O abuso de drogas, lícitas ou ilícitas, é um dos principais problemas sociais e de saúde pública do mundo, sendo assim o contato do cirurgião dentista com pacientes dependentes dessas substâncias é inevitável. Estudos sugerem que o uso de drogas aumenta as manifestações orais, como alterações do fluxo salivar, desgaste dental, cárie, doença periodontal, xerostomia e dor. Por isso, o profissional deve estar preparado para atender esses pacientes, e ter conhecimento sobre as limitações e possíveis interações, principalmente em tratamentos invasivos, seja em ambiente hospitalar com o paciente sedado ou no consultório com anestésicos locais. O objetivo deste trabalho é relatar um caso de monitoramento da pressão arterial, saturação de oxigênio e frequência cardíaca, durante um procedimento com múltiplas exodontias em uma paciente dependente química. Apesar da paciente se manter estável, foi constatado aumento da pressão diastólica no pós-operatório, podendo estar relacionado com a vasoconstrição causada pelo uso da maconha e crack, e a ação da epinefrina do anestésico. Esse aumento se relaciona com alterações no sistema simpático e parassimpático, por isso a importância de se conhecer as substâncias empregadas no procedimento e em medicamentos receitados. Conclui-se que é preciso aprimorar o conhecimento das alterações fisiológicas, químicas e neurológicas que envolvem esses pacientes, para um tratamento odontológico seguro, e quando necessário em conjunto com uma equipe multiprofissional, saber encaminhar o paciente e identificar problemas de saúde não somente bucais.
Posterior mandible region is considered a highly predicable place for primary stability during dental implant placement. Although, this region can present a significant decrease in bone density, which can lead to implant dislocation during insertion. The present case reports an unusual dislocation of dental implant in a 59 old healthy patient's mandible and a secure solution for this kind of complication. During the drilling, bone quality type IV was observed. In sequence, implant was abruptly inserted in the perforation site and dropped into the bone marrow. Panoramic radiograph showed the implant inside bone marrow, close to mandibular base. The implant was removed through the surgical site. The screw of the implant prosthesis transfer was used to reach the displaced implant. A second implant with the same dimensions as the first one, differing by the external hexagon, was inserted into the same implant site. Therefore, the authors strongly recommend the use of the presented technique prior to osteotomy on mandibular body, reserving the second in the impossibility of reaching the internal connection of the displaced implant.
Aspiration and ingestion of teeth, dental prostheses and other foreign bodies in maxillofacial injuries is a known complication necessitating prompt recognition and early treatment to minimize potentially serious and, sometimes, even fatal consequences. However, an aspirated or ingested foreign body does not always produce untoward affects and may be overlooked when no acute respiratory distress is evident or multiple life-threatening injuries are present. Here, we report a case in its presentation; the patient underwent extraction of a left upper third molar. After extraction, alveolar irrigation was performed with syringe, needle and sterile saline. the patient ingested the irrigation needle. The patient was properly referred to the emergency room of the hospital of Santa Fé do Sul and referred to the care of the general surgeon, who removed the needle with endoscopic removal under sedation. Clinicians must be aware that the instrument used for dental treatment are mostly small and there is a risk of these falling into the oropharynx and being swallowed or inhaled. The paper also emphasizes that attention to the potentially serious consequences and to offer guidance on management.
Orotracheal intubation is considered the most delicate maneuver performed by anesthesiologists, and failure to manage the airways is one of the main causes of possible complications that can be catastrophic during its performance, thus requiring good team planning. Anatomical and / or physiological characteristics, such as limited mouth opening, a condition often found in patients suffering from fractures of the zygomatic arch or who have some abnormality in the temporomandibular joint (TMJ), can characterize a difficult airway, which demands attention greatest of the professional. Therefore, in order to overcome the obstacles that may occur during a difficult or unexpected intubation, new tools have been used, such as videolaryngoscopy in which an intubation device containing miniature video cameras is used in order to allow the operator has an indirect view of the glottis to increase success rates and decrease intubation time. The aim of the present study is to report a clinical case of a trauma victim, with limited mouth opening, who underwent intubation with the aid of a video laryngoscope after failed attempts at conventional intubation.
This study aimed to analyze two cases of fracture of the metal framework of Co-Cr-based removable partial dentures, using fractography to identify a true cause of these failures. The first case concerned the coupling between the smaller and larger connectors; the patient brought his fractured removable partial dentures to the clinic. The second case referred to a larger connector; structure of the patient fractured during the test. For failure analysis, images of two fractured metal frameworks were taken by scanning electron microscopy to identify the origin of the fracture and to determine the mechanisms involved in the process. Subsequently, energy dispersive X-ray spectroscopy was used for elemental chemical mapping of the fracture interface. The fractography indicated material fatigue as a possible cause in the first case and an error in the casting process in the second. The energy dispersive X-ray spectroscopy test, performed in the specimen of case B, showed predominant and characteristic peaks for Co and Cr, with a higher concentration of chromium. The fractures identified were associated with inclusions and with material fatigue and a number important characteristics were evidenced by the technique.
A redução da altura óssea em regiões posteriores de maxila é comum em maxilas edêntulas. Pacientes que desejam reabilitação com implantes necessitam realizar tratamentos adicionais para obter ganho ósseo em altura. Entre os tratamentos mais comuns para ganho vertical, o levantamento do seio maxilar com preenchimento da cavidade com biomateriais e/ou enxerto autógeno é a forma mais relatada na literatura. Trabalhos vem demonstrando que o uso de coágulo sanguíneo como material de preenchimento e instalação imediata de implantes possibilita a neoformação óssea e osseointegração. Este trabalho tem por objetivo relatar um caso clínico de levantamento de seio bilateral comparando a forma de preenchimento (osso autógeno vs coágulo) e avaliar aspectos diferenciais na neoformação óssea com implantes imediatos. Realizou-se o procedimento num paciente masculino de 37 anos com ausência dos elementos 16 e 26. Para preenchimento do seio esquerdo utilizou-se osso autógeno particulado e no seio direito o coágulo sanguíneo. Durante 1 ano de acompanhamento realizou-se 5 tomografias computadorizadas que revelaram neoformação óssea nos dois seios maxilares e ausência de colabamento da membrana. Na análise de variação da densidade em função do tempo e tipo de tratamento observou-se uma queda na densidade óssea após o período de um ano em ambos os grupos. Nas análises transversais, observou-se que os dois tratamentos apresentam medidas semelhantes de densidade, indicando que o tratamento experimental pode ser tão efetivo quanto o tratamento controle. Os resultados são considerados positivos levando-se em consideração a simplificação da técnica empregada em comparação com aquela que requer uma área doadora.
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