A ocorrência de caninos inferiores impactados não é incomum na prática clínica odontológica diária. Assim, diversas modalidades de tratamento são propostas, com o objetivo principal de tentar reposicionar o dente para o arco dentário, estabilizando a oclusão, promovendo uma harmonia estética e funcional. Entretanto, o tracionamento ortodôntico desses dentes quando presentes na linha média mandibular se torna difícil de ser realizado. O objetivo deste artigo foi fazer o relato do tratamento cirúrgico, sob anestesia local e acesso intra-oral, de um canino inferior impactado na região mentoniana. Devido à posição horizontal do dente e à densidade óssea local, o tracionamento ortodôntico foi descartado. Com o auxílio de imagens radiográficas, o planejamento cirúrgico foi realizado com grande precisão. Concluiu-se que os exames radiográficos, principalmente a radiografia panorâmica, são importantes para o planejamento e a execução do tratamento em casos de caninos inferiores com transmigração, sendo também de fundamental importância a abordagem multidisciplinar envolvendo o planejamento orto-cirúrgico.
In order to achieve functional and esthetic oral rehabilitations, dental implants must be placed at an ideal tridimensional position in the alveolar bone. A clinical case is presented of a 49-year-old female with a severely resorbed pre-maxilla. Bone augmentation was conducted using the "tent pole" technique with human recombinant morphogenetic bone protein-2 embedded in an absorbable collagen sponge and deproteinized bovine bone. In addition, a titanium mesh was adapted over the graft to provide support. At 8 months postop, a cone beam computerized tomography (CBCT) scan showed significant bone consolidation. An ideal premaxilla ridge with more than 14 mm of vertical and 10 mm of horizontal width was observed. Four dental implants were placed. Re-entry was 6 months later. Individual crowns were made to substitute the incisors, which were in function for the 1-year follow-up.
In recent years, several studies related to fixation systems have been published, but few suggest any variations of the Le Fort I osteotomy technique, and the use of plates and screws placed along the canine and zygomatic pillar are common. The 20-year-old patient with Crouzon syndrome presented with severe hypoplasia of the maxillary, mandibular prognathism, and class III facial pattern. The patient underwent orthognathic surgery and high Le Fort I osteotomy with the fixation of eight positional screws. The aim of this paper is to describe a different technique for the fixation in high maxillary osteotomies, which can be used in specific cases.
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