the clockwise direction, of the mandibular plane in the counterclockwise direction and in a decrease of the anterior facial height. / Orientador: Ary dos Santos-Pinto / Coorientador: João Roberto Gonçalves / Banca: Tatsuko Sakima / Banca: Hélio Hissashi Terada / Mestre

O IPEN/CNEN-SP fabrica combustíveis para uso no seu reator nuclear de pesquisas, o IEA-R1. Para qualificar os seus combustíveis tem que comprovar o bom desempenho destes sob irradiação. Como o Brasil não possui reator nuclear de pesquisa com altos fluxos de nêutrons ou células quentes apropriadas para a realização de exames pós-irradiação de combustíveis nucleares, o IPEN/CNEN-SP conduziu um programa de qualificação operacional de elementos combustíveis empregando compostos de urânio já internacionalmente testados sob irradiação e qualificados para uso em reatores de pesquisas, obtendo experiência nas etapas de desenvolvimento tecnológico de fabricação de placas combustíveis, irradiação e ensaios não destrutivos pós-irradiação. Foram fabricados e irradiados diretamente no núcleo do IEA-R1, com sucesso, elementos combustíveis contendo dispersões com baixas frações volumétricas de combustível. Entretanto, existem planos no IPEN/CNEN-SP para aumentar a densidade de urânio dos seus combustíveis. O objetivo deste trabalho de tese consistiu no estudo e proposição de aplicação de um conjunto de métodos não destrutivos para a qualificação dos combustíveis a dispersão de U3O8-Al e U3Si2-Al com alta densidade de urânio fabricados no IPEN/CNEN-SP. Para tanto, foram considerados os recursos de irradiação e a aplicação, na piscina do reator IEA-R1, de métodos não destrutivos disponíveis na Instituição. A proposta consiste em especificar, fabricar e irradiar miniplacas combustíveis, nas densidades máximas já qualificadas internacionalmente e efetuar acompanhamento das condições gerais das mesmas, ao longo do período de irradiação, por meio de métodos não destrutivos na piscina do reator. Além dos métodos de inspeção visual e de sipping já empregados na Instituição, foi concluída a infraestrutura para realização de ensaios dimensionais sub-aquáticos para a avaliação do inchamento das miniplacas combustíveis irradiadas. As análises dos resultados darão subsídios para avaliar e decidir a continuidade ou não das irradiações das miniplacas, até que sejam alcançadas as queimas estipuladas para os testes de irradiação no IEA-R1. / IPEN/CNEN-SP manufactures fuels to be used in its nuclear research reactor the IEA-R1. To qualify those fuels, it is necessary to check if they have a good performance under irradiation. As Brazil doesnt have nuclear research reactors with high neutron fluxes, or suitable hot cells for carrying out post-irradiation examination of nuclear fuels, IPEN/CNEN-SP has conducted a fuel qualification program based on the use of uranium compounds, internationally tested and qualified to be used in research reactors, and has gotten experience in the technological development stages for the manufacturing of fuel plates, irradiation and non-destructive post-irradiation testing. Fuel elements containing low volume fractions of fuel in the dispersion were manufactured and irradiated successfully directly in the core of the IEA-R1. However, there are plans to increase the uranium density of these fuels. The objective of this thesis work was to study and to propose a set of non-destructive methods to qualify the dispersions fuels U3O8-Al e U3Si2-Al with high uranium density produced at IPEN/CNEN-SP. For that, the irradiation resources in the IEA-R1, and the application of non-destructive methods in the reactor pool available in the Institution were considered. The proposal is to specify, manufacture and irradiate fuel miniplates in IEA-R1 at the maximum densities, qualified internationally, and to monitor their general conditions during the period of irradiation, using non-destructive methods in the reactor pool. In addition to the non-destructives visual inspection and sipping methods, already used at the Institution, the infrastructure for dimensional sub-aquatic testing to evaluate the swelling of irradiated fuel miniplates was completed. The analyses of the results will provide means to assess and decide whether or not to continue with the irradiation of miniplates, until the desired burnup for the irradiation tests at IEA-R1 are reached.

O IPEN/CNEN-SP fabrica combustíveis para uso no seu reator nuclear de pesquisas, o IEA-R1. Para qualificar os seus combustíveis tem que comprovar o bom desempenho destes sob irradiação. Como o Brasil não possui reator nuclear de pesquisa com altos fluxos de nêutrons ou células quentes apropriadas para a realização de exames pós-irradiação de combustíveis nucleares, o IPEN/CNEN-SP conduziu um programa de qualificação operacional de elementos combustíveis empregando compostos de urânio já internacionalmente testados sob irradiação e qualificados para uso em reatores de pesquisas, obtendo experiência nas etapas de desenvolvimento tecnológico de fabricação de placas combustíveis, irradiação e ensaios não destrutivos pós-irradiação. Foram fabricados e irradiados diretamente no núcleo do IEA-R1, com sucesso, elementos combustíveis contendo dispersões com baixas frações volumétricas de combustível. Entretanto, existem planos no IPEN/CNEN-SP para aumentar a densidade de urânio dos seus combustíveis. O objetivo deste trabalho de tese consistiu no estudo e proposição de aplicação de um conjunto de métodos não destrutivos para a qualificação dos combustíveis a dispersão de U3O8-Al e U3Si2-Al com alta densidade de urânio fabricados no IPEN/CNEN-SP. Para tanto, foram considerados os recursos de irradiação e a aplicação, na piscina do reator IEA-R1, de métodos não destrutivos disponíveis na Instituição. A proposta consiste em especificar, fabricar e irradiar miniplacas combustíveis, nas densidades máximas já qualificadas internacionalmente e efetuar acompanhamento das condições gerais das mesmas, ao longo do período de irradiação, por meio de métodos não destrutivos na piscina do reator. Além dos métodos de inspeção visual e de sipping já empregados na Instituição, foi concluída a infraestrutura para realização de ensaios dimensionais sub-aquáticos para a avaliação do inchamento das miniplacas combustíveis irradiadas. As análises dos resultados darão subsídios para avaliar e decidir a continuidade ou não das irradiações das miniplacas, até que sejam alcançadas as queimas estipuladas para os testes de irradiação no IEA-R1. / IPEN/CNEN-SP manufactures fuels to be used in its nuclear research reactor the IEA-R1. To qualify those fuels, it is necessary to check if they have a good performance under irradiation. As Brazil doesnt have nuclear research reactors with high neutron fluxes, or suitable hot cells for carrying out post-irradiation examination of nuclear fuels, IPEN/CNEN-SP has conducted a fuel qualification program based on the use of uranium compounds, internationally tested and qualified to be used in research reactors, and has gotten experience in the technological development stages for the manufacturing of fuel plates, irradiation and non-destructive post-irradiation testing. Fuel elements containing low volume fractions of fuel in the dispersion were manufactured and irradiated successfully directly in the core of the IEA-R1. However, there are plans to increase the uranium density of these fuels. The objective of this thesis work was to study and to propose a set of non-destructive methods to qualify the dispersions fuels U3O8-Al e U3Si2-Al with high uranium density produced at IPEN/CNEN-SP. For that, the irradiation resources in the IEA-R1, and the application of non-destructive methods in the reactor pool available in the Institution were considered. The proposal is to specify, manufacture and irradiate fuel miniplates in IEA-R1 at the maximum densities, qualified internationally, and to monitor their general conditions during the period of irradiation, using non-destructive methods in the reactor pool. In addition to the non-destructives visual inspection and sipping methods, already used at the Institution, the infrastructure for dimensional sub-aquatic testing to evaluate the swelling of irradiated fuel miniplates was completed. The analyses of the results will provide means to assess and decide whether or not to continue with the irradiation of miniplates, until the desired burnup for the irradiation tests at IEA-R1 are reached.

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

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