Over the past decades, blood derivatives have contributed to advances in various surgical fields, and maxillofacial surgery has been no exception. Among the advantages of these products are their growth factors and platelet content, which accelerate platelet plug formation and are particulary useful in surge-ries with a high probability of significant bleeding. We present the case of a 23-year-old patient who underwent Surgically Assisted Rapid Palatal Expan-sion (SARPE) at Dr. Franco Ravera Zunino Hospital in Rancagua, with direct application of the Vivostat (R) system to the nasal fossae and Le Fort I osteotomy sites. Minimal intraoperative bleeding was observed, without the need for con-trolled hypotension by the anesthesiology team. The use of spray-applied fibrin adhesive via the Vivostat (R) system proved to be an effective and safe method for reducing intraoperative and postoperative bleeding, providing improved surgical control and uniform sealing of the surgical sites. These findings sug-gest a potential clinical benefit that should be confirmed in studies with larger sample sizes.
Tooth impaction is a common condition affecting both permanent and supernumerary teeth, with an incidence ranging from 3.1% to 17%. The case of a 19-year-old patient with an impacted mandibular third molar and a supernumerary tooth is presented, whose eruption was guided using an orthodontic button to replace a second molar with a poor prognosis. The surgical intervention involved fenestration of the third molar and extraction of the affected second molar, with placement of an L-PRF membrane to promote bone regeneration. Histopathological findings showed a dentigerous cyst. After a three-year follow-up period, tooth #48 had improved its position. Although the patient discontinued orthodontic treatment, her oral health remained stable. This case highlights the effectiveness of combined surgical and orthodontic techniques in managing impacted teeth and suggests that controlled eruption of third molars may be a viable alternative for preserving natural dentition.
Introduction: Surgical extraction of third molars is a common procedure, although not without risks. A rare but significant complication is the displa-cement of teeth or root fragments into deep anatomical planes, such as the mandibular border, posing both diagnostic and surgical challenges-particularly when undetected for years. Case presentation: We report the incidental finding of an inverted and displaced lower right third molar at the mandibu-lar inferior border in a 35-year-old female patient undergoing evaluation for orthofacial surgery. The patient was asymptomatic and reported a previous extraction of the same tooth 18 years earlier. The molar was identified using cone-beam computed tomography (CBCT) and successfully removed via a submandibular extraoral approach under general anesthesia. Conclusion: This case highlights the importance of thorough imaging evaluation in patients with prior surgical history and the need for individualized surgical planning. A submandibular approach provides a safe and effective option for accessing deeply positioned third molars, reducing infection risk and preserving adja-cent anatomical structures.
Objectives: 1) To determine the diagnostic agreement of five cephalomet-ric indicators of skeletal class and four of facial biotype through Cohen's weighted kappa test, and 2) to compare these results with those obtained after applying Cohen's weighted Chi-square test. Material and methods: In a sample of 439 lateral teleradiographs, the skeletal class indicators (ANB angle, APDI, FABA angle, Wits indicator, and Beta angle) and facial biotype indicators (FMA, skull base angle, Bj & ouml;rk-Jarabak polygon, and VERT index) were determined. Diagnostic concordance between them was assessed using Fleiss' kappa, Cohen's weighted kappa, and Cohen's weighted Chi-square tests. Results: Statistically significant differences were observed in both skeletal class and facial biotype diagnoses. While, according to Cohen's weighted kappa test, most agreements between skeletal class and facial biotype indicators were "Fair" or "Moderate," Cohen's weighted Chi-square test revealed highly signif-icant discordance in most comparisons, with negative values in Fleiss' kappa, indicating a systematic absence of concordance when all indicators were con-sidered simultaneously. The clinical relevance of these findings lies in the fact that diagnosis forms the foundation of proper clinical practice. Conclusion: 1) When analyzing diagnostic agreement of the five skeletal class indicators and the four facial biotype indicators, significant differences were found among them-a result consistently supported by Cohen's weighted Chisquare test. 2) Regarding the statistical tests to be used in assessing the significance level of diagnostic agreement, it is recommended to consider: (i) for two evaluators without extreme discrepancies, use the "classical" Cohen's kappa test; (ii) for two evaluators with extreme discrepancies, use Co-hen's weighted kappa test; and (iii) for more than two evaluators, use Cohen's weighted Chi-square test.
Introducción: La extracción quirúrgica de terceros molares es un procedimiento frecuente, aunque no exento de riesgos. Una complicación poco común es el desplazamiento de dientes o fragmentos hacia planos profundos, como el borde mandibular, lo que representa un desafío diagnóstico y quirúrgico, especialmente cuando pasa inadvertido por años. Se describe el hallazgo incidental de un tercer molar inferior derecho en posición invertida y desplazado hacia el borde mandibular, en una paciente de 35 años en planificación para cirugía ortofacial. La paciente se encontraba asintomática y refería haber sido sometida a exodoncia de la pieza referida 18 años antes. El diente fue identificado mediante tomografía computarizada de haz cónico (CBCT) y extraído con éxito por vía extraoral submandibular bajo anestesia general. La evolución postoperatoria fue favorable, sin complicaciones funcionales ni estéticas. Este caso resalta la importancia de la evaluación imagenológica en pacientes con antecedentes quirúrgicos y la necesidad de una planificación individualizada. El abordaje submandibular representa una opción segura para casos con localización profunda, al reducir el riesgo de infección y preservar la integridad de las estructuras vecinas.
