Publications by authors named "Gisele da Silva Dalben"

47 Publications

Does Infant Orthopedics and Neonate Lip Surgery Influence the Occlusal Relationship in Patients With Unilateral Cleft Lip and Palate (UCLP)?

Cleft Palate Craniofac J 2021 Jan 25:1055665620984352. Epub 2021 Jan 25.

Orthodontics Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Brazil.

Objective: To compare occlusal relationship in patients undergoing neonate versus conventional lip surgery (LS) with and without infant orthopedics (IO) by assessment of dental arch relationship in individuals with complete unilateral cleft lip and palate.

Material And Methods: Three groups treated by different protocols; Group I: neonate LS (1-15 days) + IO and palatoplasty (13-31 months); Group II: LS (3-12 months) + IO and palatoplasty (15-35 months); and Group III: LS (3-6 months) without IO and palatoplasty (12-18 months). The 112 intraoral photographs of individuals of all groups, obtained between 6 and 12 years of age, were assessed by the occlusal index for intraoral photograph rating. The groups were compared by the χ test. The correlation between surgical timing and the scores was tested by the Spearman test ( < .05).

Results: Group I presented the highest percentage of score 5, group II exhibited highest percentage of score 1, and group III presented the lowest percentage of score 5 according to the χ test ( = .029). The Spearman correlation test revealed statistically significant difference between timing of LS and the occlusal index. The earlier the surgical timing, the higher the occlusal index ( = .019).

Conclusions: Infant orthopedics has demonstrated the possibility of postponing primary plastic surgeries. Patients submitted to late lip and palate repair had the best prognosis, while patients undergoing lip repair from 1 to 15 days of life, even operating the palate later, had the worst prognosis. Neonate LS negatively influenced the occlusal relationships.
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http://dx.doi.org/10.1177/1055665620984352DOI Listing
January 2021

Hyoid Bone Position and Head Posture in Patients With Richieri-Costa Pereira Syndrome (EIF4A3 Mutations).

J Craniofac Surg 2020 Jun;31(4):e356-e359

Pediatric and Community Dentistry Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.

Robin sequence with cleft mandible and limb anomalies, known as Richieri-Costa-Pereira syndrome (RCPS), is an autosomal recessive acrofacial dysostosis characterized by mandibular cleft and other craniofacial anomalies and respiratory complications. The aim of this cross-sectional study was to describe the hyoid and head posture of 9 individuals with RCPS using cephalometric measurements and provide a discussion about its implications in obstructive sleep apnea syndrome (OSAS). The study was conducted on lateral cephalograms of patients with RCPS and 9 selected age-matched controls in tertiary cleft center in Brazil. The cephalograms were digitized and analyzed on a software to obtain the vertical and horizontal hyoid position, its relationship with the mandible and the relation of the cranial base and postvertebral line. The t test was used for analysis of means and Levene's test for equality of variances.Cephalometric measurements H-S (vertical distance between hyoid bone and sella) (Supplemental Digital Content, Figure 1, http://links.lww.com/SCS/B247) and H-C4lp (horizontal position of the hyoid in relation to the post-pharyngeal space) showed statistically significant difference compared to controls (P < 0.05). Therefore, the hyoid bone was more inferiorly and posteriorly positioned in the study group compared with the control group. The vertebrae measurements did not present differences compared to controls. The described position of hyoid bone could be involved in the severe OSAS of RCPS patients.
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http://dx.doi.org/10.1097/SCS.0000000000006338DOI Listing
June 2020

Insight Into the Ontogeny of GnRH Neurons From Patients Born Without a Nose.

J Clin Endocrinol Metab 2020 05;105(5)

Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, North Carolina.

Context: The reproductive axis is controlled by a network of gonadotropin-releasing hormone (GnRH) neurons born in the primitive nose that migrate to the hypothalamus alongside axons of the olfactory system. The observation that congenital anosmia (inability to smell) is often associated with GnRH deficiency in humans led to the prevailing view that GnRH neurons depend on olfactory structures to reach the brain, but this hypothesis has not been confirmed.

Objective: The objective of this work is to determine the potential for normal reproductive function in the setting of completely absent internal and external olfactory structures.

Methods: We conducted comprehensive phenotyping studies in 11 patients with congenital arhinia. These studies were augmented by review of medical records and study questionnaires in another 40 international patients.

Results: All male patients demonstrated clinical and/or biochemical signs of GnRH deficiency, and the 5 men studied in person had no luteinizing hormone (LH) pulses, suggesting absent GnRH activity. The 6 women studied in person also had apulsatile LH profiles, yet 3 had spontaneous breast development and 2 women (studied from afar) had normal breast development and menstrual cycles, suggesting a fully intact reproductive axis. Administration of pulsatile GnRH to 2 GnRH-deficient patients revealed normal pituitary responsiveness but gonadal failure in the male patient.

Conclusions: Patients with arhinia teach us that the GnRH neuron, a key gatekeeper of the reproductive axis, is associated with but may not depend on olfactory structures for normal migration and function, and more broadly, illustrate the power of extreme human phenotypes in answering fundamental questions about human embryology.
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http://dx.doi.org/10.1210/clinem/dgaa065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108682PMC
May 2020

Craniofacial Morphology in Patients With Opitz G/BBB Syndrome.

Cleft Palate Craniofac J 2019 11 19;56(10):1366-1372. Epub 2019 Jun 19.

Discipline of Oral Pathology, Bauru Dental School, University of São Paulo, Bauru, Brazil.

Objective: To compare the cephalometric characteristics of patients with and without Opitz G/BBB syndrome type I.

Design: Cross-sectional, case-control study.

Setting: Tertiary cleft center in Brazil.

Participants: Eighteen individuals with Opitz G/BBB syndrome with complete bilateral cleft lip and palate (BCLP), compared to 18 individuals with nonsyndromic complete cleft lip and palate and 18 individuals without malformations, matched for gender and age.

Interventions: Pretreatment lateral cephalograms of all patients were manually traced and digitized for achievement of linear and angular measurements.

Main Outcome Measures: Analysis of variance or Kruskal-Wallis followed by Tukey tests were used for intergroup comparisons at a significance level of < .05.

Results: Individuals with Opitz G/BBB syndrome exhibited alterations in SNGn, P-Co, and N'-Pr/Po-Or that were not attributable to BCLP. Co-Go, Sella-Nasion-Supramentale, ANB (maxillo-mandibular relationship), and anterior nasal spine-posterior nasal spine (ANS-PNS)/U1A-U1T were significantly different in both G/BBB and BCLP groups compared to control, but not different between G/BBB and BCLP groups. Anterior nasal spine-posterior nasal spine/Go-Gn, ANS-PNS, V-Upper pharyngeal wall, and U-lower pharyngeal wall were different in nonsyndromic BLCP compared to nonsyndromic controls and Opitz G/BBB group.

Conclusion: Patients with Opitz G/BBB syndrome exhibited some unique cephalometric alterations compared to patients with nonsyndromic complete BCLP and controls.
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http://dx.doi.org/10.1177/1055665619857001DOI Listing
November 2019

Male individuals with Robin Sequence: emerging significant association with ABO and RhD blood group phenotypes.

Hematol Transfus Cell Ther 2018 Oct-Dec;40(4):354-357. Epub 2018 Jul 5.

Universidade de São Paulo (USP), Bauru, SP, Brazil.

Background: This study investigated the association of Robin Sequence with ABO and RhD blood group phenotypes.

Methods: A retrospective cross-sectional study was performed of a cohort of Robin Sequence patients of the Hospital de Reabilitação de Anomalias Craniofaciais - Universidade de São Paulo (USP), Brazil. The study group was composed of 339 individuals of both genders with Robin Sequence referred for specific treatment. A control group was composed of 1780 individuals without syndromes. The groups were compared using the Pearson' chi-square test () with statistical significance being defined for an alpha error of 5% (-value < 0.05).

Results: A comparison of gender found a significant difference for the AB phenotype between groups (-value = 0.007). Comparing blood type by gender there was no significant difference within the same group (-value = 0.117 and 0.388 respectively, for Robin Sequence and the control group). When comparing the AB blood type between groups, there was no difference for females (-value = 0.577), but there was a significant difference for males (-value = 0.0029).

Conclusions: This study showed that the population with Robin Sequence had different patterns related to gender concerning the phenotypic distribution of ABO and RhD blood group phenotypes. Robin Sequence is more common among females. The AB phenotype was significantly higher in males with Robin Sequence than in males of the Control Group. The prevalence of the RhD-negative phenotype is higher in individuals with Robin Sequence. This result suggests a possible association of ABO and RhD phenotypes with Robin Sequence that should be better investigated by molecular studies, as it deserves greater attention.
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http://dx.doi.org/10.1016/j.htct.2018.03.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200685PMC
July 2018

Comparative Analysis of the Efficacy of Dental Plaque Removal Between Manual and Powered Toothbrushes in Individuals With Syndactyly.

J Craniofac Surg 2018 Sep;29(6):1518-1521

Department of Prosthodontics and Periodontics, Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.

Objective: To compare the efficacy of dental plaque removal between manual and powered toothbrushes in individuals with syndactyly.

Material And Methods: Seventeen patients with Apert syndrome aged 11 to 30 years. The efficacy of toothbrushing was evaluated by the O'Leary plaque index at 2 periods: initial (before toothbrushing) and final (immediately after toothbrushing), using manual toothbrush (Colgate Twister) and powered toothbrush (Colgate Actibrush). Means were compared by the ANOVA test at a significance level of 5%.

Results: The reduction in the plaque index was different for each type of toothbrush (interaction factor between manual and powered toothbrushes and initial and final periods, P = 0.026). The powered toothbrush provided greater reduction of dental plaque than the manual toothbrush.

Conclusion: In individuals with syndactyly, both manual and powered toothbrushes allowed significant plaque reduction on tooth surfaces; however, the powered toothbrush exhibited greater efficacy of plaque removal compared with the manual toothbrush.
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http://dx.doi.org/10.1097/SCS.0000000000004774DOI Listing
September 2018

Outcomes of Alveolar Graft With Rhbmp-2 in CLP: Influence of Cleft Type and Width, Canine Eruption, and Surgeon.

Cleft Palate Craniofac J 2019 03 20;56(3):383-389. Epub 2018 Jun 20.

1 Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.

Objective: To evaluate the influence of cleft type and width, canine eruption stage, and surgeon on the outcomes of alveolar graft with rhBMP-2.

Design: Cross-sectional.

Setting: Tertiary craniofacial center.

Participants: Ninety individuals submitted to alveolar graft in late mixed or early permanent dentition.

Interventions: The 90 individuals (mean age: 16.8 years) were submitted to alveolar graft with rhBMP-2. Periapical radiographs were obtained before and 6 months after surgery. Surgeries were performed by 4 experienced maxillofacial surgeons. The alveolar grafts were assigned as success or failure by 3 blinded raters based on the modified Bergland and Chelsea scales. Permanent canines adjacent to the defect were assigned as erupted and not erupted. The greatest cleft width was measured on preoperative periapical radiographs.

Main Outcome Measures: The influence of 4 independent variables (cleft type, cleft width, canine eruption phase, and surgeon) on the outcome of alveolar graft was analyzed by multivariate logistic regression ( P < .05).

Results: All independent variables presented significant influence on alveolar graft outcome. The subgroup of unerupted maxillary canines demonstrated better outcomes than erupted canines ( P = .001). The group with cleft lip and alveolus (CL/A) demonstrated better outcomes than complete cleft lip and palate (CLP; P < .001). The greater the alveolar cleft width, the less favorable were the graft outcomes ( P = .027). The surgeon also had a significant influence on the surgery success ( P = .003 and .001).

Conclusion: The type and width of CLP, the eruption of permanent canines, and the surgeon influenced the outcome of alveolar graft surgeries performed with rhBMP-2.
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http://dx.doi.org/10.1177/1055665618780981DOI Listing
March 2019

Cephalometric Findings in Nine Individuals With Richieri-Costa-Pereira Syndrome.

J Craniofac Surg 2018 Sep;29(6):1596-1600

Pediatric and Community Dentistry Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.

The Richieri-Costa-Pereira syndrome (RCPS) is an autosomal-recessive acrofacial dysostosis caused by mutations in EIF4A3, characterized by mandibular cleft comprising other craniofacial anomalies and limb defects such as cleft palate/Robin Sequence, microstomia, absence of mandibular central incisors, minor ear anomalies, clubfeet and first and 5 ray defects. The findings from this study are useful for better understanding the morphological consequences of disorders of EIF4A3, and having a better picture of the anatomic characteristics of the syndrome for a better therapeutic planning. Twenty-four angular and linear variables were measured to assess anteroposterior and vertical (superior-inferior) position of the cranial base, maxilla, mandible, and facial profile. The cephalometric radiographic analysis was performed on 9 individuals with RCPS, obtained at a mean age of 10.3 years, and compared with randomly selected age-matched 9 controls, without clefts and with well-balanced faces, with mean age of 10.6 years (both groups range 8.1 to 13.7 years). t test was used for analysis of means and Levene test for equality of variances. The syndrome group presented severe mandibular hypoplasia and retrognathism (P = 0.009, P = 0.001), greater facial convexity (N'PnPog and N'SnPog, P < 0.05) in syndrome group compared with the control group (P = 0.003, P = 0.004). In conclusion, in the RCPS group, most craniofacial defects affect the lower facial third, considering the severely affected mandible.
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http://dx.doi.org/10.1097/SCS.0000000000004588DOI Listing
September 2018

Evaluation of photobiomodulation therapy associated with guided bone regeneration in critical size defects. In vivo study.

J Appl Oral Sci 2018 7;26:e20170244. Epub 2018 May 7.

Departamento de Prótese e Periodontia, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil.

The repair of bone defects raises the interest of investigators in several health specialties. Grafting techniques with bone substitutes and laser therapies have been investigated to replace autogenous bone and accelerate the bone healing process. Objective To evaluate the effect of photobiomodulation therapy (PBMT) associated with guided bone regeneration (GBR) in critical size defects. Material and Methods The study was conducted on 80 male rats (Rattus norvegicus albinus, Wistar) submitted to surgical creation of a critical size defect on the calvaria, divided into eight study groups: group C (control - only blood clot); group M (collagen membrane); group PBMT (photobiomodulation therapy); group AB (autogenous bone); group AB+PBMT; group AB+M; group PBMT+M; group AB+PBMT+M. The animals were killed 30 days postoperatively. After tissue processing, bone regeneration was evaluated by histomorphometric analysis and statistical analyses were performed (Tukey test, p<0.05). Results All groups had greater area of newly formed bone compared to group C (9.96±4.49%). The group PBMT+M (achieved the greater quantity of new bone (64.09±7.62%), followed by groups PBMT (47.67±8.66%), M (47.43±15.73%), AB+PBMT (39.15±16.72%) and AB+PBMT+M (35.82±7.68%). After group C, the groups AB (25.10±16.59%) and AB+M (22.72±13.83%) had the smallest quantities of newly formed bone. The area of remaining particles did not have statistically significant difference between groups AB+M (14.93±8.92%) and AB+PBMT+M (14.76±6.58%). Conclusion The PBMT utilization may be effective for bone repair, when associated with bone regeneration techniques.
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http://dx.doi.org/10.1590/1678-7757-2017-0244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933825PMC
May 2018

The maxillary lateral incisor in the rehabilitation of cleft lip and palate.

J Appl Oral Sci 2018 7;26:e20170125. Epub 2018 May 7.

Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, São Paulo, Brasil.

Objective This study analyzed the maintenance of lateral incisors in the dental rehabilitation of individuals with cleft lip and palate. Material and Methods The study was conducted on a tertiary craniofacial center and comprised retrospective analysis of panoramic and periapical radiographs of Caucasoid individuals with non-syndromic complete unilateral cleft lip and palate, analyzing all radiographs available on the records of each individual, from the first to the last up to 12 years of age. Overall, 2,826 records were reviewed to achieve a sample of 1,000 individuals. Among these, 487 individuals presented the permanent lateral incisors on both cleft and non-cleft sides, which were included in this study. Results The results were evaluated in percentages and by descriptive statistics. The association between maintenance of the lateral incisor and timing of alveolar bone graft were analyzed by the t test. Among the 487 individuals, 265 had not completed treatment, 62 presented insufficient information, and 44 concluded the treatment elsewhere. Among the remaining 116 individuals, the lateral incisor was extracted from 88 (75.86%) of them on the cleft side (CS) and from 23 (19.83%) people on the non-cleft side (NCS). The age at accomplishment of alveolar bone graft was significantly associated with maintenance of the lateral incisor on the cleft side (p<0.01). Most extractions were indicated because of the inadequate positioning on the CS and for midline correction on the NCS. Rehabilitation was primarily completed by orthodontic movement (53 individuals on the CS and 13 individuals on the NCS). Conclusion In conclusion, the lateral incisor on the cleft side was not maintained in most individuals. Positive relationship was observed between extraction of the lateral incisor and age at accomplishment of the alveolar bone graft, suggesting the need to anticipate the initial radiographic evaluation to enhance its maintenance and reduce the procedures required for rehabilitation.
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http://dx.doi.org/10.1590/1678-7757-2017-0125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933831PMC
May 2018

Effect of Low-Level Laser on the Healing of Bone Defects Filled with Autogenous Bone or Bioactive Glass: In Vivo Study.

Int J Oral Maxillofac Implants 2018 Jan/Feb;33(1):169-174

Purpose: This study evaluated the effect of low-level laser therapy (LLLT) on the healing of bone defects filled with autogenous bone or bioactive glass.

Materials And Methods: A critical size defect with 5-mm diameter was created on the calvaria of 60 adult male rats divided into 6 groups (n = 10): group C (control), group LLLT (LLLT - GaAlAs, wavelength of 780 nm, power of 100 mW, energy density of 210 J/cm per point during 60 seconds/point, in five points, only once, after creation of the surgical defect), group AB (autogenous bone), group AB+LLLT (autogenous bone + LLLT), group BG (bioactive glass), group BG+LLLT (bioactive glass + LLLT). All animals were sacrificed at 30 days after surgery. The areas of newly formed bone (ANFB) and areas of remaining particles (ARP) were calculated in relation to the total area (TA).

Results: The highest mean ± SD ANFB was observed for group LLLT (47.67% ± 8.66%), followed by groups AB+LLLT (30.98% ± 16.59%) and BG+LLLT (31.13% ± 16.98%). There was a statistically significant difference in relation to ANFB between group C and the other groups, except for comparison with group BG (Tukey test, P > .05). There was no statistically significant difference in ANFB values between group AB and the other study groups (Tukey test, P > .05), group AB+LLLT and groups BG and BG+LLLT (Tukey test, P > .05), and between groups BG and BG+LLLT (Tukey test, P > .05). The highest mean ± SD ARP was found for group BG (25.15% ± 4.82%), followed by group BG+LLLT (17.06% ± 9.01%), and there was no significant difference between groups (t test, P > .05).

Conclusion: The LLLT, in the present application protocol, did not increase the area of new bone formation when associated with autogenous bone or bioactive glass.
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http://dx.doi.org/10.11607/jomi.5900DOI Listing
June 2018

Tooth Abnormalities and Occlusal Disorders in Individuals With Frontonasal Dysplasia.

Cleft Palate Craniofac J 2017 05 16;54(3):304-308. Epub 2016 Feb 16.

Objective: Frontonasal dysplasia is a rare developmental defect of the midface, and little is known about the dental involvement in individuals with this condition. This study investigated tooth abnormalities and occlusal disorders in individuals with frontonasal dysplasia.

Design: Cross-sectional.

Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.

Interventions: Clinical oral examination, analysis of patient records, and panoramic radiographs.

Participants: A total of 20 individuals with frontonasal dysplasia aged 7 to 17 years.

Main Outcome Measures: Prevalence of the several tooth abnormalities and occlusal disorders analyzed.

Results: A total of 19 individuals presented at least one tooth abnormality, with highly variable findings. In radiographs, 20% of individuals (all presenting oral clefts) presented agenesis of lateral incisors and second premolars. No supernumerary teeth were observed; 65% of individuals exhibited occlusal alterations, especially anterior open bite in the two individuals with median cleft lip.

Conclusions: Variable clinical and radiographic alterations were observed, probably due to the large variety of phenotypic characteristics. No specific dental alteration could be related with frontonasal dysplasia.
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http://dx.doi.org/10.1597/15-286DOI Listing
May 2017

[Doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty].

Rev Esc Enferm USP 2014 Dec;48(6):993-8

Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil.

Objective: To identify the main doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty.

Method: Cross-sectional study carried out in a reference hospital, between September and November 2012. The sample was composed of 50 individuals divided in two groups, of which 25 caregivers of children submitted to cheiloplasty, and 25 of children submitted to palatoplasty. The doubts were identified by an interview applied during the preoperative nursing consultation and were then categorized by similarity. Descriptive statistics was used for analysis of the outcomes.

Results: Concerning cheiloplasty, the doubts were related to feeding (36%), hygiene and healing (24% each), pain and infection (8% each). With regard to palatoplasty, the doubts were related to feeding (48%), hygiene (24%), pain (16%), bleeding (8%) and infection (4%).

Conclusion: The study evidenced the concern of caregivers in relation to feeding and care of the postoperative wound.
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http://dx.doi.org/10.1590/S0080-623420140000700005DOI Listing
December 2014

Evolution of Postoperative Edema in Alveolar Graft Performed With Bone Morphogenetic Protein (rhBMP-2).

Cleft Palate Craniofac J 2015 09 1;52(5):e168-75. Epub 2014 Dec 1.

Objective: To evaluate the evolution of facial edema in the postoperative period after alveolar graft surgeries performed with collagen membrane soaked with recombinant human bone morphogenetic protein-2 (rhBMP-2) in individuals with cleft lip and palate.

Design: Longitudinal prospective.

Setting: Tertiary craniofacial center.

Participants: One hundred fifty individuals submitted to alveolar graft.

Interventions: In the preoperative consultation and 4 days after surgery, the individuals were assessed as to age, professional performing the surgery, duration of the procedure, type of cleft, measurement of facial edema, mouth opening, and global evaluation of the postoperative period.

Main Outcome Measures: Statistical analysis was performed to compare the facial edema and different variables, at a significance level of .05.

Results: The maximum facial edema occurred between 3 and 4 days postoperatively, was inversely proportional to age and mouth opening, greater for female patients compared with male patients, for incomplete unilateral cleft lip and palate compared with other types of clefts, and for surgeon 1 compared with the other surgeons at some moment postoperatively. The surgeries were longer for complete unilateral and bilateral clefts. The difference was statistically significant for these variables.

Conclusions: The facial edema was influenced by the rhBMP-2 used in alveolar graft, and trismus was proportional to the intensity of facial edema.
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http://dx.doi.org/10.1597/14-169DOI Listing
September 2015

Accumulated knowledge and prevention practices in oral health.

Braz Oral Res 2014 4;28 Spec No:1-8. Epub 2014 Aug 4.

Hospital de Reabilitação de Anomalias Craniofaciais, Univ de São Paulo, Bauru, SP, Brazil.

This text begins by reflecting on health promotion and equity/ inequity. In health, inequity is understood as a political concept that has moral implications and that is committed to social justice. A discussion follows on some issues regarding the risk and prevention of diseases, still considered a hegemonic practice, and lack of experience in oral health-care, bearing in mind the concept of vulnerability. The risk is probabilistic and involves the mathematical chances of acquiring a disease in a certain group, whereas vulnerability addresses the potential of acquiring or not acquiring a disease in a certain environment. The need for systematic studies on determinants is stressed, with the ultimate goal of improving health and reducing inequities, and with the concern and political intention of including health equity in governmental policies.
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http://dx.doi.org/10.1590/1807-3107bor-2014.vol28.0025DOI Listing
February 2015

Equity, social inclusion and health promotion: major challenges.

Braz Oral Res 2014 20;28 Spec No. Epub 2014 Jun 20.

Department of Dentistry, Universidade Sagrado Coração, Bauru, SP, Brazil.

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http://dx.doi.org/10.1590/1807-3107BOR-2014.vol28.0019DOI Listing
September 2014

Evaluation of fecal microorganisms of children with cleft palate before and after palatoplasty.

Braz J Microbiol 2013 15;44(3):835-8. Epub 2014 Jan 15.

Tropical Diseases Department, Escola de Medicina, Universidade Estadual de São Paulo "Júlio de Mesquita Filho", Botucatu, SP, Brazil.

This study isolated and quantified intestinal bacteria of children with cleft palate before and after palatoplasty. A prospective study was conducted from May 2007 to September 2008 on 18 children with cleft palate, aged one to four years, of both genders, attending a tertiary cleft center in Brazil for palatoplasty, to analyze the effect of surgical palate repair on the concentration of anaerobes Bacteroides sp, Bifidobacterium sp and microaerophiles Lactobacillus sp in feces of infants with cleft palate before and 24 hours after treatment with cefazolin for palatoplasty. There was significant reduction of Lactobacillus sp (p < 0.002), Bacteroides sp (p < 0.001) and Bifidobacterium sp (p = 0.021) after palatoplasty, revealing that surgery and utilization of cefazolin significantly influenced the fecal microbiota comparing collections before and after surgery. However, due to study limitations, it was not possible to conclude that other isolated factors, such as surgical stress, anesthetics and other medications used in palatoplasty might have a significant influence on the microbiota. Considering the important participation of the intestinal microbiota on both local and systemic metabolic and immunological activities of the host, professionals should be attentive to the possible influence of these changes in patients submitted to cleft repair.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3910197PMC
http://dx.doi.org/10.1590/s1517-83822013000300026DOI Listing
February 2015

Prevalence, cause, and location of palatal fistula in operated complete unilateral cleft lip and palate: retrospective study.

Cleft Palate Craniofac J 2014 Mar 16;51(2):158-64. Epub 2013 Apr 16.

Objective: To evaluate the prevalence of fistulas after palate repair and analyze their location and association with possible causal factors.

Design: Retrospective analysis of patient records and evaluation of preoperative initial photographs.

Setting: Tertiary craniofacial center.

Participants: Five hundred eighty-nine individuals with complete unilateral cleft lip and palate that underwent palate repair at the age of 12 to 36 months by the von Langenbeck technique, in a single stage, by the plastic surgery team of the hospital, from January 2003 to July 2007.

Interventions: The cleft width was visually classified by a single examiner as narrow, regular, or wide. The following regions of the palate were considered for the location: anterior, medium, transition (between hard and soft palate), and soft palate.

Main Outcome Measures: Descriptive statistics and analysis of association between the occurrence of fistula and the different parameters were evaluated.

Results: Palatal fistulas were observed in 27% of the sample, with a greater proportion at the anterior region (37.11%). The chi-square statistical test revealed statistically significant association (P ≤ .05) between the fistulas and initial cleft width (P = .0003), intraoperative problems (P = .0037), and postoperative problems (P = .00002).

Conclusions: The prevalence of palatal fistula was similar to mean values reported in the literature. Analysis of causal factors showed a positive association between palatal fistulas with wide and regular initial cleft width and intraoperative and postoperative problems. The anterior region presented the greatest occurrence of fistulas.
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http://dx.doi.org/10.1597/11-190DOI Listing
March 2014

Prevalence of oral habits in children with cleft lip and palate.

Plast Surg Int 2013 27;2013:247908. Epub 2013 Feb 27.

Pediatric Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), R. Silvio Marchione, 3-20-Vila Universitária, 17012-900 Bauru, SP, Brazil.

This study investigated the prevalence of oral habits in children with clefts aged three to six years, compared to a control group of children without clefts in the same age range, and compared the oral habits between children with clefts with and without palatal fistulae. The sample was composed of 110 children aged 3 to 6 years with complete unilateral cleft lip and palate and 110 children without alterations. The prevalence of oral habits and the correlation between habits and presence of fistulae (for children with clefts) were analyzed by questionnaires applied to the children caretakers. The cleft influenced the prevalence of oral habits, with lower prevalence of pacifier sucking for children with cleft lip and palate and higher prevalence for all other habits, with significant association (P < 0.05). There was no significant association between oral habits and presence of fistulae (P > 0.05). The lower prevalence of pacifier sucking and higher prevalence of other oral habits agreed with the postoperative counseling to remove the pacifier sucking habit when the child is submitted to palatoplasty, possibly representing a substitution of habits. There was no causal relationship between habits and presence of palatal fistulae.
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http://dx.doi.org/10.1155/2013/247908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3600175PMC
March 2013

Intranasal tooth and associated rhinolith in a patient with cleft lip and palate.

Ear Nose Throat J 2013 Mar;92(3):E10-4

Department of Pediatric and Community Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies (HRAC/USP), Rua Silvio Marchione 3-20, Vila Universitária, Bauru, SP 17012-900, Brazil.

We report the case of a 9-year-old girl who presented with a complaint of a malodorous bloody discharge from the left naris. The patient had previously undergone a complete repair of left-sided cleft lip and palate. Clinical examination revealed hyperplasia of the nasal mucosa on the left side. X-ray examination of the nasal cavity demonstrated a radiopaque structure that resembled a tooth and a radiopaque mass similar to an odontoma that was adherent to the root of the suspected tooth. With the patient under general anesthesia, the structure was removed. On gross inspection, the structure was identified as a tooth with a rhinolith attached to the surface of its root. Microscopic examination revealed normal dentin and pulp tissue. A nonspecific inflammatory infiltrate was observed around the rhinolith, and areas of regular and irregular mineralization were seen. Some mineralized areas exhibited melanin-like brownish pigmentation. Areas of mucus with deposits of mineral salts were also observed. Rare cases of an intranasal tooth associated with a rhinolith have been described in the literature. We believe that this case represents only the second published report of an intranasal tooth associated with a rhinolith in a patient with cleft lip and palate.
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March 2013

Oral health under an integrality perspective.

Braz Oral Res 2012 ;26 Suppl 1:124-32

Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, Univ de São Paulo, SP, Brazil.

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http://dx.doi.org/10.1590/s1806-83242012000700019DOI Listing
April 2013

Mechanisms and clinical management of pain.

Braz Oral Res 2012 ;26 Suppl 1:115-9

Faculdade de Medicina, Univ de São Paulo, São Paulo, SP, Brazil.

Pain is an unpleasant, sensitive and emotional experience associated with or described in terms of tissue lesion, and may be acute or chronic. It may also be classified as nociceptive, neuropathic or psychogenic. Nociceptive pain involves the transformation of environmental stimuli into action potentials carried to the central nervous system, where they are modulated and integrated up to final interpretation in the cerebral cortex. Neuropathic pain may arise as a consequence of the direct lesion of axons, or of an increase in the production of neurotrophic factors. Chronic pain is always associated with anxiety and some degree of depression. Drug therapy should be selected according to its efficacy; nonetheless, the professional should also consider the tolerability and adverse effects that may occur, for example, in elderly individuals. It is necessary to emphasize the safety-considering the possibility of drug interactions-and define the posology to promote better adherence. However, the treatment of neuropathic pain should not be limited to the use of analgesic drugs, which are just one among several options enabling patients to participate in bio-psycho-social rehabilitation programs.
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http://dx.doi.org/10.1590/s1806-83242012000700017DOI Listing
April 2013

Programmatic actions in oral health: coping with social inequities.

Braz Oral Res 2012 ;26 Suppl 1:81-5

Department of Public Health, School of Dentistry, Univ Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Inequities are health imbalances that are avoidable, unfair and unnecessary. Studies on health inequities address the need for emergency care related to oral-dental lesions from external causes, toothache or prevalence of oral lesions, taking into account the differences between individuals and/or populations in terms of risk conditions to acquiring disease or access to health services. Inequities may be caused by the health service itself, because diseases affect socially deprived individuals more frequently and severely, especially because of multimorbidity. In the current Brazilian public health situation, programmatic actions are based on technological knowledge, especially epidemiology, focused on specific pathologies or disease risk groups, and relate closely to the organization of programmed demand. Moreover, programmatic actions should strategically use technological devices, without disregarding technical and policy flexibility, and should be closely related to inter-subjectivity and ethics, in order to develop emancipating capabilities. An action having this structure could make it easier to achieve Universality, Equity and Integrality.
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http://dx.doi.org/10.1590/s1806-83242012000700012DOI Listing
April 2013

Prosthetic rehabilitation of a child with Rapp-Hodgkin syndrome.

J Dent Child (Chic) 2012 May-Aug;79(2):115-9

Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.

The purpose of this paper was to report the case of a 6-year-old male patient who was clinically diagnosed as having Rapp-Hodgkin syndrome-a variant of ectodermal dysplasia characterized by dysplastic disorders of the skin, hair, and nails associated with cleft lip and/or palate. The patient exhibited only the primary maxillary and mandibular canines bilaterally. Restorative treatment was performed on all primary canines, followed by aquisition of maxillary and mandibular impressions for fabrication of acrylic removable partial dentures with circumferential clasps on the primary canines. The dentures allowed recovery of the vertical dimension and excellent esthetics. Hypodontia of several teeth associated with ectodermal dysplasia, as in this case involving Rapp-Hodgkin syndrome, causes several functional and esthetic alterations. These disorders should be diagnosed and treated as early as possible to restore the normal function, allow adequate mastication and speech, enhance esthetics, and, consequently, promote the patient's self-esteem and social integration.
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January 2013

Dental anomalies in Richieri-Costa-Pereira syndrome.

Oral Surg Oral Med Oral Pathol Oral Radiol 2012 Jul;114(1):99-106

Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.

Objective: The objective of this study was to investigate the prevalence of dental anomalies in individuals with Richieri-Costa-Pereira syndrome.

Study Design: A total of 13 individuals with Richieri-Costa-Pereira syndrome who were older than 8 years with at least 1 available panoramic radiograph were assessed. Dental anomalies were evaluated clinically and radiographically and classified as hyperplastic, hypoplastic, or heterotopic and as alterations of shape, number, position, and structure. Enamel alterations were classified by the DDE index.

Results: All individuals exhibited anomalies, with predominance of hypoplastic disorders, mainly agenesis of mandibular incisors and second premolars and demarcated creamy-white enamel opacities primarily affecting the maxillary premolars.

Conclusions: Individuals with Richieri-Costa Pereira syndrome exhibit high prevalence of tooth agenesis, especially mandibular incisors and premolars, as well as high frequency of enamel opacities. These findings are compatible with the mandibular cleft observed in all individuals and also reflect the hypoplastic characteristic of the syndrome.
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http://dx.doi.org/10.1016/j.oooo.2012.03.009DOI Listing
July 2012

Craniofacial morphology in patients with velocardiofacial syndrome.

Cleft Palate Craniofac J 2010 May;47(3):241-6

HRAC/USP-Setor de Odontopediatria e Saúde Coletiva, Rua Silvio Marchione, 3-20, Vila Universitária, CEP 17012-900, Bauru, SP, Brazil.

Objective: To compare cephalometric measurements of patients with and without velocardiofacial syndrome.

Design: Cross-sectional.

Setting: Public tertiary craniofacial center.

Subjects: Lateral cephalograms of 18 patients with velocardiofacial syndrome and 18 controls without morphofunctional alterations, matched for gender and age; all cephalograms were obtained before orthodontic intervention.

Main Outcome Measures: The cephalograms were manually traced and digitized for the achievement of linear and angular measurements.

Results: Individuals with velocardiofacial syndrome presented a reduced length of the skull base, retrusion of nasal bones, reduced posterior height of the maxilla, increased gonial angle, increased interincisal angle, greater lingual inclination of the mandibular incisors, reduced nasolabial angle, and reduced nasal depth compared with the control group.

Conclusions: Patients with velocardiofacial syndrome presented morphological differences compared with individuals without morphofunctional alterations, which might be considered in the evaluation of patients with suspected diagnosis of the syndrome, as well as for the establishment of treatment protocols adequate to their needs. The present findings did not support the hypothesis of differences in pharyngeal dimensions mentioned by other authors, suggesting that the velopharyngeal insufficiency in these patients may be caused by functional alterations rather than by anatomical differences.
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http://dx.doi.org/10.1597/08-278.1DOI Listing
May 2010

Cleft palate obturation with Brånemark protocol implant-supported fixed denture and removable obturator.

Cleft Palate Craniofac J 2010 Mar;47(2):211-5

Prosthodontics Sector, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (HRAC/USP), Bauru, Brazil.

A 41-year-old man with cleft palate presented with a wide dehiscence and missing teeth. Six implants had been placed for fabrication of an overdenture, which was unsatisfactory. A bar was waxed and cast for connection to the implants; precision attachments were placed laterally for retention. A fixed partial denture was fabricated, and milled crowns were fabricated at the molar region to provide a guiding plane for insertion of a removable palatal obturator. Good swallowing and speech outcomes were achieved. This technique provided functional and esthetic benefits, enhanced oral hygiene, and improved the psychological condition of the patient.
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http://dx.doi.org/10.1597/09-019_1DOI Listing
March 2010

Termination of pregnancy after prenatal diagnosis of cleft lip and palate--possible influence on reports of prevalence.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009 Jun;107(6):759-62

Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.

Elective termination of pregnancy is prohibited in many countries, even after prenatal diagnosis of oral clefts. Though some studies address registries on termination of pregnancy, many investigations include only livebirths. This may lead to underestimation of the overall occurrence of oral clefts, influencing their reported prevalence. This paper does not intend to discuss if termination of pregnancy because of the presence of an oral cleft is justifiable from ethical, moral, or religious standpoints. Rather, its main goal is to promote a reflection on how the prevalence of oral clefts has been addressed and to rethink the reported differences in prevalence. Authors publishing on the prevalence of oral clefts might indicate the regulations and practices on pregnancy termination in their countries, so that readers may have an idea of what is beyond those findings.
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http://dx.doi.org/10.1016/j.tripleo.2009.02.008DOI Listing
June 2009

Comparison of periodontal parameters in individuals with syndromic craniosynostosis.

J Appl Oral Sci 2009 Jan-Feb;17(1):13-20

Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil.

Craniosynostosis syndromes are characterized by premature closure of one or more cranial sutures, associated with other malformations, the most frequent of which are the Crouzon and Apert syndromes. Few studies in the literature have addressed the oral health of these individuals. The purpose of this study was to compare the periodontal status of individuals with Apert, Crouzon, Pfeiffer and Saethre-Chotzen syndromes before toothbrushing and compare the efficiency of plaque removal before and after mechanical toothbrushing. The probing depth, plaque index (according to Löe and O'Leary), clinical attachment level, gingival index (according to Silness and Löe) and amount of keratinized mucosa were evaluated before toothbrushing, and the O'Leary plaque index was assessed before and immediately after toothbrushing, on the same day, in 27 individuals aged 11 to 36 years. There was statistically significant difference in the mean probing depth and clinical attachment level among regions (p=0.00; p=0.01, respectively). The gingival index did not reveal statistically significant differences. With regard to the plaque index, the left region exhibited higher plaque index values than the right and anterior regions. No significant results were found in the analysis of keratinized mucosa. Comparison of the O'Leary plaque index before and after toothbrushing revealed statistically significant difference for all syndromes except for the Pfeiffer syndrome (p<0.05). In conclusion, there was no difference in the periodontal status among individuals with syndromic craniosynostosis. The posterior region was more affected than the anterior region as to the presence of plaque, loss of insertion and probing depth. Individuals with Pfeiffer syndrome exhibited greater toothbrushing efficiency than individuals with the other craniosynostosis syndromes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327608PMC
http://dx.doi.org/10.1590/s1678-77572009000100004DOI Listing
April 2009

Surgical planning for resection of an ameloblastoma and reconstruction of the mandible using a selective laser sintering 3D biomodel.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008 Jul;106(1):e36-40

Department of Oral and Maxillofacial Radiology, São Paulo Methodist University, São Paulo, Brazil.

Ameloblastoma is a benign locally aggressive infiltrative odontogenic lesion. It is characterized by slow growth and painless swelling. The treatment for ameloblastoma varies from curettage to en bloc resection, and the reported recurrence rates after treatment are high; the safety margin of resection is important to avoid recurrence. Advances in technology brought about great benefits in dentistry; a new generation of computed tomography scanners and 3-dimensional images enhance the surgical planning and management of maxillofacial tumors. The development of new prototyping systems provides accurate 3D biomodels on which surgery can be simulated, especially in cases of ameloblastoma, in which the safety margin is important for treatment success. A case of mandibular follicular ameloblastoma is reported where a 3D biomodel was used before and during surgery.
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http://dx.doi.org/10.1016/j.tripleo.2008.01.014DOI Listing
July 2008