Pâmela Letícia Dos Santos

PhD in Oral and Maxillofacial Surgery
Professor (Assistant)

Publications

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    ABSTRACT: The purpose of this paper was to analyze specimens of autogenous bone block grafts exposed to the oral cavity after ridge reconstructions. Specimens of chronic suppurative osteomyelitis (CSO) of the jaws were used as comparison for bacterial colonization pattern. For this, 5 specimens of infected autogenous bone grafts were used and 10 specimens of CSO embedded in paraffin were stained with Brown and Brenn technique and analyzed under light microscopy. The results showed a similar colonization pattern in both situations, with the establishment of bacterial biofilm and the predominance of Gram-positive bacteria. The conclusion was that the similarity in bacterial distribution and colonization between autogenous bone grafts and CSO stresses the necessity of more invasive procedures for the treatment of the autogenous bone grafts early exposed to the oral cavity.
    The Journal of craniofacial surgery 03/2014; 25(2):412-4. · 0.81 Impact Factor
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    ABSTRACT: Several reconstructive methods of the alveolar ridge have been reported to make possible future rehabilitations with implants. Many of these methods come from studies done in animals, mainly rats. With this clinical practice based on scientific evidence, any experimental procedure that can be undertaken in real life is fundamental. Thus, any research that emulates as closely as possible those techniques used in humans are important. This study describes the modification of the technique for block bone graft fixation (onlay) in rats using the "lag screw"-type technique, normally used in clinical procedures for grafts in humans. The conclusion was that the execution of the described procedures minimizes interference of blood flow in the area because of the maintenance of the muscle insertion in the buckle aspect of the most anterior region of the mandible, providing better stability to the graft and better contact interface of the graft and receptor bed.
    The Journal of craniofacial surgery 01/2014; · 0.81 Impact Factor
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    ABSTRACT: Purpose: This study evaluated and compared bone heating, drill deformation, and drill roughness after several implant osteotomies in the guided surgery technique and the classic drilling procedure. Materials and Methods: The tibias of 20 rabbits were used. The animals were divided into a guided surgery group (GG) and a control group (CG); subgroups were then designated (G0, G1, G2, G3, and G4, corresponding to drills used 0, 10, 20, 30 and 40 times, respectively). Each animal received 10 sequential osteotomies (5 in each tibia) with each technique. Thermal changes were quantified, drill roughness was measured, and the drills were subjected to scanning electron microscopy. Results: Bone temperature generated by drilling was significantly higher in the GG than in the CG. Drill deformation in the GG and CG increased with drill use, and in the CG a significant difference between G0 and groups G3 and G4 was observed. In the GG, a significant difference between G0 and all other groups was found. For GG versus CG, a significant difference was found in the 40th osteotomy. Drill roughness in both groups was progressive in accordance with increased use, but there was no statistically significant difference between subgroups or between GG and CG overall. Conclusion: During preparation of implant osteotomies, the guided surgery technique generated a higher bone temperature and deformed drills more than the classic drilling procedure. The increase in tissue temperature was directly proportional to the number of times drills were used, but neither technique generated critical necrosis-inducing temperatures. Drill deformation was directly proportional to the number of times the drills were used. The roughness of the drills was directly proportional to the number of reuses in both groups but tended to be higher in the GG group.
    The International journal of oral & maxillofacial implants 01/2014; 29(1):51-8. · 1.91 Impact Factor
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    ABSTRACT: PURPOSE: The present case describes an inferior alveolar nerve lateralization for implant placement that caused mandible fracture a few days after surgery. CLINICAL REPORT: In this case, a 56-year-old female patient who had a severely atrophied jaw and showing bone height less than 7 mm from the bone crest and the mandibular canal was submitted to surgery lateralization of the inferior alveolar conducted with piezzo. Even with all postoperative care, the patient suffered an incomplete fracture of the mandible a few days after lateralization of the inferior alveolar nerve for implant placement. The patient was treated with soft diet and medications for pain and antibiotics, besides removing the implant associated with the fracture. CONCLUSION: It is suggested that this procedure may be conducted in 2 operative periods: firstly, the lateralization of the inferior alveolar; and secondly, after a period of 3 months, the implant placement in a situation of more bone stability.
    The Journal of craniofacial surgery 05/2013; 24(3):e222-e224. · 0.81 Impact Factor
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    Revista de odontologia da UNESP / Universidade Estadual Paulista (UNESP) 04/2013;
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    ABSTRACT: INTRODUCTION: The pain is defined as an unpleasant experience, and control of postoperative pain a great challenge in healthcare. OBJECTIVE: To compare the efficacy of Dipyrone and acetaminophen in postoperative pain after third molar surgery. MATERIAL AND METHOD: Thirty patients of the Discipline of Surgery of School of Dentistry of Araçatuba - UNESP, that needed to extract their third included molars, were selected. Among these, 15 received Dipyrone (group I) and the other received acetaminophen (group II) in the postoperative. All patients were treated pre-operatively with dexamethasone 4 mg and amoxycillin 1 g, one hour before surgery. Pain intensity was evaluated by a visual analogue scale by forty eight hours postoperative period and in intervals of six hours. The exclusion criteria were: presence of systemic disorders, drugs hypersensitivity, pregnant, lactic and local contraindications. The scores obtained were submitted to the Mann-Whitney test (p < 0,05) for comparison of the pain intensity in the 6 hours intervals, in the initial 24 hours, in the last 24 hours and in the total period of 48 hours. RESULT: There was no statistical difference among the analgesics in the 6 hours intervals, however, in the last 24 hours and in the total period of 48 hours, the group I presented smaller medium values, significant statistically, when compared to group II. CONCLUSION: The analgesic efficacy of dipyrone was superior to paracetamol.
    Revista de Odontologia da UNESP. 04/2013; 42(2):78-82.
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    ABSTRACT: PURPOSE: To evaluate the effect of implant osteotomy on immediate bone cell viability, comparing guided surgery for implant placement with the classic drilling procedure. MATERIALS AND METHODS: For this study, 20 rabbits were used. The animals were divided into a guided surgery group (GG) and a control group (CG) and were then divided into 4 subgroups-subgroups 1, 2, 3, and 4-corresponding to drills used 10, 20, 30, and 40 times, respectively. All animals received 5 osteotomies in each tibia, by use of the classic drilling procedure in one tibia and guided surgery in the other tibia. The osteotomized areas were removed and processed immunohistochemically for detection of osteocalcin, receptor activator of nuclear factor κB ligand (RANKL), osteoprotegerin (OPG), and caspase 3. RESULTS: Immunohistochemical analysis showed that osteocalcin expression was initially higher in the CG and remained constant after drill reutilization. Although the expressions of RANKL and OPG were not statistically different for the GG and CG, the RANKL/OPG ratio tended to be higher for the GG. Moreover, caspase 3 expression was elevated in the GG, proportionally to the number of osteotomies, indicating an increase in the apoptosis index in the GG. CONCLUSIONS: The classic drilling procedure is more favorable to cell viability than guided surgery.
    Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 01/2013; · 1.58 Impact Factor
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    ABSTRACT: Placement of implants in fresh sockets is an alternative to try to reduce physiological resorption of alveolar ridge after tooth extraction. This surgery can be used to preserve the bone architecture and also accelerate the restorative procedure. However, the diastasis observed between bone and implant may influence osseointegration. So, autogenous bone graft and/or biomaterials have been used to fill this gap. Considering the importance of bone repair for treatment with implants placed immediately after tooth extraction, this study aimed to present a literature review about biomaterials surrounding immediate dental implants. The search included 56 articles published from 1969 to 2012. The results were based on data analysis and discussion. It was observed that implant fixation immediately after extraction is a reliable alternative to reduce the treatment length of prosthetic restoration. In general, the biomaterial should be used to increase bone/implant contact and enhance osseointegration.
    International Journal of Biomaterials 01/2013; 2013:307136.
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    ABSTRACT: Computed tomographic scanning is a precise, noinvasive surveying technique that enables the professionals to improve the precision of implant placement by building a prototype that allows the confection of surgical guides. The authors present a clinical case of anterior tooth rehabilitation with frozen homogenous bone graft and immediately loaded titanium implant using computer-guided surgery. A multislice computed tomography was realized, and a prototype was built. All the procedures were previously realized in the prototype before started in the patient. This technique allows a better surgical planning, makes the procedures more accurate, and reduces surgery time.
    The Journal of craniofacial surgery 09/2012; 23(5):e470-2. · 0.81 Impact Factor
  • Revista de odontologia da UNESP / Universidade Estadual Paulista (UNESP) 07/2012;
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    ABSTRACT: Objective: To evaluate the effect of implant osteotomy on immediate bone-cell viability, comparing guided surgery for implant placement to classic drilling procedure. Method: The tibias of 20 rabbits were used. The animals were divided into a guided surgery group (GG) and a control group (CG), which were then divided into subgroups (G): G1, G2, G3, and G4, corresponded to drills used 10, 20, 30 and 40 times, respectively. All animals received 5 osteotomies in each tibia, using the classic drilling procedure in one, and guided surgery in another. The osteotomized areas were processed and embedded in paraffin. Sections were submitted to H&E-staining for morphological observation and to immunohistochemistry for detection of and osteocalcin (OC), receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG) and caspase-3 (CAS-3). Results: Immunohistochemical analysis showed that OC expression was initially higher in the CG, and remained constant after drill reutilization. Although the expressions of RANKL and OPG (proteins associated with osteoclast formation and activity) were not statistically different for GG and CG, RANKL:OPG ratio tended to be higher for GG. Moreover, CAS-3 expression was elevated in the GG, proportionally to the number of osteotomies, indicanting an inscrease in the apoptosis index, in GG. Conclusion: The classic drilling procedure is more favorable to immediate cell viability than guided surgery.
    IADR General Session 2012; 06/2012
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    ABSTRACT: Objective: To evaluate commercially pure titanium implants (cpTi) with surface nanomodified by laser beam (LS) without and with hydroxyapatite deposition by the biomimetic method, without (HAB) and with post thermal treatment (HABT), and compare them with implants with surface modified by acid treatment (AS) and with machined surfaces (MS). Method: A topographical analysis of the surfaces was performed by scanning electron microscopy and by roughness evaluation. Then, forty-five rabbits received 150 implants (2 implants per tibia). After 30, 60 and 90 days, the animals were euthanized, 75 implants and their surrounding bones were removed and prepared for a non-decalcified histological analisys of the percentage of bone-implant contact (BIC) and of the bone area (BA) formed between the implant threads in the higher cortical region. Moreover, the surrounding bones of other 75 implants decalcified and paraffin embedded were submitted to immunohistochemistry for detection of core binding factor alpha1 (CBFa-1), osteoprotegerin (OPG) and receptor activator of NF-κB ligand (RANKL). Result: The topographical analysis showed significant differences among the roughness of LS, HAB and HABT versus (vs.) AS and MS. BIC was higher on the LS, HAB and HABT, compared with AS and MS (p<0.001), in the three periods. At 30 days, BA of HAB, was higher than all other groups (p<0.01). At 60 and 90 days, BA of LS, HAB and HABT was higher than the MS (p<0.001). CBFa-1 immunolabelling revealed increased staining at 30 and 60 vs. 90 days for all nanotopography modified surfaces. The RANKL:OPG ratio tended to decrease over time for the treated surfaces vs. MS. Conclusion: The physicochemical modifications promoted nanotopography implant surfaces which in turn favored the interaction between bone tissue and implant surfaces, in periods of 30 and 60 days and accelerated the expression of proteins important to osseointegration.
    IADR General Session 2012; 06/2012
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    ABSTRACT: Maxillofacial trauma caused by firearms has considerably increased, in which the mandibular body is the site of highest incidence of firearm projectiles. In these cases, the use of titanium plates and screws allows the early restoration of form and function of the mandible with stable and predictable results. Recently, conventional plates have been extensively used to treat comminuted mandibular fractures. Nevertheless, the conventional system presents several limitations such as screw compression against the bone interface and the necessity of precise fit of plate to the bone. To overcome such drawbacks, the locking plates have emerged. The present clinical case reported the operative treatment of mandibular fracture caused by firearm projectiles with the use of locking plate. The indications, advantages, and disadvantages of this system are presented.
    Craniomaxillofacial Trauma and Reconstruction 06/2012; 5(2):91-6.
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    ABSTRACT: The aim of this study was to evaluate the bone repair process in the maxillary sinus in monkeys treated with high-density porous polyethylene (Medpor) Four capuchin monkeys (Cebus apella) were submitted to bilateral horizontal osteotomies in the anterior wall of the maxillary sinus and divided into 2 groups: control group, left side with no implants, and porous polyethylene group, right side with Medpor. After a period of 145 days after implant placement, the maxillae were removed for histologic and histometric analyses. Bone repair in osteotomized areas took place by connective tissue in 58.5% and 58.7% in the control group and the porous polyethylene group, respectively. In the contact surface with Medpor, bone repair occurred in 41.3%. Medpor was not reabsorbed within the period of this study and allowed bone repair surrounding it. The porous polyethylene constitutes a feasible alternative for bone defect reconstruction.
    The Journal of craniofacial surgery 11/2011; 22(6):2337-40. · 0.81 Impact Factor
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    ABSTRACT: Odontogenic myxomas (OMs) are nonencapsulated rare benign tumors that can occur in gnathic bones. They are locally invasive and have a high recurrence rate. Radiologically, OMs show a multilocular (in the majority of cases) or unilocular radiolucency, with either distinct or poorly defined margins. Histopathologically, OMs are characterized by spindle-, wedge-, or stellate-shaped cells loosely arranged in an abundant mucoid background. Myxomas are mainly asymptomatic. Radical surgery, excision, and enucleation followed by curettage of the surrounding bony tissue have all been advocated as treatment options. This study presents a successful case of conservative treatment of OMs with a 5-year follow-up.
    The Journal of craniofacial surgery 09/2011; 22(5):1939-41. · 0.81 Impact Factor
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    ABSTRACT: The biologic width is an essential dental space that always needs to be maintained to ensure periodontal health in any dental prosthetic restorations. An iatrogenic partial fixed prosthesis constructed in lower posterior teeth predisposed the development of subgingival caries, which induced violation of the biologic width in involved teeth, resulting in an uncontrolled inflammatory process and periodontal tissue destruction. This clinical report describes a periodontal surgical technique to recover a violated biologic width in lower posterior teeth, by crown lengthening procedure associated with free gingival graft procedure, to ensure the possibility to place a modified partial fixed prosthesis in treated area. The procedure applied to recover the biologic width was crown lengthening with some modifications, associated with modified partial fixed prosthesis to achieve health in treated area. The modified techniques in both surgical and prosthetic procedures were applied to compensate the contraindications to recover biologic width by osteotomy in lower posterior teeth. The result, after 4 years under periodic control, seems to achieve the projected goal. Treating a dental diseased area is necessary to diagnose, eliminate, or control all etiologic factors involved in the process. When the traditional methods are not effective to recover destructed tissues, an alternative, compensatory, and adaptive procedure may be applied to restore the sequelae of the disease, applying a restorative method that respects the biology of involved tissues.
    The Journal of craniofacial surgery 09/2011; 22(5):1913-6. · 0.81 Impact Factor
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    ABSTRACT: Foreign bodies, although they are often found throughout the body, to a lesser degree in the face, still constitute a diagnostic challenge for the trauma surgeon. Its removal means danger of damaging important facial anatomic structures, even if its exact position from the image data was known. So, the objective is to describe a clinical report of a patient (42 years of age, male sex) who experienced falling to the ground, attended by the Department of Surgery and Traumatology Bucco-Maxillo-Facial Surgery, Faculty of Dentistry of Araçatuba, São Paulo State University, and 2 days after the trauma, he reported difficulty in mouth opening and pain. After clinical evaluation, we observed the presence of injury in the left preauricular region already in the process of healing. During the intraoral physical examination, a limitation of the mouth opening was noted. Radiographic posteroanterior and profile of the face showed 2 radiopaque foreign bodies in the left side, lying apparently at the region of the mandibular condylar process. Under local anesthesia, foreign body removal was carried from there with access to it through the preexisting facial injury. Further clinical examinations showed an improvement in mouth opening, absence of pain complaints, and/or functional complaints.
    The Journal of craniofacial surgery 07/2011; 22(4):1531-3. · 0.81 Impact Factor
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    ABSTRACT: The objective of the study was to analyze 2-flap designs for surgical extraction of third molar, evaluating the periodontal status of the second lower molar. Forty-five lower third molars were extracted from 24 patients. In 23 teeth, a vertical incision to the mandibular ramus was used (technique A), whereas 22 teeth were submitted to classic L-shaped flap (technique B) with controls at 60 and 90 days postoperatively. Pearson correlation coefficient analysis showed a significant correlation only between immediate preoperative probing depth variables from techniques A and B in the studied surfaces. Statistical significances in the preoperative (vestibular) and postoperative day 60 (distovestibular and vestibular) were noted. In contrast, Student t-test showed no statistical difference in probing depths between preoperative and postoperative values, as well as no statistically significant difference regarding the type of incision alone. Technique A allowed a less traumatic surgery, guaranteeing a more comfortable postoperative period.
    The Journal of craniofacial surgery 05/2011; 22(3):1003-7. · 0.81 Impact Factor
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    ABSTRACT: The median palatine cyst is a rare benign nonodontogenic lesion that attacks the median palatine suture. There is controversy about its pathogenesis; however, its origin is generally attributed to the enclavement of epithelial remnants within the palatine suture between the 2 lateral maxillary processes during their fusion in the origin of the hard palate. The purpose of this report was to relate a case of a median palatine cyst, discussing the rarity of the lesion, its pathogenesis, and the different modalities that could be used for the correct treatment of this pathologic entity.
    The Journal of craniofacial surgery 03/2011; 22(2):737-40. · 0.81 Impact Factor

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