Publications by authors named "Heloísa Fonseca Marão"

12 Publications

  • Page 1 of 1

Successful Management of Ludwig's Angina due to Dental Implant Displacement: A Rare Case Report.

Case Rep Dent 2020 19;2020:6934286. Epub 2020 Feb 19.

Department of Implantology, University of Santo Amaro, São Paulo, São Paulo, Brazil.

Dental implant surgery is a common procedure in oral and maxillofacial surgery practices. Extensive training, skill, and experience allow this procedure to be performed with an atraumatic approach, but like any surgical technique, it is subject to accidents and complications. This is an unusual clinical case of an accidental displacement of an implant into the submandibular space that progressed to Ludwig's angina, and it has not yet been described in the literature. This case report describes a clinical case of dental implant displaced into the submandibular space after healing cap removal. After seven days, it progressed to Ludwig's angina. The removal was performed through extraoral access in the submandibular area by using hemostatic forceps and radioscopic technique. After implant removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical planning to achieve an appropriate treatment plan, which is essential for a favorable prognosis. Therefore, prevention and management of displaced objects requires proper planning and surgical technique.
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http://dx.doi.org/10.1155/2020/6934286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049839PMC
February 2020

The Synergistic Effect of Leukocyte Platelet-Rich Fibrin and Micrometer/Nanometer Surface Texturing on Bone Healing around Immediately Placed Implants: An Experimental Study in Dogs.

Biomed Res Int 2016 30;2016:9507342. Epub 2016 Nov 30.

Department of Biomaterials and Biomimetics, New York University, 433 1st Ave., Room 844, New York, NY 10010, USA; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA.

. This study evaluated the effects of L-PRF presence and implant surface texture on bone healing around immediately placed implants. . The first mandibular molars of 8 beagle dogs were bilaterally extracted, and implants (Blossom™, Intra-Lock International, Boca Raton, FL) were placed in the mesial or distal extraction sockets in an interpolated fashion per animal. Two implant surfaces were distributed per sockets: (1) dual acid-etched (DAE, micrometer scale textured) and (2) micrometer/nanometer scale textured (Ossean™ surface). L-PRF (Intraspin system, Intra-Lock International) was placed in a split-mouth design to fill the macrogap between implant and socket walls on one side of the mandible. The contralateral side received implants without L-PRF. A mixed-model ANOVA (at = 0.05) evaluated the effect of implant surface, presence of L-PRF, and socket position (mesial or distal), individually or in combination on bone area fraction occupancy (BAFO). . BAFO values were significantly higher for the Ossean relative to the DAE surface on the larger mesial socket. The presence of L-PRF resulted in higher BAFO. The Ossean surface and L-PRF presence resulted in significantly higher BAFO. L-PRF and the micro-/nanometer scale textured surface resulted in increased bone formation around immediately placed implants.
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http://dx.doi.org/10.1155/2016/9507342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155071PMC
January 2017

The Effect of Osteotomy Dimension on Implant Insertion Torque, Healing Mode, and Osseointegration Indicators: A Study in Dogs.

Implant Dent 2016 Dec;25(6):739-743

*Assistant Professor, Postgraduate Program in Dentistry UNIGRANRIO, University School of Health Sciences, Duque de Caxias, Rio de Janeiro, Brazil. †Assistant Professor, Department of Prosthodontics, University of Sao Paulo, Bauru College of Dentistry, Bauru, Sao Paulo, Brazil. ‡Associate Professor, Department of Periodontology, University of Florida College of Dentistry, Gainesville, FL; Director of the Graduate Program in Periodontics of the University of Florida College of Dentistry, Gainesville, FL. §PhD Candidate, Department of Dentistry, Division of Oral and Maxillofacial Surgery, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil. ¶Assistant Professor, Department of Oral and Maxillofacial Surgery, University of the West of Sao Paulo, Presidente Prudente, Sao Paulo, Brazil. ‖Associate Professor, Department of Prosthodontics and Operative Dentistry, Tufts University School of Dental Medicine, Boston, MA. #Associate Professor, Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY.

Purpose: This study investigated the effect of the osteotomy diameter for implant placement torque and its effect on the osseointegration.

Materials And Methods: Eight male beagle dogs received 48 implants (3.75 mm × 10 mm) in their right and left radius, 3 implants per side and allowed to heal for 3 weeks. Three experimental groups were evaluated. Group 1: implant with an undersized osteotomy of 3.0 mm; group 2: osteotomy of 3.25 mm, and group 3: osteotomy of 3.5 mm. The insertion torque was recorded for all implants. Histological sectioning and histometric analysis were performed evaluating bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO).

Results: Implants of group 1 presented statistically higher insertion torque than those of groups 2 and 3 (P < 0.01). No differences in BIC or BAFO were observed between the groups. From a morphologic standpoint, substantial deviations in healing mode were observed between groups.

Conclusion: Based on the present methodology, the experimental alterations of surgical technic can be clinically used with no detrimental effect over the osseointegration process.
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http://dx.doi.org/10.1097/ID.0000000000000476DOI Listing
December 2016

Effects of ovariectomy on periodontal tissues following tooth replantation.

Arch Oral Biol 2016 May 30;65:9-16. Epub 2016 Jan 30.

Department of Surgery and Integrated Clinics, Aracatuba Dental School, Univ Estadual Paulista-UNESP, Rua José Bonifácio, 1193-Vila Mendonça, Aracatuba, SP 16015-050, Brazil.

Objectives: The aim of the study was to analyze the effects of ovariectomy on periodontal tissues following immediate tooth replantation by histomorphometric, immunohistochemistry, and μCT analysis.

Materials And Methods: Eighty wistar rats (Rattus norvegicus albinos) with normal estrous cycles were randomly divided into two groups: ovariectomized (OVX) and Sham. Two months after surgery, the rats' upper right incisor was extracted followed by immediate reimplantation. The animals were sacrificed after 28, 45, and 60 days healing time. Histomorphometric and immunohistochemical analysis were performed by evaluation of PCNA and TRAP straining.

Results: The periodontal ligament was reinserted into the bone and cementum in the both groups. The immunohistochemical analysis revealed PCNA positive cells on the periodontal ligament in both groups at 28 days. Root resorption was noted at 45 days with immunoreactive cells for TRAP present in bone and tooth surface however no statistical differences between the groups were noticed. Histomorphometric analysis showed significant difference between groups in the periodontal ligament and root resorption parameters for the sub-items: intensity of chronic inflammatory infiltrate at 60 days (p<0.01), the organization of the periodontal ligament at 28 days (p<0.05), depth of root resorption at 45 days (p<0.05) and at 60 days (p<0.001). The μCT analysis showed multiple areas of bone resorption in association with OVX at 28 and 60 days with no significant differences between times in vivo.

Conclusion: The ovariectomy did not have significant influence in periodontal tissue parameters following tooth reimplantation.
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http://dx.doi.org/10.1016/j.archoralbio.2016.01.006DOI Listing
May 2016

Evaluation of Crystallized Biosilicate in the Reconstruction of Calvarial Defects.

J Maxillofac Oral Surg 2015 Sep 10;14(3):659-65. Epub 2015 Mar 10.

Dentistry School of Araçatuba, Universidade Estadual Paulista (UNESP), São Paulo, Brazil.

Introduction: The objective of this study was to assess the bone repair process of crystallized Biosilicate in surgically created defects on rats' calvaria. This biomaterial was recently developed for odontological use.

Materials And Methods: We used fifteen rats (rattus norvegicus albinus, Wistar), and two 5 mm surgical defects were performed on each of them; the defects were made with trephine drill on the calvarium region prior to the biomaterial placement. Groups were divided as follows: Group 1-defect filled with clot; Group 2-defect filled with crystallized Biosilicate. After 7, 14 and 28 days the animals were killed, the parts were retrieved and slides were prepared for histological studies.

Results: Bone formation was satisfactory in all groups, with direct contact between biomaterial surface and bone and absence of infection signs. The 28 days periods showed better results, and statistically significant difference between Clot Group (90.2 %) and Biosilicate (58 %; p = 0.002) was seen, regarding presence of bone tissue on the surgical defects.

Conclusion: Our study revealed that defects filled with clot present better results on bone formation compared to crystallized Biosilicate, which is considered a biocompatible material with favorable osteoconductive properties.
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http://dx.doi.org/10.1007/s12663-015-0755-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511902PMC
September 2015

Delayed tooth replantation following root canal filling with calcium hydroxide and MTA: Histomorphometric study in rats.

Arch Oral Biol 2015 Sep 20;60(9):1254-62. Epub 2015 Feb 20.

Univ Estadual Paulista-UNESP-Araçatuba Dental School, Rua José Bonifácio, 1193, Vila Mendonç, Zip Code 16015-050, Araçatuba, SP, Brazil.

Objective: The aim of this study was to perform a histomorphometric evaluation of the repair process in rat teeth replanted after root canals were filled with calcium hydroxide (CH) and mineral trioxide aggregate (MTA).

Design: Upper right incisors were extracted from 30 rats divided into three groups (n=10). The teeth were stored dry for 60min, after which the pulp and periodontal ligament (PDL) were removed and immersed in acidulated-phosphate sodium fluoride solution. In Group I, the root canals were filled with saline; in Group II, they were filled with CH; and in Group III, they were filled with CH, and the foramen was sealed with an MTA plug. The teeth were replanted, and the animals were sacrificed after 60 days. The sections with teeth were removed for histological preparation (haematoxylin and eosin, H&E). The characteristics of the PDL, cementum, dentine, and alveolar bone, as well as the occurrence of inflammatory and replacement root resorption and apical sealing, were subjected to histological and morphometric analysis (P<0.05).

Results: Group I was the most affected by root resorption (mean=67.05%). In Groups II and III, the resorption averaged 42.2% and 11.7%, respectively. Group III was less affected by inflammatory resorption and presented more areas of apical sealing by mineralized tissue (P<0.05).

Conclusion: An apical MTA plug improved the repair of the replanted tooth by decreasing surface resorption and repairing mineralized tissue in the periapical region.
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http://dx.doi.org/10.1016/j.archoralbio.2015.02.002DOI Listing
September 2015

Effect of the treatment of root surface-adhered necrotic periodontal ligament with propolis or fluoride in delayed rat tooth replantation.

Clin Oral Investig 2014 May 19;18(4):1329-1333. Epub 2013 Sep 19.

Program in Dental, Araçatuba Dental School, Univ Estadual Paulista - UNESP, Araçatuba, Brazil.

Objectives: The purpose of this study was to evaluate the application of 15 % propolis and 2 % acidulated-phosphate sodium fluoride solutions on the root surface-adhered necrotic cemental periodontal ligament in delayed tooth replantation.

Materials And Methods: Thirty Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. After this period, the dental papilla, enamel organ, and pulp tissue were removed, and the animals were randomly assigned to three groups: group I = immersion in saline for 10 min; group II = immersion in a 2 % acidulated-phosphate sodium fluoride solution for 10 min; and group III = immersion in a 15 % propolis and propylene glycol solution for 10 min. The root canals were filled with a calcium hydroxide paste and the teeth were replanted.

Results: Inflammatory resorption, replacement resorption, and ankylosis were observed in all groups without a statistically significant difference (p > 0.05) among them.

Conclusions: Under the tested conditions, the application of fluoride or propolis on root surface-adhered necrotic periodontal ligament did not favor the healing process in delayed tooth replantation.
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http://dx.doi.org/10.1007/s00784-013-1103-3DOI Listing
May 2014

Importance of clinical examination in dentoalveolar trauma.

J Craniofac Surg 2012 Sep;23(5):e404-5

Dental injuries are often the result of direct trauma. The most affected teeth are the upper incisors, and the most frequent lesions are coronal fractures, contusions, and lip and alveolar mucosa lacerations. The objective of this study was to draw attention to the importance of the correct management of cases of crow fractures associated with soft tissue lacerations when the fragment is not located. This is a clinical case of crown fracture, the fragment of which remained lodged inside the lip. After fragment removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical examination to achieve a correct diagnosis and an appropriate treatment plan, which is essential for a favorable prognosis.
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http://dx.doi.org/10.1097/SCS.0b013e31825bd2e5DOI Listing
September 2012

Histological and immunohistochemical analyses of the chronology of healing process after immediate tooth replantation in incisor rat teeth.

Dent Traumatol 2013 Feb 13;29(1):15-22. Epub 2012 Mar 13.

Department of Surgery and Integrated Clinic, Araçatuba Dental School, UNESP - Univ Estadual Paulista, Araçatuba, SP, Brazil.

Dental tissues have special characteristics, and its regenerative capacity is noteworthy. However, understanding the circumstances that lead to regeneration is challenging. In this study, the chronology of the healing process after immediate replantation of rat incisor teeth was examined by histological and immunohistochemical analyses within a 60-day period. Thirty-six male Wistar rats had their maxillary right incisors extracted and replanted after 15 min in saline storage. The rats were sacrificed immediately 3, 7, 15, 28, and 60 days after replantation. The histological analysis showed rupture of the periodontal ligament and formation of a blood clot, which started being replaced by a connective tissue after 3 days. At 7 days, the gingival mucosa epithelium was reinserted and areas of root resorption could be seen. At 15 days, the periodontal ligament was repaired. At 3 days, the pulp presented an absence of the odontoblast layer, which started being replaced by a connective tissue. This tissue suffered gradual calcification, filling the root canal at 28 and 60 days. The root ends were closed. The immunohistochemical analysis revealed greater expression of OP, OPG, and RANK proteins in the initial periods (0 and 3 days), while TRAP expression predominated at 28 and 60 days (P < 0.05). In conclusion, in delayed tooth replantation, there is great new bone formation activity in the earlier periods of the repair process, while a predominance of bone resorption and remodeling is observed in the more advanced periods.
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http://dx.doi.org/10.1111/j.1600-9657.2012.01127.xDOI Listing
February 2013

Periapical tissue reactions to calcium hydroxide and MTA after external root resorption as a sequela of delayed tooth replantation.

Dent Traumatol 2012 Aug 8;28(4):306-13. Epub 2011 Dec 8.

Division of Oral and Maxillofacial Surgery, School of Dentistry of Araçatuba, UNESP, São Paulo State University, Araçatuba, SP, Brazil.

Clinical experience has shown that most avulsed teeth are replanted after a long extra-alveolar time and dry or inadequate wet storage, causing necrosis of periodontal ligament cells. This condition invariably leads to development of external root resorption, leaving the filling material in contact with the periapical connective tissues. In this study, the periapical tissue reactions to calcium hydroxide (CH) and mineral trioxide aggregate (MTA) were evaluated after occurrence of external root resorption as an expected sequela of delayed tooth replantation. Twenty male Wistar rats (Rattus norvegicus, albinus) had their right upper incisor extracted and maintained in dry storage for 60 min. Then, the dental papilla, enamel organ, pulp tissue, and periodontal ligament were removed, and the teeth were immersed in a 2% acidulated phosphate sodium fluoride solution, pH 5.5, for 10 min. The teeth were randomly assigned into two groups (n = 10), in which the canals were filled with either a CH and saline paste (CH group) or MTA (MTA group). The sockets were irrigated with saline, and the teeth were replanted. After 80 days, it was possible to observe large areas of replacement root resorption and some areas of inflammatory root resorption in both groups. More severe inflammatory tissue reaction was observed in contact with calcium hydroxide compared with the mineral trioxide aggregate. New bone formation was more intense at the bottom of the socket in the MTA group. In conclusion, as far as periapical tissue compatibility is concerned, intracanal MTA can be considered as a viable option for root canal filling in delayed tooth replantation, in which external root resorption is an expected sequela.
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http://dx.doi.org/10.1111/j.1600-9657.2011.01090.xDOI Listing
August 2012

Occurrence of odontogenic infections in patients treated in a postgraduation program on maxillofacial surgery and traumatology.

J Craniofac Surg 2011 Sep;22(5):1689-94

Department of Surgery and Integrated Clinic, Dental School of Araçatuba, São Paulo State University, Araçatuba, São Paulo, Brazil.

This study assessed the occurrence and characteristics of oral and maxillofacial infections in patients treated at a Brazilian oral and maxillofacial emergency service during a 7-year period. The clinical files of all patients treated at the Oral and Maxillofacial Surgery and Traumatology Service of the Araçatuba Dental School, São Paulo State University, Brazil, between 2002 and 2008 were reviewed. From a population of 3645 patients treated in this period, the study sample consisted of 93 subjects who presented odontogenic infections. Data referring to the patients' sex, age, medical history, and the etiology, diagnosis, complications, drug therapy/treatment, and evolution of the pathologic diseases were collected and analyzed using the Epi Info 2000 software. Of these patients, 54 were men (58.1%) and 39 were women (41.9%). Most patients were in the 31- to 40-year-old (20.7%) and 21- to 30-year-old (19.6%) age groups. The most frequent etiology was pulp necrosis due to caries (80.6%). Regarding the treatment, antibiotics were administered to all patients, surgical drainage was done in 75 patients (82.4%), and 44 patients (47.3%) needed hospital admission. First-generation cephalosporin alone or combined with other drugs was the most prescribed antibiotic (n = 26) followed by penicillin G (n = 25). Most patients (n = 85, 91.4%) responded well to the treatment. Five cases had complications: 3 patients needed hospital readmission, 1 case progressed to descending mediastinitis, and 1 patient died. Odontogenic infections can be life-threatening and require hospital admission for adequate patient care. Complications from odontogenic infections, although rare, may be fatal if not properly managed.
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http://dx.doi.org/10.1097/SCS.0b013e31822e5c8dDOI Listing
September 2011

Use of titanium mesh for reconstruction of extensive defects in fronto-orbito-ethmoidal fracture.

J Craniofac Surg 2010 May;21(3):748-50

Division of Oral and Maxillofacial Surgery, Department of Surgery and Integrated Clinic, Dental School of Araçatuba (UNESP), Araçatuba, São Paulo, Brazil.

Traumatic injuries treatment of the fronto-naso-orbito-ethmoidal region has been one of the most challenging treatments within maxillofacial surgery, particularly of extensive orbital defects, very common in this type of pathologic condition. A 48-year-old man involved in a car collision presented an extensive bilateral fracture of the orbit medial wall, nasal bones, the nasal septum, and the frontal anterior table. The clinical and tomographic findings concluded the diagnosis of a maxilla and fronto-naso-orbito-ethmoidal fracture. Among the variety of biomaterials, the titanium mesh was elected because of the extension and magnitude of the bone defect, obtaining this way esthetic and functional results with better prognosis.
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http://dx.doi.org/10.1097/SCS.0b013e3181d7f1b5DOI Listing
May 2010