Dr. Luis Pagotto, DDS, MS
Atuo na assistência, docência e pesquisa.
Faculdade de Odontologia - DDS (Doctor of Dental Surgery) - CROSP: 67438
Especialista em Cirurgia Bucomaxilofacial - CFO
Mestre (MS) em Ciências - Patologia Oral e Maxilofacial - Universidade de São Paulo - USP
Certificate of Completion for Oral Surgery and Implantology Study and Observation - E.U.A.
Reconhecimento profissional e honras
Título de Comendador nas áreas de Cirurgia Ortognática e Implantodontia outorgado pela Câmera Brasileira de Cultura. A honraria é cunhada ao ensejo do cinquentenário de magistério do eminente comendador Prof. Dr. Clóvis Marzola (in memorian) com a finalidade de distinguir profissionais que com sua competência e ética nas várias especialidades da odontologia contribuem para o desenvolvimento da ciência.
Fellow of the International Association of Oral and Maxillofacial Facial Surgeons
Membro Titular e Especialista pelo Colégio Brasileiro de Cirurgia Bucomaxilofacial
Membro Colaborador da Associação Brasileira de Cirurgia Crânio-Maxilo-Facial
Hospitais onde atuo como membro do corpo clínico
Hospital Israelita Albert Einstein
Hospital Nove de Julho
Hospital Alemão Oswaldo Cruz
Fleury - Hospital dia
Artigos científicos publicados
PIEZOELECTRIC VERSUS CONVENTIONAL TECHNIQUES FOR ORTHOGNATHIC SURGERY: SYSTEMATIC REVIEW AND META- ANALYSIS. Luis Eduardo Charles Pagotto; Thiago de Santana Santos; Sara Juliana de Abreu de Vasconcellos; Joanes Silva Santos; Paulo Ricardo Saquete Martins-Filho. Jornal of Cranio-Maxillo-Facial Surgery. June 30, 2017. Vol. 45, Issue 10, p1607-1613. DOI:
Purpose: The purpose of this study is to perform a systematic review and meta-analysis on complications after orthognathic surgery comparing piezosurgery with conventional osteotomy.
Methods: We conducted this study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a systematic search to identify randomized (RCTs) and non-randomized controlled trials (nRCTs) from PubMed, Scopus, Science Direct, Lilacs, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar and OpenThesis that compared piezoelectric osteotomy and conventional osteotomy in patients submitted to orthognathic surgery with regard to operative time, intraoperative blood loss, postoperative swelling, pain, and neurosensitivity. We used mean difference (MD) and risk difference (RD) with 95% confidence interval to pool individual results of continuous and dichotomous outcome data, respectively.
Results: Eight (3 RCTs and 5 nRCTs) studies were selected. No difference was observed in operative time between piezosurgery and conventional osteotomies. We found a decrease of intraoperative blood loss by using piezosurgery (MD -128 mL; P < 0.001). Our meta-analysis also yielded a pooled difference in severe blood loss of 35% (P = 0.008) favoring piezosurgery. We pooled individual results of studies evaluating the neurosensitivy based on clinical neurosensory testing. Our meta-analysis showed a pooled difference in severe nerve disturbance of 21% (P < 0.0001) favoring piezosurgery over conventional osteotomy. The test for subgroup differences (I2 = 26.6%) indicated that follow-up time may have an impact on neurosensory disturbance. We found differences between piezosurgery and conventional osteotomy at 3 months (RD 28%; P < 0.001) and 6 months (RD 15%; P = 0.001) after surgery. Due to a lack of sufficient studies, meta-analysis for pain and swelling was not performed.
Conclusion: Our meta-analysis suggests that piezosurgery has favorable effects on complications associated with orthognathic surgery, including a reduction in intraoperative blood loss and severe nerve disturbance.
ESTUDO CLÍNICO PATOLÓGICO RETROSPECTIVO DOS CASOS DE TUMORES ODONTOGÊNICOS DIGNÓSTICADOS NO SERVIÇO DE PATOLOGIA CIRÚRGICA DA FOUSP NO PERÍODO DE 1957 A 2012. Dissertação de Mestrado - Pagotto, Luis Eduardo Charles (Catálogo USP).
Os tumores odontogênicos formam um grupo complexo de lesões, de comportamento clínico variado e encontrado exclusivamente na região bucomaxilofacial. Originam-se a partir das células que normalmente teriam a função de formar o dente, processo esse denominado odontogênese, que tem seu início entre a sexta e a sétima semanas de vida intrauterina. O objetivo deste trabalho foi realizar um estudo clinicopatológico de tumores odontogênicos diagnosticados no Serviço de Patologia Cirúrgica da Faculdade de Oodontologia da Universidade de São Paulo de 1957 a 2012. Foram compilados das fichas de requisição de exames e/ou prontuários dados referentes ao sexo, idade no momento do diagnóstico, cor da pele (branca, negra, ou outras), sintomatologia, tamanho da lesão, duração, localização anatômica, aspectos radiográficos, diagnóstico clínico e histopatológico. Os casos diagnosticados como tumores odontogênicos foram revisados, por um examinador previamente calibrado, com o objetivo de reclassificação das lesões conforme proposição atual da Organização Mundial da Saúde em 2005. Todos os dados obtidos foram inseridos e tabulados no Microsoft Office Excel 2013 e analisados no software BioEstat 5.0. Medidas de frequência central e de dispersão foram obtidas e os resultados apresentados em forma de tabelas e gráficos. Na análise estatística, foi empregado o teste Z de duas proporções com nível de significância de 5%. No período compreendido de 01 de janeiro de 1957 a 31 de dezembro de 2012, foram diagnosticados 2.114 casos de tumores odontogênicos. Do total de casos diagnosticados, 75 casos foram retirados da análise, pois representavam a mesma lesão em diferentes momentos. Portanto, 2.039 casos de tumores odontogênicos foram incluídos e, após revisão dos casos e reclassificação diagnóstica dos tumores odontogênicos, os 2.039 casos foram agrupados em 16 tipos histológicos diferentes, entre os quais 2.029 (99,51%) eram benignos e 10 (0,49%) malignos. De uma maneira geral, os tumores odontogênicos afetam pacientes na segunda e terceira décadas de vida, sem predileção por sexo, apresentam-se menores do que 1cm de diâmetro e são diagnosticados, em média, 2 anos após seu surgimento. A maioria das lesões acometem a região posterior da mandíbula, com exceção do odontoma e tumor odontogênico adenomatóide, e apresentam aspecto radiográfico radiolúcido inespecífico, o que dificulta um diagnóstico preciso sem a avaliação anatomopatológica.
ECTOPIC TOOTH ANKYLOSED IN THE LATERAL BONE WALL OF THE MAXILLARY SINUS. Lilian Caldas Quirino, Luis Pagotto, Décio dos Santos Pinto, Fábio Daumas Nunes, Juliana Seo. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. February 2014. Volume 117, Issue 2, Page e154. DOI: 10.1016/j.oooo.2013.12.023
Ectopic teeth erupting in the maxillary sinus are rarely reported. Woman, 38, demonstrated radiographic evidence of ectopic tooth in the right maxillary sinus that had been growing for 8 years. Radiographic examination showed a radiopaque mass linked to the lateral wall of the maxillary sinus in intimate contact with the third molar's root but causing no sinus pathology or obstruction. Surgical management via Caldwell-Luc access was performed under general anesthesia. The ectopic third molar with the calcified mass was easily removed from the bone wall with a chisel. Histopathological examination showed dental tissue fragment displaying mostly dentinal tissue, basophilic line adjacent to the root, bone tissue, and amorphous eosinophilic mineralized mass. The patient is being followed-up. The causes of eruption of a tooth into the maxillary sinus are unclear, but several hypotheses are offered in the literature, such as developmental disturbances (cleft palate), trauma, cyst, infection, genetic factors, and dense bone.
PROGRESSIVE CONDYLAR RESORPTION OF TEMPOROMANDIBULAR JOINT AFTER ORTHOGNATHIC SURGERY. Luis Eduardo Charles Pagotto. Journal of Oral and Maxillofacial Surgery. Volume 40, Issue 10, October 2011, Pages 1190. DOI: 10.1016/j.ijom.2011.07.555
The resorption of the temporomandibular joint (TMJ) can occur, among some clinical situations, after orthognathic surgery in specific patients. This pathology affects a group with common characteristics, female patients, carrying of Class II dentofacial deformity, that had temporomandibular joint dysfunction (TJD) previously to the orthodontic and surgical treatment and that were operated by means of bimaxillary osteotomy involving great mandibular advancements. It is imperative that this group of patients receives adequate cares, like the treatment of the TJD's symptoms before the orthodontic/surgical procedures and monitoring. The main goal in these cases is to prevent or at least to minimize this resorption, that is an instability that leads to the relapse of the deformity after orthodontic and surgical treatment. To review the literature about this issue and report a clinical case of progressive condylar resorption.
MONOSTOTIC FIBROUS DYSPLASIA OF THE MAXILLA: A REVIEW OF THE LITERATURE AND REPORT OF 2 CASES*. Luis Eduardo Charles Pagotto, et al. Brazilian Journal of Oral and Maxillofacial Surgery. V.9, n.2, p.23-32, abr./jun.2009
Fibrous dysplasia is a benign fibrous osseous lesion that may involve on or more bones of the skeleton, the maxilla being the facial bone most frequently involved. It is a sporadic condition that results form a post- zygotic mutation in the GNAS1 gene, a protein linked to the guanine nucleotide, α stimulant of polypeptide 1 activity. Its main histopathologic feature is the replacement of normal bone tissue and medullar tissue by fibrocellular tissue and immature bone. This paper presents two cases of monostotic fibrous dysplasia involving the maxilla and zygomatic bone, describing and discussing the clinical, radiological and histopa- thologic characterisitics, the differential diagnosis and treatment.
EPIDEMIOLOGY OF THE FACIAL FRACTURES AT THE HOSPITAL MUNICIPAL DE URGÊNCIAS DE GUARULHOS, BRAZIL. Luis Eduardo Charles Pagotto. Journal of Oral and Maxillofacial Surgery. Volume 38, Issue 5, May 2009, Pages 493. DOI: 10.1016/j.ijom.2009.03.346
Background and Objectives: The objective of this study was to update the epidemiology of 815 cases of facial fractures at the Hospital Municipal de Urgências de Guarulhos, Brazil.
Methods: In a retrospective evaluation from January 2006 to December 2008 we have treated 815 cases of facial fractures in our Oral and Maxillofacial Urgency Service. We have statistically analysed the cases in relation of aetiology, gender, age, classification and localisation of the fracture as soon as the treatment form.
Results: Out of 815 cases treated, 36% were due to interpersonal injury, 30% from car accidents, 14% from gunshots and 20% from domestic accidents including falls. 63% of patients were male and 47% female. The average age was 26.7 years of age. The most prevalent fractures were mandible fractures with 22.7% followed by nasal bone fractures, 20.4%; zygomatic fractures, 18.2%; middle third fractures (Le Fort I, Le Fort II, Le Fort III), 13.0%; dentoalveolar fractures, 11.9%, multiple associated fractures 7.2%, naso-orbital-ethmoid fractures, 2.7%, only orbital fractures, 2.4% and superior third fractures 1.5%. 83% of all fractures were surgically treated. 17% were treated with non-surgical approach.
Conclusion: Mandibular fractures and nasal bone fractures were the most prevalent fractures. Zygomatic fractures were the third most common fractures. Facial fractures were most common in male in our service. The main aetiologies were due interpersonal fights and car accidents, and most fractures were surgically treated. Our statistics is comparable with world statistics differing only in percentage of which type of fractures.
USE OF RESORBABLE PLATES AND SCREWS FIXATION FOR MAXILLARY ADVANCEMENT: AN INITIAL EXPERIENCE. P.B. Mariani, F.R Marques, L.E.C. Pagotto. Journal of Oral and Maxillofacial Surgery. Volume 36, Issue 11, November 2007, Pages 1019. DOI: 10.1016/j.ijom.2007.08.191
The use of polylatic implants for orthognathic surgery has growing in the beginning of the century. The major advantages of this use consist on the fact that there is no residual implant and the patient acceptance on this material. The disadvantages include the cost and the handling. Herein, we show the initial experience in our service using resorbable plates and screws for maxillary fixation in maxillary advancement in 21 cases. We observed the need of maxilo-mandibular fixation (MMF) in the immediate post-operative time, and the stability in the immediate post-operative time, 1 month and 3 months after surgery. The stability was objectively evaluated observing the occlusion in the post-operative time and subjectively, the maxillary movement during palpation and mastication. We observe 2 (9.5%) cases of maxillary instability that need MMF in the immediate pos-operative. The first case we observed great maxillary movement. We opted for 15 days of MMF. The second case we observe maxillary retrusion, put in MMF for 10 days. Both cases have a good follow-up in 30 and 90 days. Disadvantages cited are not major problems in choosing the resorbable plates for maxillary fixation. The resorbable plates and screws is a good choice for maxillary fixation.
SURGICALLY ASSISTED MAXILLARY EXPANSION: COMPARISON AND ANALYSIS OF THE RESULTS OF 2 SURGICAL TECHNIQUES. Luis Pagotto, et al. Journal of Oral and Maxillofacial Surgery. Volume 65, Issue 9, Supplement, Pages 43.e108–43.e109, September 2007
Statement of the Problem: Compare and analyze the results of the surgical techniques, simplified and Le Fort I “subtotal” that can be performed for the maxillary surgical expansion.
Materials and Methods: Both male and female patients were chosen, 12 male and 08 female, ranging from 20 and 36 years old, regardless of their race, that couldn’t submit only to the maxillary orthopedic and transversal expansion. All surgeries were performed under general anesthesia by the same practitioner. The simplified sur- gical technique was performed in 10 patients (group-A). The Le Fort I “subtotal” surgical technique was per- formed in the other 10 patients (group-B). Both patients from (group-A) and (group-B) had the Hyrax palate-split- ting appliance previously assembled. All the patients (group A and B) were submitted to the same palate splitting appliance activation, being 2 mm during the surgery and from the fourth say after surgery, and 1mm daily divided in two activations. The measures were taken with a caliper straight into the patient’s oral cavity, among the mesiolingual cusp of the upper right and left first molars before the surgery and immediately after the end of activation.
Results: (Group-A) – The maxillary transversal expan- sion planned was obtained in the 10 cases. The average of maxillary transversal expansion was 9.05 mm. The mean time for activating the palate-splitting appliance was 9.3 days. A complication was observed due to the palate splitting appliance breakage. (Group-B) – The maxillary transversal expansion planned was obtained in the 10 cases. The average of maxillary transversal expan- sion was 8.82 mm. The mean time for activating the palate-splitting appliance was 8.8 days. A complication was observed where the patient presented a hematoma in jugal region immediately after surgery.
THE USE OF POLYLACTIC IMPLANTS AND PLATES (DELTA SYSTEM - LEIBINGER) IN ORAL AND MAXILLOFACIAL TRAUMA: A PRELIMINARY REPORT. PB. Mariani, L.E.C. Pagotto, A.R.S. Colucci, L.C. Manganello-Souza. Journal of Oral and Maxillofacial Surgery.
Volume 34, Supplement 1, 2005, Pages 85. Abstracts of the 17th International Conference on Oral and Maxillofacial Surgery
The purpose of this study was to evaluate and report our initial expe- rience with a resorbable fixation system in maxillofacial trauma. The specific goals were to evaluate the stability, complications, advantages and disadvantages of the use of resorbable. From January 2004 to January 2005 we operated 15 cases of facial fractures including 4 children and 11 adults from 4 to 53 years of age. Children were treated with a single 1.7 mm plate. The adults fractures evolved were 4 blow-out orbital floor fractures, 5 zigomatic fractures, 2 LeFort II fracture. Blow- out fractures were treated with resorbable mesh for orbital floor reconstruction. Zigomatic fractures and LeFort II fractures were treated with fixation in two points with 2.2 mm resorbable plate. In adult cases we observed one case of post-operative diplopia in very high supra-version, and the patient opted for no new surgical intervention. In one case of LeFort II fracture we observed what we considered a high level of maxillary mobility and opted for 10 days of maxillo-mandibular immobilization with successful result. Resorbable plates and mashes bring a good result in maxillofacial trauma in selected cases. In children there were more advantages because of the facial growth that is not affected with the fixation. In adults we opted in used resorbale material in fractures with no or minimal muscle influence in the estability. The complications observed were no related with resorbable material. More patients, more and extensive follow-ups is needed.