interview an interview with paulo josé d’albuquerque medeiros · assisted rapid maxillary...

© 2012 Dental Press Journal of Orthodontics Dental Press J Orthod. 2012 Sept-Oct;17(5):8-238

An interview with

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• GraduatedfromtheSchoolofDentistry,RiodeJaneiroFederalUniversity(UFRJ)–PraiaVermelha,Brazil,1978.

• SpecialistinOralandMaxillofacialSurgery,UERJ,1979.

• ResidencyinOralandMaxillofacialSurgery,UniversityofTexas-Dallas–USA,1981-1984.

• MScandPhD,SchoolofDentistry,UFRJ–1991and2001.

• ProfessoratUFRJandRiodeJaneiroStateUniversity(UERJ)since1979todate.

• HeadProfessor,OralSurgery,SchoolofDentistry,UERJ,since1995.

• Authorofthefollowingbooks:“OrthognathicSurgeryforOrthodontists”(Ed.Santos),“RetainedToothSurgery”(Ed.San-

tos),“UpdateonOralandMaxillofacialSurgeryandTraumatology”(Ed.Santos).

• InprivatepracticeinRiodeJaneiro,Brazil,since1979.

•RenownedlecturerinBrazilandabroad.

Prof.PauloJoséd’AlbuquerqueMedeiroswasborntoPauloPinhodeMedeirosandConceiçãoRosáriod’AlbuquerqueMe-

deirosinthecityofRiodeJaneiro,BrazilonMarch7,1957.Hehasbeenmarriedfor31yearstoPatriciaLeoMedeirosandthey

havetwochildren:AlessandraLeãoMedeirosParente,30,alawjudge,andLeoBrunoMedeiros,28,economist.Heisfondof

musicandthemovies,andisafinesinger.Hehasdevelopedarefinedtasteforgoodwines,hisfavoritebeingChateauPalmer.

Heiscurrentlyreadingapocketbooktitled“1001winestodrinkbeforeyoudie”.Hismostdauntingchallengeinlife:“Keeping

upthemotivationtoteach,whichismytruecalling”.

MarcoAntonioAlmeida

How to cite this interview:MedeirosPJD.Interview.DentalPressJOrthod.2012Sept-Oct;17(5):8-23.Submitted:July2,2012-Revised and accepted:August7,2012

»Patientsdisplayedinthisarticlepreviouslyapprovedtheuseoftheirfacialandintraoralphotographs.

Paulo Joséd’Albuquerque Medeiros

Medeiros PJD


AEStHEticSWhat is the greatest demand of patients: Esthet-ics of function? (AntenorAraújo)

Most patients expect improved esthetics.Don’tforgetthat- ifthepatient’sfacialestheticsisnotcompromised-itisquiteachallengefortheorthodontist to persuade the patient to agree toortho-surgicaltreatment,evenif theyhavesomesortofmalocclusion.

Which parameters are most important in the analysis of facial esthetics?(CarlosEstevanellTavares)

Icouldciteseveralvariables,butIprefertohigh-lightthesmile,whichisour“callingcard.”I’vehadseveral patients who, after correction of verticalmaxillaryexcess,cametobequestionedbyfriendswhowanted to know if theywerewearing contactlenses(Fig1).Itseemsthatanunsightlysmilecan“erase”other interestingfacial features.The“buc-calcorridor”,whichissometimestreatedbyortho-surgical expansion (Fig 2), and in other situationsby simply improving the shape of dental archesthrough tooth movement, also greatly affects thesmileandfacialesthetics(Fig3).

Figure 1 - Class II patient with vertical maxillary excess and anteroposterior mandibular deficiency (A). After max-illary repositioning and mandibular advancement. The surgical procedure highlighted the eyes (B).A B

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Figure 3 - Class III malocclusion and maxil-lary constriction before ortho-surgical treat-ment. Occlusion after osteotomies of maxilla and mandible without segmentation. The up-per arch was expanded and its form improved through tooth movement.

Figure 2 - Before (A) and after (B) surgically assisted rapid maxillary expansion. “Buccal corridor” shows improvement. Initial occlu-sion (C) and after intervention (D).

Figure 4 - Note nasal base tapering toward the tip. Increased nose harmony after slight base enlargement as a result of maxillary ad-vancement.

A

A

A

B

B

B

C D

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What steps do you take in cases of advancement or repositioning orthognathic surgery in the maxilla to avert undesirable effects on facial es-thetics?(CarlosEstevanellTavares)

Nasal esthetics is amajor concernof surgeonsin planning and performing maxillary orthogna-thicsurgery.LeFortIosteotomycouldcausenasalenlargement due to muscle detachment, but this

issue is particularly challenging in the aforesaidmovements, i.e., maxillary advancement/reposi-tioning.Inrare,selectcasesenlargementmayevenbedesirable(Fig4).Thevastmajorityofpatients,however,havethebaseoftheirnosesuturedaftermaxillaryrepositioning,whichisintendedtopre-ventenlargement.Thisprocedureiscalled“Nasalplication”(Fig5).

A B

Figure 5 - A, B) This patient is a good candi-date for maxillary advancement combined with maxillary repositioning. C, D) Good con-trol of nasal base although the movement performed can be considered potentially det-rimental to the esthetics of the nose.C D

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How do you address cases of closed mandibu-lar plane and decreased lower face? (CarlosEstevanellTavares)

In the past, this conditionwasmistakenly called“Short Face Syndrome”. Although not a true syn-drome,itsexpressiontendstorecuratdifferentlevels.Thestartingpoint for treatment isdetermininghowmanymillimetersthemaxillashouldbelowered,andwhetherthisloweringwillhaveonesinglemagnitudeor differentmagnitudes, considering the incisal and

molar regions. A predictive tracing should indicatewhetherthemandibleislikelytoundergoaclockwiserotationonly,andrequiresurgery,orwhether itwillhavetoundergoadvancementorsetbackosteotomy,depending on the initial malocclusion. The heightof themandibular symphysis in these individuals isusually short. Therefore, performing a genioplastyto increase theverticaldimensionmaybebeneficial(Fig 6). These procedures elongate the face and im-provethemandibularplaneatthesametime.

Figure 6 - Patient presented with anteroposterior and vertical maxillary hypoplasia in addition to anteroposterior mandibular excess. Lateral cephalometric radiograph highlighting the discrepancy between maxilla and mandible. Lateral cephalogram with mouth slightly open enabling visualization and quantification of vertical maxillary deficiency in relation to the upper lip. Patient after lowering and maxillary advancement combined with mandibular setback.

A

C

B

D

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Figure 8 - Note unfavorable aspect of submental region (A). Note beneficial effect in the submental region after mandibular advancement (B).

Figure 7 - Note the unsightly shape of the nasal dorsum (A). Improved nasal esthetics as a result of orthognathic surgery (B).

When do you recommend plastic surgery as a com-plement to facial esthetics, concurrently with or-thognathic surgery? (CarlosEstevanellTavares)

Theplasticsurgeryproceduresmorecommonlyperformedas adjuncts toorthognathic surgery arerhinoplasty,submentalliposuctionandplicationoftheplatysmamuscle.Asregardsindicationandtim-ing,oneshouldbearinmindthatsurgicalmovementofthemaxillaand/ormandiblecaneffectfavorablechangesintheseanatomicalregions.Therearecas-esofindividualswhowishedtoundergorhinoplasty

andwhogave itupafterdeciding that theeffectoforthognathicsurgeryonthenosehaddeliveredthedesired esthetic outcome (Fig 7). Currently, mostmaxillofacial surgeons only indicate rhinoplastywhenitiscombinedwithisolatedosteotomiesofthemandible.Whenthepatientisundergoingmaxillaryosteotomy,rhinoplasty isplannedfor6monthsaf-terorthognathicsurgery,butonlyifatthattimethepatientstillwishesit.Thesameappliesinthecaseofmandibularadvancement,which in itselfproducesestheticeffectsinthesubmentalregion(Fig8).

A

A

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Conversely, in apatientundergoingmandibular set-backwhopresentswithexcesssubmentaltissue,lipo-suctionand/orplicationoftheplatysmaatthetimeoforthognathicsurgeryseemstobethebestapproach.

FUNctiONSurgical mandibular retrusions can impair the airspace and compromise breathing. currently, how does surgical planning deal with this issue? (ArnoLocks)

Although decreases in airspace have been ob-served in mandibular setback samples, there are

no studies demonstrating functional impairmentin these individuals. This may be because man-dibular setbacks in excess of 7 mm or 8 mm areextremely rare. In treating severe Class III mal-occlusions,withoverjets inexcessof10mm,pro-fessionals tend todividemovementsbetween themaxillary advancement and mandibular setbackmovements (Fig 9). Our group published an ar-ticle in the September/October 2011 issue of thisjournal which analyzed 17 patients who had un-dergone isolated mandibular setbacks and othersetbacks associated withmaxillary advancement.

Figure 9 - Patient had a -17 mm overjet (A), Pro-nounced disharmony between maxilla and man-dible (B). After 8 mm maxillary advancement and 9 mm mandibular setback, an insignificant decrease in the airways can be seen. Patient reported that there was no respiratory impair-ment (C). Final occlusion (D, E).

A

D

B

E

C

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The average mandibular setback was of about 7mm, andwe noted an average reduction of about1mminoropharynx,andabout3.5mminthehy-popharynx. Despite these findings, none of thepatients in the sample reported impairedbreath-ing after surgery. In over 30 years of practice inorthognathic surgery I cannot recall having hadany patientswho returnedwith respiratory com-plaintsafterthisprocedure.Iwouldonlybereluc-tanttoindicatemandibularsetbackforindividualswithpriorrespiratorydisordersorobesepatients.

What scientific evidence is there regarding a cause-and-effect relationship between orthog-nathic surgery and snoring or sleep apnea? (MarcoAntonioAlmeida)

Orthognathic surgery has been used to treatsleepapneaincasesthatproverefractorytomoreconservative,lessinvasivetherapies.Theliteraturereportsthatmaxillaryadvancementperformedsi-multaneously with mandibular advancement hasyieldedfavorableresultsinasignificantnumberofpatients.Thereareresearchersouttherewhohavebeen conducting reliable, well-designed researchthatcanattest to this fact,butI’vehadnoexperi-encewiththesepatients.

A patient with no tMD symptoms before treat-ment starts presenting with tMD signs and symptoms after orthognathic surgery, such as clicking joints, pain in the tMJ region and re-stricted opening. What are the possible causes of this condition? Are the causes somehow re-lated to orthodontic treatment, orthognathic surgery or attributable to chance?(WeberUrsi)

Joint dysfunction hardly ever occurs after or-thognathic surgery. The most frequently occur-ring symptoms are muscle pain and discomfort,which the literature refers to as Myofascial PainandDysfunction Syndrome.This condition tendstobetransientandistreatedthroughmeasurestomitigatethesymptomsand increasepatientcom-fort. The rare cases of patients who experiencedjointnoises,whichbythewaywerenotpainful,theincidentoccurredinthefirstweeksofthepostop-erative period and resolved spontaneously. Thisadaptability of patients might be due to the fact

thattheyareyoungandwithoutpriordysfunction.I don’t believe either orthognathic surgery or or-thodonticsisresponsiblefortheonsetofjointdys-functioninthisparticularpopulation.

tEcHNiQUEWhat aspects of orthodontic preparation are you most often confronted with, which poten-tially compromise the outcome and stability of orthognathic surgery? How can these prob-lems be avoided? (WeberUrsi)

Instability of movements during dental orth-odonticpreparationusuallymanifestsitselfinthemediumor longterm.Aftersurgerythepatient isstillundergoingorthodontictreatmentforabout1year,afterwhicha retainer tends tomaintain theteeth in their correct position. In reassessingpa-tients10,20andeven25yearsafterortho-surgicaltreatmentIhavenoticedthatthemostsignificantlossesoccurinthetransversedirection,asisusu-ally thecasewith surgical relapses.When thepa-tient needs significant transverse gains, eitherorthopedicorsurgicallyassistedmaxillaryexpan-sionseemstoofferbetterresults.

Do you believe that evaluation by a psycholo-gist experienced with this type of patient in order to detect specific responses regarding acceptance of changes in appearance, actual motivation toward surgery, anxiety level, etc, would go a long way towards averting dissatis-faction with the outcome? Or is it your belief that this sort of detection can always and eas-ily be carried out by the orthodontist and/or surgeon? (CarlosEliasFerreiradeFreitas)

I see noneed for ortho-surgical patients to beroutinely evaluated by a psychologist. In specificcasesIdothinksuchanevaluationwouldbehighlyadvisable.Onoccasion,Ihaveobviouslyhadafewunsuccessfulcases,andhavealsoencountereddif-ficultiesintreatingahandfulofpatients.

Thosepatientswho lack familysupport, thoseliving inconflictwith relativesandmaking regu-lar use of antidepressants should be more care-fully evaluated by a professional psychologist. Istrongly believe that patient selection is the keytoasuccessfulpractice.

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to what extent have the new distraction osteo-genesis techniques contributed to resolve large mandibular advancements—including mandibu-lar ramus lengthening—causing counterclockwise mandibular rotation? (ArnoLocks)

Distraction osteogenesis, unlike what was ini-tially believed, has not replaced conventional or-thognathic surgery in conventional cases.Distrac-tionosteogenesisisoptimallyindicatedinthefirstdecade of the patient’s life to treat mandibulargrowth deficiencies. Cases of hemifacial microso-mia or retrognathia resulting fromTMJ ankylosishavebeensuccessfullytreatedbythismethod.Thediscomfortcausedbyprolongeduseofadistractorin addition to difficulty in controlling the distrac-tionvectoraresomeofthedisadvantagesofdistrac-tionosteogenesisvs.orthognathicsurgerystartingintheseconddecadeofthepatient’slife.

the conduct advocated by U.S. professor Lar-ry Wolford, who often indicates surgical in-terventions in the temporomandibular joint concurrent with orthognathic surgery when the patient presents with intra-joint changes, has met with widespread acceptance in Brazil. What is your opinion on the subject? (CarlosEliasFerreiradeFreitas)

IworkedwithDr.Wolford for 2 years duringmyresidencyprogramandIknow fora fact thathe isahighly judicious professional. I believe this is not aroutine approach, and thenumerous joint interven-tions that he performs simultaneously with orthog-nathic surgery are due to, firstly, the large volumeofpatientsheoperateson,andsecondly,becauseheisareference inthetreatmentofpatientswith jointdysfunction.IhavelimitedexperienceinperformingorthognathicsurgeryinjointTMDpatients.ThevastmajorityofpatientsItreatareyoungandhardlyeverpresentwithjointTMDpain.Iseenoneedtoperformconcurrentjointintervention.Asinthecasesofmus-cleTMD, these patients’ dysfunction is treated con-servativelybeforeorthognathicsurgeryand,ifneces-sary,furthertreatmentisprovidedaftersurgery.

StABiLitYSome patients, after mandibular advancement surgery for correction of class ii, present with

condylar resorption, totally compromising the outcome. What have studies so far contributed on this topic? (ArnoLocks)

Itisimportanttodifferentiatecondylarresorp-tion from condylar remodeling. Condylar remod-elingisasortof“wear”,albeitminor,whichoccursin surgical and non-surgical patients, causing in-creasedoverjetovera fewyears.Thiscanbecon-sidered a physiological phenomenon. It has beenmoreoftenobserved inpatientswhohaveunder-gonemandibularadvancement,especiallyinthosewith the following three setsof features: 1) Smallmandibularcondylesinclinedposteriorly,2)openmandibular plane and short mandibular ramus,and 3) decreased posterior facial height and in-creased anterior facial height. Treatment resultsforthesepatientsmaybepartiallyortotallycom-promised by this phenomenon. Condylar resorp-tionhasbeenwidelystudiedanddescribed,espe-ciallyby the teamof researchers ledbyDr.Leon-ardKaban,inBoston.Inthesecasescondylesdis-appearaltogetherasmeaningfulretrognathiaandopenbitedevelop.Therearemanyidiopathiccas-es, where patients never underwent orthodonticor ortho-surgical treatment. Among the possiblecausesof this condition are rheumatoid arthritis,useofcorticosteroids,systemiclupuserythemato-sus,scleroderma,othercollagendiseases,andevenorthognathic surgery. Healthy patients who aregoodcandidatesfororthognathicsurgery,butwhopresentwiththethreesetsoffeaturesImentionedearliershouldbealertedaboutthepossibilitythatthisphenomenonmightoccur.

the hierarchy of stability of ortho-surgical cases established by the North carolina team of researchers is usually cited in scientific pa-pers. Drawing on your extensive experience, how would you assess this hierarchy, and what factors can affect it?(MarcoAntonioAlmeida)

Thetwoextremesofthis“hierarchy”seemquiterelevant: Maxillary repositioning is very stable,and maxillary expansion induces a certain medi-umandlongterminstability.Researchshowsthattheroutineuseofrigidinternalfixationhastakenmaxillaryloweringoffthelistofunstablemaxillaryprocedures. The presence of four mini-plates for

Medeiros PJD


stabilization combined with bone grafting appearto give optimum vertical stability to the maxilla.Asfarasmandibularsetbacksurgeryisconcerned,contrarytowhatisstatedinthearticle,Ihavehadexcellentstability.Idohoweveruse,wheneverpos-sible,intraoralverticalosteotomy,whichisatech-niquerenownedforitshighstability.Theliteraturedemonstratesthattheoptimalstabilityaffordedbysagittal osteotomy inmandibular advancement isnotreplicatedinmandibularsetbacks,andthelat-terwasthetechniqueusedinthestudygroup.Themajorhurdle in termsof stability inorthognathicsurgerytodayhastodowithmandibularadvance-ment,and thisprocedureappears in thearticleasthe second most stable. However, when you readthearticlecarefullyyoucan’thelpbutrealizethatmandibular advancement was performed or dis-cussed only in individuals with normal or shortfacialheight,whichdoesnotencompassthosepa-tients presentingwith the three sets of features Ireferredtoearlieron.Istronglybelievethatastudyconducted inClass II patientswith the three setsof characteristics described above will inevitablyyielddifferentoutcomes.

FUtUREHow do you view the current position held by orthognathic surgery in Brazil? How would you compare it to other countries? (AntenorAraújo)

We owe the inception of orthognathic surgeryinBrazil to pioneers, the likes ofMarioGraziani,Paulo Pinho deMedeiros, Italo Gandelman, JoãoJorgedeBarros andJoãoEphraimWagner, and Ican’tthinkofabetterstart.Withthedevelopmentof “ModernOrthognathic Surgery”—bywhich ismeantacombinationofsurgeryandorthodontics-therewasarefinementinsurgicaltechniquesthatalready existed, and are still widely employed tothisday,combinedwithnewconceptsindiagnosisandtreatmentplanning.WhenhearrivedinBrazilin 1978 after 3 years spent inDallas, Texas,USA,Dr.AntenorAraújohelpedtodevelopBrazilianor-thodontics and enabled a most fruitful exchangewithcentersofexcellenceabroad.TodayBrazilhasestablished itself in the international scenegiventhe quality of our professionals, which is compa-rable to thatof thebestcenters in theworld.The

challengewe face today lies in traininghigh-levelprofessionals to serve 200 million people in acountry of continental proportions. It is still notuncommon to see surgeons packing a “doctor’sbag” with surgical instruments and traveling tooperate on patients a longways fromhome. Thisisobviouslynot thebestcareyoucanprovide. I’dhate to have, say an abdomen surgery, today andnothavethesurgeonaroundthenextdaybecausehe has flown off somewhere else to see anotherpatient. Our challenge is to trainmore andmorequalityprofessionalsandspreadthemthroughoutBrazil.Itrytogivemyhumblecontribution.

What medium to long-term advances can we expect in the field of Orthognathic Surgery? What will this major surgery be like 20 years from now? (WeberUrsi)

Although there have been refinements in sur-gical techniques, themain developments have oc-curredandtendtodevelop further insurgicalma-terials and in the area of digital technology. Rigidfixationtechniqueshaveimprovedthroughthede-velopment of finer plates and screws,without anynoticeable loss inquality.AlloplasticmaterialsarereplacingautograftsatsucharatethatIbelieveinthenearfuturewewillnolongerneedtoremovethepatient’sownboneforanypurpose.Digitaldiagnos-tics and planning save time and impart reliabilitytoortho-surgical treatments. I really look forwardto the development of less traumatic bone cuttinginstruments.Less invasivesurgeries?RoboticSur-gery?Timewilltell.

YOUR SPAcEWhat were the three most gratifying ortho-surgi-cal cases in your career? (MarcoAntonioAlmeida)

ThefirstpatientIwouldhighlightisagirlnow25.Shehasa7-year-olddaughterwithasevereretrogna-thiaandnomouthopeningasaresultoftemporoman-dibular jointankylosis.Thepatientwasoperatedontoresolvetheankylosisintwodifferentsteps,i.e.,shereceived costochondral graft to improvemandibulargrowthinanotherintervention,andfinallyunderwentorthognathicsurgery.The interventionsput inplaceduring the first decade of life are aimed at enablingmobility and stimulating growth.Theortho-surgical

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Figure 11 - After two interventions and 4 years into treatment, there was improvement in oral movements and esthetics (A, B). Patient at age 7 and 14 (C, D).

CA DB

A B

D E

C

Figure 10 - Seven-year-old patient showing retrognathia with severe mandibular deviation to the left (A, B). Marked Class II malocclusion (C) and se-verely underdeveloped mandible (D). CT scan showed a major ankylotic block on the left side (E).

Medeiros PJD


Figure 12 - Patient at age 21 years.

A B C

Figure 13 - Note degree of mandibular develop-ment about 14 years after interventions.

treatmentachievedabetterocclusionandsatisfactoryfacialesthetics(Figs10to13).

Shy andwithdrawn, the secondpatientpresent-edfortreatmentat20yearsofage.Accordingtohismother,hehadbeenbulliedformanyyearsbecauseof his unsightly facial appearance. He underwent

orthodontic treatment and maxillomandibular os-teotomies, and was given psychological supportpostoperatively.Aboutayearaftersurgeryandorth-odontictreatment,hereturned,nowmoretalkative,livelyandevenrespondingtothejokesandremarksfrommembersofoursurgicalteam(Figs14,15,16).

A B

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Figure 16 - 14 months postoperatively. Note improvement in interlabial relationship. Changes in behavior and attitude were remarkable.

A B C

Figure 15 - Preoperative occlusion. Due to difficulties in social adjustment, “Anticipated Benefit” was employed (A). Occlusion about 14 months after surgery (B).

Figure 14 - Hypoplastic mandible and greatly increased mandibular plane. Note long face and severe lip incompetence (A, B); patient was extremely shy and hardly ever smiled (C).

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A

B

B

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Medeiros PJD


The third patientwas a youngwoman aged 23,whoexhibitedseveralpositivecharacteristicssuchas beautiful skin, eyes and hair which, however,were undermined by a complex dentofacial de-formity. She presented with maxillary retrusion,

maxillary vertical hypoplasia,mandibular progna-thism and lateral deviation of the mandible. As aresultofthesuccessfulfunctionalandestheticout-comeachieved,positivechangesoccurred inmanyareasofherlife(Figs17to20).

A

Figure 19 - Patient about 8 months after surgery.

A

Figure 17 - A) The maxilla was retruded, the mandible overly protruded and the nasal dorsum showed an unfavorable contour, B) patient had facial asym-metry with marked mandibular deviation; C) the maxilla was uneven and also hypoplastic in the vertical direction, which compromised the smile.

B C

Figure 18 - Preoperative occlusion (A) and approximately 8 months after surgery (B).

A B

B

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Figure 20 - Changes in frontal view resulting from esthetic treatment (A, B). Profile before and after surgery (C, D). An improved facial symmetry and smile highlighted other patient features (E, F).

E

A B

C D

F

Medeiros PJD


Antenor Araújo» Post-Doc inBucomaxillofacial Surgery,University

ofTexas.

Arno Locks» PhDinOrthodontics,UNESP.Post-Doc,RoyalSchool

ofDentistry,UniversityofAarhus.

carlos Elias Ferreira de Freitas» ProfessorofSurgeryandBucomaxillofacialTrauma,

HospitalGeralRobertoSantos.» Professor of Orthognatic Surgery, Specialization

CoursesinOrthodontics,UFBAandABO-BA.» HeadoftheBucomaxillofacialSurgeryandTrauma

Division,SESAB.» HeadoftheBucomaxillofacialSurgeryandTrauma

Division,HospitaldaBahia.

carlos Estevanell tavares» PhDinDentistry,UFRJ.

Marco Antonio Almeida» Post-DocinOrthodontics,UniversityofNorth

Carolina.Weber Ursi» PhDinOrthodontics,USP.

1. Gornic C, Nascimento PP, Melgaço CA, Ruellas ACO, Medeiros PJD, Sant’Anna EF.

Análise cefalométrica das vias aéreas superiores de pacientes Classe III submetidos

a tratamento ortocirúrgico. Dental Press J Orthod. 2011 Sept-Oct;16(5):82-8.

REFEREnCEs

interview an interview with paulo josé d’albuquerque medeiros · assisted rapid maxillary...

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