Medication-related osteonecrosis of the jaws (MRONJ) remains a challenging complication associated with antiresorptive therapy, highlighting the need for effective adjunctive preventive strategies. This study evaluated the effects of systemic ozone therapy, alone or combined with topical 10% metronidazole paste or 2% chlorhexidine gel, on alveolar repair in a zoledronate-induced rat model of MRONJ. Forty-two ovariectomized female Wistar rats were allocated into seven experimental groups. Following mandibular first molar extraction, animals received systemic ozone therapy and/or topical antimicrobial treatment according to the experimental protocol. Clinical, histomorphometric, micro-computed tomography (micro-CT), Picrosirius Red, and immunohistochemical analyses were performed. Zoledronate treatment markedly impaired alveolar repair, resulting in reduced new bone formation, increased non-vital bone, epithelial disorganization, and unfavorable bone microarchitecture. Systemic ozone therapy significantly increased new bone formation and improved bone microstructural parameters compared with untreated zoledronate animals. Ozone-treated groups also exhibited more organized collagen fibers and increased VEGF and osteocalcin immunostaining. Topical metronidazole and chlorhexidine were associated with favorable tissue repair findings, while combined therapies showed more favorable outcomes than zoledronate treatment alone. These findings suggest that systemic ozone therapy, particularly when associated with topical antimicrobial treatments, improves alveolar repair and represents a promising adjunctive strategy for preventing MRONJ.

Introduction: Fractures of the frontal bone originate from minor or high-intensity accidents. Various treatment modalities have been described, such as conservative treatment or osteosynthesis of the fracture. Objective: The objective of the present work is to report a surgical approach to a reduction and fixation of a panfacial fracture involving the frontal bone. In this work, coronal access was used for anatomical repositioning and reestablishment of the contour in the frontal region. No complications or sequelae were observed at approximately three months follow-up. Report: Female patient, 22 years old, was evaluated by the Oral and Maxillofacial Surgery and Traumatology team, in a reference hospital, with a history of an automobile accident, with multiple facial fractures. At the initial examination, the patient was conscious, hemodynamically stable and with all vital signs within normal limits. Computed tomography was performed, which indicated multiple fractures in the face, including in the frontal bone. In view of this, we opted for surgical treatment, which was performed through a bicoronal access, with reduction and rigid internal fixation of the multiple fractures on the face, including the frontal region, under general anesthesia, without intercurrences. Result: The aesthetic and functional reestablishment of the frontal region was obtained, maintaining the integrity of the anterior wall of the frontal sinus. Currently, the patient is four months after the operation, with resolution of the complaints, and the access site completely healed. Final considerations: Coronal access is a viable option for the aesthetic restoration of frontal sinus fractures, providing excellent intraoperative visibility and adequate healing.

Angina de Ludwig é um grave processo infeccioso majoritariamente odontogênico, de rápida evolução, que acomete os espaços submandibulares, sublinguais e submentonianos bilaterais, podendo evoluir para uma complicação conhecida como mediastinite, uma patologia com altas taxas de mortalidade, mais prevalente em homens. Para a terapêutica de infecções graves é importante drenagem da coleção purulenta, remoção do foco infeccioso e administração de antibioticoterapia. O objetivo é relatar um caso de Angina de Ludwig com evolução para mediastinite de um paciente do sexo masculino, 42 anos, avaliado pela equipe de Cirurgia e Traumatologia Buco Maxilofacial FOA-UNESP em pronto-socorro hospitalar com história de tratamento odontológico no elemento 38 há três dias. O paciente foi submetido a abordagem cirúrgica para drenagem, remoção do elemento 38 e instalação de drenos de penrose sob anestesia geral. Após dois dias, o paciente evoluiu com dor torácica e queda de saturação. Foi constatado, após avaliação da tomografia de tórax em conjunto com clínica médica e equipe da cirurgia torácica, evolução para mediastinite, necessitando de drenagem torácica em centro-cirúrgico. Manteve-se o acompanhamento multidisciplinar até a completa resolução do quadro do paciente. Sendo assim, as infecções odontogênicas e demais focos infecciosos da região cervical devem ser minuciosamente conduzidos e acompanhados, e em casos de complicações é importante considerar abordagem interdisciplinar.

Objective: The objective of this work is to report the reconstruction and rehabilitation of an atrophic mandible with an iliac crest graft and dental implants. Methods: Patient A.F, 55 years old, attended the dental clinic in the city of Araçatuba/SP, with aesthetic complaints and edentulism. Bone graft collected from the iliac crest was used for reconstruction, followed by the installation of 4 dental implants and a block graft fixed with a titanium screw. Results: At the end of the work, the patient showed notable functional and aesthetic improvements. The free iliac bone graft is considered a favorable alternative for maintaining satisfactory functional and aesthetic results in patients with severely atrophied alveolar ridges. It was possible to note that oral rehabilitation with iliac crest bone graft and dental implant is a complex procedure that involves several challenges, both from a surgical and rehabilitation point of view. Conclusion: Therefore, we can conclude that overcoming these challenges requires a multidisciplinary approach, involving oral surgeons, periodontists, prosthetists and other health professionals to ensure the best possible result for the patient.

As fraturas mandibulares são altamente prevalentes nos traumatismos faciais e representam uma parte significativa dos atendimentos em Cirurgia e Traumatologia Bucomaxilofacial, especialmente no Brasil. Entre as regiões mais acometidas, o ângulo mandibular se destaca devido à sua propensão a complicações, como desalinhamento oclusal e dificuldades na consolidação óssea. O tratamento adequado é fundamental para minimizar sequelas funcionais e estéticas. O objetivo deste trabalho é relatar o caso de um paciente atendido na Santa Casa de Misericórdia de Araçatuba, que sofreu uma queda de bicicleta na semana anterior. Durante a avaliação clínica, foram observados edema endurecido na região submandibular direita, trismo, dor espontânea, crepitação mandibular e alteração oclusal. A tomografia computadorizada revelou uma fratura no ângulo mandibular direito. O paciente foi submetido a uma cirurgia para redução e fixação da fratura, realizada sob anestesia geral com a técnica de Champy, utilizando placas e parafusos do sistema 2.0. Além disso, um dreno de Penrose foi instalado para facilitar a drenagem pós-operatória e foi removido 24 horas depois, na alta hospitalar. O paciente recebeu alta com bom progresso e está sendo acompanhado ambulatorialmente. Este caso reforça a importância de um diagnóstico preciso e de intervenções terapêuticas adequadas, como a técnica de Champy, que se mostra eficaz na estabilização de fraturas mandibulares. O sucesso no manejo cirúrgico e na recuperação do paciente evidencia a relevância de abordagens individualizadas e criteriosas para minimizar complicações e garantir resultados funcionais e estéticos favoráveis.