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A new technique for mandibular osteotomy
Edela Puricelli
Head & Face Medicine , 2007, DOI: 10.1186/1746-160x-3-15
Abstract: Osteotomies of the mandible have fundamental importance for correction of dental facial deformities (ICD K07). Osteotomy of the condylar neck was originally introduced by Jaboulay and Bérard in 1898 (apud Caldwell and Letterman, 1954) [1], and received important contributions by Babcock in 1909 [2].Osteotomies of the mandibular ramus are currently preferred to osteotomies of the mandibular body. Their main advantages are related to lower risk of damage to the inferior alveolar neurovascular bundle, maintenance of extension of the mandibular body and no need for tooth extraction. They also allow for better aesthetic results in the region of the mandibular angle, through correction of the obtuse angle which characterizes prognathism [1].Sagittal ramus osteotomy is one of the most efficient of these techniques [3]. The original designs for sagittal ramus osteotomy, performed with extra-oral access and involving a horizontal cut above the lingula, presented problems related to the small surface of contact between the resulting bone segments. Complications such as open bite and pseudarthrosis were usually a consequence of the procedures. Since the suggestion of cuts with inclined orientation by Kazanjian [4], the technique received a number of improvements. Schuchardt (apud Obwegeser) [5] suggested cutting the medial cortical surface of the ramus above the lingula, and the external surface 10 mm below the first cut. Trauner and Obwegeser [6] and Obwegeser [7] suggested that this distance should be increased to 25 mm, allowing for a larger area of contact. They were also responsible for the introduction of intra-oral access for performance of the technique.Dal Pont [8] modified Obwegeser's method with the introduction of retromolar osteotomy. This alteration resulted in smaller displacement of the proximal segment due to muscle activity (jaw elevator muscles), so that the method could be used for other anomalies besides prognathism, such as retrognathism and open bite. Re
Panorametry: suggestion of a method for mandibular measurements on panoramic radiographs
Edela Puricelli
Head & Face Medicine , 2009, DOI: 10.1186/1746-160x-5-19
Abstract: Panoramic radiography (orthopantomography), which technically results from collecting images with a rotating system, allows wide view of the oral maxillofacial complex, in occlusion as well as in frontal overbite. In Orthodontics and in Oral Maxillofacial Surgery, panoramic X-ray remains an important source of information. Even presenting very little image superposition, particularly for the mandible, it is not employed in comparative studies such as frontal and lateral cephalometries. As a frontolateral panoramic image of the face, it results in some distortion which involves, in decreasing degree of importance, horizontal, vertical and angular projections, respectively.Correction of this distortion, considered the main limitation of panoramic radiography or orthopantomography, has been subject to much research since the first suggestions of technical use of the method were made. A great number of studies have explored this topic [1-11].Graphimetric methods have been proposed by different authors in studies involving dry skulls, mandible, dental models and patients [1,3,4,8,12-25]. The distortions resulting from this type of radiograph cannot, presently, be eliminated or minimized by any type of equipment or technique. They remain, however, within acceptable proportionality, particularly for the mandible. The comparison of measurements in dental models and in panoramic X-ray, for instance, has been providing information for the establishment of methods for comparative proportion studies [3,5,6]. Based on an earlier proposal (Puricelli, 2004) [23], the author presents a graphic tracing method for the mandible, base on panoramic radiography, allowing the comparison of proportions between skeletal and dental structures, individually and as a whole. The method can also provide bilateral information, as well as establish bilateral comparison. It has been named Panorametry, and presents the possibility to measure the mandible (Mandibular Panorametry) and the posterior ma
Apicotomy: a root apical fracture for surgical treatment of impacted upper canines
Edela Puricelli
Head & Face Medicine , 2007, DOI: 10.1186/1746-160x-3-33
Abstract: Canines guide the teeth into proper bite, and have therefore specific functions in chewing and in excursive movements of the mandible. According to Fiedler and Alling in 1968 [1] and Mead and Monsen in 1965 [2], canines present proprioceptive and reflexive fibres which protect and stabilize occlusion. Due to their position, they provide an aesthetic and harmonious transition between the anterior and posterior segments of the dental arch. Canines have the longest roots and are the most resistant teeth [3,4] and thus are often displaced or impacted [5]. The prevalence of maxillary canine impaction seems to be related to the ethnic origin [6]. The lowest frequency (0.27%) is seen among Japanese individuals [7], while the highest (1.8%) is observed in Iceland [8]. Impacted canines occur more frequently in females than males, with a proportion of 2.5:1 [9].Maxillary canines travel a long, tortuous path before they erupt, and the long axis may adopt an inclined or horizontal position related to the occlusal plane. Impaction might occur due to general or local factors. The etiopathological investigation of impaction may reveal the existence of systemic diseases such as cleidocranial dysplasia, or Gardner and Gorlin-Goltz syndromes. However, many local problems may be involved, particularly those related to alterations in bone or dental structures and volumes. Bone condensation, alveolar ridge, dental arch length discrepancy, ankylosis and root dilaceration are among the local causes of impaction. Dentoalveolar or oral maxillofacial traumas are among the possible local causes of impaction, in variable combinations involving factors such as the kind of trauma or the age of the patient at diagnosis [10].Surgical intervention for impacted canines can be classified as: exposure for spontaneous eruption, exposure for orthodontic traction with bonding devices and extraction [11-16]. Planning the adequate surgical strategy depends on radiographic analyses or computed tomography (C
Histological evaluation of the influence of magnetic field application in autogenous bone grafts in rats
Edela Puricelli, Nardier B Dutra, Deise Ponzoni
Head & Face Medicine , 2009, DOI: 10.1186/1746-160x-5-1
Abstract: Metal devices consisting of commercially pure martensitic stainless steel washers and titanium screws were employed. Thirty male Wistar rats were divided into 3 experimental and 3 control groups. A surgical bone cavity was produced on the right femur, and a bone graft was collected and placed in each hole. Two metallic washers, magnetized in the experimental group but not in the control group, were attached on the borders of the cavity.The animals were sacrificed on postoperative days 15, 45 and 60. The histological analysis of control and experimental samples showed adequate integration of the bone grafts, with intense bone neoformation. On days 45 and 60, a continued influence of the magnetic field on the surgical cavity and on the bone graft was observed in samples from the experimental group.The results showed intense bone neoformation in the experimental group as compared to control animals. The intense extra-cortical bone neoformation observed suggests that the osteoconductor condition of the graft may be more susceptible to stimulation, when submitted to a magnetic field.Bone grafts are widely used for oral and maxillofacial reconstructive procedures [1]. The influence of electric fields, electromagnetic fields and magnets on the stimulation of endogenous mechanisms in tissues is under research [2-5], in situations such as the repair of bone fractures with pseudoarthrosis, integration of bone grafts, osteoporosis and osteonecrosis [6-8]. Electromagnetic fields may influence different cell functions [9-11].Electromagnetic fields may be applied with specifically designed devices, composed of spirals connected to a pulse generator. When the generator is turned on, electric current circulates and a magnetic field is established between the spirals. This type of electromagnetic field has been used for the stimulation of connective tissue repair [7], and has shown positive results in the treatment of fractures in humans [6,8,12].Bruce and colleagues [2] investigate
Histological analysis of the effects of a static magnetic field on bone healing process in rat femurs
Edela Puricelli, Lucienne M Ulbrich, Deise Ponzoni, Jo?o Filho
Head & Face Medicine , 2006, DOI: 10.1186/1746-160x-2-43
Abstract: A metallic device was developed, consisting of two stainless steel washers attached to the bone structure with titanium screws. Twenty-one Wistar rats (Rattus novergicus albinus) were used in this randomized experimental study. Each experimental group had five rats, and two animals were included as control for each of the groups. A pair of metal device was attached to the left femur of each animal, lightly touching a surgically created bone cavity. In the experimental groups, washers were placed in that way that they allowed mutual attraction forces. In the control group, surgery was performed but washers, screws or instruments were not magnetized. The animals were sacrificed 15, 45 and 60 days later, and the samples were submitted to histological analysis.On days 15 and 45 after the surgical procedure, bone healing was more effective in the experimental group as compared to control animals. Sixty days after the surgical procedure, marked bone neoformation was observed in the test group, suggesting the existence of continued magnetic stimulation during the experiment.The magnetic stainless steel device, buried in the bone, in vivo, resulted in increased efficiency of the experimental bone healing process.Bone neoformation is of primary importance for the success of dental clinical-surgical treatments. Much attention has been given to the research of new strategies to improve oral maxillofacial surgical techniques, as well as on the knowledge and application of biomaterials [1] an their possible chemical and physical consequences on the patients.Electromagnetic fields have been used for the stimulation of bone neoformation processes. Their effects are observed in the treatment of osteoporosis, osteonecrosis, osteotomized areas, integration of bone grafts and post-traumatic pseudarthrosis [2]. Several cell functions were also shown to be influenced by electromagnetic fields [3,4]. Electromagnetism affects osteogenesis through mechanisms such as neovascularization, col
Applied mechanics of the Puricelli osteotomy: a linear elastic analysis with the finite element method
Edela Puricelli, Jun Fonseca, Marcel de Paris, Hervandil Sant'Anna
Head & Face Medicine , 2007, DOI: 10.1186/1746-160x-3-38
Abstract: Laboratory tests complied with an Applied Mechanics protocol, in which results from the Control group (without osteotomy) were compared with those from Test I (Obwegeser-Dal Pont osteotomy) and Test II (Puricelli osteotomy) groups. Mandible edentulous prototypes were scanned using computerized tomography, and digitalized images were used to build voxel-based finite element models. A new code was developed for solving the voxel-based finite elements equations, using a reconditioned conjugate gradients iterative solver. The Magnitude of Displacement and von Mises equivalent stress fields were compared among the three groups.In Test Group I, maximum stress was seen in the region of the rigid internal fixation plate, with value greater than those of Test II and Control groups. In Test Group II, maximum stress was in the same region as in Control group, but was lower. The results of this comparative study using the Finite Element Analysis suggest that Puricelli osteotomy presents better mechanical stability than the original Obwegeser-Dal Pont technique. The increased area of the proximal segment and consequent decrease of the size of lever arm applied to the mandible in the modified technique yielded lower stress values, and consequently greater stability of the bone segments.This work showed that Puricelli osteotomy of the mandible results in greater mechanical stability when compared to the original technique introduced by Obwegeser-Dal Pont. The increased area of the proximal segment and consequent decrease of the size of lever arm applied to the mandible in the modified technique yield lower stress values and displacements, and consequently greater stability of the bone segments.Surgical orthopedic treatment of the mandible depends on the development of techniques allowing for larger and better adapted surfaces for bone contact, which result in faster healing processes and decreased displacement due to muscle forces [1].The first osteotomies were performed on the ma
HAIRY POLYP on the dorsum of the tongue – detection and comprehension of its possible dinamics
Edela Puricelli, Marinez Barra, Bruno Hochhegger, Deise Ponzoni, Henrique de Azambuja, Mário Morganti, Jorge Schmitt
Head & Face Medicine , 2012, DOI: 10.1186/1746-160x-8-19
Abstract: Imaging diagnostics with the application of a topical oral radiocontrastant was used to determine the extent of the tumor. Performed treatment was complete excision and diagnostics was confirmed with anatomopathological analysis.The patient was controlled for five months and, showing no signs of relapse, was considered free from the lesion.Accurate diagnostics of such a lesion must be performed in depth so that proper surgical treatment may be performed. The imaging method proposed has permitted the visualization of the tumoral insertion and volume, as well as the comprehension of its threatening dynamics.Although the Hairy Polyp, also called Teratoid Polyp, has its origins and classification hugely debated [1-3], authors do agree that it is a benign and rare lesion. It’s essentially composed of normal tissue located at an abnormal place, containing elements of the ectodermal and mesodermal germ layers [1,2,4,5]; such as adipose, glandular and muscular tissues, covered by epithelial squamous stratified tissue.Hairy Polyp is more frequently seen among women, mainly newborns, scarcely happening to adults [2]. Its presence in the tongue isn’t common because, at such location and in considerable volume, it could undermine breathing and swallowing [2,3,5-9].For diagnostic purposes, imaging exams such as computed tomography (CT) or magnetic resonance (MRI) might be performed. Particularly we indicated the computed tomography with a topic radiocontrast as it may not only detected the presence, but also the dynamics of a tumor located on the dorsum of the tongue. This paper, therefore, aims to describe and discuss the presence of a Hairy Polyp in the tongue of a newborn girl, rapidly developing into complications regarding the vital functions of swallowing and breathing.A 90 days old female patient, according to information given by the mother, had shown progressive signs of difficulty in swallowing and breathing, together with repeated incidences of cough and vomiting. The
Characterization of bone repair in rat femur after treatment with calcium phosphate cement and autogenous bone graft
Edela Puricelli, Adriana Corsetti, Deise Ponzoni, Gustavo L Martins, Mauro G Leite, Luis A Santos
Head & Face Medicine , 2010, DOI: 10.1186/1746-160x-6-10
Abstract: The potential of alpha-TCP on bone repair was compared to autogenous bone grafting, and unfilled cavities were used as negative control. Surgical cavities were prepared and designated as test (T), implanted with alpha-TCP blocks; negative control (C - ), unfilled; and positive control (C + ), implanted with autogenous bone graft. Results were analyzed on postoperative days three, seven, 14, 21 and 60.The histological analyses showed the following results. Postoperative day three: presence of inflammatory infiltrate, erythrocytes and proliferating fibroblasts in T, C - and C + samples. Day seven: extensive bone neoformation in groups T and C + , and beginning of alpha-TCP resorption by phagocytic cells. Days 14 and 21: osteoblastic activity in the three types of cavities. Day 60: In all samples, neoformed bone similar to surrounding bone. Moderate interruption on the ostectomized cortical bone.Bone neoformation is seen seven days after implantation of alpha-TCP and autogenous bone. Comparison of C - with T and C + samples showed that repair is faster in implanted cavities; on day 60, control groups presented almost complete bone repair. Alpha-TCP cement presents biocompatibility and osteotransductivity, besides stability, but 60 days after surgery the cavities were not closed.Bone exists in two main structural types: primary bone and lamellar or secondary bone [1]. Bone repair occurs in a process that may take months or years [2]. The morphological and functional recovery of hard tissues lost during the treatment of pathological processes and traumatic lesions has been extensively studied, and different approaches have been suggested.Autogenous bone graft is considered to be the gold standard for replacement of lost tissue [3,4]. Garg, in 1999 [5], defined the three processes associated to the fate of bone grafts: osteogenesis, osteoinduction and osteoconduction. Osteogenesis is formation of bone, whereas osteoinduction is the process by which osteogenesis is induced
Histomorphometric analysis of the temporal bone after change of direction of force vector of mandible: an experimental study in rabbits
Puricelli, Edela;Ponzoni, Deise;Munaretto, Jéssica Cerioli;Corsetti, Adriana;Leite, Mauro Gomes Trein;
Journal of Applied Oral Science , 2012, DOI: 10.1590/S1678-77572012000500006
Abstract: objectives: the present study aimed at performing a histological evaluation of the response of temporal bone tissue to a change of direction of the force vector of the mandible in relation to the base of the skull. material and methods: adult rabbits were assigned into four groups with two control and four experimental animals in each group. experimental animals underwent surgery, which resulted in a change of direction of the force vector on the right temporomandibular joint. samples were collected after 15, 30, 60 and 90 days for histological analysis. results: in the two-way analysis of variance, the effect of group and time was statistically significant (p<0.001). additionally, a statistically significant interaction between group and time was observed (p<0.001). control animals showed normal growth and development of the temporal region. in the experimental group, the change in direction of the force vector of the mandible induced significant changes in the temporal bone, with a bone modeling process, which suggests growth of this cranial structure. conclusions: the methodology used in this experiment allows us to conclude that the change in direction of the force vector of the mandible in relation to the skull base induces remodeling and modeling processes in the temporal bone. the resumption of normal oral functions after bone healing of the mandibular fracture appears to increase cell activation in the remodeling and modeling of the temporal bone structure. the observation of areas of temporal bone modeling shows the relevance of further investigation on the correlation between the joint structures and craniofacial growth and development.
Partial maxillary osteotomy following an unsuccessful forced eruption of an impacted maxillary canine: 10 year follow-up. Review and case report
Puricelli, Edela;Morganti, Mário Alexandre;Azambuja, Henrique Voltollini de;Ponzoni, Deise;Friedrisch, Clarice C.;
Journal of Applied Oral Science , 2012, DOI: 10.1590/S1678-77572012000600013
Abstract: the maxillary canines are amongst the most frequently impacted teeth, second only to the third molars. several conservative orthodontic and surgical techniques are available to position the teeth properly in the dental arch, even in severe cases. however, when an extraction is necessary, it often leaves a critical alveolar defect of difficult management. the authors present the technique of partial maxillary osteotomy, in which a dento-alveolar segment is moved mesially, hence closing the remaining space, allowing for the formation of healthy periodontium and resulting in an adequate functional and aesthetic outcome. a case report is presented with a 10 year follow-up, proving the technique's stability in the long term.
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