Sensitivity or pain of the mucoperiosteum covering the mandibular edentulous ridge is often thought to limit bite forces in complete-denture wearers. Therefore, bite forces with mandibular implant-retained overdentures may depend on the degree of implant support. This study analyzed the effects of different degrees of support for the mandibular denture on bite forces measured four years after denture treatment as
EA Fontijn-Tekampl; A. P. Slagter; M. A. van't Hof; M. E. Geertman; W. Kalk
The introduction of implant-supported overdentures as a clinical alternative has improved the quality of life of the edentulous population. Implant-supported overdentures have diminished many of the problems associated with conventional dentures by providing improved retention, stability, function, esthetics and physical and emotional health. Greater support and stability of the implant borne prosthesis is associated with improved bite force and oral function for overdentures when compared to conventional complete dentures. An adequate amount of restorative space is required when fabricating implant-supported overdentures. This space must accommodate a denture base of sufficient dimensions, appropriately positioned denture teeth, and an implant attachment system. Insufficient space may lead to reduced structural integrity of the prosthesis and/or compromised oral function. Typically a mandibular removable prosthesis is more vulnerable to fracture due to its shape and overall dimensions. Incorporation of a metal framework, metal reinforcing mesh, or woven or fiberglass-impregnated mesh have been recommended to improve resistance to denture fracture during function. This article presents a method for fabricating a framework that is specifically and predictably suspended within the denture base in order to decrease fracture susceptibility of implant-supported overdentures. PMID:24431723
Ahuja, Swati; Jain, Vinay; Cagna, David; Wicks, Russell
This prospective study has been designed to compare the results of immediate and delayed loading of implant-retained mandibular overdentures after a 2-year follow-up. Twenty patients have been randomly divided into two groups. Group 1 patients (test group) received four ITI implants in the intraforaminal area of the mandible. Octa abutments were immediately screwed on implants; 2 days after surgery, the implants were rigidly connected with a U-shaped Dolder gold bar and loaded with an overdenture. Group 2 patients (control group) received, in the same area, the same type and number of implants, which were left to heal according to the standard protocol. At 3-4 months, Octa abutments were screwed on the implants and the same prosthetic procedure of the test group was applied. The minimum follow-up period lasted 2 years, with recall appointments at 2 weeks, 1, 3, 6 months, 1 year and every following year postoperatively, evaluating: MPI, MBI, PD, Periotest and radiographic peri-implant bone resorption. Success criteria according to Albrektsson et al. were used. Only one implant out of the 40 of group 2 failed, whereas none failed in group 1. No statistical difference of the clinical parameters evaluated was noticed in the two groups. Therefore, immediate loading of implants, if connected with a U-shaped bar, can provide the same results of the 'traditional' technique as far as osseointegration and short-term survival rates of implants are concerned. Moreover, this method significantly shortens the treatment period, thus increasing patient satisfaction. PMID:12453126
Romeo, Eugenio; Chiapasco, Matteo; Lazza, Andrea; Casentini, Paolo; Ghisolfi, Marco; Iorio, Marco; Vogel, Giorgio
PURPOSE The aim of this systematic review was to address treatment outcome according to attachment systems for mandibular implant overdentures in terms of implant survival rate, prosthetic maintenance and complications, and patient satisfaction. MATERIALS AND METHODS A systematic literature search was conducted using PubMed and hand searching of relevant journals considering inclusion and exclusion criteria. Clinical trial studies on mandibular implant overdentures until August, 2010 were selected if more than one type of overdenture attachment was reported. Twenty four studies from 1098 studies were finally included and the data on implant survival rate, prosthetic maintenance and complications, patient satisfaction were analyzed relative to attachment systems. RESULTS Four studies presented implant survival rates (95.8 - 97.5% for bar, 96.2 - 100% for ball, 91.7% for magnet) according to attachment system. Ten other studies presented an implant survival rate ranging from 93.3% to 100% without respect to the attachment groups. Common prosthetic maintenance and complications were replacement of an assay for magnet attachments, and activation of a matrix or clip for ball or bar attachments. Prosthetic maintenance and complications most commonly occurred in the magnet groups. Conflicting findings were found on the rate of prosthetic maintenance and complications comparing ball and bar attachments. Most studies showed no significant differences in patient satisfaction depending upon attachment systems. CONCLUSION The implant survival rate of mandibular overdentures seemed to be high regardless attachment systems. The prosthetic maintenance and complications may be influenced by attachment systems. However patient satisfaction may be independent of the attachment system.
Kim, Ha-Young; Lee, Jeong-Yol; Bryant, S. Ross
Statement of problem. It is unknown what minimum number of implants are required to satisfactorily support and retain a mandibular overdenture.Purpose. The purpose of this study was to evaluate a treatment modality by using mandibular overdentures anchored to single implants in a geriatric patient population.Material and methods. Twenty-one patients with a mean age of 74.2 years were treated with single
Giampiero Cordioli; Zeina Majzoub; Stefano Castagna
The prosthetic management of the edentulous patient has long been a major challenge. Complete maxillary and mandibular dentures have been the traditional standard of care. However, most of the patients report problems adapting to their mandibular denture due to a lack of comfort, retention, stability and inability to masticate. Implant-supported overdentures have been a common treatment for edentulous patients for the past 20 years and predictably achieve good clinical results. Implant supported overdentures offer many practical advantages over conventional complete dentures and removable partial dentures. These include decreased bone resorption, reduced prosthesis movement, better esthetics, improved tooth position, better occlusion, increased occlusal function and maintenance of the occlusal vertical dimension. This article presents a design and fabrication technique of the implant-retained overdenture that uses four freestanding mandibular implants.
Lambade, Pravin; Gundawar, Sham
This case report describes the clinical and laboratory procedures used in the rehabilitation of a patient treated for oral cancer with surgery and radiation therapy. During surgery, a large portion of the mandible was removed and reconstructed with a bone graft. Following therapy, the patient was left with poor esthetics and difficulties with mastication and speech. The goal of prosthodontic treatment was to improve esthetics and restore function. This was successfully achieved through the placement of dental implants and the construction of an implant retained overdenture. A bar was employed to split the implants together and an O-ring system was chosen for retention. The decision to use this type of prosthesis and attachment selection was based on the patient's dental history, esthetic demands, and the need for stress distribution. PMID:9709634
Huband, M L
Classic guidelines in osseointegration for root-form dental implants include a long healing period, during which functional load should be avoided. However, the long healing period might impose an intolerable situation on some patients, especially in the completely edentulous situation. Subperiosteal dental implant guidelines demonstrate that the implant upon insertion can be put into immediate function and be restored with the final prosthesis soon after surgery. Studies on immediately functional loaded implant-supported prostheses in patients who are completely edentulous have been reported, exhibiting high success rates comparable with conventionally loaded implants. This article describes the surgical and prosthodontic procedure for the immediately functional loaded mandibular implant overdentures in 2 different dentalimplant modalities, as well as its clinical rationale. PMID:15587020
Lozada, Jaime L; Ardah, Aladdin J; Rungcharassaeng, Kitichai; Kan, Joseph Y K; Kleinman, Alejandro
The most frequent mechanical complications of bar-retained implant overdentures (IODs) are fracture of the dentures, loosening of the bar screws, and the need to reactivate the retentive clips. When a bar-retained IOD with an acrylic resin base fractures, the existing bar attachment should be removed to fabricate a new overdenture. So far, no method has been previously described for remaking a fractured mandibular bar-retained IOD without removing the existing bar attachment. This article describes fabrication of a fractured mandibular bar-retained IOD with distally placed ball attachments using attachment transfer analogs. The described technique allows the patient to use the existing overdenture temporarily until the new overdenture is delivered. PMID:22938207
Retention of a mandibular denture can be achieved by an implant-retained or natural tooth-retained bar and stud attachment in the anterior segment of the mandible. The same design principles holds true for both implant-retained and tooth-retained methods of anchoring the bar and stud attachment. A simple and cost effective treatment for more complex implant overdenture is the concept of conventional tooth-retained overdentures. When few firm teeth still remain in a compromised dentition, preservation of these teeth for overdentures can improve retention and stability. The authors present a clinical report of a patient treated with a mandibular tooth-borne overdenture with bar and O-ring attachment. A splinted bar supported the prosthesis and an O-ring retained the denture.
Guttal, Satyabodh S.; Tavargeri, Anand K.; Nadiger, Ramesh K.; Thakur, Srinath L.
Locator attachments are commonly used for mandibular implant-retained overdentures. This case report presents an alternative mandibular overdenture impression technique that is pressure free. PMID:20557148
Uludag, Bulent; Cogalan, Kemal; Polat, Serdar
Seventeen subjects with preexisting conventional complete dentures were evaluated in this prospective clinical study. Two implants were placed bilaterally in the anterior mandible. In a crossover experimental design, the conventional dentures were modified, and the retention, stability, and tissue response for conventional dentures were compared with implant overdentures that had O-ring and magnet overdenture attachments for all subjects. The study indicated statistical superiority of the implant overdenture to the conventional denture. The O-ring attachment proved significantly better than the magnet attachment for retention and stability. The soft tissue response showed a slight but significant improvement with implant overdenture therapy. PMID:7783014
Burns, D R; Unger, J W; Elswick, R K; Beck, D A
The aim of this study was to evaluate the clinical performance of the implants supporting mandibular overdentures, and to investigate the prosthodontic outcomes of the mandibular implant overdentures. Twenty edentulous patients participated in this study. Forty implants were placed in the canine areas of the mandibles of all patients using the 1-stage approach. New maxillary complete dentures and the mandibular implant overdentures were delivered to 10 patients in the test group 1 week after surgery, while new maxillary and mandibular complete prostheses were delivered to 10 patients in the control group. These conventional mandibular prostheses were converted to mandibular implant overdentures 3 months after surgery. No implants were lost neither in test nor in control group. The average ISQ values between the two groups were not statistically significant during 2 years (P > 0.05). The average marginal bone resorptions were 0.4 and 0.5 mm for the test and the control group after 2 years. The number of appointments required for the prosthodontic maintenance of the mandibular implant overdentures in the first year was higher than that in the second year, which was statistically significant(P < 0.001). The results of the study suggest that the 1-week early loading approach does not adversely influence the clinical performance of the implants supporting mandibular overdentures. PMID:17824890
Turkyilmaz, I; Tumer, C
Aims: The aim of this study is to evaluate the treatment outcome of immediately loaded Implants in the interforaminal region of anterior mandible. Materials and Methods: A total of 15 completely edentulous patients aged between 50 and 70 years were selected satisfying certain inclusion and exclusion criteria. Two implants were placed in 33 and 43 region (B and D location) and the implants were loaded immediately by mandibular overdenture retained with O-ring attachments. The implants were evaluated for various clinical parameters at 6 months, 1 year, 1.5 years, and 2 years intervals after initial placement. Results: There was increased marginal bone loss around implants during the 1st year after that the bone loss was insignificant. Clinical stability of immediately loaded implants was lower initially for 6 months, but improved by the end of 1st year. Survival rate for immediately loaded implants was 96.6% at the end of the period of study. Conclusion: Immediate loading of interforaminal mandibular implants demonstrated a highly acceptable clinical success at the end of 2 years. However, initially the marginal bone level and clinical stability were significantly lower which showed improvement with time.
Arora, Vimal; Kumar, Dinesh; Legha, V. S.; Arun Kumar, K. V.
The purpose of this study was (1) to investigate denture satisfaction following the conversion of existing mandibular complete dentures to implant overdentures (IOD) in very old edentulous patients who depend on help for activities of daily living and (2) to evaluate secondary end points, such as functional, structural, nutritional, and patient-centered aspects. For this randomized clinical trial, 2 interforaminal short implants were placed in the intervention group (n = 16, 85.0 ± 6.19 yrs) to retain mandibular IODs; the control group (n = 18, 84.1 ± 5.55 yrs) received conventional relines. During the first year, no implant was lost; however, 2 patients died. IODs proved more stable, and participants in the intervention group demonstrated significantly higher denture satisfaction as well as an increased oral health-related quality of life compared to the control group. Maximum voluntary bite force improved significantly with IODs, yet the chewing efficiency was not different between groups. Masseter muscle thickness increased with IODs, mainly on the preferred chewing side. Body mass index decreased in both groups, but the decline tended to be smaller in the intervention group; blood markers and the Mini Nutritional Assessment did not confirm this tendency. These results indicate that edentulous patients who depend on help for activities of daily living may benefit from IODs even late in life. PMID:24158342
Müller, F; Duvernay, E; Loup, A; Vazquez, L; Herrmann, F R; Schimmel, M
The purpose of this research was to evaluate the maximum stress around osseointegrated implants and alveolar ridge, in a mandible with left partial resection through a photoelastic mandibular model. The first group consisted of two implants: traditional model (T), implants placed in the position of both canines; fulcrum model (F), implants placed in the position of left canine CL and right lateral incisor LiR. Both models linked through a bar and clips. The second group was consisted of three implants, with implants placed in the position of both canines (CR and CL) and the right lateral incisor (LiR), which composed four groups: (1) model with 3 "O" rings, (2) model 2 ERAs, bar with clips, (3) model 2 ERAs bar without clips; (4) model "O" ring bar and ERA. An axial and an oblique load of 6.8 kgf was applied on a overdenture at the 1st Pm, 2nd Pm, and 1st M. Results showed that the area around the left canine (CL) was practically free of stress; the left lateral incisor (LiL) developed only small tensions, and low stress in all the other cases; the right canine tooth suffered the largest concentrations of stress, mainly with the ERA retention mechanism. PMID:20467562
da Silva, Dorival Pedroso; Cazal, Claudia; de Almeida, Fernanda Campos Sousa; Dias, Reinaldo Brito E; Ballester, Rafael Yagüe
Purpose. To compare treatment outcome (survival rate, condition of hard and soft peri-implant tissues) and prosthodontic maintenance requirements of two versus three narrow-diameter bone level implants with Locator attachments supporting mandibular overdentures. Materials and Methods. Twenty completely edentulous patients with atrophic mandibles were treated. Ten patients (Group A) were treated with overdentures supported by two narrow (3.3-mm diameter) implants (Straumann AG, Basel, Switzerland) and ten patients (Group B) were treated with overdentures supported by three narrow implants. Locator (Zest Anchors, USA) attachments were used for prosthetic anchorage. Standardized clinical and radiographic parameters (survival rate, plaque index, calculus index, gingival index, bleeding index, probing depth and marginal bone loss) were evaluated at the time of the completion of the prosthetic treatment (baseline) and after 6, 12 and 24 months of functional loading. Prosthodontic maintenance requirements were also scored. Results. Only one implant was lost (Group B) during the healing period. There were no significant differences with regards to any of the studied clinical and radiographic parameters between the two groups (P > 0.05). Few prosthetic complications were recorded. Conclusions. No need to insert more than two narrow-diameter bone level implants with Locator attachments in cases of atrophic mandible to support an overdenture, however, long-term prospective studies are required to support this notion.
El-Sheikh, Ali M.; Shihabuddin, Omar F.; Ghoraba, Sahar M. F.
In an implant-supported overdenture, the optimal stress distribution on the implants and least denture displacement is desirable. This study compares the load transfer characteristics to the implant and the movement of overdenture among 3 different types of attachments (ball-ring, bar-clip, and magnetic). Stress on the implant surface was measured using the strain-gauge technique and denture displacement by dial gauge. The ball/O-ring produces the optimal stress on the implant body and promotes denture stability. PMID:22891704
Manju, V; Sreelal, T
The aim of this 1-year study was to evaluate and compare crestal bone loss and clinical outcomes of immediate and delayed loaded implants supporting mandibular overdentures with Locator attachments. In a randomised controlled clinical trial, 36 completely edentulous patients (mean age 59·6 years) who desired to improve the stability of their mandibular dentures were randomly assigned into two groups. Each patient received two implants in the canine area of the mandible after a minimal flap reflection. Implants were loaded by mandibular overdentures either 3 months (delayed loading group, G1) or the same day (immediate loading group, G2) after implant placement. Locator attachments were used to retain all overdentures to the implants. Peri-implant vertical (VBL) and horizontal (HBLO) bone losses and clinical parameters [plaque scores (PI), gingival scores (GI), probing depths (PD) and implant stability (ISQ)] were assessed at time of overdenture insertion (T0), 6 months (T6) and 12 months (T12) after overdenture insertion. After 12 months of overdenture insertion, two implants (5·5%) failed in G2. Vertical bone loss was significantly higher in G2 compared with G1, while HBLO demonstrated insignificant differences between groups. All clinical parameters (PI, GI, PD and ISQ) did not differ significantly between groups. Vertical bone loss was significantly correlated with PD and HBLO. Immediately loaded two implants supporting a Locator-retained mandibular overdenture are associated with more vertical bone resorption when compared to delayed loaded implants after 1 year. Clinical outcomes do not differ significantly between loading protocols. PMID:24814408
Elsyad, M A; Elsaih, E A; Khairallah, A S
A multicenter retrospective study has been conducted on 226 patients necessitating an implant-supported overdenture in the lower jaw. The patients were provided with 904 osseointegrated implants inserted in the interforaminal area of the mental symphisis (4 implants per patient). 4 titanium implant systems were used: TPS and ITI screw implants (Straumann Institute, Waldenburg, Switzerland); Ha-Ti screw implants (Mathys Dental Implants, Bettlach, Switzerland); NLS screw implants (Friatec, Mannheim, Germany). Immediately after implant placement, a U-shaped gold bar was fabricated and implants were immediately loaded with an implant-retained overdenture. Out of 226 patients treated, 194 were followed from a minimum of 2 years to a maximum of 13 years, with a mean follow-up of 6.4 years, whereas 32 patients dropped out during follow-up. The overall failure rate of implants was 3.1% (24/776 implants), whereas the failure rate of bars was 1.5% (3/194 bars). Results from this study showed that the success rate of immediately loaded implants is similar to that obtained in the case of delayed loading, after osseointegration has taken place. In contrast, this method shortens dental rehabilitation times with relevant satisfaction for patients. PMID:9586456
Chiapasco, M; Gatti, C; Rossi, E; Haefliger, W; Markwalder, T H
The effects of attachment clips on force transmission in two implant-stabilised over-dentures with cantilever extensions were investigated, using a previously developed in-vitro model, which simulated functional mandibular deformation. Two retentive configurations were used: an avoid gold bar cranked anteriorly with 13 mm distal cantilevers and the same configuration without attachment clips on the distal cantilevers. The dentures were loaded at individual tooth positions with a strain gauge beam and the forces exerted on the implants were measured using strain gauges mounted on their trans-mucosal abutments. The difference between the two retentive configurations was significant (P < 0.05) as tested by ANOVA. It is concluded that the retentive configuration without clips on the distal cantilevers results in a significant decrease in compressive forces on the implants. PMID:12526275
el-Sheikh, Ali M; Hobkirk, John A
This article introduces a technique for modifying an existing mandibular complete denture for use as a radiographic template with a radiopaque light-activated calcium hydroxide (Ca(OH)2) preparation. This allows prosthetically-driven treatment planning and surgical placement of 2 implants to support the existing mandibular denture.
Huynh-Ba, G; Alexander, P; Vargas, A; Vierra, M; Oates, TW
Today implant dentistry has made great inroads into the treatment modalities that are available in treating an edentulous patient. Popularity of a two implant retained overdenture has created a necessity to examine the various attachment systems being used and the stresses that are transmitted to the alveolar bone. Hence a Three dimensional Finite Element Analysis was done to analyze the stress distribution in the mandibular bone with implant-supported overdenture having Ball/O-ring and Magnet attachments of different diameters. A segment of the anterior region of the mandible was modeled with implant and the overdenture. Four different models were generated having Ball/O-Ring and Magnet Attachments. Forces of 10 N, 35 N and 70 N were applied from the horizontal, vertical and oblique directions respectively and the stress distribution studied. It was concluded that the greatest stress concentrations were seen at the crest of the cortical bone and could be reduced by using smaller sized attachments for implant supported-overdenture. PMID:23450217
John, Jins; Rangarajan, V; Savadi, Ravindra C; Satheesh Kumar, K S; Satheesh Kumar, Preeti
This study aimed to compare the influence of single-standing or connected implants on stress distribution in bone of mandibular overdentures by means of two-dimensional finite element analysis. Two finite element models were designed using software (ANSYS) for 2 situations: bar-clip (BC) group-model of an edentulous mandible supporting an overdenture over 2 connected implants with BC system, and o'ring (OR) group-model of an edentulous mandible supporting an overdenture over 2 single-standing implants with OR abutments. Axial loads (100 N) were applied on either central (L1) or lateral (L2) regions of the models. Stress distribution was concentrated mostly in the cortical bone surrounding the implants. When comparing the groups, BC (L1, 52.0 MPa and L2, 74.2 MPa) showed lower first principal stress values on supporting tissue than OR (L1, 78.4 MPa and L2, 76.7 MPa). Connected implants with BC attachment were more favorable on stress distribution over peri-implant-supporting tissue for both loading conditions. PMID:20485031
Tabata, Lucas Fernando; Assunção, Wirley Gonçalves; Barão, Valentim Adelino Ricardo; Gomes, Erica Alves; Delben, Juliana Aparecida; de Sousa, Edson Antônio Capello; Rocha, Eduardo Passos
When multiple anterior teeth are missing, many options of replacement are available. Traditionally, the choice was between a fixed or removable prostheses. Today, with the predictability of dental implants, the options of tooth replacement range from removable partial dentures to implant-supported fixed prostheses. The choice of which restoration that will best provide occlusion and esthetics depends on multiple factors including the number and location of missing teeth, the residual ridge form in relation to the replacement teeth, the relationship of the maxillary and mandibular anterior teeth, the condition of teeth adjacent to the edentulous span, the amount of bone available for implant placement, the patients "smile line" and display of teeth, lip support, and financial constraints. When there is minimal loss of the ridge contour, restorations that emerge from the ridge are the most functional and esthetic restorations, adhesive-type fixed partial dentures, conventional fixed partial dentures, and implant-supported restorations can be indicated with the choice of restoration dependent on a risk benefit and cost benefit analysis. When there is a loss of ridge contour due to residual ridge resorption or trauma, the decision becomes more complex as not only does the tooth structure need to be replaced, the ridge form also has to be replaced. (Figures 1 and 2). This can be assessed clinically as illustrated by Figures 1 and 2 where a dis crepancy in arch form and ridge form in relation to the adjacent teeth and/or opposing arch can be observed. Other considerations are lip support and display of the teeth when smiling. This article presents a case and rationale for implant-supported par tial overdentures. Many authors have written on the merits of com plete overdentures. The complete overdenture has proven to be an improvement over conventional complete prostheses with respect to chewing efficiency, patient comfort and satisfaction. In partial edentulism, the implant-supported overdenture has several advantages, some in common with a removable partial denture. PMID:15915882
Chee, Winston W L
A long-term denture wearer exhibited advanced alveolar bone loss, resulting in an atrophic mandible. Symphyseal bone height was 10 mm. The inferior alveolar nerve and mental foramen were close to the crest of the mandible. The symphyseal region was available for endosteal implant placement. Patient was an 83-year-old white male who was medically compromised. Anticoagulant therapy was stopped and INR evaluated prior to implant surgery. With the help of computerized tomography, four Nobel Biocare Tapered TiUnite narrow platform implants were placed anteriorly between the mental foramina. An implant-supported mandibular overdenture was fabricated. Locator attachments provided retention and stability for the prosthesis. This helped improve the patient's quality of life. PMID:20533713
Eight-year clinical and radiologic results of maxillary and mandibular implant-retained bar overdentures carried out on oxidized (TiUnite™) replace select implants placed in regenerated bone: a clinical case.
This article describes the clinical and radiologic long-term results of a healthy, nonsmoker women aged 62 at the time of treatment, with severely resorbed edentulous jaws in which bar and clip supported complete dentures were delivered in both jaws and followed for 8 years after prosthesis delivery. The patient had been edentulous in both arches since she was 50 years old. Treatment included the placement of four mandibular implants with maximum spacing anterior to the mandibular nerve, and four maxillary implants anterior to sinus wall without tilting the posterior implants, because of the insufficient bone quantity necessary to angulate implants. Guided bone regeneration was required in the maxilla, due to a bone atrophy that limited the placement of conventional dental implants. After 4 months, a second-stage surgery was performed, and after 1 month of healing time the patient received definitive restorations. Implant survival rate, patient satisfaction, marginal bone maintenance, and soft tissue conditions at the modified titanium surface of the dental implants were evaluated after 8 years of function. A multifactorial approach, clinician-patient relationship, and vigilant maintenance of oral hygiene were needed in order to ensure an optimal treatment and a long-term successful result. Positive results regarding bone maintenance in the long-term perspective, also on regenerated bone, were observed using implants with implant-retained bar overdentures, when adequate levels of oral hygiene and prosthodontic adjustments are maintained. PMID:24389566
French, David; Tallarico, Marco
To widen the availability of implant supported mandibular overdentures, their inclusion in the undergraduate clinical training curriculum has been encouraged. The aim was to determine whether implant supported mandibular overdentures provided by undergraduates could achieve similar levels of improvement in patient satisfaction and quality of life as previously demonstrated by experienced prosthodontists. Nineteen patients were treated by Stage 3 undergraduate students at Newcastle University, School of Dental Sciences. Changes between pre-treatment and 3 month post-treatment satisfaction and oral health related quality of life suggest dental undergraduates achieve similar levels of improvement as experienced prosthodontists. PMID:23495559
Calvert, G; Thomason, J M; Ellis, J S
Summary Aims The success of maxillary and mandibular tissue supported implant prostheses varies in the literature, and the ideal protocol may be elusive from given the numerous studies. The oral rehabilitation option is an alternative to conventional dentures and should improve function, satisfaction, and retention. The purpose of this review article is to clarify these questions. Methods The search of literature reviews English non-anecdotal implant overdentures articles from 1991 to 2011. Results The results display an aggregate comprehensive list of categorical variables from the literature review. Overall success of maxillary and mandibular implant overdenture was respectively, 86.6% and 95.8%. Conclusion The literature indicates that the implant overdenture prosthesis provides predictable results – enhanced stability, function and a high-degree of satisfaction compared to conventional removable dentures.
Laurito, Domenica; Lamazza, Luca; Spink, Michael J.; De Biase, Alberto
Statement of problem. When 2 implants are used to support a removable overdenture, optimal stress distribution to minimize forces to the implants is desired. Purpose. This study used photoelastic analysis to compare the stress patterns generated around implants with 2 retention mechanisms. Material And Methods. Two root form implants were anchored in a photoelastic mandible and a removable overdenture was
Robert Kenney; Mark W. Richards
Lichen planus is a common inflammatory mucocutaneous disease that often manifests itself intraorally. Oral lichen planus can appear in many forms; the most significant form for the edentulous patient is the erosive variety. For the patient, wearing a complete denture is quite dramatic because of the friability of the tissue. Implant-supported overdentures are a predictable treatment for edentulous patients, but this has been discouraged for the patient with erosive lichen planus. This article describes 2 patients with oral erosive lichen planus who were successfully treated with implant-retained mandibular overdentures. PMID:12589278
Esposito, Salvatore J; Camisa, Charles; Morgan, Michael
A patient's extreme susceptibility to periodontal disease, likely exacerbated by a history of smoking, resulted in severe periodontal breakdown. Employing a systematic approach that identified both patient risk and prognosis using data gathered during the patient examination, a treatment plan was developed that included extraction of structurally compromised teeth and the use of implant-assisted complete overdentures. This treatment approach accomplished a reduction of biomechanical, periodontal, and dentofacial risk, as well as an increase in functional harmony. PMID:22073809
The aim of this study was to compare the stress distribution induced by posterior functional loads on conventional complete dentures and implant-retained overdentures with different attachment systems using a two-dimentional Finite Element Analysis (FEA-2D). Three models representative of edentulous mandible were constructed on AutoCAD software; Group A (control), a model of edentulous mandible supporting a complete denture; Group B, a model of edentulous mandible supporting an overdenture over two splinted implants connected with the bar-clip system; Group C, a model of edentulous mandible supporting an overdenture over two unsplinted implants with the O-ring system. Evaluation was conducted on Ansys software, with a vertical force of 100 N applied on the mandibular left first molar. When the stress was evaluated in supporting tissues, groups B (51.0 MPa) and C (52.6 MPa) demonstrated higher stress values than group A (10.1 MPa). Within the limits of this study, it may be concluded that the use of an attachment system increased stress values; furthermore, the use of splinted implants associated with the bar-clip attachment system favoured a lower stress distribution over the supporting tissue than the unsplinted implants with an O-ring abutment to retain the mandibular overdenture. PMID:18482352
Assunção, W G; Tabata, L F; Barão, V A R; Rocha, E P
Despite the greater retention and low maintenance of bar attachment system, the longer clinical time and increased number of visits were the assignments to overcome in bar attachment system. This case report describes SFI-Bar® (Cendres et Métaux, Biel/Bienne, Switzerland) to be solve those problems. A 65-year-old female, who had severely absorbed mandible, hoped to wear a stable mandibular denture without pain. As soon as two implants were placed on mandible, a tube bar was connected to two adaptors connected to each implant. The length of the tube bar was adjusted considering inter implant distance, and reconnected to the adaptors. Finally a female part was seated beneath the denture. This case report showed that a satisfactory clinical result was achieved by delivering bar overdenture immediately after implant placement without laboratory procedure.
Kim, Ha-Young; Kim, Ryan Jin-Young; Qadeer, Sarah; Jeong, Chang-Mo; Shin, Sang-Wan
The purposes of this study were to photoelastically measure the biomechanical behavior of 4 implants retaining different cantilevered bar mandibular overdenture designs and to compare a fixed partial denture (FPD). A photoelastic model of a human edentulous mandible was fabricated, which contained 4 screw-type implants (3.75 × 10 mm) embedded in the parasymphyseal area. An FPD and 3 overdenture designs with the following attachments were evaluated: 3 plastic Hader clips, 1 Hader clip with 2 posterior resilient cap attachments, and 3 ball/O-ring attachments. Vertical occlusal forces of 100 N were applied between the central incisor and unilaterally to the right and left second premolars and second molars. Stresses that developed in the supporting structure were monitored photoelastically and recorded photographically. The results showed that the anterior loading, the overdenture with 3 plastic Hader clips, displayed the largest stress concentration at the medium implant. With premolar loading, the FPD and overdenture with 3 plastic Hader clips displayed the highest stresses to the ipsilateral terminal implant. With molar loading, the overdenture with 3 ball/O-ring attachments displayed the most uniform stress distribution in the posterior edentulous ridge, with less overloading in the terminal implant. It was concluded that vertical forces applied to the bar-clip overdenture and FPD created immediate stress patterns of greater magnitude and concentration on the ipsilateral implants, whereas the ball/O-ring attachments transferred minimal stress to the implants. The increased cantilever in the FPD caused the highest stresses to the terminal implant. PMID:22067869
Mazaro, José Vitor Quinelli; Filho, Humberto Gennari; Vedovatto, Eduardo; Pellizzer, Eduardo Piza; Rezende, Maria Cristina Rosifini Alves; Zavanelli, Adriana Cristina
In this study, effects of different overdenture attachments on the stress distributions in the maxillary bone surrounding the overdenture implants are studied. Four different types of attachment are considered. They are rigid Dalbo Stud, movable Dalbo Stress Broken, movable Dalro, and movable O-ring attachments. Three-dimensional finite element analysis was conducted with commercial package to obtain the stress distributions in the maxillary bone. Varying the attachment types and angle of inclination of load, the stress distributions in the portions of compact bone and trabecular bone were monitored separately. The analysis was conducted by assuming two different boundary conditions at the interface between cap and overdenture abutment in order to evaluate influence of interface boundary condition on stress distribution in the maxillary bone. They were perfect bonding condition and contact with friction at the interfaces. However, it is preferable to assume perfect bond condition at the interface for rigid type attachment systems and contact with friction at the interface for movable type attachment systems. From the numerical results, it was found that the load transfer mechanism of the implant system is altered significantly by the types of the overdenture attachment and also special care must be taken to assign proper boundary conditions at the interface for the analysis. The movable type Dalro attachment generated the highest maximum effective stress in the maxillary bone among the models under the same inclined loading condition for contact with friction. The rigid type Dalbo Stud attachment generated the smallest maximum effective stress in the maxillary bone among the models under the same inclined loading condition for perfect bonding condition. PMID:15707430
Chun, H-J; Park, D-N; Han, C-H; Heo, S-J; Heo, M-S; Koak, J-Y
The purpose of this study was to evaluate dental students' performance when fabricating a mandibular two-implant overdenture (OD) as compared to conventional dentures (CD) and to determine if these prostheses were successful. Twenty students and twenty patients were divided into two groups: complete denture group (CDG) and maxillary denture and two-implant OD group (ODG). Students' progress was evaluated at each appointment as they were given a clinical assessment score (CAS), which varied from 1 (unacceptable, needs to repeat procedure) to 4 (acceptable, no errors). The success of the prosthesis was evaluated by the patients using a visual analog scale (VAS) and an expert (a prosthodontist) using a denture quality assessment (DQA) form. Performance for both groups was not statistically different across all eight appointments (CDG 3.16 versus ODG 3.25; p=0.46). Patients with ODs reported greater stability with their dentures (p=0.048) and greater ability to chew than patients with CDs (p=0.03). There were no differences between the groups in terms of expert appraisal (ODG 71.1 versus CDG 67.5; p=0.59). The performance of dental students when fabricating a two-implant OD is thus not different from that of a CD. Students can successfully fabricate a two-implant OD as perceived by both patients and prosthodontists. PMID:20837741
Aragon, Cecilia E; Cornacchio, Angelica Lee Petrina; Ibarra, Lilia Marcela; Saad, Muhammed N; Zibrowski, Elaine
This finite element analysis compared stress distribution on complete dentures and implant-retained overdentures with different attachment systems. Four models of edentulous mandible were constructed: group A (control), complete denture; group B, overdenture retained by 2 splinted implants with bar-clip system; group C, overdenture retained by 2 unsplinted implants with o'ring system; and group D, overdenture retained by 2 splinted implants with bar-clip and 2 distally placed o'ring system. Evaluation was performed on Ansys software, with 100-N vertical load applied on central incisive teeth. The lowest maximum general stress value (in megapascal) was observed in group A (64.305) followed by groups C (119.006), D (258.650), and B (349.873). The same trend occurred in supporting tissues with the highest stress value for cortical bone. Unsplinted implants associated with the o'ring attachment system showed the lowest maximum stress values among all overdenture groups. Furthermore, o'ring system also improved stress distribution when associated with bar-clip system. PMID:19553853
Barão, Valentim Adelino Ricardo; Assunção, Wirley Gonçalves; Tabata, Lucas Fernando; Delben, Juliana Aparecida; Gomes, Erica Alves; de Sousa, Edson Antonio Capello; Rocha, Eduardo Passos
Four short root form implants were inserted in an atrophic mandible and the case restored with a lower connecting bar and an overdenture, opposing a complete maxillary denture. Root form implants were selected, as opposed to a subperiosteal implant in this case. The patient had a favorable medical history, appeared healthy, did not smoke, drink, or do illicit drugs, and had good bone quality. PMID:21767215
Piermatti, Jack; Nikas, John; Winkler, Sheldon
This clinical report explains a convenient, efficient, yet effective alternative for management of fractured substructure cast bars for implant-retained overdentures. The technique allows the fracture to be repaired at low cost and short time without remaking the substructure and the denture and further allowing the patient to keep their denture. The report sketches the clinical and laboratory procedures involved in the repair.
Vohra, Fahim; Al Fawaz, Amani
...2010-04-01 2010-04-01 false Mandibular implant facial prosthesis. 874...Prosthetic Devices Â§ 874.3695 Mandibular implant facial prosthesis. (a) Identification. A mandibular implant facial prosthesis is a...
...2009-04-01 2009-04-01 false Mandibular implant facial prosthesis. 874...Prosthetic Devices Â§ 874.3695 Mandibular implant facial prosthesis. (a) Identification. A mandibular implant facial prosthesis is a...
This clinical report presents an implant-retained obturator overdenture solution for a Prosthodontic Diagnostic Index Class IV maxillectomy patient with a large oronasal communication and severe facial asymmetry, loss of upper lip and midfacial support, severe impairment of mastication, deglutition, phonetics, and speech intelligibility. Due to insufficient bone support to provide satisfactory zygomaticus implant anchorage, conventional implants were placed in the body of the left zygomatic arch and in the right maxillary tuberosity. Using a modified impression technique, a cobalt-chromium alloy framework with three overdenture attachments was constructed to retain a complete maxillary obturator. Patient-reported functional and quality of life measure outcomes were dramatically improved after treatment and at the two-year follow-up. PMID:20040025
Leles, Cláudio Rodrigues; Leles, José Luiz Rodrigues; de Paula Souza, Carlos; Martins, Rafael Ragonezi; Mendonça, Elismauro Francisco
Mandibular reconstruction has posed significant problems, particularly when dealing with loss of mandibular substance. Various implant substances have been utilized in attempts to repair mandibular defects. These have included metals, synthetic material, and organic substances. All have posed significant problems, particularly with rejection and inability of the implant to develop a stable fusion with the surrounding bone. Recently, calcium sulfate has been successfully used as an implant in frontal sinuses, mastoid cavities, and, in one report, as a mandibular implant. The present study looks at the ability of calcium sulfate to induce osteoneogenesis in canine mandibles with and without the presence of a periosteal covering around the implant. Infection somewhat limited the success of the study, but in those animals without major infections, successful replacement of the calcium sulfate by normal bone occurred both with and without the presence of periosteum. PMID:6431365
McKee, J C; Bailey, B J
SUMMARY Objectives: To evaluate and compare retentive and stabilizing properties of stud (ERA Overdenture (orange and white), Locator Root (pink) and OP anchor # 4) and magnetic attachments (Hyperslim 4513, Hyperslim 4013, Magfit EX600W, Magnedisc 500 and Magfit-RK) by measuring maximum retentive force and retentive energy during linear and rotational dislodgments. Material and methods: Twelve specimens of each type of
This case report presents the treatment sequence of a 56 years old patient after he developed periimplantitis at the implant in position of tooth 22. This implant was integrated in an overdenture reconstruction connected to a soldered screw retained gold bar. The entire 2-stage procedure of implant explantation, simultaneous bone augmentation and new implant placement is documented. The onlay-graft was performed by means of the Transfer-Ring-Control System (Meisinger). The existing gold bar could be resoldered and adapted to the new implant. Accordingly the overdenture was relined and the female retainer mounted. The treatment period covered almost one year. PMID:20020591
Albrecht, Dominic; Enkling, Norbert; Mericske-Stern, Regina
Development of patient-based questionnaire about aesthetic and functional differences between overdentures implant-supported and overdentures tooth-supported. Study of 43 patients with a follow up of 1 year
SUMMARY Development of patient-based questionnaire about aesthetic and functional differences between overdentures implant-supported and overdentures tooth-supported. Study of 43 patients with a follow up of 1 year. Objective The aim of this study is to compare functional efficiency and patients satisfaction between tooth-supported and implant-supported overdenture through a questionnaire that accurately reflects the real concerns of patients with dental prosthesis. Methods Forty-three patients were selected from the out patient clinic, Department of Dentistry “Fra G.B. Orsenigo Ospedale San Pietro F.B.F.”, Rome, Italy. Their age were ranging from 61 to 83 years. Eighteen patients were rehabilitated with overdentures supported by natural teeth and twenty-five with overdentures implant-supported. Discussion and Result The questionnaire proposed one year after the insertion of the prosthetis has showed that there isn’t difference statistically significant in terms of function, phonetics and aesthetics between overdenture implant-supported and tooth-supported. Conclusions The results of the questionnaire showed that the patients generally had a high level of satisfaction concern to the masticatory function, esthetics and phonetics. In addition, on average, they haven’t difficulty in removal and insertion of the denture and in oral hygiene. They haven’t in both groups problems related to fractures.
GARGARI, M.; PRETE, V.; PUJIA, M.; CERUSO, F. M.
The purpose of this study was to determine the effects of implant-overdenture treatment (IOT) on patients' complaints about dentures and the degree to which subjective treatment outcome could be predicted from baseline patient and treatment characteristics. Four groups of patients were distinguished: one pretreatment group, two posttreatment groups (1 year after treatment) and one reference group of denture wearers, who had not applied for any kind of treatment. They finished a questionnaire with 20 statements on denture complaints. Four scales concerning denture complaints could be distinguished and named after their underlying variables. Differences between the groups were analyzed. IOT treatment was shown to be very effective on a wide range of denture complaints. Little change was seen in patient satisfaction with regard to maxillary dentures when measured on the scales, although many patients wanted improvement in retention and stability for the maxillary denture after IOT treatment in the mandible. Sixteen percent of the denture wearers who had not applied for IOT expressed complaints regarding their mandibular dentures that matched or were more severe than those of the patients that had applied for IOT, before the actual start of treatment. Although generally the subjective treatment outcome of IOT was favorable, it could not be individually predicted from baseline patient and treatment characteristics. PMID:7932261
Cune, M S; de Putter, C; Hoogstraten, J
Some subperiosteal mandibular implants of the earlier designs failed because of bone resorption beneath the posterior portions of the implant. Conversely, bone loss was observed rarely in the anterior region. The resorption was more profound posteriorly because there can be as much as 250 lb. of biting force per square inch and the bone is more porous than in the symphyseal region, which receives about 25 lb. per square inch. The independent movements of the condyles and the inferior border of the mandible at the gonial angles have dictated the success or failure of conventional mandibular subperiosteal implants in many of the earlier designs. Often, the rigidity of the implant framework prevents its posterior portion from moving in unison with the flexion and flexibility of the condyles upon the opening and closing of the mouth. Flexure usually is 2-4 mm in range and varies according to the quality of bone, age, sex, and musculature of the patient. Approximately 2% of these patients demonstrate movements of up to 4 mm. This has influenced an altered approach to posterior design-especially with tripodal mandibular subperiosteal implants. A brief history of the contributions of the earlier pioneers and their important contributions to the subperiosteal implant follows: G. Dahl inserted the first mandibular subperiosteal implant and was awarded his patent in 1941. Gershkoff and Goldberg, were the first to report clinical cases with mandibular subperiosteal implants in the United States. N. Berman reported on a direct bone impression of the mandible and transosseous wiring of the implant to the bone for stabilization. I. Lew introduced his own surgical bone impression technique for the mandibular subperiosteal implant and had published case histories on maxillary and mandibular implants. B. D. Weinberg reported an early unilateral subperiosteal implant consisting of a latticework portion that seated over the bone connected to the protruding post by four uprights. Leonard I. Linkow reported on the posterior unilateral mandibular subperiosteal implant. He followed up with a 5-year report, an 8-year follow-up report, and a 12-year report. R. L. Bodine reported his experiences with mandibular subperiosteal implants. A. N. Cranin and P. Schnitman introduced the Brookdale bar for an improved support of an overdenture for the mandibular subperiosteal implants. L. I. Linkow made some significant changes in the mandibular subperiosteal implant. D. D'Alise reported on the O-ring design for retention of implant dentures. R. A. James reported on the support system and perigingival mechanism surrounding oral implants and changed the subperiosteal based on peri-implant tissue behavior. L. I. Linkow reported on an entirely new mandibular tripodal design concept as well as a distinct change in the surgical protocol for obtaining the bone impressions without exposing those parts of the body of the mandible from the mental nerves to the ascending rami. PMID:10483422
Linkow, L I; Ghalili, R
PURPOSE This study was accomplished to assess the biomechanical state of different retaining methods of bar implant-overdenture. MATERIALS AND METHODS Two 3D finite element models were designed. The first model included implant overdenture retained by Hader-clip attachment, while the second model included two extracoronal resilient attachment (ERA) studs added distally to Hader splint bar. A non-linear frictional contact type was assumed between overdentures and mucosa to represent sliding and rotational movements among different attachment components. A 200 N was applied at the molar region unilaterally and perpendicular to the occlusal plane. Additionally, the mandible was restrained at their ramus ends. The maximum equivalent stress and strain (von Mises) were recorded and analyzed at the bone-implant interface level. RESULTS The values of von Mises stress and strain of the first model at bone-implant interface were higher than their counterparts of the second model. Stress concentration and high value of strain were recognized surrounding implant of the unloaded side in both models. CONCLUSION There were different patterns of stress-strain distribution at bone-implant interface between the studied attachment designs. Hader bar-clip attachment showed better biomechanical behavior than adding ERA studs distal to hader bar.
Various options have been introduced for the selection of implant overdenture attachments. Attachment wear due to the repeated insertion and removal of dentures has caused problems such as decreased retention and the requirement for suprastructure remanufacturing. In these cases, a Locator bar system was applied using the drill and tapping technique to achieve total retrievability. In a 55-year-old female patient who showed three degrees of mobility in most of her teeth due to severe alveolar bone loss, a complete denture in the maxilla and an implant supported type overdenture in the mandible were planned after extracting all the remaining teeth. Six implants were placed from canine region to the distal molar region, and the locator was connected to the milled bar using the drill and tapping technique. For a 61-year-old female edentulous patient who complained of poor retention with old denture, a complete denture in the maxilla and an implant-tissue supported type overdenture in the mandible were planned. Four implants were placed in front of mental foramen, and the Locator was also connected to the Hader bar using the drill and tapping technique. With this technique, female parts can be easily replaced, and retention can be continuously maintained.
Kim, Min-Su; Yoon, Mi-Jung; Huh, Jung-Bo; Jeon, Young-Chan
Abstract The aim of this study was to assess the prevalence of denture-related stomatitis (DRS) in different attachment-retained overdenture wearers and its association with particular colonizing Candida species. Thirty-seven edentulous patients with implant-supported maxillary or mandibular overdentures were enrolled. A full clinical history was obtained, including details of their oral hygiene practices and the levels of erythema based on Newton's classification scale. Swabs were taken from the palate and investigated mycologically to identify the yeast colonies. Quantitative and qualitative microbiological assessments were performed, recording the total numbers of colonies (cfu), their color, and their morphological characteristics. Significant differences were found in cfu values from the attachment and inner surfaces of locator- and bar-retained overdentures (P < 0.05). Candida albicans was the most common species in both evaluations, being isolated from 81.3% of bar-retained overdentures and 38.1% of locator-retained overdentures. DRS developed in all patients using bar-retained overdentures, but in only 71.4% of those using locator-retained overdentures. No statistically significant relationship was found between bar and locator attachments according to smoking habit, overnight removal, or plaque and gingival indices (P > 0.05). PMID:23020624
Kilic, Kerem; Koc, Ayse Nedret; Tekinsen, Fatma Filiz; Yildiz, Pinar; Kilic, Duygu; Zararsiz, Gokmen; Kilic, Erdem
The study aimed to evaluate the effect of different mucosa thickness and resiliency on stress distribution of implant-retained overdentures using a two-dimensional finite element analysis. Models were used in order to simulate two situations. In group A, model represented an edentulous mandible supporting an overdenture retained by two-splinted-implants connected with bar-clip system while in group B, model simulated an edentulous mandible supporting an overdenture retained by two-splinted-implants connected with bar-clip system associated with two-distally placed o'ring system. In each group, mucosa assumed three characteristics of thickness (1, 3 and 5 mm) in the resiliencies: hard, resilient and soft, respectively. Evaluation was performed on Ansys software. Group A showed higher stress values regardless of the mucosa characteristics. Overall, stress decreased at the supporting tissues as mucosa thickness and resiliency increased. Regarding supporting tissues, cortical bone showed the highest stress values. The use of bar-clip attachment system with distally placed o'ring attachment design optimized the stress distribution. PMID:18783845
Barão, Valentim Adelino Ricardo; Assunção, Wirley Gonçalves; Tabata, Lucas Fernando; de Sousa, Edson Antonio Capello; Rocha, Eduardo Passos
The purpose of this implant study was to evaluate the transverse stability of the basal maxillary and mandibular structures. The sample included 25 subjects between 12 and 18 years of age who were followed for approximately 2.6 years. Metallic implants were placed bilaterally into the maxillary and mandibular corpora before treatment. Once implant stability had been confirmed, treatment (4 first
Luiz G. Gandini; Peter H. Buschang
Patients with complete or partial edentulism who have insufficient bone for endosseous dental implant treatment present a challenge for the dental practitioner. Alveolar distraction osteogenesis is a technique for creating bone and soft tissue, without the need for bone grafting and its potential complications. In this article, alveolar distraction osteogenesis is compared with traditional bone grafting techniques. A case is presented to illustrate successful bilateral mandibular vertical distraction osteogenesis with creation of adequate bone volume for endosseous implant-supported dental restoration. PMID:15763035
Walker, David A
This study sought to determine the influence of mechanical fatigue on four varieties of implant overdenture studtype attachments (Supra-Snap, O'Ring, TSIB, ZAAG). Measurements of the initial vertical retentive force and the weight of the implant abutment were recorded. The same procedure was performed after the equivalent of 2 months, 6 months, and 12 months of clinical wear. For the four attachments, weight variation of the abutment between 0 and 1,080 cycles demonstrated no significant difference. Results indicated the TSIB to be significantly most retentive; next most retentive was the O'Ring, followed respectively by Supra-Snap and ZAAG. PMID:10379298
Fromentin, O; Picard, B; Tavernier, B
Residual alveolar ridge changes brought on by bone loss has always been one of the great problems related to denture prosthesis. The changes beneath denture bases has been investigated and the agreement on individual difference on the rate of bone resorption has been proven. Clinical experience and studies gave great knowledge of the prosthetic factors which influence bone resorption. It has been proved that excessive pressure, and shearing forces are the main causes of ridge changes. Very common is the problem associated with patient having only natural mandibular anterior teeth occluded with complete upper denture. The anterior maxillary region is the weakest area in the upper arch to resist stress when the lower natural anterior teeth occlude anterior to the basal support; trauma is inevitable. PMID:8299531
Gadalla, A A; Aboul-Ela, A I; el-Mahdy, M; Badawy, M S
Background Over the years, there has been a strong consensus in dentistry that at least two implants are required to retain a complete mandibular denture. It has been shown in several clinical trials that one single median implant can retain a mandibular overdenture sufficiently well for up to 5 years without implant failures, when delayed loading was used. However, other trials have reported conflicting results with in part considerable failure rates when immediate loading was applied. Therefore it is the purpose of the current randomized clinical trial to test the hypothesis that immediate loading of a single mandibular midline implant with an overdenture will result in a comparable clinical outcome as using the standard protocol of delayed loading. Methods/design This prospective nine-center randomized controlled clinical trial is still ongoing. The final patient will complete the trial in 2016. In total, 180 edentulous patients between 60 and 89 years with sufficient complete dentures will receive one median implant in the edentulous mandible, which will retain the existing complete denture using a ball attachment. Loading of the median implant is either immediately after implant placement (experimental group) or delayed by 3 months of submerged healing at second-stage surgery (control group). Follow-up of patients will be performed for 24 months after implant loading. The primary outcome measure is non-inferiority of implant success rate of the experimental group compared to the control group. The secondary outcome measures encompass clinical, technical and subjective variables. The study was funded by the Deutsche Forschungsgemeinschaft (German research foundation, KE 477/8-1). Discussion This multi-center clinical trial will give information on the ability of a single median implant to retain a complete mandibular denture when immediately loaded. If viable, this treatment option will strongly improve everyday dental practice. Trial registration The trial has been registered at Deutsches Register Klinischer Studien (German register of clinical trials) under DRKS-ID: DRKS00003730 since 23 August 2012. (http://www.germanctr.de).
Speech is often perturbed after placement of maxillary implant-retained prostheses. We tested the hypothesis that the rate of speech errors varies with prosthetic design. Thirty edentulous subjects with mandibular implant prostheses entered two within-subject crossover trials. Subjects wore maxillary fixed prostheses and removable long-bar overdentures (Trial 1), or overdentures with and without palates (Trial 2). Test words from a French
G. Heydecke; D. H. McFarland; J. S. Feine; J. P. Lund
The treatment of extensive pathologic lesions in the jaw, most of the time, can generate rehabilitation problems to the patient. The solid ameloblastoma is a locally invasive odontogenic tumor with a high recurrence rate. Its treatment is aggressive and accomplished through resection with safety margin. The criterion standard for reconstruction is autogenous bone, but it can provide a high degree of resorption, causing inconvenience to the patient because of lack of rehabilitative option. This study aimed to describe a patient with ameloblastoma treated through resection and reconstruction with autogenous bone graft, in which, after an extensive resorption of the graft was made, a modified bar was applied to support a prosthetic implant overdenture. PMID:24036834
Dos Santos Pereira, Rodrigo; Boos, Fernanda Brasil Daura Jorge; Lourenço, Eduardo José Veras; Hochuli-Vieira, Eduardo; da Costa Rodrigues, Paulo; Homsi, Nicolas
Comparison of different designs of implant-retained overdentures and fixed full-arch implant-supported prosthesis on stress distribution in edentulous mandible--a computed tomography-based three-dimensional finite element analysis.
A finite element analysis was used to compare the effect of different designs of implant-retained overdentures and fixed full-arch implant-supported prosthesis on stress distribution in edentulous mandible. Four models of an human mandible were constructed. In the OR (O'ring) group, the mandible was restored with an overdenture retained by four unsplinted implants with O'ring attachment; in the BC (bar-clip) -C and BC groups, the mandibles were restored with overdentures retained by four splinted implants with bar-clip anchor associated or not with two distally placed cantilevers, respectively; in the FD (fixed denture) group, the mandible was restored with a fixed full-arch four-implant-supported prosthesis. Models were supported by the masticatory muscles and temporomandibular joints. A 100-N oblique load was applied on the left first molar. Von Mises (?vM), maximum (?max) and minimum (?min) principal stresses (in MPa) analyses were obtained. BC-C group exhibited the highest stress values (?vM=398.8, ?max=580.5 and ?min=-455.2) while FD group showed the lowest one (?vM=128.9, ?max=185.9 and ?min=-172.1). Within overdenture groups, the use of unsplinted implants reduced the stress level in the implant/prosthetic components (59.4% for ?vM, 66.2% for ?max and 57.7% for ?min versus BC-C group) and supporting tissues (maximum stress reduction of 72% and 79.5% for ?max, and 15.7% and 85.7% for ?min on the cortical and trabecular bones, respectively). Cortical bone exhibited greater stress concentration than the trabecular bone for all groups. The use of fixed implant dentures and removable dentures retained by unsplinted implants to rehabilitate edentulous mandible reduced the stresses in the periimplant bone tissue, mucosa and implant/prosthetic components. PMID:23518207
Barão, V A R; Delben, J A; Lima, J; Cabral, T; Assunção, W G
The subperiosteal implant was originally described in the 1940s. The inadequate long-term results of subperiosteal implants are in contrast to the excellent results documented for endosseous osseointegrated oral implants. Consequently, subperiosteal implants and other soft-tissue-anchored implants should not be used presently. Furthermore, these implants are seldom seen today, because they generally were removed rather shortly after placement. The present report documents a full 41-year history of a mandibular subperiosteal implant inserted in 1957 by focusing upon the consequences of not removing an implant in spite of continuous periods of complications during 4 decades. Implant exposure, inflammation, infection, and fistula formation occurred persistently. Total implant removal was refused by the patient in 1973. After 25 years without control, tremendous resorption of the mandible was observed in 1998. Consequently, the entire implant was then removed. Placement of osseointegrated oral implants was impossible without extensive autogenous bone grafting. The present report has demonstrated that regular control of patients with subperiosteal implants is mandatory. Furthermore, subperiosteal implants should definitely be removed, if continuous periods of complications occur. PMID:11168208
Schou, S; Pallesen, L; Hjørting-Hansen, E; Pedersen, C S; Fibaek, B
The loss of mandibular molars can result in a maxillary dentoalveolar extrusion, leading to an insufficient interarch space. In severe cases, this space must be regained before the prosthetic reconstruction of the opposite edentulous area. The posterior maxillary segmental osteotomy (PMSO) is a simple but precision technique to manage this problem; without which one can achieve a good surgical outcome but a poor final occlusion. The purpose of this paper was to present a case of PMSO for mandibular implant placement and to discuss the important steps. PMID:17052616
Meningaud, Jean-Paul; Pitak-Arnnop, Poramate; Corcos, Laurent; Bertrand, Jacques-Charles
This case report describes the replacement of a failed subperiosteal implant with a tripodal design in a 60-year-old woman. The patient had been given the option of an augmentation using an autogenous iliac crest graft with subsequent insertion of endosteal implants or of replacing the failed implant with another of more sophisticated design. The latter, a more conservative approach, was selected for both economic and quality-of-life issues. PMID:10551150
Mansueto, R F
Follow-up, maintenance, and treatment of complications of 81 mandibular subperiosteal implants placed at the University of Southern California Advanced Prosthodontic Clinic were recorded for periods up to 21 years. Few patients were lost to follow-up, but a significant number of patients died before termination of the study. A 10-year survival rate of 79% was calculated for 63 patients, and a 15-year survival rate of 60% was calculated for 34 patients. It was found that subperiosteal implants have a low long-term survival rate, and the rate of loss of subperiosteal implants increases over time without reaching a steady state. However, subperiosteal implant therapy did provide function for patients who otherwise could not use dentures. PMID:8196000
Yanase, R T; Bodine, R L; Tom, J F; White, S N
Summary Objectives this report describes the masticatory implant- supported rehabilitation of a patient undergoing resection for mandibular ameloblastoma. Case report in the reported case the patient underwent resection and reconstruction with a fibula flap for masticatory rehabilitation of 7 implants at the level of the mandible. Discussion ameloblastoma is a benign locally invasive tumor of maxillary bones that often causes facial disfigurement. The dental management of the patient requires a collaboration of various specialists such as anesthetists, maxillofacial surgeons, and dentists. Conclusions in patients with oral cancers such as ameloblastoma, the correct planning of surgery for the tumor resection as well as prosthetic rehabilitation are crucial. Osseointegrated implants open a new perspective of treatment to improve the quality of life of patients resected for cancer.
Carini, Fabrizio; Francesconi, Manuel; Saggese, Vito; Monai, Dario; Porcaro, Gianluca
Background and Objectives. A key factor for the long-term function of a dental implant is the manner in which stresses are transferred to the surrounding bone. The effect of adding a stiffener to the tissue side of the Hader bar helps to reduce the transmission of the stresses to the alveolar bone. But the ideal thickness of the stiffener to be attached to the bar is a subject of much debate. This study aims to analyze the force transfer and stress distribution of an implant-supported overdenture with a Hader bar attachment. The stiffener of the bar attachments was varied and the stress distribution to the bone around the implant was studied. Methods. A CT scan of edentulous mandible was used and three models with 1, 2, and 3?mm thick stiffeners were created and subjected to loads of emulating the masticatory forces. These different models were analyzed by the Finite Element Software (Ansys, Version 8.0) using von Mises stress analysis. Results. The results showed that the maximum stress concentration was seen in the neck of the implant for models A and B. In model C the maximum stress concentration was in the bar attachment making it the model with the best stress distribution, as far as implant failures are concerned. Conclusion. The implant with Hader bar attachment with a 3?mm stiffener is the best in terms of stress distribution, where the stress is concentrated at the bar and stiffener regions. PMID:24459589
Satheesh Kumar, Preeti; Satheesh, Kumar K S; John, Jins; Patil, Geetha; Patel, Ruchi
A combination implant reconstruction using both subperiosteal and endosseous root-form implants for advanced mandibular resorption is presented. In theory and practice, physiologic endosseous implant support should prevent further resorption in the mandibular symphysis region. Three patients' post-treatment outcomes demonstrate a complete return of mandibular oral function. The greater risk of mandibular fracture, which is associated with other treatment options (multiple root-form implants or transmandibular implants), is avoided with this treatment approach. With follow-up periods ranging from 6 months to 28 months the three patients are satisfied with comfort, function, and appearance. A long-term follow-up study is planned for future publication. PMID:9743638
Perry, R T
To evaluate the long term results of telescopically retained overdentures, 92 patients with a total of 106 overdentures on 236 teeth were examined after two to eleven years. Thirty-three teeth were lost during the follow-up period. A higher tooth survival rate of the double-crowned teeth was found under mandibular overdentures (92%) than under maxillary overdentures (86%) after five years. The palladium-silver-alloy used seemed to be more suitable for telescopic crowns than the use of precious gold-copper-alloys because of tarnishing the latter alloys. PMID:11307388
Coca, I; Lotzmann, U; Pöggeler, R
History of the tripodal mandibular subperiosteal implant and the evolution of its design are discussed. Basic principles of bone physiology are reviewed especially as they relate to bone response to loading. Modeling and remodeling are controlled by a strain-related environment. Modeling can alter the shape and volume of bone. This aspect of bone growth has been reported with transosteal implants. A case report is presented in which apparent bone growth occurred following placement of a hydroxylapatite-coated subperiosteal implant. The implant was successfully revised following an acute infection around one of the permucosal sites. PMID:11831233
Fish, J M; Misch, C E
Since the introduction of the ad modum Branemark prototype prosthesis for the mandibular edentulous patient more than 30 years ago, design permutations have met clinician and patient considerations. Dental student training and specialist continuing education often rely on anecdotal reports of success to determine the recommended design for patients. Decision-making algorithms for treatment are optimally predicated on the best available evidence. The purpose of this article is to elucidate the benefit/risk calculus of various implant modalities for the mandibular edentulous patient. PMID:23889976
Sadowsky, Steven J; Hansen, Peter W
Restoring the edentulous mandible with a removable prosthesis can be a challenging prospect for both the dentist and patient during and after treatment. Poor retention and support are the major problems reported with a mandibular complete denture and these can be significantly improved with the use of implants and retentive attachments. Utilizing implants requires careful planning from both the surgical and restorative aspects to ensure that the intended treatment aim and outcome is achieved. Clinical Relevance: This case highlights the importance of both restorative and surgical considerations when planning the rehabilitation of the mandible with dental implants. PMID:24783882
Patel, Upen; Walmsley, Damien
A tripodal mandibular subperiosteal dental implant is a three piece cast metal framework that fits on the residual ridge beneath the periosteum and provides support for a dental prosthesis by means of posts or other mechanisms protruding through the oral mucosa. This implant is indicated in patients with advanced atrophy of the mandible where the unstable alveolar bone has completely disappeared, leaving in place the more stable basal bone with specific anatomical contours. The authors present their experience of 317 cases carried out in three different centers related to this implant modality and underline the importance of the basic anatomic, physiologic, and medical knowledge required to optimize the results. PMID:9759037
Linkow, L I; Wagner, J R; Chanavaz, M
The restoration of the mandibular arch up to the first molars with 5 one-piece implants presents a viable and cost-effective treatment plan in patients with adequate bone volume and favorable ridge relationships. The early loading of the implants with a provisional restoration reduces the period of edentulousness and restores the patient's ability to eat, talk, and smile effectively. Implants in younger patients prevent resorption of the residual alveolar ridge. This article presents a case report of the restoration of an edentulous mandibular arch with an early loaded implant-supported fixed restoration in a young patient. PMID:21905889
Mathew, Miriam; John, Bobby; George, Arun
A 55-year-old woman developed chronic infections of the maxillary sinuses with osteomyelitis resulting in extensive bone destruction and atrophy from a failed subperiosteal implant. After surgical removal of the subperiosteal implant, extensive debridement of the maxilla, and long-term antibiotic therapy, maxillary reconstruction was initiated. A Le Fort I osteotomy and downgraft was performed, and a posterior iliac bone graft was harvested and grafted to reconstruct the severely atrophic maxilla. In a later surgical procedure, maxillary and mandibular implants were placed. Implant-retained overdentures were fabricated to restore function and esthetics. PMID:9545927
Cutilli, B J; Smith, B M; Bleiler, R
Orthodontic appliances for skeletal anchorage are becoming increasingly more common in clinical practice. Similarly, different terms such as mini-implants, microimplants, and miniscrews have been used. There is a wide array of appliances currently on the market, in different designs and sizes, diameters, degree of titanium purity, and surface treatment. These appliances have been used for a variety of indications, including tooth retraction, intrusion, and traction. This study aimed to report the clinical case of a 19-year-old patient with a fractured mandible and to propose a novel use of mini-implants: the perioperative placement of mini-implants as anchors for maxillomandibular fixation steel wire ligatures. We concluded that this appliance provides an effective maxillomandibular fixation in patients with mandibular fracture, with little increase in the cost of surgery.
Pires, Mario Sergio Medeiros; Reinhardt, Leandro Calcagno; Antonello, Guilherme de Marco; Torres do Couto, Ricardo
Although the destructive effect of cantilevered implant supported fixed partial prosthesis is well known, in some cases usage of cantilever extension seems to be inevitable for many clinicians. The purpose of this study was to evaluate the effect of additional placement of a shorter implant in place of a cantilever extension on stress distribution compared with cantilevered fixed prosthesis in mandibular posterior edentulism. A mandibular Kennedy II finite element model was constructed. Six different implant supported fixed partial prosthesis were designed according to two main configurations; anterior and posterior cantilever extensions compared with the placement of additional shorter implant configurations. An oblique occlusal load of 400 N was applied. Tensile and compressive stress values in the cortical bone surrounding the cervical regions of implants and Von Misses stress values in the implants were evaluated. Significant lower stress values were recorded at the shorter implant placement configurations compared with the cantilevered prosthesis. Posterior cantilever extension performed higher stress values than the anterior counterpart. In clinical applications where cantilevered fixed partial prosthesis seems to be inevitable because of anatomical restrictions and/or complications such as loss of implant, an additional placement of a shorter implant should be considered. PMID:11966968
Akça, K; Iplikçio?lu, H
Four patients with high internal carotid artery (ICA) occlusive disease were indicated for surgical endarterectomy and needed additional exposure besides regular head rotation and extension. When indicated, in our clinic this is usually achieved by mandibular subluxation with interdental wiring. Due to dental wear and periodontal disease, all 4 patients were edentulous. As a consequence, the technique of interdental wiring could not be used. In this technical note we will explain a method for interarch fixation with the use of two ipsilateral monocortical miniscrews and wiring, and the use of patients' pre-existing mandibular implants and provisional overdenture. This method gives rise to an additional exposure of 15 to 20 mm of the ICA. PMID:19782520
Jaspers, Gijs W; Witjes, Max J; van den Dungen, Jan J; Reintsema, Harry; Zeebregts, Clark J
Micrognathia complicated by edentulous maxilla was treated by performing sagittal-split mandibular osteotomy and immobilizing a subperiosteal implant using transmaxillary screws. The patient was a 42-year-old man who had a birdlike facial deformity caused by significant hypoplasia of the mandible. He also demonstrated significant malocclusion attributable to micrognathia and edentulous maxilla caused by resorption of the alveolar bone. These conditions impaired his mastication and articulation, making it impossible for him to eat regular food or carry out normal conversation. A subperiosteal implant was placed on the edentulous maxilla, and was rigidly immobilized to the maxilla using five transmaxillary screws. A prosthesis was then attached to the implant, and by using the implant as the point of reference and the anchor, the mandible was moved forward by sagittal-split mandibular osteotomy. Intermaxillary fixation was subsequently performed. The postoperative course has been favorable, and his facial complexion has improved significantly. One and a half years after his surgery, there has been no sign of complications or malocclusion caused by mandibular retraction. He is now able to eat regular food and speak normally. PMID:11314123
Kiyokawa, K; Kiyokawa, M; Nakano, T; Tai, Y; Tanaka, S; Inoue, Y; Yanaga, H
Purpose: The purpose of this finite element study was to compare the stresses, strains, and displacements of double versus single implant in immediate loading for replacing mandibular molar. Materials and Methods: Two 3D FEM (finite element method) models were made to simulate implant designs. The first model used 5-mm-wide diameter implant to support a single molar crown. The second model used 3.75-3.75 double implant design. Anisotropic properties were assigned to bone model. Each model was analyzed with single force magnitude (100 N) in vertical axis. Results: This FEM study suggested that micromotion can be controlled better for double implants compared to single wide-diameter implants. The Von Mises stress for double implant showed 74.44% stress reduction compared to that of 5-mm implant. The Von Mises elastic strain was reduced by 61% for double implant compared to 5-mm implant. Conclusion: Within the limitations of the study, when the mesiodistal space for artificial tooth is more than 12.5 mm, under immediate loading, the double implant support should be considered.
Desai, Shrikar R.; Karthikeyan, I.; Gaddale, Reetika
To briefly summarize our results, two of the five three-pin staples (40%) have survived and have functioned well for more than six years. Four of the five four-pin staples (80%) have survived five years or longer and are functioning well. Twenty-four of the 25 seven-pin staples (96%) are functioning well, some for a period of 4-1/2 years; a few in this group have been used a little less than a year. Our total percentage of survival with good function is 30 of 35, or 86%, which includes our pilot study of the three- and four-pin staples. A more significant statistic, however, might be those patients with staples who we feel have been free of any significant trouble; these are 27 of 35, or 77%. All of our patients have been subjected to peer review examination and grading by members of the oral surgery staff at Sinai Hospital. They were examined and graded according to three criteria. The first was clinical appearance which included firmness of the staple and clinical appearance of the gingiva (Fig 16). The second was radiographic evidence of bone loss along the transosteal pins and retentive pins (Fig 17). The third category was patient evaluation of improved function and stability of the lower denture (Fig 18). The peer review group used marks A, B, C, D, as excellent, good, fair, and failure. Four points were assigned to A, 3 points to B, 2 points to C, and 1 point to D, so that the grade averages for all three categories were as follows: clinical appearance, 3.6; radiographic appearance, 3.5; and patient evaluation, 3.9. The conclusion of the review group was that the mandibular staple was functioning well and that it was clinically useful. I have presented an overview of some of the characteristics of metallic implants that make them implantable devices, and some of the qualities of the host tissues that will allow placement of foreign material. We do not yet understand all of the factors that make alloplastic materials biocompatible or some of the reasons for rejection by the host. We need continued research in animal models to study new devices and new materials that might permit biologic attachments of the host to implant. We also need controlled clinical studies with peer review to establish reliability of those devices that are clinically useful. The mandibular staple has had an initial clinical trial that seems very promising and is worthy of continued clinical study and clinical application. PMID:1095708
Small, I A
The aim of this study was to elucidate the association between the bone structure at implant insertion sites and stress distribution around the mandibular canal by means of three-dimensional finite element (3D FE) analysis. Four FE models were created with slice data using micro-computed tomography (micro-CT), and 3D FE analysis was performed. Mechanical analysis showed that the load reached the mandibular canal via the trabecular structure in all FE models. High levels of stress were generated around the mandibular canal when the distance between the mandibular canal and the implant decreased. High stress levels were also observed when cortical bone thickness and bone volume/total volume (BV/TV) were low. Our findings suggest that load is transmitted to the mandibular canal regardless of differences in the thickness of cortical bone or cancellous bone structure, but excessive load may be generated in bone with thin cortical and coarse cancellous structures. PMID:23903647
Kinoshita, Hideaki; Nakahara, Ken; Matsunaga, Satoru; Usami, Akinobu; Yoshinari, Masao; Takano, Naoki; Ide, Yoshinobu; Abe, Shinichi
Objectives. The aim of this study was to investigate intrasurgical and after surgical, pain and the incidence of after surgical alteration of sensation in the mandible and lower lip when placing implants in the posterior mandible using ridge mapping, panoramic radiography, and infiltration anesthesia. Methods. This was a longitudinal clinical study of healthy patients needing implant placement in the posterior mandible. After thorough examination and treatment plan using ridge mapping and panoramic radiography, all patients received dental implants under local infiltration anesthesia. The patients were then given a questionnaire to assess the pain during anesthesia and implant surgery. Change of sensation in the lower lip was evaluated by standard neurosensory examination tests at 7 days and 1 and 4 months. Prosthetic treatment was carried out 4 months postsurgery and the patients were followed for an average of 28.5 months afterwards. Results. A total of 103 implants were placed in 62 patients. Patients reported very minor pain during injection. No pain was reported during either implant placement or bone grafting procedures. No alteration of sensation in the mandible or lower lip was recorded postsurgery. Conclusion. In most cases, ridge mapping, panoramic radiography, and infiltration anesthesia are sufficient for posterior mandibular implant placement without pain or complications.
PURPOSE: A 1-year blinded two-arm parallel randomized controlled clinical trial was conducted to test the null hypothesis that immediate loading of four dental implants between the mental foramina with a fixed prosthesis has no benefits compared with the conventional loading technique in terms of implant success and clinical function. MATERIALS AND METHODS: Forty-five patients, completely edentulous in the mandibles seeking implant-supported prostheses at the Faculty of Dentistry, University of Toronto, were recruited. Four TiUnite dental implants (NobelBiocare®, Göteborg, Sweden) were placed following the one-stage surgical protocol. Immediately after surgery, the patients were randomly assigned to either study arms by a third independent party. In the experimental arm (EA), existing mandibular denture was converted into an interim implant-supported fixed bridge (ISFB) on the same day of surgery. In the control arm (CA), the mandibular denture was hollowed out and relined with a soft tissue reline. The implants were loaded with the permanent ISFB at least 3 months postsurgery. Patients were assessed by a calibrated independent investigator at 2, 6, and 12 months following completion of treatment. RESULTS: A total of one hundred sixty implants were placed. Due to anatomical limitations, one patient was excluded from the study. Four patients in the EA did not receive intervention as allocated and were transferred to the CA. Implant success rate was comparable between the two arms and exceeded 96%. Marginal bone loss was statistically significantly more in the immediate loading arm, -0.296?mm versus -0.037?mm (intention to treat: p?=?.002; per protocol: p?=?.021). The relatively early intervention and insertion of the final prosthesis in the immediate arm, when bone healing and remodeling process had not yet been completed, might explain the difference in the amount of bone loss. CONCLUSION: Immediate loading of four dental implants with a fixed prosthesis in the edentulous mandible is a feasible treatment option and leads to a substantial improvement in perceived oral health status. PMID:23506407
Alfadda, Sara Abdulaziz
Purpose. The purpose of this finite element study was to compare stresses, strains, and displacements of double versus single implant, in immediate loading for replacing mandibular molar. Materials and Methods. Two 3D FEM models were made to simulate implant designs. The first model used 6?mm wide-diameter implant to support a single molar crown. The second model used 3.75-3.75 double implant design. Each model was analyzed with a single force magnitude of 70?N in oblique axis in three locations. Results. This FEM study suggested that micromotion can be well controlled by both double implants and 6?mm single wide-diameter implant. The Von Mises stress for double implant had 31%-43% stress reduction compared to the 6?mm implant. Conclusion. Within the limitations of the paper, when the mesiodistal space for artificial tooth is more than 12.5?mm, under immediate loading, the double implant support should be considered. PMID:22461992
Desai, Shrikar R; Karthikeyan, I; Singh, Rika
Purpose. The purpose of this finite element study was to compare stresses, strains, and displacements of double versus single implant, in immediate loading for replacing mandibular molar. Materials and Methods. Two 3D FEM models were made to simulate implant designs. The first model used 6?mm wide-diameter implant to support a single molar crown. The second model used 3.75-3.75 double implant design. Each model was analyzed with a single force magnitude of 70?N in oblique axis in three locations. Results. This FEM study suggested that micromotion can be well controlled by both double implants and 6?mm single wide-diameter implant. The Von Mises stress for double implant had 31%–43% stress reduction compared to the 6?mm implant. Conclusion. Within the limitations of the paper, when the mesiodistal space for artificial tooth is more than 12.5?mm, under immediate loading, the double implant support should be considered.
Desai, Shrikar R.; Karthikeyan, I.; Singh, Rika
Mandibular autopsy specimens were examined with different radiographic techniques in order to evaluate the visibility of the mandibular canal and the measurement accuracy of distances related to the mandibular canal. Hypocycloidal, spiral and computed tom...
One of the normal interesting variations that we may encounter in the mandible is bifid mandibular canal. This condition can lead to difficulties when performing mandibular anesthesia or during extraction of lower third molar, placement of implants, and surgery in the mandible. Therefore diagnosis of this variation is sometimes very important and necessary.
Sheikhi, Mahnaz; Badrian, Hamid; Ghorbanizadeh, Sajad
One of the normal interesting variations that we may encounter in the mandible is bifid mandibular canal. This condition can lead to difficulties when performing mandibular anesthesia or during extraction of lower third molar, placement of implants, and surgery in the mandible. Therefore diagnosis of this variation is sometimes very important and necessary. PMID:23814555
Sheikhi, Mahnaz; Badrian, Hamid; Ghorbanizadeh, Sajad
Oral characteristics of ectodermal dysplasia (ED) include hypodontia or anodontia of the primary or permanent teeth, impacted teeth, malformed and widely spaced peg-like teeth, and underdeveloped alveolar ridges. Patients with this disease often need a multidisciplinary approach to treatment planning and dental treatment to regain appropriate function, esthetics, and comfort. The definitive treatment plan may include removable, fixed, or implant-supported prostheses or a combination of these options. Depending on the remaining available alveolar bone and the pattern of missing teeth, the ideal treatment option for an adult ED patient often includes the use of implants. This clinical report describes the multidisciplinary approach to diagnosis and treatment of ED in a 37-year-old woman. The treatment included a mandibular implant-supported fixed denture and a maxillary conventional overdenture fabricated to establish acceptable occlusal vertical dimension, esthetics, and oral function. PMID:14508742
Because optimal reconstruction of maxillofacial defects requires functional rehabilitation, the current study demonstrates the successful secondary reconstruction of a large mandibular continuity defect using a fully digitally planned prefabricated free vascularized fibula with immediate implant-supported prosthodontic restoration. A 56-year-old man presented with a large mandibular continuity defect after resection of an enlarged squamous cell carcinoma arising from the floor of the mouth. For secondary reconstruction, the shape of the neomandible and implant position for support of the lower prosthesis were planned virtually. The combined cutting and drilling guide was printed in 3 dimensions. In a 2-step surgical approach, first, the implants were inserted into the fibula and covered with a split-thickness skin graft to form a neogingiva. In a second operation, the fibula was harvested, osteotomized, and fixed with the denture on the preinserted implants. The fibula was placed to its final position guided by the occlusion. Using three-dimensional virtual backward planning, it was feasible to perform a mandibular reconstruction with immediate prosthetic rehabilitation. PMID:24670276
Freudlsperger, Christian; Bodem, Jens Philipp; Engel, Eva; Hoffmann, Jürgen
The objective of this study was to evaluate the location of the mandibular canal and the thickness of the occlusal cortical bone at dental implant sites in the lower second premolar and lower first molar by using dental cone-beam computed tomography (CBCT). Seventy-nine sites (47 second premolar and 32 first molar sites) were identified in the dental CBCT examinations of 47 patients. In this study, 4 parameters were measured: (1) MC-the distance from the mandibular canal to the upper border of the mandible; (2) CD-the distance from the mandibular canal to the buccal border of the mandible; (3) MD-the distance from the mandibular canal to the lingual border of the mandible; (4) TC-the thickness of the cortical bone at the occlusal side. A statistical analysis was employed to compare the size and differences between these 4 parameters at the lower second premolar and lower first molar. Regarding the MC and MD, the experimental results showed no statistical difference between the first molar and second premolar. However, the TC for the second premolar was greater than that of the first molar. Thus, careful consideration is necessary in choosing the size of and operation type for dental implants. PMID:24302975
Hsu, Jui-Ting; Huang, Heng-Li; Fuh, Lih-Jyh; Li, Rou-Wei; Wu, Jay; Tsai, Ming-Tzu; Shen, Yen-Wen; Tu, Ming-Gene
The objective of this study was to evaluate the location of the mandibular canal and the thickness of the occlusal cortical bone at dental implant sites in the lower second premolar and lower first molar by using dental cone-beam computed tomography (CBCT). Seventy-nine sites (47 second premolar and 32 first molar sites) were identified in the dental CBCT examinations of 47 patients. In this study, 4 parameters were measured: (1) MC—the distance from the mandibular canal to the upper border of the mandible; (2) CD—the distance from the mandibular canal to the buccal border of the mandible; (3) MD—the distance from the mandibular canal to the lingual border of the mandible; (4) TC—the thickness of the cortical bone at the occlusal side. A statistical analysis was employed to compare the size and differences between these 4 parameters at the lower second premolar and lower first molar. Regarding the MC and MD, the experimental results showed no statistical difference between the first molar and second premolar. However, the TC for the second premolar was greater than that of the first molar. Thus, careful consideration is necessary in choosing the size of and operation type for dental implants.
Huang, Heng-Li; Fuh, Lih-Jyh; Li, Rou-Wei; Wu, Jay; Tsai, Ming-Tzu; Shen, Yen-Wen; Tu, Ming-Gene
SUMMARY Implant supported rehabilitation of thin edentulous ridges with horizontal atrophy necessitates a regenerative approach. Within the procedures for horizontal bone defects augmentation, ridge expansion techniques permit dislocation of the buccal bone plate in a labial direction and simultaneous implant insertion in single-stage surgery, abbreviating overall treatment time. The piezoelectric ridge expansion technique permits to obtain the expansion of very mineralized bone crests without excessive traumas or the risk of ridge fractures. The case reported shows an implant treatment for partial edentulous lower arch rehabilitation. A full-split thickness flap was raised. The mucoperiosteal reflection permitted to identify alveolar crest contour where osteotomies had to be performed. Split thickness dissection allowed periosteal blood supply to be mainteined on the buccal bone plate. After horizontal and vertical osteotomies were performed with OT7 piezoelectric microsaw (Piezo-surgery, Mectron), a single-bevel scalpel was used to move the buccal bone plate to the labial. Two Straumann TE 3.3/4.8 mm wide implants were inserted in the lower right premolar area, and 1 Straumann 4.8 mm Wide Neck implant was inserted to replace lower right first molar. The amount of bone expansion was equal to the cervical diameter of the placed implants (4.8 mm) and residual bone gap was packed with Bio-Oss granules (Geistlich). Healing was uneventful and 3 months later final restorations with implant-supported porcelain-fused-to-metal crowns were cemented.
BELLEGGIA, F.; POZZI, A.; ROCCI, M.; BARLATTANI, A.; GARGARI, M.
Dental implant education has increasingly become an integral part of predoctoral dental curricula. However, the majority of implant education emphasizes the restorative aspect as opposed to the surgical. The University of Illinois at Chicago College of Dentistry has developed an Advanced Predoctoral Implant Program (APIP) that provides a select group of students the opportunity to place implants for single-tooth restorations and mandibular overdentures. This article describes the rationale, logistics, experiences, and perspectives of an innovative approach to provide additional learning experiences in the care of patients with partial and complete edentulism using implant-supported therapies. Student and faculty perspectives on the APIP were ascertained via focus group discussions and a student survey. The qualitative analysis of this study suggests that the select predoctoral dental students highly benefited from this experience and intend to increase their knowledge and skills in implant dentistry through formal education following graduation. Furthermore, the survey indicates that the APIP has had a positive influence on the students' interest in surgically placing implants in their future dental practice and their confidence level in restoring and surgically placing implants. PMID:24789837
Afshari, Fatemeh S; Yuan, Judy Chia-Chun; Quimby, Anastasiya; Harlow, Rand; Campbell, Stephen D; Sukotjo, Cortino
Patients who have received radiotherapy to the head and neck area must avoid dental extractions and seek simplicity in treatment and home care follow-up. For partially edentulous patients, removable partial overdenture therapy can fulfill these goals while maintaining the high level of function and aesthetics desired by patients.11 references.
Rosenberg, S.W. (New York Univ. School of Dentistry, NY (USA))
Objectives: To evaluate the outcome of immediately loaded distally cantilevered mandibular full-arch prostheses according to the 'all-on-four' concept supported by implants placed in both fresh extraction and healed sites. Material and methods: A prospective study was conducted in 24 patients with extraction of all remaining mandibular teeth and placement of 4 implants per patient (2 mesial axial and 2 distal tilted) for full-arch mandibular restorations. Implants were inserted in fresh extraction sockets 2.3 ± 1.0 per patient and 1.7 ± 1.0 implants in healed sites. Implants placed in fresh extraction sites (n = 55) were significantly (P <0.01) more deeply inserted than implants (n = 41) placed in healed sites (peri-implant alveolar crest: +1.6 ± 0.8 mm vs +0.6 ± 0.7 mm). Patients received an immediate provisional fixed dental prosthesis and, 3 months later, a definite resin veneered prosthesis with metal framework. At the 12-and 24-month follow-up, patients were evaluated for implants and prosthesis success, for prosthodontic maintenance efforts and patient satisfaction. At both follow-up examinations, peri-implant marginal bone level, implant pocket depth, plaque, bleeding, gingival and calculus indices were evaluated and compared between implants placed in fresh extraction and healed sites. Results: At the 24-month follow-up, no implant failed and all prostheses were stable. There were five fractures of the provisional prosthesis in 5 patients but no fracture of the definite prostheses. For the definite prostheses, 15 acrylic teeth had to be renewed/repaired (in 10 patients) and 18 patients presented the need for the implant-supported prosthesis to be rebased. Peri-implant marginal bone level after 12 and 24 months was -0.18 ± 0.20 mm and -0.40 ± 0.29 mm for all implants (P <0.001) representing bone level differences of 0.35 mm between implants placed in healed and post-extractive sites at both the 1st year (95%-CI:-0.49 to -0.20) and the 2nd year (95%-CI: -0.57 to -0.14) assessment. Plaque (1st year: 1.17 ± 0.48 versus 0.5 ± 0.6; P <0.001; 2nd year: 1.21 ± 0.51 versus 0.55 ± 0.6; P <0.001) and calculus indices (1st year: 0.92 ± 0.28 versus 0.45 ± 0.51; P <0.001; 2nd year: 1.00 ± 0.42 versus 0.5 ± 0.51; P <0.001) were significantly higher for implants placed in fresh extraction than in healed sites. Patients' subjective satisfaction score rating assessed by 5 items was high at the 1- (score: 4.6 ± 0.4) and 2-year evaluation (score: 4.7 ± 0.36). Conclusion: Within the limits of this study, immediately loaded full-arch prostheses can be supported by four implants placed simultaneously into healed and fresh extraction sites. Conflict of interest statement: Prof Gerald Krennmair was supported by a grant from Camlog Foundation to conduct this research. PMID:24977253
Krennmair, Stefan; Seemann, Rudolf; Weinländer, Michael; Krennmair, Gerald; Piehslinger, Eva
OBJECTIVE: The aim of this study was to evaluate a new method to quantify longitudinal mandibular bone remodeling three-dimensionally by superimposition of cone beam computed tomography images. MATERIALS AND METHODS: This method is used to quantify the treatment effects of implant-retained overdentures in 20 patients aged 52-79 at recruitment after 1 and 2 years post treatment. Three dimensional models of pre- and post-treatment were reconstructed for each patient and superimposed using Standard Tessellation Language registration method and segmentation. RESULTS: Color maps of the differences generated by superimposition allow detailed examination and quantification of the progressive dimensional changes of bone in a three-dimensional manner and enable the visualization of the apical displacement and thinning of the cortical layer of bone underneath the denture base. Most of the remodeling changes took place during the first year with a mean decrease in volume of 3.7% (SD = 4.4%; range = +3.7% to -15.9%, median = -3.7%). This remodeling pattern continued during the second year, but at a reduced rate of 2.5% per year (SD = 4.2%; range = +2.1% to -11.3%, median = -3.9%). CONCLUSION: Standard Tessellation Language registration based superimposition of cone beam computed tomography images may be considered an objective and reproducible method to three-dimensionally quantify mandibular bone remodeling. PMID:22862429
Ahmad, Rohana; Abu-Hassan, Mohamed I; Li, Qing; Swain, Michael V
Defects requiring reconstruction in the mandible are commonly encountered and may result from resection of benign or malignant lesions, trauma, or osteoradionecrosis. Mandibular defects can be classified according to location and extent, as well as involvement of mucosa, skin, and tongue. Vascularized bone flaps, in general, provide the best functional and aesthetic outcome, with the fibula flap remaining the gold standard for mandible reconstruction. In this review, we discuss classification and approach to reconstruction of mandibular defects. We also elaborate upon four commonly used free osteocutaneous flaps, inclusive of fibula, iliac crest, scapula, and radial forearm. Finally, we discuss indications and use of osseointegrated implants as well as recent advances in mandibular reconstruction.
Chim, Harvey; Salgado, Christopher J.; Mardini, Samir; Chen, Hung-Chi
In order to solve a series of problems ridge augmentation by subperiosteal implantstion, HA combined with BMP was implanted in between the two pieces of mandible produced by osteotomy. Nine adult mongrel dogs were used in this study and six patients were treated with this mathod. The specimens were examined by light microscope, scanning electron microscope in the experimental study. The results show that there are a large amount of new bone formation both within and around the combined material. The amount is increasing as the time lapsed and the new bone is connected directly with the host bone of two side. Clinical application showed that after augmentation of the atrophic alveolar ridge with this mathod, the shape and volume of the alveolar ridge were good. The retention and stability of the lower denture was improved significantly. The results showed that this method of alveolar ridge augmentation has many advantages. PMID:10677944
Zhang, H; Zhou, X; Wang, X
This article describes a method for fabrication of a custom-made device for cleaning dome-shaped overdenture abutments. A kid toothbrush and a rubber cup were used for fabrication of a prophylactic device. After regular use of this device periodontal health status of the overdenture abutments patients improved satisfactorily. PMID:23230248
Mall, Priyanka; Singh, Kamleshwar; Singh, Saumyendra Vikram; Agrawal, Kaushal Kishor; Siddharth, Ramashanker; Chand, Pooran
Precision attachments have been largely ignored by most dental professionals for trivial reasons such as cost and reluctance\\u000a of a practitioner to grasp the intricacies of its indications and applications. Precision attachments offer considerable advantages\\u000a such as increased retention of a denture, preservation of teeth which are otherwise indicated for extraction, as a viable\\u000a alternative to implant retained overdenture and
V. Dileep Nag; P. Ravindra; B. Thirupathi Reddy
Implant-retained mandibular ball-supported and bar-supported overlay dentures are the two most common treatment options for the edentulous mandible. The superior option in terms of strain distribution should be determined. The three-dimensional model of mandible (based on computerized tomography scan) and its overlying implant-retained bar-supported and ball-supported overlay dentures were simulated using SolidWorks, NURBS, and ANSYS Workbench. Loads A (60 N) and B (60 N) were exerted, respectively, in protrusive and laterotrusive motions, on second molar mesial, first molar mesial, and first premolar. The strain distribution patterns were assessed on (1) implant tissue, (2) first implant-bone, and (3) second implant-bone interfaces. Protrusive: Strain was mostly detected in the apical of the fixtures and least in the cervical when bar design was used. On the nonworking side, however, strain was higher in the cervical and lower in the apical compared with the working side implant. Laterotrusive: The strain values were closely similar in the two designs. It seems that both designs are acceptable in terms of stress distribution, although a superior pattern is associated with the application of bar design in protrusive motion. PMID:20712443
Vafaei, Fariborz; Khoshhal, Masoumeh; Bayat-Movahed, Saeed; Ahangary, Ahmad Hassan; Firooz, Farnaz; Izady, Alireza; Rakhshan, Vahid
Overdenture principles can be applied to dentitions that are relatively complete without preparation or alteration of the existing teeth. Such overdentures may cover the traditional denture-bearing tissues as well as the unaltered remaining teeth. The primary advantages derived are reversibility, simplicity, and cost effectiveness. The primary indications are restoration of congenital and acquired anomalies. A detailed clinical and laboratory technique for fabricating these overdentures is presented. Effective restorations require care and attention to detail using the principles of conventional prosthodontics. No special equipment or material is needed. Two patient histories are presented, illustrating use of the technique. PMID:2083008
Rogoff, G S; Graser, G N
Placement of dental implants in the anterior mandible is considered by many clinicians to be a relatively low-risk procedure. However, hemorrhagic episodes following implant placement in the mandibular symphysis are regularly reported and can have serious consequences. The use of high-resolution focused cone beam scanners has given us the ability to visualize the intricate neurovascular network of the intraforaminal region without distortion and in greater detail. Knowledge of the arterial supply and navigated implant placement in the mandibular symphysis can help to avoid these potentially life-threatening emergencies. PMID:20932161
Miller, Robert J; Edwards, Warren C; Boudet, Carlos; Cohen, Jonathon H
The location and configuration of mandibular canal variations are important in surgical procedures involving the mandible, such as extraction of an impacted third molar, dental implant treatment, and sagittal split ramus osteotomy. We report 3 Japanese patients with bifid mandibular canals using panoramic radiograph and multi-slice helical computed tomography (CT) images. In 2 of the 5 sides, the bifid mandibular canal was suggested on panoramic radiograph. The bifid mandibular canal had a short and narrow upper canal toward the distal area of the second molar in 4 sides, and a short and narrow lower canal toward the distal area of second molar in 1 side, as revealed on reconstructed CT images. Since the location and configuration of mandibular canal variations are important in surgical procedures involving the mandible, they should be carefully observed using reconstructed CT images. PMID:17356369
Naitoh, Munetaka; Hiraiwa, Yuichiro; Aimiya, Hidetoshi; Gotoh, Masakazu; Ariji, Yoshiko; Izumi, Masahiro; Kurita, Kenichi; Ariji, Eiichiro
Large osseous defects secondary to resection of the mandibular segment may lead to significant facial deformity, functional disabilities, and associated psychologic problems. The therapeutic approach is more complicated in pediatric patients because it must not interfere with normal craniofacial growth process. Here, we present a clinical report to emphasize the application of extraoral short implants with magnetic abutments used for mandible of a growing patient reconstructed with free iliac flap after resection of Ewing sarcoma. A 5-year-old boy, complaining of an ulcerated mass of the anterior mandibular area and floor of the mouth, was referred to our clinic. Incisional biopsy from the lesion confirmed the diagnosis of Ewing sarcoma. After resection, free iliac osteocutaneous flap, with a 6.5 × 4.0-cm skin paddle and based on the deep circumflex iliac vessels, was used to reconstruct the mandibular integrity and to cover the floor of the mouth simultaneously. Nine months after the operation, the patient was referred for oral rehabilitation. Prosthodontic plan included the placement of 5 extraoral implants with magnetic abutment and fabrication of an implant-retained overdenture. Magnetic abutment was preferred not to interfere with the expected craniofacial growth. During a follow-up period, radiographic images showed no pathologic signs with consideration of overall bone loss and recurrence of the tumor; 12 months after the initiation of prosthetic loading, no peri-implant bone loss was observed. In conclusion, this reported case would be an example for the management of challenging pediatric mandibular tumor cases in terms of resection, reconstruction and dental rehabilitation. PMID:24699098
Aksu, Ali Emre; Dursun, Erhan; Calis, Mert; Ersu, Bahadir; Safak, Tunc; Tözüm, Tolga F
Sinus lifting and reconstruction of localized alveolar defects are often required after closure of a large oroantral fistula (OAF) to allow for subsequent implant installation. This study describes a combined surgical technique that involves sinus lifting, bony closure, and reconstruction of the alveolar defect at the site of an OAF. The sinus membrane was reconstructed as a continuous layer by combining the residual sinus membrane with a rotated part of oral mucosa around the OAF. Autogenous bone from the chin and/or ramus was grafted into the prepared sinus space and alveolar defect, and the graft was covered by a buccal advancement flap. This technique was used to treat 8 patients who had large OAFs in the posterior maxillary region. The treatment was successful in all cases, and the technique appears to be suitable for large OAFs where implants are subsequently desired. PMID:21420631
Ahmed, Mamdouh S; Askar, Niveen A
Introduction In view of the increase in the life expectancy of humans and in edentulism of the population above 50 years of age, in which\\u000a the prevalence of osteoporosis is also higher, it is fundamental to better understand the effects of systemic bone mass loss\\u000a on the healing process of dental implants and to determine the quality of the bone that surrounds
M. A. L. Amorim; L. Takayama; V. Jorgetti; R. M. R. Pereira
The preservation of teeth to support an attachment-retained overdenture is an appropriate and stable alternative to extractions and complete dentures. A key to success is the strategic selection of teeth for retention. This clinical report discusses a method for fabricating an overdenture based on a combination of direct and indirect impression techniques. This technique is a simple and time-efficient alternative to traditional methods that aids in overcoming difficulties in fabricating overdentures. PMID:23328190
Schuch, Cristian; de Moraes, Aline Pinheiro; Sarkis-Onofre, Rafael; Pereira-Cenci, Tatiana; Boscato, Noéli
The Hader bar system is a popular bar and clip concept because of its 20-degree clip rotation, simplicity, and versatility. Two procedures may be used to incorporate the Hader nylon clip into a denture base. The direct technique consists of attaching the clip to the denture base as a clinical procedure. With the indirect technique, the clip is attached during laboratory processing. An alternative method of attaching the clip with a metal superstructure is presented. This procedure combines the advantages of the direct and indirect techniques for incorporation of the nylon clip of the Hader bar into the denture base. PMID:12589297
Sadig, Walid M
The crown- and sleeve-coping denture is a removable prosthesis that is supported by both selectively retained teeth and the residual ridge or mucosa. It is a versatile and successful means of achieving long-term restoration of a partially edentulous jaw. Insertion and removal of the denture and routine oral hygiene are easy to perform. The beneficial results of this form of treatment can be considered for a wide variety of clinical applications for the severely advanced periodontitis case. This paper presents a case report on the prosthetic rehabilitation of a partially edentulous patient with a telescopic overdenture for the mandible and complete denture for the maxilla. PMID:24124317
Goswami, Roma; Mahajan, Puneet; Siwach, Amit; Gupta, Ankur
An accelerated technique for casting a direct-pattern post and core restoration for use in fixed prosthodontics has been previously described. Similar techniques for use in removable prosthodontics show potential for clinical use, specifically for the fabrication of radicular stud overdenture attachments and their corresponding copings. The procedure uses a chairside technique and readily available components to fabricate a direct, acrylic resin pattern combining the elements of a cast coping with a fixed radicular attachment. This pattern can subsequently be invested, cast, finished and polished, luted, and attached to the removable prosthesis in a single clinical appointment. PMID:22024184
Scherer, Michael D; Campagni, Wayne V
Bifid mandibular canal is a rare anatomical variation that can be of considerable interest to a dentist. This condition can lead to complications when performing mandibular anesthesia or during surgery of the lower third molar, orthognatic or reconstructive mandibular surgery, or placement of dental implants and prosthesis; bleeding and traumatic neuroma are possible complications. Therefore, awareness of this condition is important. We report two cases of bilateral bifid mandibular canal: one in a 22-year-old male and the other in a 24-year-old female. PMID:19553729
Karamifar, Kasra; Shahidi, Shoaleh; Tondari, Afsoon
Demonstrates technical variations which are utilized in adapting the usual laboratory procedures for the fabrication of an overdenture. Also, the use of pressure indicator paste is shown to obtain equalized contacts at the time of delivery. Explains oral ...
Condylar hyperplasia is a rare non-neoplastic pathology associated with overgrowth of the mandibular condyle. Presentation of condylar hyperplasia with bifid mandibular condyle has never been reported in literature. Early management of the hyperplastic disorders of the mandibular condyle can prevent occlusal canting and developing asymmetric deformities. We report a case of 'Bifid Hyperplastic Mandibular Condyle' in a 14-year-old male with emphasis on early surgical intervention. To best of our knowledge, the present case is the first reported case of bifid mandibular condyle with condylar hyperplasia and 66th reported case of bifid mandibular condyle in living human population. PMID:24431890
Neelakandan, R S; Bhargava, Darpan
A replica of an atrophied mandible was constructed in which two Brånemark implants were embedded to simulate osseointegration. Ferromagnetic keepers were then attached to the implants. A complete overdenture was constructed which had magnets positioned directly over the keepers. The denture was then subjected to different loads and the stresses were photographically recorded. The denture was also tested for its retention capabilities. Because of the equitable stress distribution with the absence of high foci of concentration, a magnetically-retained overdenture with osseointegrated supports lends itself well as a prosthetic replacement. In addition, the magnets exhibit sufficient retention without unduly loading the implants or residual ridge. It may be concluded that in a similar in vivo situation, magnets could be an alternative to other attachment systems; however, there are many variables to be considered on an individual patient basis. PMID:3054071
Highton, R; Caputo, A A; Kinni, M; Matyas, J
The aim of the study was to describe an unusual method to stabilize the surgical template during the treatment of a severely resorbed edentulous mandible by means of computer-guided implant surgery. Pre-operative computer-based planning revealed the difficulty to stabilize the surgical template in a 67-year-old healthy woman. A deviation of the original NobelGuide™ protocol was performed to ensure the stability of the surgical template: four anchor pins were used to stabilize the surgical template, two in the buccal side of the anterior template and two unusual pins were placed in the lingual site. Four straight TiUnite® Nobel Biocare™ implants were then placed, according to a modified All-on-4™ concept procedure, to avoid graft procedures and to reduce the cumulative chair-side treatment time and costs. A temporary restoration was placed immediately after implant placement. Three months later a definitive, full acrylic restoration was delivered. PMID:22669061
Pozzi, A; Tallarico, M; Barlattani, A
This case demonstrates a pragmatic, yet systematic, team approach to resolving a challenging clinical situation. It is essential to understand and accept the challenges presented and limitations of the treatment options available in the provision of an MIO. The dental surgeon and clinical dental technician collaborated using their combined skills set. Working as a team gives each clinician a greater appreciation of the difficulties faced clinically and technically. We believe that an enhanced standard of care is delivered to patients by using this team approach. PMID:23726494
Parker, Craig; Hughes, Jonathan
This study evaluated retention force and fatigue resistance of two overdenture attachment systems. Twenty samples (O-ring and Bar-Clip) from two manufacturers (Conexão Sistemas de Prótese and Lifecore Biomedical) were prepared and divided into four groups: (i) Conexão/O-ring; (ii) Conexão/Bar-Clip; (iii) Lifecore/O-ring and (iv) Lifecore/Bar-Clip, with five samples in each group. They were submitted to mechanical fatigue test using a servohydraulic machine performing 5500 cycles of insertion and removal (f=0.8 Hz), immersed in artificial saliva. Retention force values were obtained three times (0, 3000 and after 5500 cycles) simulating the clinical service, using a tensile strength at 1 mm min(-1) and load cell of 1 kN. Data were analysed with analysis of variance and Tukey's test at 5% level. Results showed that Conexão/Bar-Clip specimens had significantly higher retention values than Lifecore/Bar-Clip (44.61 and 18.44 N, respectively), Conexão/O-ring specimens had significantly lower values than Lifecore/O-ring (13.91 and 19.75 N, respectively). Conexão/Bar-Clip values were always significantly higher than those of Conexão/O-ring group (44.61 and 13.91 N, respectively). Lifecore (O-ring and Bar-Clip) presented similar values (19.75 and 18.44 N, respectively). The systems evaluated showed satisfactory retention force values, before and after fatigue testing. Conexão/Bar-Clip specimens presented the highest values. A 5-year simulation of insertion and removal did not decrease retention values or fracture components. PMID:15369470
Botega, D M; Mesquita, M F; Henriques, G E P; Vaz, L G
Several treatment options with implants have been described for maxillary edentulous patients. Maxillary implant-supported overdentures have been shown to be a predictable, accepted treatment option for the edentulous maxilla. Patients with severe bone resorption present additional difficulties, and implant treatment in the atrophic maxilla represents a challenge. Anatomical limitations and patient desires in this case have forced the treatment to be 4 angulated implants supporting an upper overdenture. Since conventional single-retention mechanisms such as ball (O-ring), locator, or telescopes would transfer too much force to the implants, especially because of their angulation, an individual bar was fabricated. One-year follow-up of the case showed a stable peri-implant condition on bone as well as soft tissue level. Although further follow-up and higher case numbers will give more information about this treatment modality, the actual result is encouraging and can be recommended for similar cases. PMID:18390243
This study evaluated the influence of cross-section geometry of the bar framework on the distribution of static stresses in an overdenture-retaining bar system simulating horizontal misfit and bone loss. Three-dimensional FE models were created including two titanium implants and three cross-section geometries (circular, ovoid or Hader) of bar framework placed in the anterior part of a severely resorbed jaw. One model with 1.4-mm vertical loss of the peri-implant tissue was also created. The models set were exported to mechanical simulation software, where horizontal displacement (10, 50 or 100 ?m) was applied simulating the settling of the framework, which suffered shrinkage during the laboratory procedures. The bar material used for the bar framework was a cobalt--chromium alloy. For evaluation of bone loss effect, only the 50-?m horizontal misfit was simulated. Data were qualitatively and quantitatively evaluated using von Mises stress for the mechanical part and maximum principal stress and ?-strain for peri-implant bone tissue given by the software. Stresses were concentrated along the bar and in the join between the bar and cylinder. In the peri-implant bone tissue, the ?-strain was higher in the cervical third. Higher stress levels and ?-strain were found for the models using the Hader bar. The bone loss simulated presented considerable increase on maximum principal stresses and ?-strain in the peri-implant bone tissue. In addition, for the amplification of the horizontal misfit, the higher complexity of the bar cross-section geometry and bone loss increases the levels of static stresses in the peri-implant bone tissue. PMID:23791086
Spazzin, Aloísio Oro; Costa, Ana Rosa; Correr, Américo Bortolazzo; Consani, Rafael Leonardo Xediek; Correr-Sobrinho, Lourenço; dos Santos, Mateus Bertolini Fernandes
Median cleft of lower lip and mandible is a rare congenital anomaly described as cleft number 30 of Tessier's classification. In minor forms only lower lip cleft is seen. We report the case of a patient with median cleft of lower lip, severe ankyloglossia, cleft of mandibular symphysis, and residual cleft involving on right soft palate and associated with other facial clefts. These deformities were corrected in multiple stage procedure, consisting of release of the tongue from floor of the mouth and lower alveolus and fixation of the mandibular cleft done with right iliac bone graft using stainless steel miniplate. PMID:24711928
Guttikonda, Leela Krishna; Nadella, Koteswara Rao; Uppaluru, Vijayalakshmi; Kodali, Rama Mohan; Nallamothu, Ranganadh
Median cleft of lower lip and mandible is a rare congenital anomaly described as cleft number 30 of Tessier's classification. In minor forms only lower lip cleft is seen. We report the case of a patient with median cleft of lower lip, severe ankyloglossia, cleft of mandibular symphysis, and residual cleft involving on right soft palate and associated with other facial clefts. These deformities were corrected in multiple stage procedure, consisting of release of the tongue from floor of the mouth and lower alveolus and fixation of the mandibular cleft done with right iliac bone graft using stainless steel miniplate.
Guttikonda, Leela Krishna; Nadella, Koteswara Rao; Uppaluru, Vijayalakshmi; Kodali, Rama Mohan; Nallamothu, Ranganadh
The purpose of this paper is to present the first case of unusual reverse oblique (110 degrees to midsagittal plane) migration of mandibular right canine crossing the jaw midline and piercing the lower border of the mandible at the level of the opposite canine and also to report two more cases of transmigrated mandibular canine and one case of transmigrating mandibular canine. Mandibular canines are “cornerstone” of dental arch; their importance is manifested by their efficiency in masticatory function, stability of dental arch, and aid in maintaining natural facial expression. Early detection of this anomaly can help preserving these canines by orthodontic intervention or by surgical transplantation. This developmental anomaly is properly diagnosed by radiographic evaluation, which is primarily based on the panoramic radiograph. In patients with overretained deciduous canines or missing permanent canines, an intraoral radiograph should be supplemented with panoramic radiograph. This paper discusses the importance of early diagnosis of canine transmigration in treatment planning and reviews the various possible treatment options.
Umashree, N.; Kumar, Avinash; Nagaraj, Tejavathi
Mandibular motion along three axes is measured by three motion transducers on floating yoke that rests against mandible. System includes electronics to provide variety of outputs for data display and processing. Head frame is strapped to test subject's skull to provide fixed point of reference for transducers.
Dimeff, J.; Rositano, S.; Taylor, R. C.
This study reviews the literature regarding the factors contributing to failures of dental implants. An electronic search was undertaken including papers from 2004 onwards. The titles and abstracts from these results were read to identify studies within the selection criteria. All reference lists of the selected studies were then hand-searched, this time without time restrictions. A narrative review discussed some findings from the first two parts where separate data from non-comparative studies may have indicated conclusions different from those possible to draw in the systematic analysis. It may be suggested that the following situations are correlated to increase the implant failure rate: a low insertion torque of implants that are planned to be immediately or early loaded, inexperienced surgeons inserting the implants, implant insertion in the maxilla, implant insertion in the posterior region of the jaws, implants in heavy smokers, implant insertion in bone qualities type III and IV, implant insertion in places with small bone volumes, use of shorter length implants, greater number of implants placed per patient, lack of initial implant stability, use of cylindrical (non-threaded) implants and prosthetic rehabilitation with implant-supported overdentures. Moreover, it may be suggested that the following situations may be correlated with an increase in the implant failure rate: use of the non-submerged technique, immediate loading, implant insertion in fresh extraction sockets, smaller diameter implants. Some recently published studies suggest that modern, moderately rough implants may present with similar results irrespective if placed in maxillas, in smoking patients or using only short implants. PMID:24612346
Chrcanovic, B R; Albrektsson, T; Wennerberg, A
Implants have been designed to provide edentulous patients with fixed prostheses or overdentures. Recently, implant-supported fixed partial prostheses and single crowns have become successful treatment alternatives to removable and fixed partial dentures. However, few researchers have examined "removable partial dentures on implants and natural teeth". In this article, we report two patients fitted with "removable partial dentures on implants and natural teeth". The patients were satisfied with their dentures in terms of function and aesthetics. Regular follow-up visits revealed that the periodontal and peri-implant conditions were stable. There was no evidence of excessive intrusion or mobility of the teeth, nor were any visible changes in the bone levels of the natural teeth or implants noted on radiographs. Since the average duration of observation was about 38 months, further follow-up examinations are necessary to determine whether these dentures remain stable long-term. PMID:17760280
Chang, Li-Ching; Wang, Jen-Chyan; Tasi, Chi-Cheng
It has been suggested that the provision of dental implants can improve the oral function of subjects with severely resorbed mandibles, possibly restoring function to the level experienced by satisfied wearers of conventional complete dentures. Nevertheless, a quantitative comparison has never been made and can be drawn from the literature only with difficulty, since studies differ greatly in methodology. To
F. A. Fontijn-Tekamp; A. P. Slagter; A. Van Der Bilt; M. A. Van'T Hof; D. J. Witter; W. Kalk; J. A. Jansen
Cross-talk between cells and cytokines in peri-implant tissue is largely unknown. The immune response in the gingival mucosa appears to favor implant integration over rejection, since titanium-implant-retained overdentures show long-term success. This study evaluates pro-inflammatory (interleukin [IL]-2, interferon [IFN]-gamma, IL-12) and anti-inflammatory (IL-4, IL-10, transforming growth factor [TGF]-beta1) cytokine mRNA expression and tissue morphometry in peri-implant soft tissue from patients before and during treatment with Brånemark titanium implants. Immediately after treatment with endosseous implant and overdenture, TGF-beta1 mRNA increased in peri-implant mucosa specimens; transcript accumulation for IL-10 was elevated at 4 months and decreased dramatically thereafter. Transcripts for IL-2, IFN-gamma, IL-12, and IL-4 were absent. Healthy osseointegrated implants showed no histological inflammation in most patients. These findings suggest that newly classified TGF-beta and/or IL-10 secreting T regulatory (r)/T helper (h)-3 cells may populate implant insertion sites. PMID:12766193
Schierano, G; Bellone, G; Cassarino, E; Pagano, M; Preti, G; Emanuelli, G
Ectodermal dysplasia is a hereditary disorder of ectodermal origin. A 12-year-old boy was referred for management of the oral manifestations of his ectodermal dysplasia. An overdenture retained by natural teeth for the maxilla and a double-crown-retained denture for the mandible were made. Double-crown-retained dentures may be modified into complete dentures if the abutment teeth are lost. The patient was instructed to maintain oral hygiene and return periodically for follow-up visits. This report describes a potential routine approach to restoring the appearance, function, and psyche of a growing boy with ectodermal dysplasia. PMID:21465010
Pae, Ahran; Kim, Kyu; Kim, Hyeong-Seob; Kwon, Kung-Rock
Objective To compare outcomes following osteocutaneous radial forearm and fibula free flap reconstruction of lateral mandibular defects. Study Design Retrospective case controlled study. Setting Two academic tertiary care centers. Subjects and Methods Patients who underwent free flap reconstruction of lateral mandibular defects from 1999 to 2010 were classified into four groups based on type of reconstruction: 1) radial forearm swing (n = 8), 2) radial forearm with bar (n = 5), 3) osteocutaneous radial forearm (n = 73) and 4) fibula free flap reconstruction (n = 51). Patient characteristics, length of hospital stay, recipient and donor site complications, and long term outcomes including postoperative diet were evaluated. Results The majority of patients were male (67%) and presented with advanced T-stage (73%) squamous cell carcinoma (93%) involving the alveolus (26%) retromolar trigone (21%) or oral tongue (25%). Median length of hospital stay was 8 days (range 4–22). The recipient site complication rate approached 34% and included infection (n=11), mandibular malunion (n=9), exposed bone or mandibular plates (n=11) and flap failure (n=5). Most patients demonstrated little to no trismus following reconstruction (81%) and were able to resume a regular or edentulous diet (61%). No difference in complication rates or postoperative outcomes was seen between osteocutaneous radial forearm and fibula free flap groups (P > 0.05). One patient underwent dental implantation following osteocutaneous radial forearm free flap reconstruction. No patients from the fibula free flap group underwent dental implantation. Conclusion The osteocutaneous radial forearm and fibula free flap provide equivalent wound healing and functional outcomes in patients undergoing lateral mandibular defect reconstruction.
Dean, Nichole R.; Wax, Mark K.; Virgin, Frank W.; Magnuson, J. Scott; Carroll, William R.; Rosenthal, Eben L.
This study aims to identify dental students' perceptions of pre-patient care laboratory exercises (PCLEs) and clinical experiences that influence their future plans for providing implant care. One of two questionnaires was administered to dental student classes at one dental school (D2: Survey 1; D3 and D4: Survey 2). Future plans as graduates to provide implant diagnosis and treatment planning (DxTP), restoration of single-tooth implants (STIs), and implant-retained overdentures (IODs) were cross-sectionally assessed along with potential influences such as PCLE, clinical experiences, gender, and class. The majority of students planned to provide implant services after graduation (DxTP 68.9 percent; STI 61.2 percent; IOD 62.1 percent). Bivariately, males reflected more preparedness from PCLEs than females (p=.002) and the D2 students more than D3 and D4 students (p<.001). Multivariate models revealed the perceived preparedness from PCLEs generally had the strongest association with future plans for performing implant therapy. However, this varied by gender and class. These findings indicate that PCLEs are important for their influence on students' future plans to provide implant therapy. However, further studies are needed to validate actual PCLEs and clinical implant practices (both longitudinally and for other schools) and to determine educational interventions to optimize the provision of implant care. PMID:21642520
Yuan, Judy Chia-Chun; Kaste, Linda M; Lee, Damian J; Harlow, Rand F; Knoernschild, Kent L; Campbell, Stephen D; Sukotjo, Cortino
Orthodontic treatment for adults can be difficult because they often have several problems, including some associated with aging. This article reports the successful use of miniscrews to treat a 51-year-old woman with Class III malocclusion, unstable occlusion, periodontal disease, and temporomandibular disorder. The patient had a skeletal Class III jaw-base relationship, anterior and unilateral posterior crossbites, and a deviated midline. It was therefore necessary to confirm her mandibular position with a stabilization splint. Miniscrews were implanted in the retromolar area and used to move the mandibular teeth en masse distally. After orthodontic treatment, the mandibular molars and anterior teeth were moved distally, and the patient had a stable occlusion. Acceptable occlusion and periodontal health were maintained after 1 year of retention. Our results suggest that miniscrews are useful for en-masse distal movement of mandibular teeth in aging patients. PMID:18174080
Sugawara, Yasuyo; Kuroda, Shingo; Tamamura, Nagato; Takano-Yamamoto, Teruko
The provision of an implant-retained overdenture with two implants in the canine regions is a well established treatment modality. Assessment of the form of the anterior mandible is essential in order to avoid surgical complications. Cross-sectional imaging gives ideal images but has radiation and economic costs. A panoramic radiograph supplemented by a lateral cephalometric radiograph is commonly used in these cases, but the latter is not widely available in dental practices. A transymphyseal radiographic technique is presented, using equipment and materials readily available in general dental practice, which may be used as an alternative to the lateral cephalometric radiograph. PMID:19192691
Shelley, Andrew; Horner, Keith
Today's dentistry should aim at minimizing cost, simplifying techniques, allowing procedural revi sions and finally at facilitating corrections and repairs. The development of direct or indirect light-cured composite resin copings, coupled with ball attachments (Dalbo-Rotex according to Brunner) and a suprastructure which is veneered by means of light-cured composite or acrylic resin, may offer a cost-effective perio-overdenture without compromising on periodontal health and providing optimal esthetics. Since July 2003, eighteen new perio-overdentures with a total of 70 copings made of light-cured microhybrid composite resin were delivered. The aim of this article is to discuss the technical aspects and preliminary results regarding this technique. PMID:17078514
Germanier, Philippe; Ernst, Bruna; Palla, Sandro
The mandibular canal transmits the inferior alveolar artery, vein and the inferior alveolar nerve. From an embryological perspective, there might be three inferior dental nerves innervating three groups of mandibular teeth. During rapid prenatal growth and remodeling in the ramus region there is spread of intramembranous ossification that eventually forms the mandibular canal. Occurrence of bifid/trifid mandibular canals in some patients is secondary to incomplete fusion of these three nerves. Various types of bifid mandibular canals have been classified according to anatomical location and configuration. This case report highlights an unusual variant of the mandibular canal. PMID:18197857
Wadhwani, P; Mathur, R M; Kohli, M; Sahu, R
Mandibular growth was studied in 36 human fetuses (both sexes) ranging from 13 to 37 weeks of gestation by bivariate and multivariate analyses (bivariate allometry and principal components analysis, PCA). Several mandibular dimensions were measured and correlated with fetal weight. Considering the different mandibular dimensions in sequence of increasing component weights, PCA agreed with bivariate analysis. No mandibular dimension was
Carlos Alberto Mandarim-de-Lacerda; Maria Urania Alves
The morphology of the mandibular torus was examined, and comparisons were made between a Medieval Norse skeletal population from Greenland and a 14th to 17th century Greenland Eskimo skeletal series. Three parameters were analyzed: degree of development (on a 4-point scale), position and length, and surface morphology according to the number of knobs, or lobuli. It was found that the Eskimos have a high frequency of weakly developed tori and no cases of the extreme development, while over 20% of the Norsemen had tori in the "extreme" category. The Norse torus was generally found to be longer than that of the Eskimos, and both groups exhibited a slight asymmetry between the sides, the torus on the left side tending to be longer and more forward in position than the right. A great difference was found in surface morphology. The Norse torus is in general very irregular, while the Eskimo torus is rather smooth. These differences are believed to be genetically determined. PMID:7468791
Sellevold, B J
Aggressive juvenile fibromatosis of the jawbones is a rare tumor presenting as infiltrative mass with unpredictable evolution. We report herein a 17-year-old student with a 6-month history of radiologically proven resorption of a part of the mandible, lingual displacement of tooth 34 and malocclusion. Alveolar ridge resorption and three dark-brown foci in the bone were seen after the tooth was extracted. Histological study showed the tumor tissue to have a bundle-like structure; immunohistochemically it was positive for vimentin, smooth muscle actin, beta-catenin, Ki-67 (5%), and negative for desmin and cytokeratin 34bE12. The golden standard in the diagnostics of desmoid fibromatoses is the nuclear or membrane expression of beta-catenin, which is found in 90% of the cases. Differential diagnosis include mandibular fibroma, well-differentiated fibrosarcoma, fibrosing histiocytoma, and infiltration from adjacent soft-tissue tumor. Aggressive juvenile fibromatosis should be managed by radical excision. Local recurrences are not rare, but metastases do not develop. In rare cases this type of fibromatosis has been known to regress spontaneously. Aggressive fibromatosis is a diagnostic challenge, since it remains in the grey zone between benign and malignant lesions of the oral cavity. PMID:24712289
Ivanov, Georgi P; Atanasov, Dimitar T; Anavi, Beniamin L
The objective of this case report is to help clinicians identify bifid mandibular canals on panoramic radiographs and subsequently use the information in the modification of dental treatment planning. A 45-year old man was referred to the service of Oral Diagnosis and Radiology. Routine panoramic radiography, suggested the presence of bilateral bifid mandibular canals (BMC). Mandibular computed tomography revealed a clear view of bilateral mandibular canals. BMC can be detected on a panoramic radiograph. PMID:19218898
Miloglu, Ozkan; Yilmaz, Ahmet Berhan; Caglayan, Fatma
Pre-eruptive migration of a tooth across the midline is termed as transmigration. It is believed that transmigration is rare and unique to the mandibular permanent canines, and even more rarely reported for others. Transmigration is a phenomenon of yet unknown etiology. It follows the direction of its long axis, with the crown leading the migration. The tendency of a canine to cross the barrier of mandibular midline suture is a more important consideration than the distance of migration after crossing the midline. Here we present one new case of aberrantly positioned right mandibular canine which has undergone migration and was accidently found on radiological examination before orthodontic treatment. Once diagnosed an aberrantly positioned impacted canine requires surgical removal.
Bahl, Rashi; Singla, Jeetinder; Gupta, Mohita; Malhotra, Ankit
To determine how many 55-year-old edentulous subjects were suitable candidates for implant-retained overdentures of fixed implant bridges and how many of them might be interested in such treatment, case histories were reviewed, and clinical and radiologic examinations were performed on 146 subjects (100 women, 46 men) in a medium-sized city in northern Finland. Numbers and lengths of implants required in altogether 16 regions in the upper and lower jaw were evaluated. The commonest implant length was 8 mm in the upper jaw and 16 mm in the lower jaw. Construction of an implant-retained fixed bridge would have been possible in the upper jaw in 121 subjects (83%) and of an overdenture in all lower jaws. Information about the benefits of the treatment is important because, although the percentage of subjects who were suitable candidates for implant-retained prostheses was high, few subjects were aware of or interested in this type of treatment. PMID:8184676
Salonen, M A; Oikarinen, K S; Raustia, A M; Knuuttila, M; Virtanen, K K
This article describes the treatment of a 61-year-old man who had a completely edentulous maxillary arch and partially edentulous mandibular arch. The patient was orthodontically treated to correct an anterior crossbite by distalization of the mandibular teeth using a removable prosthesis serving as an anchorage unit. Subsequently, the patient received two zygomatic implants, five conventional implants in the maxillary arch, and six conventional implants in the mandibular arch. By the end of treatment, the convexity of the facial profile improved, and esthetic and functional occlusion was established. PMID:23551750
Farret, Milton M B; Farret, Marcel Marchiori; Carlesso, Jhosué; Carlesso, Oscar
Forty-one complete mandibular subperiosteal implant-supported and retained dentures were consecutively inserted between 1952 and 1971, and patients were monitored through 1992. After variables and methods of follow-up were described, the implants were divided into three categories: 14 (34%) nonfunctional implants, 9 (22%) functioning implants, and 18 (44%) functional implants prematurely terminated by death or cause unrelated to implant condition. Five percent of the implants failed by 5 years, 22% failed by 10 years, 34% failed by 20 years, and none failed after 20 years. Nine implants were still functioning 21 to 36 years after insertion, of which five were functioning for more than 30 years. The implants that were developed later were notably superior to earlier implants. The results of this review could be interpreted to suggest consideration of mandibular subperiosteal implants for selected patients, particularly those with resorbed mandibles. PMID:8850449
Bodine, R L; Yanase, R T; Bodine, A
The aim of this study was to present and evaluate a modified technique to inferior alveolar nerve lateralization (IANL) that allows the placement of longer implants in the posterior mandibular region. One hundred and forty-three consecutive patients were enrolled in this study; these patients had between 1.8 and 8mm residual crestal height above the mandibular canal. Vertical splitting of the mandibular body was performed using piezoelectric surgery followed by bone expansion and insertion of special conical implants of 10 and/or 12mm in length. Two hundred and sixty-nine osteotomies were performed and 636 implants were inserted, with a survival rate of 99% at the end of 12 months. Immediately postoperative there was an alteration of sensation in the lip/chin area in 8.5% of cases; 4.1% regained full sensation within 10-14 days, 2.6% after 8 weeks, and 0.7% had persistent paresthesia that did not affect their daily activities. Progressively increasing pain and numbness was present in 1.1%; the implants were removed 6 months postoperatively. This is a relatively simple procedure that has no limitations in clinical situations with minimal bone height. It allows for greater implant stability, and the risk of neurological disturbance is minimal. PMID:23769148
Rodriguez, J G; Eldibany, R M
Bone continuity defects in the mandible are caused by tumor surgery, trauma, infection, or osteoradionecrosis. Today, reconstruction of long-span mandibular defects with a free fibular flap is a routine procedure. However the bone height of the mandible after reconstruction is about half that of the dentulous mandible. Therefore, the deficiency in bone height makes implant placement impractical. In our case, because it was necessary to restore the mandibular height, a vertical distraction osteogenesis was performed on the grafted mandible of the patient who was referred to our clinic with a reconstructed mandible owing to a gunshot injury. As a result, the vertical discrepancy between the fibula and the native hemimandible of the patient was corrected. And the placement of dental implants was performed without any complications. In conclusion, we believe that the vertical distraction osteogenesis of free vascularized fibula flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation. PMID:16997100
Ortakoglu, Kerim; Suer, Berkay Tolga; Ozyigit, Aykut; Ozen, Tuncer; Sencimen, Metin
The aim of this paper is to present a new approach to bone regeneration in a patient with multiple recurrent ameloblastoma of the left mandibular angle. Through an extraoral approach, complete resection of the tumor was achieved. Bone marrow aspirate from the iliac crest was centrifuged to concentrate the mesenchymal cellular fraction. Based on a stereolithographic cast, titanium mesh was bent preoperatively to accurately reconstruct the mandibular angle. The mesh was filled with two blocks of xenogenic material mixed with recombinant bone morphogenetic protein 7 (BMP-7) and stem cells. Nine months later, three endosseous implants were placed in the regenerated bone to restore the patient's masticatory function. At this time, bone samples were obtained for histomorphometric analysis. New bone formation was confirmed around the particles of xenograft material. The results indicate that adequate esthetics and function may be achieved with bone marrow aspirate seeded on a scaffold obtained from bovine xenograft blocks and BMP-7. This technique attains new bone formation with sufficient quantity and quality to allow for implant placement, with decreased patient morbidity and surgical time compared to conventional reconstructive methods. PMID:22408782
Hernández-Alfaro, Federico; Ruiz-Magaz, Vanessa; Chatakun, Punjamun; Guijarro-Martínez, Raquel
...2009-04-01 2009-04-01 false Mandibular condyle prosthesis. 872.3960 ...Prosthetic Devices Â§ 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device...
...2010-04-01 2010-04-01 false Mandibular condyle prosthesis. 872.3960 ...Prosthetic Devices Â§ 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device...
Full-thickness periosteal flap elevation for implant placement is often accompanied by potential marginal bone loss and/or soft tissue recession around the implant due to compromised blood supply to underlying bone. To preserve the blood supply to underlying bone, implants can be placed with a flapless surgical procedure. This procedure also provides numerous other benefits, such as decreased trauma, short recovery time, less pain, reduced rate of infection, and improved patient compliance. This report presents a case of flapless implant placement in the mandibular posterior region that achieved optimum results and caused minimal discomfort to the patient. The advantages and limitations of this procedure are also discussed. PMID:24914919
Jain, Deshraj; Gaur, Ghanshyam
Australopithecus robustus has a distinct mandibular anatomy, with a broad and deep corpus and a tall, relatively upright ramus. How this anatomy arose through development is unknown, as gross mandibular size and shape change have not been thoroughly examined quantitatively in this species. Herein, I investigate A. robustus mandibular growth by comparing its ontogenetic series with a sample of recent humans, examining age-related size variation in 28 linear measurements. Resampling is used to compare the amount of proportional size change occurring between tooth eruption stages in the small and fragmentary A. robustus sample, with that of a more complete human skeletal population. Ontogenetic allometry of corpus robusticity is also assessed with least squares regression. Results show that nearly all measurements experience greater average increase in A. robustus than in humans. Most notably, A. robustus corpus breadth undergoes a spurt of growth before eruption of M1 , likely due in part to delayed resorption of the ramus root on the lateral corpus. Between the occlusion of M1 and M2 , nearly all dimensions experience greater proportional size change in A. robustus. Nested resampling analysis affirms that this pattern of growth differences between species is biologically significant, and not a mere byproduct of the fossil sample size. Some species differences are likely a function of postcanine megadontia in A. robustus, although the causes of other differences are less clear. This study demonstrates an important role of the postnatal period for mandibular shape development in this species. Am J Phys Anthropol 154:436-446, 2014. © 2014 Wiley Periodicals, Inc. PMID:24820665
Purpose: This study compared mandibular and condylar mobility after open or closed treatment for fractures of the mandibular condylar process.Patients and Methods: One hundred thirty-six patients (111 male, 25 female), 74 treated by closed and 62 by open methods, were included in this study. They underwent testing of mandibular and condyle mobility at 6 weeks, 6 months, and 1, 2,
Celso Palmieri; Edward Ellis; Gaylord Throckmorton
To test whether the mandible opens more during deep sleep and whether the mandibular position is affected by body position during sleep, the vertical mandibular position was recorded intraorally using a magnet sensor at the same time as a standard sleep study in seven normal healthy male adults. Measurements were recorded during the period before sleep onset (WAKE) and during
K. Miyamoto; M. M. Özbek; A. A. Lowe; T. T. Sjöholm; L. L. Love; J. A. Fleetham; C. F. Ryan
BACKGROUND Mandibular displacement is a common complication of condylar fracture. In the mandibular displacement due to condylar fracture, it is difficult to restore both esthetics and function without using orthognathic surgery. CASE DESCRIPTION This clinical report described a full mouth rehabilitation in the patient with bilateral condylar fractures and displaced mandible using bilateral sagittal split ramus osteotomy (BSSRO) and simultaneous dental implant surgery. Mandibular position was determined by model surgery through the diagnostic wax up and restoration of fractured teeth. The precise amount of the mandibular shift can be obtained from the ideal intercuspation of remaining teeth. CLINICAL IMPLICATION Mandibular displacement by both condylar fractures can be successfully treated by orthognathic surgery. Determination of occlusal plane and visualization from diagnostic wax up are mandatory for mandibular repositioning of model surgery. Stable occlusion and regular recall check up are needed for long-term outcome.
Park, Jee-Youn; Ahn, Kang-Min; Lee, Joo-Hee
After studying this article, the reader will be able to: (1) review the incidence and etiology of mandibular angle fractures; (2) gain an understanding of patient evaluation and general management principles; and (3) discuss indications and available techniques for management of mandibular angle fractures. Angle fractures represent the highest percentage of mandibular fractures. Two of the most common causes of mandibular angle fractures are motor vehicle accidents and assaults or altercations. With any patient who has sustained facial trauma, a thorough history and comprehensive physical examination centering on the head and neck region as well as proper radiological assessment are essential. These elements are fundamental in establishing a diagnosis and developing an appropriate treatment plan for any mandibular fracture.
Perez, Ramiro; Oeltjen, John C.; Thaller, Seth R.
The titanium mandibular modular endoprosthesis fixed with polymethylmethacrylate cement in the medullary space of the mandible has been introduced in previous studies. However, the internal parts of these devices have been found to be prone to loosening and wound dehiscence. The current study introduces a newly designed bioactive-coated cementless modular mandibular endoprosthesis, which was used for reconstruction in Macaca fascicularis. The devices were coated with hydroxyapatite (HA) and hydroxyapatite/bioglass (HA/BG) and implanted in unilateral mandibular segmental defects in nine monkeys for 6 months. Biomechanical testing found the reconstructed mandible to have a mean stiffness value of 110.43N/mm. Histologically, there were both fibrous capsule and woven bone around the device body, and histomorphology analysis showed 64.17% bone contact to device stem surface. The percentage bone volume calculated from micro-computed tomography analysis around the stem surface was found to be superior to that reported in previous studies of cemented mandibular endoprostheses. Intermodular connection screw loosening has also been resolved with the dovetail interconnection. In conclusion, the current bioactive-coated cementless mandibular endoprosthesis is feasible for use in mandibular segmental reconstruction. However, insufficient load-bearing capability and a high rate of intraoral wound dehiscence were found in the majority of the study animals. Further device modifications and improvements in the surgical technique need to be addressed in future studies. PMID:24507820
Chanchareonsook, N; Tideman, H; Lee, S; Hollister, S J; Flanagan, C; Jansen, J A
This case report describes the treatment of an adolescent girl with a skeletal Class II Division 2 malocclusion and impinging overbite. One of 2 previously extracted premolars had to be replaced by a single-tooth implant after adequate space reopening. An optimal overbite-overjet relationship was achieved through significant intrusion and proclination of maxillary and mandibular incisors. A horizontally impacted mandibular second
Loss of sensation in the lip after insertion of an implant is annoying. The aim of this paper was to describe two techniques for management of osseointegrated dental implants that impinge on the mandibular nerve, the purpose of which is to improve sensation without unscrewing the dental implant. PMID:24814928
Gennaro, Paolo; Chisci, Glauco; Gabriele, Guido; Iannetti, Giorgio
Purpose: A two stage approach of ridge splitting and lateral expansion in the mandible to achieve enough bone width for the purpose of dental implants is presented. Materials and Methods: A total of 13 consecutive patients with 16 long-span edentulous areas of the mandibular ridge were included in this study and 42 dental implants were inserted. Corticotomy of a rectangular buccal segment was carried out followed by 3 weeks of recovery; the mandibular ridge was stretched laterally, leaving the buccal periosteum attached to the lateralized segment. In this modification, there was no need for the use of grafted foreign materials to fill the defect and neither the use of barrier membranes, since it was treated practically as a fresh extraction site. To prevent the undesirable movement of the lateral plate, a small chip (2-3 mm in diameter) of bone spacer was properly fixed. The dental implants were placed 3-5 months later on. Results: Approximately, 86% of the expanded areas were successful in providing an adequate width to accommodate an implant. The average gain in width was 3.22 ± 0.97 mm. All intended implants were inserted. Prosthetic loading with fixed prosthesis was successfully implemented in all cases. Conclusion: This modified technique is a simple and short procedure with satisfactory results and minimal morbidity. Of note, this approach is devoid of foreign materials usage and has a low rate cost, therefore, should be employed more often.
Abu Tair, Jawad A.
Background Bifid mandibular canals (BMC) and trifid mandibular canals (TMC) are variations on the normal anatomy with incidences ranging\\u000a from 0.08% to 65.0%. Such aberrations have an important clinical impact. For example, an extra mandibular canal may explain\\u000a inadequate anesthesia, especially when two mandibular foramina are involved. Furthermore, during mandibular surgery, a second,\\u000a or even third, neurovascular bundle may be damaged
K. Mizbah; N. Gerlach; T. J. Maal; S. J. Bergé; Gert J. Meijer
Phylogenesis, embryology and anatomy are emphasizing that two ligaments are found between the temporo-mandibular joint and the middle ear. These two oto-mandibular ligaments are named the disco-mallear ligament and the malleo-mandibular ligament. Originating from the first arch, these ligaments are not involved in the otologic manifestations of the temporo-mandibular joint syndrome. The disco-mallear ligament is a brake applied to the anterior excursion of the disc. When this disco-mallear ligament is stretched the disc can be displaced anteriorly breeding disc displacement, hypermobility and temporo-mandibular dislocation. The malleo-mandibular ligament is a remainder of the Meckel's cartilage: its role is not clear. When excessive forces are applying on the mandible, ossicles dislocation can be seen the forces being transmitted through it. PMID:9324731
Gola, R; Chossegros, C; Cheynet, F
The influence of masticatory loading stimulus on mandibular development is not fully clear. In this paper, experimental alterations in the daily muscle use, caused by a changed diet consistency, were continuously monitored, while adaptations in bone and cartilage were examined. It is hypothesised that decreased muscular loading will result in a decrease in the growth factor expression and mandible growth. Fourteen 21-day-old Wistar strain male rats were randomly divided into two groups and fed on either a hard or soft diet for 14 weeks. An implanted radio-telemetric device recorded continuously muscle activity of the superficial masseter muscle. Chondroblast proliferation in the condylar cartilage was identified by insulin-like growth factor-1 receptor (IGF-1r) immunostaining. Furthermore, an X-ray was taken for cephalometric analysis. In the soft-diet group, the duty time of the superficial masseter muscle at higher activity levels was significantly lower than that in the hard-diet group. This decrease in muscular loading of the jaw system was accompanied by: a significant reduction in (i) articular cartilage thickness, (ii) expression of IGF-1r immunopositive cells and (iii) mandible ramus height. In conclusion, a decrease in masticatory demand during the growth period leads to insufficient mandibular development. PMID:24702545
Hichijo, N; Kawai, N; Mori, H; Sano, R; Ohnuki, Y; Okumura, S; Langenbach, G E J; Tanaka, E
The bifid mandibular condyle is a rare anomaly. A variety of causes are implicated with its development such as developmental origin and trauma. Because of the lack of epidemiological data, there is little information about the real incidence of this malformation. The purpose of this paper is to report a case of bifid mandibular condyle in a 20-year-old woman who referred to a private radiological clinic for routine dental examination. A panoramic radiography incidentally revealed a discrete modification of the left mandibular condyle. Magnetic resonance imaging (MRI) was taken and confirmed the diagnostic proposed. PMID:16617199
Ramos, Flávia Maria de Moraes; Filho, José Osmar de Vasconcelos; Manzi, Flávio Ricardo; Bóscolo, Frab Norberto; Almeida, Solange Maria de
Children with mandibular growth deficiency may develop airway obstruction. The standard treatment of severe airway obstruction involves invasive procedures such as tracheostomy. Mandibular distraction osteogenesis has been proposed in neonates with mandibular deficiency as a treatment option to avoid tracheostomy procedure later in life. Both tracheostomy and distraction osteogenesis procedures suffer from substantial shortcomings including scarring, unpredictability, and surgical complications. Forward jaw positioning appliances have been also used to enhance mandible growth. However, the effectiveness of these appliances is limited and lacks predictability. Current and future approaches to enhance mandibular growth, both experimental and clinical trials, and their effectiveness are presented and discussed.
PurposeThe aim of this study was to evaluate the effects of different inter-implant distances on stress distribution in the bone around the endosseous titanium implants under vertical, oblique and horizontal loads in the posterior mandibular edentulousim by finite element analysis (3D FEA).
Bar?? ?im?ek; Erkan Erkmen; Dervi? Yilmaz; At?l?m Eser
Ameloblastoma is a locally invasive benign odontogenic tumor with a high rate of recurrence in the long term. The authors conducted a retrospective study of patients with mandibular ameloblastoma in order to evaluate recurrent ameloblastoma management. The study included data from 31 patients over a period of 10 years. Data collected included age, gender, tumor location, histological findings, initial treatment, number of recurrences and year of onset, type of treatment of recurrence, reconstruction and follow-up. Recurrences were detected in nine patients (29%). Tumor recurrences appeared at 32 months on average following the initial surgical procedure. Recurrences were associated mainly to inadequate initial therapeutic approach and were treated by bone resection with a safety margin of at least 1 cm beyond the radiographically visible margins. Immediate reconstruction of bone defects was performed with grafts or free flaps.
INFANTE-COSSIO, PEDRO; PRATS-GOLCZER, VICTORIA; GONZALEZ-PEREZ, LUIS-MIGUEL; BELMONTE-CARO, RODOLFO; MARTINEZ-DE-FUENTES, RAFAEL; TORRES-CARRANZA, EUSEBIO; GACTO-SANCHEZ, PURIFICACION; GOMEZ-CIA, TOMAS
... 11.14 Read More Find a Cosmetic Dentist Teeth Whitening Accredited and General Member Dental Patients ? Cosmetic Procedures ? Dental Implants Dental Implants The ... key benefit of dental implants over other tooth replacement systems is that an implant connects directly ...
Experimental studies on dogs are reported, comparing autologous marrow grafts with surface decalcified allogenic grafts and surface decalcified allogenic grafts with autologous marrow fragments. Findings indicate that mandibular bone grafts composed of a ...
D. B. Osbon G. E. Lilly J. C. Jones P. B. Hackett
Five cases of patients having supernumerary teeth in the distomolar regions of the mandibular and maxillary arches are reported. Supernumerary bicuspids were also seen in three of the five cases. The patients complained of pericoronitis or had no symptoms...
P. S. Grover L. Lorton
An experimental study concerning mechanical behaviour and stability through mandibular osteosynthesis has been carried out. 3 different kinds of mandibular osteosynthesis: figure-of-8 wiring; ASIF--Swiss Association for the Study of Internal Fixation - compression plate; monocortical juxta-alveolar miniature screwed plate (Champy plate), were analysed in photoelastic model experiments. The strain distribution differs remarkably according to these 3 methods as well as stability against loading forces. PMID:3088152
Kárász, I; Köröndi, L; Szabó, G
Purpose: The configuration and degree of corticalization of bifid mandibular canals were examined using medical computed tomography (CT) images from 170 hemimandibles obtained from 308 Taiwanese adults. Materials and Methods: The configurations of the bifid canals were assessed according to their anatomical position in relation to the ramus, molars, premolars, and mental foramen; their course (anterior/posterior or superior/inferior); the presence or absence of confluence with the main mandibular canal; and the presence or absence of penetration through the mandible to form an accessory foramen. The percentage of the canal length that was corticalized was measured. Two different classifications of bifid canals were also briefly summarized and compared. Results: When bifid canals are present (41.2% of patients; 27.6% of hemimandibles), the bifid canals were primarily located in the ramus and retromolar regions (67.7%) running anteriorly (95.9%) and superiorly (95.9%) without confluence with the main mandibular canal (91.1%). Up to 16.5% of bifid canals form accessory foramina on the cortical surface of the mandible. Approximately 78% of the bifid canals have varied degrees of corticalization around the bifid canals. Conclusion: The configuration and course of 170 mandibular bifid canals were evaluated with CT images. The bifid canals were primarily located in the ramus and retromolar regions; however, 32.4% of the bifid canals were located in potential positions for dental implant placement. Most of the bifid canals ran anteriorly superior to the main mandibular canal, did not rejoin with the main mandibular canal, and diminished within the mandibular body. Approximately half of the bifid canals (45%) were completely corticated. PMID:25032769
Shen, E-Chin; Fu, Earl; Fu, Martin Ming-Jen; Peng, Michelle
In a split-mouth design, 6 implants were placed in edentulous mandibular ridges of 10 mongrel dogs after preparation of 6 cylindrical mid-crestal defects, 5 mm in depth and 10 mm in diameter. An implant site was then prepared in the center of each defect ...
W. C. Stentz
Twelve patients were followed for 15 years after treatment with a 12-unit cantilever fixed partial denture on the mandibular canines opposite to a complete maxillary denture. Four constructions failed and had to be removed but four were still in function after 15 years. Four patients died during the observation period still wearing their constructions. Endodontic complications, pulpal necrosis and loss of retention of posts were the most frequent, while caries and periodontal lesions were rare. The maintenance costs over the years were fairly low even compared to maintenance costs for patients treated with implants. Extensive mandibular cantilever fixed partial dentures may be used in the rehabilitation of patients with a very reduced dentition and a history of difficulties adapting to removable dentures. PMID:8667121
Carlson, B R; Yontchev, E
We investigated the reconstruction of a surgically created critical size mandibular defect in sheep using a newly developed automatic distraction device. The device has an implantable component, which is fixed to the mandible to allow the transfer of the transport disc across the created defect, and an external component which is mounted on the activation pump and secured away from the site of bone distraction. Compression of the bellows in the external component causes fluid to be forced through the connecting tube into the distraction component. Distraction at a rate of 1 mm over 24 h was achieved in six sheep. New bone generated at the site of the created defects both anterior (compression side) and posterior (tension side) to the transport disc and had similar radiodensity to the adjacent mandibular bone eight weeks after the completion of distraction. PMID:11601816
Ayoub, A F; Richardson, W; Koppel, D; Thompson, H; Lucas, M; Schwarz, T; Smith, L; Boyd, J
The treatment records of thirty-eight cases of mandibular prognathism treated by orthodontics means only (ORTHO) were evaluated. The pretreatment records of twenty cases of mandibular subapical esteotomy (SUB) and twenty cases of mandibular setback (SET) were evaluated for comparison and contrast with the pretreatment ORTHO records and with each other. Dental, skeletal, and soft-tissue parameters in the vertical and horizontal planes of space were recorded. Statistical analysis of means of parameters of the pretreatment records provided documentation of the discriminant variables in each of the following paired groups: ORTHO-SUB, ORTHO-SET, and SUB-SET. Analysis of the data as indicated above led to the following conclusions: 1. Three discriminant groups of mandibular prognathism of various degrees of severity were discernible when comparisons of treatment categories simulating clinical decisions were made. The ORTHO group was distinguished from the SUB group in the horizontal plane and, more strongly, in the vertical plane. The ORTHO group was distinguished from the SET group in the vertical plane and, more strongly, in the horizontal plane. The SUB group was distinguished from the SET group in the horizontal plane. 2. The physiologic developmental status of the patient should be carefully evaluated. 3. Anteroposterior dysplasias should be assessed relative to the cant of the mandibular plane. True denture base discrepancies can be noted relative to the occlusal plane. 4. Documentation of vertical dysplasias should include measurements of craniofacial divergence (SN-MP, FH-MP, and OP-MP). 5. In assessing the profile evaluation of the patient with mandibular prognathism, particular attention should be focused on facial contour angle (FCA), nasolabial angle (NLA), and relative lower lip protrusion (LLP). 6. Any numerical values obtained in the evaluation of the dental, skeletal, or soft-tissue characteristics of mandibular prognathism should be considered only as descriptive, diagnostic guides and not as components of a diagnostic formula. PMID:266365
Sperry, T P; Speidel, T M; Isaacson, R J; Worms, F W
Experimental investigation of mandibular bone strain in cercopithecine primates has established that the mandible is bent in the transverse plane during the power stroke of mastication. Additional comparative work also supports the assumption that the morphology of the mandibular symphysis is functionally linked to the biomechanics of lateral transverse bending, or "wishboning" of the mandibular corpus. There are currently no experimental data to verify that lateral transverse bending constitutes an important loading regime among hominoid primates. There are, however, allometric models from cercopithecoid primates that allow prediction of scaling patterns in hominoid mandibular dimensions that would be consistent with a mechanical environment that includes wishboning as a significant component. This study uses computed tomography (CT) scans to visualize cortical bone distribution in the anterior corpus of a sample of four genera of extant hominoids. From the cortical bone contours, area properties of the mandibular symphysis are calculated, and these variables are subjected to an allometric analysis to detect whether scaling of jaw dimensions are consistent with a wishboning loading regime. Scaling of the hominoid symphysis recalls patterns observed in cercopithecoid monkeys, which lends indirect support for the hypothesis that wishboning is an integral part of the masticatory loading environment in living apes. Inclination of the symphysis, rather than changes in cross-sectional shape or development of the superior transverse torus, represents a morphological solution for minimizing the potentially harmful effects of wishboning in the jaws of these primates. PMID:11599012
Daegling, D J
The terms "mandibular angle reduction" and "reduction angleplasty" refer to operations to reduce the width of the lower face and change a square face to an oval one. Because the terms emphasize the word angle, however, they imply that the operations apply to the mandibular angle. The most frequent complaint after these operations is that the change in the lateral appearance is clear but that the change in the frontal appearance is not noticeable. Such a result is related to the fact that bone resection is performed mainly in the mandibular angle area and is focused particularly on resection of the posterior projection through curved ostectomy. That is, because operations limited to the mandibular angle area cannot properly satisfy patients' requirements, the operation must be applied to a larger area. Therefore, it seems reasonable to change the terms "mandibular angle reduction" and "reduction angleplasty" to "mandible reduction" and "reduction mandibuloplasty." In addition, the most important technique in the operation is the resection of the outer cortex of the mandible. In particular, the corticectomy technique using a reciprocating saw is quite safe and effective for the maximum resection of lateral flaring within a very short time. PMID:15457047
Jin, Hoon; Kim, Byung Gun
Vertical mandibular posture is thought to be related to narrowing of the upper airway, because mouth opening is associated with an inferior–posterior movement of the mandible and the tongue which influences pharyngeal airway patency. To test whether the mandibular posture is related to the occurrence and\\/or termination of obstructive sleep apnoea (OSA), the vertical mandibular position was recorded intraorally using
Keisuke Miyamoto; M. M. Özbek; Alan A. Lowe; Tommy T. Sjöholm; Leslie L. Love; John A. Fleetham; C. Frank Ryan
To consider the dynamic response of implant bridge caused by occlusion, the deformation of the bridge and the near mandible subjected to occlusional force was measured by holographic interferometry. In the study, the mandibles of Japanese monkeys were used. A screw type ceramic implant was placed in the site of the second molar, when it was about one year since the mandibular first and second molars were extracted. An implant bridge was then fabricated and placed between the implant and the first and second premolars. After the mandibular bone was extracted, double exposure holographic interferograms were recorded under various loads for the mandible. It was found that the stress on the implant bridge concentrated on the mesial of the pontic when the vertical load was applied to the second premolar. This shows that the mandible near the implant receives most of stress and suffers frequent damage such as the bone resorption, when the loads were applied to its mesial side.
Matsumoto, Toshiro; Tamamura, Kentaro; Sugimura, Tadataka; Inada, Joji
Short-length implants should be at a performance disadvantage because of the more limited surface area with which to resist occlusal forces. Nevertheless, anecdotal observations find many short implants performing well in different restorative conditions. This retrospective, multicenter study seeks to compare formally implant performance based on length. The success of 7 and 8.5-mm Osseotite implants (Implant Innovations, Inc., Palm Beach Gardens, FL) was determined as: absence of mobility; no persistent and/or irreversible signs or symptoms of pain, infection, paresthesia, or violation of the mandibular canal; no evidence of peri-implant radiolucency; and no progressive crestal bone loss. Implant location, restoration type, bone density, and smoking status of the patients were recorded. A total of 188 patients received 311 short Osseotite implants that were placed mostly in soft bone and supported 216 partially edentulous cases in the maxilla or mandible. Most restorations (95.2%) are short-span fixed partial dentures placed in the posterior sextants. During 3 years of follow-up, 13 implants failed, yielding a cumulative success rate of 95.8%. In 9 of these cases, failure occurred before prosthetic loading, and in 4, the patient was a smoker. The overall success rate compares favorably with the available literature for the performance of implants in general, and short implants in particular. PMID:16160574
Goené, Ronnie; Bianchesi, Carlo; Hüerzeler, Markus; Del Lupo, Ricardo; Testori, Tiziano; Davarpanah, Mithriadade; Jalbout, Ziad
Bifid mandibular condyle is a rare disorder and little is known about the etiology and pathogenesis. We reported a patient with left bifid mandibular condyle with a history of trauma. There was no limitation of mouth opening but the patient was complaining of pain while chewing. Underdeveloped lateral head of the bifid condyle was excised at the level of condylar neck under general anesthesia. The patient healed without any problem. Microscopic evaluation of the excised condyle supported a congenital etiology. Although most cases of the bifid condyle discovered by chance it should be recognized and treated by plastic surgeons interested in craniomaxillofacial surgery. PMID:17119433
Tunçbilek, Gökhan; Cavdar, Günay; Mavili, M Emin
Endosteal implants fail for a variety of reasons. These include failure to osseointegrate, long-term loss of osseointegration, and invasion of a vital structure or anatomic placement that prohibits its use. This case report describes the removal of an implant because of patient discomfort secondary to invasion of the mandibular canal. These histologic findings offered a unique opportunity to examine an osseointegrated human dental implant section. PMID:9477858
Cranin, A N; Baraoidan, M; DeGrado, J
Background: The aim of this study was to evaluate the clin- ical and radiographic changes in the peri-implant tissues around one-stage implants with different smooth neck portion lengths before and after functional prosthetic loading. Methods: Twelve one-stage implants were placed in adult patients with bilateral edentulous posterior mandibular ridges. The sites were randomly assigned into two groups of six each:
Julio Cesar Joly; Antonio Fernando Martorelli de Lima; Robert Carvalho da Silva
Bifid mandibular condyle (BMC) is a rare asymptomatic morphological alteration with no predilection for age group or gender. Its morphology varies from a shallow groove to two condylar heads with separate necks, oriented mediolaterally or anteroposteriorly. This report describes an unusual case of anteroposterior bifid condyle in a 39-year-old female patient with the main complaint of mouth-opening limitation and a deviation of the mandible to the left side. Magnetic resonance imaging (MRI) findings revealed a bifid condyle on the left side and duplicated mandibular fossa, with the articular disc over the anterior head. The MRI images in the open-mouth position revealed minimal movement of the condyle. Despite the increased number of mediolateral bifid mandibular condyle cases described in the literature, none of previously reported cases of BMC included an anteroposterior bifid condyle case with two distinct mandibular fossa. PMID:22674644
Melo, S L S; Melo, D P; Oenning, A C C; Haiter-Neto, F; Almeida, S M; Campos, P S F
Recent studies and personal experience of the Authors in the field of dental implants have encountered the same fundamental problem which arises with orthopedic prosthesis procedures. The basic problem is that of adhesion between the bone tissue and the metal implant. Chrome-cobalt alloy, Tantalum and Titanium are the metals of most recent use. The Authors therefore proceeded to investigate the behaviour of alveolar bone tissue in the proximity of artificial teeth made of alloy (platinum-gold) covered with ceramic, as used in prosthetic dentistry. The experiment was carried out in a dog and a man. In the dog, two of its mandibular teeth were substituted with the same ceramic-gold implants: the first, a replica of natural tooth, was placed in the socket and held in place by metal splint and mandibular circumferential wirings. The other implant, without a replicated crown, was left free, within the alveolus, without contacting the near or opposing teeth. A solid smooth surfaced alumina device, shaped like a small cylinder, was implanted in the upper femoral epiphysis of the same animal. PMID:1105133
Cini, L; Gasparini, F; Michieli, S; Pizzoferrato, A; Sandrolini-Cortesi, S
During dental rehabilitation of a patient with ICD, an upper telescope retained overdenture with acrylic baseplate and lower cantilever bridges were constructed. In the consultation following the anamnesis and the clinical examination, the cardiologist did not believe antibiotic profilaxis to be necessary, adding that it is advisable to avoid the use of ultrasonic depurator and electrocauter. Nowadays after saving the life the improving of patient's better quality of life is an important aspect. The risk of ICD-implantation is minimal however, not negligible, the patient can pursue a way of life free of limitation. According to the latest trends, the number of ICD-implantations will increase exponentially in the near future, due to the aging of the population, the simplification and safeness of implantation and the increase of patients who can be treated with the device. In case of arritmia or putative dysfunction, the latest ICD-s are able to send emergency alert to the arritmia centre with the help of an outer transmitter. Probably the system will completely change the follow-up of patients with ICD within the next few years, clinical researches of its efficiency are going on at present. PMID:22826909
Imre, Ildikó; Tóth, Zsuzsanna
A 26-year-old man was suffering from pericoronitis of his mandibular third molars. To determine the position of the mandibular canal in relation to the roots of the third molars, a panoramic radiograph was made. The radiograph revealed at the right side a bifid mandibular canal and the upper part of the canal seemed to be related to the third molar. Additionally, a cone beam CT was made, which revealed a bifid mandibular canal at the left side and a trifid mandibular canal at the right side. Anatomical anomalies of the mandibular canal may have clinical implications, such as an increased risk of injury to the inferior alveolar nerve in case of removing a mandibular third molar and inadequate local anesthetics. PMID:21298889
Mizbah, K; Gerlach, N; Maal, T J; Bergé, S J; Meijer, G J
The interface characteristics of porous rooted cobalt-chromium-molybdenum alloy (Co-Cr-Mo) dental implants which had been in free standing function in canine mandibles for a period of two years were investigated. The displacement of the implants and of points on the adjacent mandibular cortex were determined by mechanical testing. Bone ingrowth was quantified, and the structure of the bone-implant interface and mandibular cortex were characterized using histologic and microradiographic analyses. Displacement characteristics were correlated with determinations of the tissue structure adjacent to and growth within the implant to provide information about the biological attachment. A correlation was found between the thickness of the buccal and lingual cortical plates and implant displacements; implants having the greatest displacement response were in mandibles with the thinnest cortical plates. A relationship could not be established between the implant displacement response and the quantitative tissue structure data. Differences observed in the displacement response of the implant by mechanical testing were not observed by clinical measurements of mobility. It was concluded that implant retention mechanical behavior results from both interfacial displacement and deflection of the adjacent mandibular structures. PMID:7139020
Cook, S D; Weinstein, A M; Sander, T A; Klawitter, J J
Objectives: The impaction of the second mandibular molar (MM2) has recently become more prevalent. Several etiological hypothesis have been proposed to investigate the association between skeletal features and impaction of MM2. The aims of this study were to analyze the skeletal features in patients with MM2 impaction and the association between arrested eruption of MM2 and the presence of the third mandibular molar (MM3). Study Design: In this retrospective study 48 subjects from 3,530 Caucasian orthodontic patients with MM2 impaction were included in a study group (SG) and compared to a control group (CG) of 200 subjects without MM2 impaction. Panoramic radiographs evaluated the presence or absence of the MM3 germ. Cephalometric analysis was performed to evaluate linear and angular skeletal values. For the statistical analysis, descriptive statistics, Student’s t-test, ?2 test and odds ratio (OR) were used. Results: The paired comparisons between SG and CG showed in cephalometric analysis both a reduced mandibular gonial angle (ArGoMe) and lowered Jarabak’s polygon value with a statistically significant difference (P? 0.05). MM3 was statistically significant associated (P? 0.05) with MM2 impaction but it is not a risk factor (OR 0.817). Conclusions: Subjects with MM2 impaction show a vertical condylar growth direction. MM3 is not a risk factor for MM2 impaction. Key words:Impacted mandibular second molar, skeletal features, orthodontic.
Altieri, Federica; Calasso, Sabrina
A fifth mandibular incisor is a eumorphic supernumerary tooth and has rarely been described in the medical literature. We report here a large Lebanese consanguineous family where four individuals displayed five incisors in the anterior mandible. Such familial observation has not been previously described. The possibility of an autosomal recessive inheritance for this nonsyndromic trait is discussed.
A Cassia; A Feki; A Megarbane; S El-Toum
The mandible's contour determines the shape of the lower part of the face and thus influences the appearance of the face and neck. There are two types of operative procedures that can be used on mandibular contour and they do not require orthodontic treatment: mandible angle reduction and genioplasty. We divided the mandible angle reduction group into Types A, B,
Doo Byung Yang; Chul Gyoo Park
It has been nearly 90 years since a dentist first fabricated a dental appliance for a patient with snoring. Since then, mandibular advancement devices or MADs have become a common treatment for obstructive sleep apnea and are used to increase the caliber of the airway during sleep. Their primary use is for the patient who has snoring or mild to
Glenn T. Clark
The use of space maintenance in mandibular defects as an interim measure before definitive osseous reconstruction may prevent problems associated with delayed reconstruction including increased technical difficulty, contracture of soft tissues that limits the volume of the final reconstruction, and the potential for iatrogenic injury to adjacent anatomical structures. The use of a condyle/ramus spacer made of medical grade, ultrahigh-molecular-weight polyethylene, and a flexible body spacer made of high quality, inert, non-toxic medical and food grade silicone rubber, was tested in 38 patients with mandibular defects after the resection of benign but locally aggressive disease, advanced osteomyelitis, and injuries. The spacer was retained for a maximum of 8 weeks, and was then removed through an extraoral approach before definitive reconstruction with a particulate corticocancellous bone graft. One of the 38 patients failed to attend for follow up and returned 7 months later with severe, generalised sepsis that required removal of the spacer and exclusion from the study. Of the remaining 37 patients, 32 healed uneventfully, 1 required removal of the spacer 2 weeks after implantation for intraoral wound dehiscence, and 4 had mild to moderate disturbances of wound healing that required either minor revision or local wound care until removal at the time of reconstruction. The use of a spacer promotes wound healing and simplifies and expedites secondary reconstruction of mandibular defects. PMID:22818045
Ferretti, Carlo; Rikhotso, Ephraim; Muthray, Enesh; Reyneke, Johan
Impacted mandibular third molars are located between the second mandibular molar and mandibular ramus. However, ectopic mandibular third molars with heterotopic positions are reported in the subcondylar or pterygomandibular space. The usual cause of malposition is a cyst or tumor, and malposition without a pathology is rare. This case report described an impacted mandibular third molar in the pterygomandibular space without any associated pathology.
Lee, Young-Kyu; Park, Sung-Soo
Objectives: To compare the effectiveness of onlay bone blocks of equine origin (test or XB group) with autogenous bone blocks (control or AB group) harvested from the ramus or the iliac crest for the rehabilitation of partially or fully edentulous atrophic jaws with implant supported prostheses. Materials and methods: Forty patients with partially or fully edentulous atrophic jaws having less than 5 mm of residual crestal bone height and/or less than 3 mm of bone thickness, as measured on computerised tomography (CT) scans, were randomised into two groups according to a parallel group design, either to be augmented with autogenous onlay bone blocks (20 patients; AB group) from the mandibular ramus or the iliac crest, or with onlays blocks of spongious bone of equine origin (20 patients; XB group). Two centres treated 20 patients each. Six XB blocks were modelled on lithographic models of the jaws before grafting. The blocks were fixed with screws and osteosynthesis plates and were covered with resorbable barriers made of equine cortical bone and fixed with tacks. The autogenous bone grafts were left to heal for 4 months and the xenografts for 7 months before placing implants, which were submerged. After 4 months, either bar-retained overdentures or provisional reinforced acrylic prostheses were delivered. Provisional prostheses were replaced, after 4 months, by definitive fixed prostheses. Outcome measures were: prosthesis and implant failures; complications; patient satisfaction; pain recorded 3 and 10 days post-augmentation; number of days of hospitalisation, total and partial infirmity days. All patients were followed for 4 months after loading. Results: All patients could be rehabilitated with implant-supported prostheses and none dropped out. Twenty-eight patients were augmented in the maxilla (15 with AB and 13 with XB) and 12 in the mandible (5 with AB and 7 with XB). No AB graft failed totally versus 10 XB grafts (difference = 0.5; 95% CI 0.23 to 0.68; P = 0.0004). In particular, all 7 XB mandibular grafts and 5 out of 6 XB blocks (3 in mandibles and 2 in maxillas), which were previously modelled on lithographic models of the jaws failed. One implant failed in one AB patient versus 11 implants in 4 XB patients (P = 0.3416). All but 1 prostheses were loaded in time in the AB patients, versus 4 prostheses which were loaded with delays in XB patients because of graft and implant failures (P = 0.3416). Four complications occurred in 4 AB patients versus 15 complications in 12 XB patients (difference = 0.4; 95% CI 0.09 to 0.63; P = 0.0225). Fourteen AB patients reported moderate pain 3 days postoperatively versus 6 XB patients (P = 0.0562); at 10 days, 10 AB patients reported moderate pain versus 1 XB patient (difference = -0.45; 95% CI -0.65 to -0.17; P = 0.0033). The 14 patients harvested from the iliac crest were hospitalised for an average of 3.1 nights, whereas 7 patients treated with XB were hospitalised on average for 1.4 nights (P <0.0001). The number of total and partial infirmity days was 126 for theAB group and 43 for the XB group, and 220 for the AB group and 93 for the XB group, respectively (mean day difference = -4.15; 95% CI -7.35 to -0.95; P = 0.0134 and mean day difference = -5.7; 95% CI -10.01 to -1.39; P = 0.0116, respectively). Seventeen AB patients versus 19 XB patients were fully satisfied with function of their prostheses (P = 0.6050), 18 AB patients versus 12 XB patients were fully satisfied with aesthetics of their prostheses (P = 0.0648), and 5 and 3 patients, respectively would not undergo the same procedure again (P = 0.6948). There were no differences between the outcomes of the two centres with exception of prosthesis failures and complications in the maxilla. Conclusions: Autogenous onlay bone blocks are superior to equine onlay bone blocks, especially in mandibles, where all equine blocks failed, therefore we strongly discourage the use of onlay bone blocks of equine origin in mandibles. Conflict of interest statement: Bioteck, Arcugnano (VI), Italy, partially supported this trial,
Pistilli, Roberto; Felice, Pietro; Piatelli, Maurizio; Nisii, Alessandro; Barausse, Carlo; Esposito, Marco
'Dentures: A question of grinning and bearing it' is not just the title of a 25-year-old thesis, but it also reflects the content well. Dissatisfaction with complete dentures is not only determined by the quality of the dentures and the oral conditions, but also and just as much by the patient's capacity to adapt to and accept the dentures. In order to treat an edentulous patient adequately, an oral healthcare provider should pay special attention to these aspects. After 25 years of further scientific study, this conclusion is still true. The current care standard for edentulous patients with atrophy of the residual mandibular alveolar ridge is an overdenture supported by 2 implants. For edentulous patients with a solid residual mandibular alveolar ridge, conventional complete dentures are the first choice of treatment. Only in cases of obvious remaining complaints, should an implant-supported overdenture be considered. PMID:21661249
van Waas, M A J
This article reports the preliminary results from a clinical study involving the use of implants with a natural taper design in edentulous and partially edentulous patients. Implants were followed for at least 12 months after occlusal loading. Three hundred nine implants were placed by two periodontists (176 maxillary, 133 mandibular; 198 anterior, 111 posterior). Digital radiographs were taken immediately after implant placement and 1 year after occlusal loading. Computerized measurements were made, with distances calculated between the implant restorative platforms and the greatest heights of interproximal bone on both interproximal surfaces at the time of implant placement and 12 months postplacement. At the 12-month recall appointments, it was noted that 8 of the 309 implants had failed. Osseotite NT implants can be used in the treatment of edentulous and partially edentulous patients using two-stage, single-stage, and immediate occlusal loading protocols with survival rates equivalent to those seen for cylindrically shaped implants. PMID:16939015
Drago, Carl J; Del Castillo, Robert A
Stem cell-based bone tissue regeneration in the maxillofacial complex is a clinical necessity. Genetic engineering of mesenchymal stem cells (MSCs) to follow specific differentiation pathways may enhance the ability of these cells to regenerate and increase their clinical relevance. MSCs isolated from maxillofacial bone marrow (BM) are good candidates for tissue regeneration at sites of damage to the maxillofacial complex. In this study, we hypothesized that MSCs isolated from the maxillofacial complex can be engineered to overexpress the bone morphogenetic protein-2 gene and induce bone tissue regeneration in vivo. To demonstrate that the cells isolated from the maxillofacial complex were indeed MSCs, we performed a flow cytometry analysis, which revealed a high expression of mesenchyme-related markers and an absence of non-mesenchyme-related markers. In vitro, the MSCs were able to differentiate into osteogenic, chondrogenic, and adipogenic lineages. Gene delivery of the osteogenic gene BMP2 via an adenoviral vector revealed high expression levels of BMP2 protein that induced osteogenic differentiation of these cells in vitro and induced bone formation in an ectopic site in vivo. In addition, implantation of genetically engineered maxillofacial BM-derived MSCs into a mandibular defect led to regeneration of tissue at the site of the defect; this was confirmed by performing micro-computed tomography analysis. Histological analysis of the mandibles revealed osteogenic differentiation of implanted cells as well as bone tissue regeneration. We conclude that maxillofacial BM-derived MSCs can be genetically engineered to induce bone tissue regeneration in the maxillofacial complex and that this finding may be clinically relevant. PMID:18636943
Steinhardt, Yair; Aslan, Hadi; Regev, Eran; Zilberman, Yoram; Kallai, Ilan; Gazit, Dan; Gazit, Zulma
Bone growth is a complex process that is controlled by a multitude of mechanisms that are not fully understood.Most of the current methods employed to measure the growth of bones focus on either studying cadaveric bones from different individuals of different ages, or successive two-dimensional (2D) radiographs. Both techniques have their known limitations. The purpose of this study was to explore a technique for quantifying the three dimensional (3D) growth of an adolescent human mandible over the period of one year utilizing cone beam computed tomography (CBCT) scans taken for regular orthodontic records. Three -dimensional virtual models were created from the CBCT data using mainstream medical imaging software. A comparison between computer-generated surface meshes of successive 3-D virtual models illustrates the magnitude of relative mandible growth. The results of this work are in agreement with previously reported data from human cadaveric studies and implantable marker studies. The presented method provides a new relatively simple basis (utilizing commercially available software) to visualize and evaluate individualized 3D (mandibular) growth in vivo. PMID:22046201
Reynolds, Mathew; Reynolds, Michael; Adeeb, Samer; El-Bialy, Tarek
Bone growth is a complex process that is controlled by a multitude of mechanisms that are not fully understood.Most of the current methods employed to measure the growth of bones focus on either studying cadaveric bones from different individuals of different ages, or successive two-dimensional (2D) radiographs. Both techniques have their known limitations. The purpose of this study was to explore a technique for quantifying the three dimensional (3D) growth of an adolescent human mandible over the period of one year utilizing cone beam computed tomography (CBCT) scans taken for regular orthodontic records. Three -dimensional virtual models were created from the CBCT data using mainstream medical imaging software. A comparison between computer-generated surface meshes of successive 3-D virtual models illustrates the magnitude of relative mandible growth. The results of this work are in agreement with previously reported data from human cadaveric studies and implantable marker studies. The presented method provides a new relatively simple basis (utilizing commercially available software) to visualize and evaluate individualized 3D (mandibular) growth in vivo.
Reynolds, Mathew; Reynolds, Michael; Adeeb, Samer; El-Bialy, Tarek
Objectives. This study aimed to evaluate the effect of immediate and delayed loading of orthodontic micro-implants on bone-implant contact. Materials and Methods. Sixty four micro-implants were implanted in dog's jaw bone. The micro-implants were divided into loaded and unloaded (control) groups. The control group had two subgroups: four and eight weeks being implanted. The loaded group had two subgroups of immediate loading and delayed (after four weeks healing) loading. Loaded samples were subjected to 200g load for four weeks. After sacrificing the animals micro-implants and surrounding tissues were observed histologically. Bone-implant contact ratios (BIC) were calculated and different groups' results were compared by three-way ANOVA. Results. Mean survival rate was 96.7% in general. Survival rates were 96.7%, 94.4% and 100% for control, immediate and delayed loaded groups, respectively. BIC values were not significantly different in loaded and control groups, immediate and delayed loading groups, and pressure and tension sides. Mandibular micro-implants had significantly higher BIC than maxillary ones in immediate loading, 4-weeks control, and 8-weeks control groups (P = 0.021, P = 0.009, P = 0.003, resp.). Conclusion Immediate or delayed loading of micro-implants in dog did not cause significant difference in Bone-implant contact which could be concluded that healing time had not significant effect on micro-implant stability.
Ramazanzadeh, Barat Ali; Fatemi, Kazem; Dehghani, Mahboobe; Mohtasham, Nooshin; Jahanbin, Arezoo; Sadeghian, Hamed
Osteochondroma of the mandibular condyle is fairly rare. We describe a case of this lesion in a 52-year-old woman who presented with symptoms of temporomandibular joint dysfunction. Although a panoramic radiograph demonstrated the bony exostosis, a pre-operative CT examination showed the relationship of the tumour to the condyle and also depicted soft-tissue changes secondary to the growth. PMID:17881606
Avinash, K R; Rajagopal, K V; Ramakrishnaiah, R H; Carnelio, S; Mahmood, N S
Bifid mandibular condyle (BMC) is a rare asymptomatic morphological alteration with no predilection for age group or gender. Its morphology varies from a shallow groove to two condylar heads with separate necks, oriented mediolaterally or anteroposteriorly. This report describes an unusual case of bilateral mediolateral bifid condyle in a 24-year-old female patient with the main complaint of mouth-opening limitation. MRI and CT findings revealed bilateral bifid condyle. PMID:22922936
Tutar, Onur; Bas, Ahmet; Gülsen, Gökçe; Bayraktarov, Elmar
Mandibular reconstruction is important for providing good functional and cosmetic results after the resection of a mandibulary segment. Reconstruction plates and titanium meshes are usually used to reconstruct the bony defects in mandible. Although their complications are well known there is not a report on the fractures of a titanium mesh after mandible reconstruction in the literature. We reported a case of a broken titanium mesh after mandible reconstruction. PMID:16327566
Aytaç, Selçuk; Ozbek, Serhat; Kahveci, Ramazan; Ozgenel, Ye?im; Akin, Selçuk; Ozcan, Mesut
Prosthodontic treatment is difficult if the alveolar ridge is low or thin. To develop a method for alveolar ridge preservation after tooth extraction, we need an experimental model of a small animal, in which we can analyze the socket healing easily and quantitatively. The purpose of the present study was to establish such an experimental model. Ten weeks old male rats of Wistar strain were used. The edge of the right mandibular incisor was cut every three days three times and the incisor was extracted at three days after the final cut. The animals were sacrificed 0, 1, 2, 4, 8, 12 weeks after the extraction and the mandibles were dissected out. The length of the alveolar bone was measured on soft X-ray photographs and bone mineral content was measured with a dual energy X-ray absorptiometer (DEXA). Then, transverse sections of the alveolar bone were prepared. Periodic three-times cutting of the edge of the mandibular incisor made the extraction easy. Quantitative analyses of new bone formation in the socket and the resorption of the alveolar bone were possible with soft X-ray photography and DEXA. The histological findings corresponded well with the data from the soft X-ray photos and DEXA measurements. The present results demonstrated the possibility of simple and quantitative analyses of socket healing after the extraction of rat mandibular incisors. This experimental model would be useful for developing a method to prevent atrophy of the alveolar ridge after tooth extraction. PMID:15856778
Introduction: Unilateral mydriasis is a seriously significant finding in neurologic examinations indicating life-threatening conditions such as cerebral vascular injuries. Case Presentation: A 24 year old woman with mandibular trauma was referred to our center after five days for a reduction of the right mandibular angle fracture. The patient had no history of any loss of consciousness after the accident. Her physical examination showed no abnormalities, except those related to her mandibular fracture. The laboratory results were normal as well. At 8:30 am a general anesthesia was induced. The patient’s eyes were kept shut throughout the surgical procedure. The operation included an intraoral open reduction and fixation using two miniplates without any complications. After the operation, it was noticed that the left eye was completely dilated with no reaction to light, while the right eye was normal. The management and outcomes in this patient were described in the present case report. Conclusions: Evaluating the size of the patient’s pupils before, during and after the operation, careful history, consult, CT scan and MRI would help to diagnosis. Although no probable cause was found to explain the transient mydriasis in our patient.
Nesioonpour, Sholeh; Khiabani, Kazem; Hassanijirdehi, Marzieh
Introduction: Amongst the various calcified structures in the human body, teeth have gained lot of popularity in estimating the sex of an individual as they are highly resistant to destruction and decomposition. Using permanent mandibular canines many researchers have predicted a high level of accuracy in identifying the sex correctly. The purpose of our study was to gauge the effectiveness of mandibular canines in discerning sex. Materials & Methods: Fifty dental casts each of males and females were utilized for the study. Mesio-distal dimension and inter-canine distance of mandibular right and left canine was recorded using digital vernier caliper and mandibular canine index was calculated. Results: The mean value of mesio-distal dimensions of right and left mandibular canine was slightly greater in males compared to females. The mandibular canine index was equal in both sexes. Inter-canine distance was marginally higher in males compared to females. Despite of higher values in males none of the parameters were statistically significant. Conclusion: The results herein bolster contemporary studies that mesio-distal dimensions of mandibular canines and mandibular canine index do not reflect sexual dimorphism and that its application should be discontinued in sex prediction among Indian populations. How to cite this article: Hosmani J V, Nayak R S, Kotrashetti V S, Pradeep S, Babji D. Reliability of Mandibular Canines as Indicators for Sexual Dichotomy. J Int Oral Health 2013; 5(1):1-7. PMID:24155571
Hosmani, Jagadish V; Nayak, Ramakant S; Kotrashetti, Vijayalakshmi S; S, Pradeep; Babji, Deepa
Dental anomalies of tooth number in development of the permanent dentition are quite common than the primary dentition, however, the combined occurrence of hypodontia and hyperdontia is a rare phenomenon, especially in the same dental arch. The purpose of this report is to describe a case of concomitant hypo-hyperdontia (CHH) in three patients (one girl and two boys) with missing mandibular central incisor and an erupted mandibular mesiodens. Three rare cases of mandibular CHH were observed during routine examination, where the two anomalies manifested in the anterior region of the mandible. Furthermore, these are the only cases exhibited taurodontism in association with mandibular CHH. PMID:24778987
Nirmala, S V S G; Sandeep, C; Nuvvula, Sivakumar; Mallineni, Sreekanth Kumar
Introduction: Amongst the various calcified structures in the human body, teeth have gained lot of popularity in estimating the sex of an individual as they are highly resistant to destruction and decomposition. Using permanent mandibular canines many researchers have predicted a high level of accuracy in identifying the sex correctly. The purpose of our study was to gauge the effectiveness of mandibular canines in discerning sex. Materials & Methods: Fifty dental casts each of males and females were utilized for the study. Mesio-distal dimension and inter-canine distance of mandibular right and left canine was recorded using digital vernier caliper and mandibular canine index was calculated. Results: The mean value of mesio-distal dimensions of right and left mandibular canine was slightly greater in males compared to females. The mandibular canine index was equal in both sexes. Inter-canine distance was marginally higher in males compared to females. Despite of higher values in males none of the parameters were statistically significant. Conclusion: The results herein bolster contemporary studies that mesio-distal dimensions of mandibular canines and mandibular canine index do not reflect sexual dimorphism and that its application should be discontinued in sex prediction among Indian populations. How to cite this article: Hosmani J V, Nayak R S, Kotrashetti V S, Pradeep S, Babji D. Reliability of Mandibular Canines as Indicators for Sexual Dichotomy. J Int Oral Health 2013; 5(1):1-7.
Hosmani, Jagadish V; Nayak, Ramakant S; Kotrashetti, Vijayalakshmi S; S, Pradeep; Babji, Deepa
The invention has for its object the provision of an intravascular implant that has mechanical characteristics and physiological characteristics and is very low in cell cytotoxicity and provides an intravascular implant having an implant body made of a metal material that contains gadolinium and magnesium and is free of yttrium.
Endosseous dental implants have revolutionized the methods clinicians use to treat edentulous and partially edentulous patients. Traditional implant protocol specifies a healing period of several months after tooth extraction, as well as an unloaded healing period prior to restoration. Over the last decade, numerous studies have documented successful immediate placement of endosseous dental implants in fresh extraction sites and have found positive results with early functional loading. The purpose of this article is to present a clinical treatment protocol for the immediate placement and early loading of dental implants and to report the clinical and radiographic outcomes of the SLActive surface Straumann Bone Level implant placed in either maxillary or mandibular fresh extraction sockets. PMID:21365027
Di Felice, Roberto; D'Amario, Maurizio; De Dominicis, Alessandro; Garocchio, Santo; D'Arcangelo, Camillo; Giannoni, Mario
In this work an ultrasound device was used to perform an ostectomy for the removal of blade implants in order to save as much bone tissue as possible, so that root form implants might later be inserted. Two patients underwent surgery for the removal of two blade implants (one maxillary, the other mandibular) that were no longer functional. The peri-implant ostectomy was carried out with a piezoelectric surgery device. The instrument demonstrated to be effective and precise during ostectomy, providing an extremely thin cutting line. During the course of the operation and at controls after 7 and 30 days, patients did not show any relevant complications and both still had sufficient alveolar bone to be treated with root form implants. The piezosurgery device proved to be an effective instrument in interventions requiring a significant saving of bone tissue, extreme precision in cutting, and respect of soft tissues. PMID:17287707
Sivolella, S; Berengo, M; Fiorot, M; Mazzuchin, M
Rehabilitation of patients with severe dental wear is a complex diagnostic and restorative problem. As wear occurs, space for restorative materials is lost, and unique treatment techniques are needed to provide good esthetics and function. Use of orthognathic surgery to reposition mandibular anterior teeth and supporting alveolar bone can create a more ideal environment for restorative procedures. PMID:1507127
Schmitt, S M; Cronin, R J; Berg, S
The present study was conducted to investigate whether there was a functional coupling between the head and mandibular movements in ten patients with mandibular protrusion (MP) and ten control subjects with normal occlusion (Normal), using a six degrees-of-freedom measuring device. Single-peak waveforms were predominantly seen in both MP (98.2%) and Normal (99.3%). However, vertical displacements of the upper and lower incisor points (VD(UIP) and VD(LIP)) were all significantly larger in MP than those in Normal. The ratio VD(UIP)/VD(LIP) also increased more sharply with an increase in VD(LIP) in MP, compared to that in Normal. Mandibular rotation in MP was also significantly larger than that in Normal. The results showed that, in MP, the head moves more vertically in rhythmical coordination with mandibular movement during tapping. Finally, it may be that this larger vertical head movement is related to the greater condylar rotation in MP subjects. PMID:16541840
Nibe, Hiroshi; Yamada, Kazuhiro; Fukui, Tadao; Kohno, Shoji; Hanada, Kooji
The authors report on a retrospective study of 205 consecutive patients at the Maxillofacial Unit of The Royal Melbourne Hospital to assess if adherence to Champy's principles in placement of miniplates in mandibular fractures minimises morbidity. 205 well documented cases of mandibular fractures treated with internal fixation, January 1985 to April 1990 were studied. The patients were assigned into three
T. F. Renton; D. Wiesenfeld
Successful endodontic management of mandibular first molar with a single root and single canal is diagnosed with the aid of dental operating microscope and multiple angled radiographs. In addition all the mandibular molars and premolars were single rooted on either side.
Sooriaprakas, Chandrasekaran; Ballal, Suma; Velmurugan, Natanasabapathy
Successful endodontic management of mandibular first molar with a single root and single canal is diagnosed with the aid of dental operating microscope and multiple angled radiographs. In addition all the mandibular molars and premolars were single rooted on either side. PMID:24715990
Sooriaprakas, Chandrasekaran; Ballal, Suma; Velmurugan, Natanasabapathy
This was a retrospective, longitudinal cephalometric and cast study of 29 white patients at pretreatment, posttreatment, and an average of 6 years 3 months postretention. The goal was to assess changes with treatment and retention with the expanding mandibular lingual arch appliance in conjunction with fixed edgewise treatment. Seven mandibular cast measurements were assessed, including arch crowding, arch perimeter, arch
Jeffrey A Housley; Ram S Nanda; G. Fräns Currier; Dale E McCune
This study analyzed stress and strain mediated by 2 different implant materials, titanium (Ti) and experimental fiber-reinforced composite (FRC), on the implant and on the bone tissue surrounding the implant. Three-dimensional finite element models constructed from a mandibular bone and an implant were subjected to a load of 50 N in vertical and horizontal directions. Postprocessing files allowed the calculation of stress and strain within the implant materials and stresses at the bone-to-implant interface (stress path). Maximum stress concentrations were located around the implant on the rim of the cortical bone in both implant materials; Ti and overall stresses decreased toward the Ti implant apex. In the FRC implant, a stress value of 0.6 to 2.0 MPa was detected not only on the screw threads but also on the implant surface between the threads. Clear differences were observed in the strain distribution between the materials. Based on the results, the vertical load stress range of the FRC implant was close to the stress level for optimal bone growth. Furthermore, the stress at the bone around the FRC implant was more evenly distributed than that with Ti implant. PMID:20545537
Shinya, Akikazu; Ballo, Ahmed M; Lassila, Lippo V J; Shinya, Akiyoshi; Närhi, Timo O; Vallittu, Pekka K
Mandibular condyle aplasia is a congenital or acquired malformation, which can be or not associated to some head and neck syndromes. Its treatment involves either a surgical approach or a more conservative treatment with orthopedic functional appliances. This clinical report presents a case of mandibular condyle aplasia treated with a modified KLAMT functional appliance, after a surgical procedure failed to stimulate mandibular condyle remodelling. The successful results presented here, with an orthopedic functional approach, support treatment with functional appliances as an alternative, producing similar results to those reported with surgery. Therefore, functional appliances are proposed as a valid alternative to stimulate mandibular condyle remodelling in patients with mandibular condyle aplasia. Treatment provided at an early age appears to be relevant for a successful result. PMID:24683785
Mauricio, Mejia-Gomez Carlos; Omar, Ramirez-Yanez German
The use of transoral noncompression unicortical miniplates in treating 42 consecutive patients with 64 displaced mandibular fractures (excluding subcondylar) was reviewed. Titanium miniplates (Wurzburg) were used for fixation. The principles set forth by Champy and colleagues, with two plates for body and symphyseal fracture fixation and one plate superiorly along the oblique ridge for angle fractures, were performed. Intermaxillary fixation was not used postoperatively. Results compared favorably with other forms of treatment with no evidence of postoperative malocclusion, with an overall complication rate of 3%. The advantage of no external incision, avoidance of intermaxillary fixation, and normal postoperative incisal opening and occlusion make this technique our treatment of choice. PMID:1622016
Davies, B W; Cederna, J P; Guyuron, B
Intracoronal bleaching of pulpless discolored mandibular incisors is a valuable treatment modality currently disregarded by many clinicians because of the potentially disastrous consequence of cervical resorption. A patient-administered, intracoronal carbamide peroxide bleaching technique is described. This modified, walking bleaching method minimizes the risks because treatment time is reduced to days, as opposed to weeks with the original walking bleaching protocol, the concentration of the hydrogen peroxide is markedly reduced, and residual hydrogen peroxide is completely eliminated with the use of catalase prior to the definitive restoration. PMID:17402632
Liebenberg, William H
Background The Pierre Robin Sequence features were first described by Robin in 1923 and include micrognathia, glossoptosis and respiratory distress with an incidence estimated as 1:8,500 to 1:20,000 newborns. Upper airway obstruction and feeding difficulties are the main concerns related to the pathology. Mandibular distraction should be considered a treatment option (when other treatments result inadequate). Patiants and methods Ten patients between the ages of 1 month and 2 years with severe micrognathia and airway obstruction were treated with Mandibular Distraction Osteogenesis (MDO). All patients underwent fibroscopic examination of the upper airway and a radiographic imaging and/or computed tomography scans to detect malformations and to confirm that the obstruction was caused by posterior tongue displacement. All patients were evaluated by a multidisciplinary team. Indications for surgery included frequent apneic episodes with severe desaturation (70%). Gavage therapy was employed in all patients since oral feeding was not possible. The two tracheotomy patients were 5 months and 2 years old respectively, and the distraction procedure was performed to remove the tracheotomy tube. All patients were treated with bilateral mandibular distraction: two cases with an external multivector distraction device, six cases with an internal non-resorbable device and two cases with an internal resorbable device. In one case, the patient with Goldenhar's Syndrome, the procedure was repeated. Results The resolution of symptoms was obtained in all patients, and, when present, tracheotomy was removed without complications. Of the two patients with pre-existing tracheotomies, in the younger patient (5 months old) the tracheotomy was removed 7 days postoperatively. In the Goldenhar's syndrome case (2 years old) a Montgomery device was necessary for 6 months due to the presence of tracheotomy-inducted tracheomalacia. Patients were discharged when the endpoint was obtained: symptoms and signs of airway obstruction were resolved, PAS and maxillomandibular relationship improved, and tracheotomy, when present, removed. During the follow-up, no injury to the inferior alveolar nerve was noted and scarring was significant in only the two cases treated with external devices. Conclusion Mandibular Distraction Osteogenesis is a good solution in solving respiratory distress when other procedures are failed in paediatric patients with severe micrognatia.
Implantable devices such as cardiac pacemakers, drug-delivery systems, and defibrillators have had a tremendous impact on the quality of live for many disabled people. To date, many devices have been developed for implantation into various parts of the human body. In this paper, we focus on devices implanted in the head. In particular, we describe the technologies necessary to create implantable microimagers. Design, fabrication, and implementation issues are discussed vis-à-vis two examples of implantable microimagers; the retinal prosthesis and in vivo neuro-microimager. Testing of these devices in animals verify the use of the microimagers in the implanted state. We believe that further advancement of these devices will lead to the development of a new method for medical and scientific applications.
Ng, David C.; Tokuda, Takashi; Shiosaka, Sadao; Tano, Yasuo; Ohta, Jun
The loss of mandibular molars can result in a 'collapsed bite' owing to tilting of teeth adjacent to the gap and overeruption of maxillary molar segments. The lost interarch and interdental space must be regained before prosthetic reconstruction. This case report documents the treatment of a patient by orthodontic, surgical and prosthetic means. The teeth were orthodontically aligned to meet predetermined surgical and prosthetic requirements. The surgical phase comprised a posterior segmental maxillary osteotomy and one-stage placement of three large-diameter implants in the mandible. Finally, the occlusion was restored with mandibular implant-supported prostheses. PMID:11494802
Daly, P F; Pitsillis, A; Nicolopoulos, C
The patterned ion implantation ``PARTIAL IMPLANT'' has been developed as a productivity improvement tool. The Partial Implant can form several different ion dose areas on the wafer surface by controlling the speed of wafer moving and the stepwise rotation of twist axis. The Partial Implant system contains two implant methods. One method is ``DIVIDE PARTIAL IMPLANT,'' that is aimed at reducing the consumption of the wafer. The Divide Partial Implant evenly divides dose area on one wafer surface into two or three different dose part. Any dose can be selected in each area. So the consumption of the wafer for experimental implantation can be reduced. The second method is ``RING PARTIAL IMPLANT'' that is aimed at improving yield by correcting electrical characteristic of devices. The Ring Partial Implant can form concentric ion dose areas. The dose of wafer external area can be selected to be within plus or minus 30% of dose of wafer central area. So the electrical characteristic of devices can be corrected by controlling dose at edge side on the wafer.
Hino, Masayoshi; Miyamoto, Naoki; Sakai, Shigeki; Matsumoto, Takao
In this tutorial we describe the basic principles of the ion implantation technique and we demonstrate that emission Mössbauer spectroscopy is an extremely powerful technique to investigate the atomic and electronic configuration around implanted atoms. The physics of dilute atoms in materials, the final lattice sites and their chemical state as well as diffusion phenomena can be studied. We focus on the latest developments of implantation Mössbauer spectroscopy, where three accelerator facilities, i.e., Hahn-Meitner Institute Berlin, ISOLDE-CERN and RIKEN, have intensively been used for materials research in in-beam and on-line Mössbauer experiments immediately after implantation of the nuclear probes.
Langouche, G.; Yoshida, Y.
Morphological changes such as bifid and trifid mandibular condyle are rare entities. The aim of the present report is to describe a unique morphological variation of the mandibular condyle which has four separate condylar heads (tetrafid mandibular condyle) and to discuss clinical and radiological differential diagnosis of tetrafid mandibular condyle with advanced imaging techniques. PMID:22065803
Sahman, H; Etöz, O A; Sekerci, A E; Etöz, M; Sisman, Y
The purpose of this article is to report the management of a transmigrated mandibular canine with emphasis on saving the tooth as natural part rather than surgical removal of the transmigrated tooth. There are several treatment options proposed for impacted mandibular canines including surgical removal, exposure and orthodontic alignment, intra-alveolar tooth transplantation (surgical repositioning of a tooth in its alveolar socket) and observation. The technique, surgical repositioning of a tooth involves the surgical extraction of impacted tooth and fixation in the correct position in the dental arch after surgical preparation (correction) of the alveolar socket. It is especially valuable in cases of difficult-to-treat impaction. A repositioned tooth is better substitute than fixed or removable prostheses, and the technique is more cost effective than other methods. Patients with excellent oral hygiene should be considered as preferred candidates for surgical repositioning of tooth. Disadvantages include the invasiveness of surgery, the difficulty of projecting long term stability due to chances of root resorption and loss of gingival attachment.
Verma, Sneh Lata; Sharma, V. P.; Singh, Gyan P.
Summary Background Transmigration is a phenomenon of movement of an unerupted tooth in the bone across the midline. This anomaly is not often found. Transmigration is more prevalent in females than in males, and more often encountered in the mandible than maxilla, it affects mostly canines. Case Report The aim of this study was to present a case report of a mandibular canine transmigration in a patient aged 12. Intraoral examination determined hypodontia of right second premolar and delayed eruption of left second premolar in maxilla, as well as persistent deciduous teeth: right second molar, left canine and second molar. The patient was referred for a Cone-Beam CT examination, which allowed precise visualization of the transmigrating canine as well as ruled out resorption of roots of mandibular incisors. Results The treatment with a maxillary fixed orthodontic appliance was finished after obtaining a satisfactory result. Proper alignment of the incisors in the anterior-posterior plane and correct midline position were accepted by the patient. Transmigrating canine after consultation with the surgeon was designed to further radiological observation.
Gruszka, Katarzyna; Rozylo, T. Katarzyna; Rozylo-Kalinowska, Ingrid; Denkiewicz, Katarzyna; Maslowska, Klaudia
Bilateral bifid mandibular condyle is a rarely seen malformation. The aetiology of bifid condyle is not completely understood, although developmental anomaly, traumas, condylar fracture, teratogenic embryopathy and surgical condylectomy may all be causative factors. Although a few studies on human dried skulls tried to shed light on this entity it remains obscure. As most bifid condyle subjects have no complaint related to temporamandibular joint(TMJ), the cases are generally diagnosed through incidental radiographic findings. The case of a 54-year-old female is presented. In a panoramic radiograph obtained after a clinical examination, bilateral bifid mandibular condyle was observed. The open-closed lateral radiograph of the TMJ (obtained using the TMJ-specific program of the panoramic device) demonstrated duplication of the right and left condyles. In order to better evaluate the TMJ morphology and to eliminate pathologies such as fractures that might be missed with conventional radiographs, a computed tomography scan was also obtained. The joint head orientation was observed in the mediolateral direction. The case is discussed in the context of the relevant literature. Until large population-based studies are undertaken and further experimental studies are performed, bifid condyle will remain an incidental finding of anatomic variation rather than a clinically informative observation. PMID:16938108
The Periotest device was used to evaluate the damping characteristics of different bone-to-implant interfaces of Brånemark implants. Implant and abutment lengths were found to have a significant influence on Periotest value (PTV). There was no statistical difference between PTVs of implants located in the anterior and posterior areas of the same jaw at abutment connection. No differences were found between PTVs of standard and self-tapping implants. PTVs at abutment connection were highly influenced by the bone quality. The contact with two corticals, one at each extremity of the implant, was of a greater influence in the maxillary than in the mandibular jaw, indicating a firmer anchorage between the bi-cortical implants and the surrounding bone. A progressive decrease of PTVs over time was observed, significant up to 5 years of loading. PMID:7669865
van Steenberghe, D; Tricio, J; Naert, I; Nys, M
Cherubism is a rare non-neoplastic, fibro-osseous hereditary disorder characterized by bilateral expansion of the maxilla and mandible producing a characteristic facial appearance. It can affect the facial and dental growth of the individual and often results in gross aesthetic and functional deficiencies. The teeth may also be displaced or submerged and these problems can often compromise successful restorative rehabilitation. This paper describes the restorative management of an adult patient with Cherubism involving a fixed implant retained mandibular restoration. The care utilized 3D planning software and implant insertion guides to facilitate an early loading protocol and the use of optimum bone quality/volume areas. PMID:21780729
Dewan, Karun; Bishop, Karl
An increasing number of patients receive and benefit from osteosynthesis materials or artificial joint replacement. The most common complications are mechanical problems or infection. Metals like nickel, chromium and cobalt as well as bone cement components like acrylates and gentamicin are potential contact allergens which can cause intolerance reactions to implants. Eczema, delayed wound/bone healing, recurrent effusions, pain and implant loosening all have been described as manifestation of implant allergy. In contrast to the high incidence of cutaneous metal allergy, allergies associated with implants are rare. Diagnosis of metal implant allergy is still difficult. Thus differential diagnoses--in particular infection--have to be excluded and a combined approach of allergologic diagnostics by patch test and histopathology of peri-implant tissue is recommended. It is still unknown which conditions induce allergic sensitization to implants or trigger peri-implant allergic reactions in the case of preexisting cutaneous metal allergy. Despite the risk of developing complications being unclear, titanium based osteosynthesis materials are recommended for metal allergic patients and the use of metal-metal couplings in arthroplasty is not recommended for such patients. If the regular CoCr-polyethylene articulation is employed, the patient should give informed written consent. PMID:20204719
Thomas, P; Thomsen, M
... result of an original surgery. There are two types of breast implants approved for sale in the United States: saline- ... Encourage reporting of adverse events associated with breast implants through our Medwatch Reporting System. Related Links Medscape Interview with FDA staff on ...
Traumatic degloving injuries of the mandible are rare intraoral soft tissue traumas. A simple review of the medical literature shows that no article up to this date has reported the prevalence of the degloving injuries of the mandible. Moreover, the highest incidence of mandibular degloving injuries is reported in children and young adults. In this article, the author describes the mandibular degloving injury, characterized by the separation of periosteum and soft tissues of the anterior buccal side of the mandible, and the bone suture technique. This article outlines that a correct diagnostic assessment and appropriate treatment plan can reduce the complications after mandibular degloving injuries. PMID:24470849
Rahpeyma, Amin; Khajeahmadi, Saeedeh
Traumatic degloving injuries of the mandible are rare intraoral soft tissue traumas. A simple review of the medical literature shows that no article up to this date has reported the prevalence of the degloving injuries of the mandible. Moreover, the highest incidence of mandibular degloving injuries is reported in children and young adults. In this article, the author describes the mandibular degloving injury, characterized by the separation of periosteum and soft tissues of the anterior buccal side of the mandible, and the bone suture technique. This article outlines that a correct diagnostic assessment and appropriate treatment plan can reduce the complications after mandibular degloving injuries.
Rahpeyma, Amin; Khajeahmadi, Saeedeh
Mandibular premolars have earned the reputation for having aberrant anatomy. The literature is replete with reports of extra canals in mandibular first premolars, but reports about the incidence of extra roots in these teeth are quite rare. This paper attempts at explaining a rare case of successful endodontic management of a four-rooted mandibular first premolar with diagnostic, interoperative and postoperative radiographic records along with a substantial data on the incidence of extra roots in these teeth. The standard method of radiographic appraisal was maintained as the criteria for determining the presence of extra roots.
Vaghela, Dakshita Joy; Sinha, Ashish Amit
47 end-stage TMJ patients with high occlusal plane angulation, treated with TMJ custom-fitted total joint prostheses and simultaneous maxillo-mandibular counter-clockwise rotation were evaluated for pain and dysfunction presurgery (T1) and at the longest follow-up (T2). Patients subjectively rated their facial pain\\/headache, TMJ pain, jaw function, diet and disability. Objective functional changes were determined by measuring maximum interincisal opening (MIO) and
L. P. Pinto; L. M. Wolford; P. H. Buschang; F. H. Bernardi; J. R. Gonçalves; D. S. Cassano
The purpose of this multicenter study was to review the results of treatment and identify complications in edentulous patients who were treated with the transmandibular implant. A total of 190 patients were treated in four university departments. These patients presented for treatment with mandibular bone heights that ranged from 4 to 18 mm (mean, 10 mm). After postoperative periods that ranged from 3 months to 5 years, 182 of the 190 implants (95.8%) were stable and functional. Three implants were removed due to perioperative fractures in mandibles with 4 to 6 mm of bone height. Five were removed due to infection which occurred within the first 3 months after surgery. Reversible complications that developed in 22.2% of the patients were treated successfully. The 182 implants in function demonstrated no mobility and no infrabony pockets around any of the transmucosal posts. The results of this study demonstrate that the transmandibular implant has acceptable predictability and reliability for reconstruction of patients with severe atrophy of the mandibular alveolar process. PMID:2664104
Maxson, B; Sindet-Pedersen, S; Tideman, H; Fonseca, R J; Zijlstra, G
This multicenter case series introduces an innovative ultrasonic implant site preparation (UISP) technique as an alternative to the use of traditional rotary instruments. A total of 3,579 implants were inserted in 1,885 subjects, and the sites were prepared using a specific ultrasonic device with a 1- to 3-year follow-up. No surgical complications related to the UISP protocol were reported for any of the implant sites. Seventy-eight implants (59 maxillary, 19 mandibular) failed within 5 months of insertion, for an overall osseointegration percentage of 97.82% (97.14% maxilla, 98.75% mandible). Three maxillary implants failed after 3 years of loading, with an overall implant survival rate of 97.74% (96.99% maxilla, 98.75% mandible). PMID:24396835
Vercellotti, Tomaso; Stacchi, Claudio; Russo, Crescenzo; Rebaudi, Alberto; Vincenzi, Giampaolo; Pratella, Umberto; Baldi, Domenico; Mozzati, Marco; Monagheddu, Chiara; Sentineri, Rosario; Cuneo, Tommaso; Di Alberti, Luca; Carossa, Stefano; Schierano, Gianmario
At the present time several techniques of bone grafting for restoration of mandibular defects are being employed. These methods are well established by clinical trials and animal research. Other methods are in the experimental stage. Regardless of the technique utilized it remains paramount that the surgeon plan the initial procedure with great care as each failure results in diminished blood supply to the graft bed and makes subsequent procedures less likely to succeed. The well known principles of bone grafting involve establishing good nutritional status of the patient, proper preparation of the graft bed by insuring adequate soft tissue and adequate blood supply, elimination of infection from the graft bed, provision of adequate fixation and immobilization of the graft, and careful closure of soft tissues to prevent hematoma formation. These principles remain inviolable if the procedure is to succeed. PMID:1098836
Morgan, L R; Thompson, C W
The purpose of this study was to retrospectively evaluate the complications of 58 patients who underwent surgery for mandibular condylar process fractures. Data were collected from patients during a 10-year period (1999-2009). The data recorded included demographic data, etiology, diagnosis, type of condylar fracture, surgical approaches, and postoperative complications. A total of 58 underwent surgery for reduction of the condylar fractures. There were 22 patients with bilateral condyle fractures and 36 patients with unilateral condyle fractures, accounting for 65 surgeries. In 8 fractures, a preauricular approach was performed to access the fractures condyle, whereas the retromandibular approach was performed in 57 fractures. There were 2 temporary facial palsies, 1 permanent facial palsy, and 1 sialocele. There were no cases of hypertrophic scar, Frey syndrome, or salivary fistula. In conclusion, permanent deformities after surgical complications were unusual, and the results are acceptably safe. PMID:21778851
Lima, Sergio Monteiro; Asprino, Luciana; Moreira, Roger Willian Fernandes; de Moraes, Márcio
Microvascular free tissue transfer has provided a variety of methods of restoring vascularized bone and soft tissue to difficult defects created by tumor resection and trauma. Over 7 years, 26 patients have undergone 28 free flaps for mandibular reconstruction, 15 for primary squamous cell carcinoma of the floor of the mouth or tongue, 7 for recurrent tumor, and 6 for other reasons (lymphangioma (1), infection (1), gunshot wound (1), and osteoradionecrosis (3)). Primary reconstruction was performed in 19 cases and secondary in 9. All repairs were composite flaps including 12 scapula, 5 radial forearm, 3 fibula, 2 serratus, and 6 deep circumflex iliac artery. Mandibular defects included the symphysis alone (7), symphysis and body (5), symphysis-body-ramus condyle (2), body or ramus (13), and bilateral body (1). Fourteen patients had received prior radiotherapy to adjuvant or curative doses. Eight received postoperative radiotherapy. All patients had initially successful vascularized reconstruction by clinical examination (28) and positive radionuclide scan (22 of 22). Bony stability was achieved in 25 of 26 patients and oral continence in 24 of 26. One complete flap loss occurred at 14 days. Complications of some degree developed in 22 patients including partial skin necrosis (3), orocutaneous fistula (3), plate exposure (1), donor site infection (3), fracture of reconstruction (1), and fracture of the radius (1). Microvascular transfer of bone and soft tissue allows a reliable reconstruction--despite previous radiotherapy, infection, foreign body, or surgery--in almost every situation in which mandible and soft tissue are absent. Bony union, a healed wound, and reasonable function and appearance are likely despite early fistula, skin loss, or metal plate or bone exposure.
Coleman, J.J. III; Wooden, W.A. (Emory Univ. School of Medicine, Atlanta, GA (USA))
Mandibular nerve block is often performed for diagnostic, therapeutic and anesthetic purposes for surgery involving mandibular region. Advantages of a nerve block include excellent pain relief and avoidance of the side effects associated with the use of opiods or Non-steroidal anti-inflammatory drug (NSAIDs). A patient with maxillo facial trauma was scheduled for open reduction and internal fixation of right parasymphyseal mandibular fracture. The mandibular nerve was approached using the lateral extraoral approach with an 18-gauge i.v. cannula under general anesthesia. He received 4 ml boluses of 0.25% plain bupivacaine for intraoperative analgesia and 12 hourly for 48 h post operatively. VAS scores remained less than 4 through out observation period. The only side effect was numbness of ipsilateral lower jaw line, which subsided after local anesthetic administration was discontinued. Patient was discharged after four days. PMID:22442616
Sawhney, Chhavi; Agrawal, Pramendra; Soni, Kapil Dev
Mandibular nerve block is often performed for diagnostic, therapeutic and anesthetic purposes for surgery involving mandibular region. Advantages of a nerve block include excellent pain relief and avoidance of the side effects associated with the use of opiods or Non-steroidal anti-inflammatory drug (NSAIDs). A patient with maxillo facial trauma was scheduled for open reduction and internal fixation of right parasymphyseal mandibular fracture. The mandibular nerve was approached using the lateral extraoral approach with an 18-gauge i.v. cannula under general anesthesia. He received 4 ml boluses of 0.25% plain bupivacaine for intraoperative analgesia and 12 hourly for 48 h post operatively. VAS scores remained less than 4 through out observation period. The only side effect was numbness of ipsilateral lower jaw line, which subsided after local anesthetic administration was discontinued. Patient was discharged after four days.
Sawhney, Chhavi; Agrawal, Pramendra; Soni, Kapil Dev
Canalicular adenomas are uncommon benign salivary gland neoplasms of the oral cavity. They are typically located on the upper lip, buccal mucosa and infrequently found on the palate and derived from minor salivary glands. Intra-mandibular localization of canalicular adenoma is extremely rare. Due to benign character of the tumour, canalicular adenomas rarely present with bone erosion. Histologically, trabecular type of basal cell adenoma, pleomorphic adenoma and polymorphous low-grade adenocarcinoma should be discriminated from canalicular adenomas. A-56- year old female patient with asymptomatic intra-mandibular canalicular adenoma was presented. The lesion was managed surgically under local anesthesia and 2 year's follow up was uneventful. Only two other intra-mandibular canalicular adenoma cases have been reported up till now. This case report describes the third intra-mandibular canalicular adenoma, and reviews the literature. PMID:23866420
Dayisoylu, Ezher Hamza; Pampu, Ali Alper; Mungan, Sevdegul; Taskesen, Fatih
It is known that the mandibular first molar can display significant anatomical variations namely the number of root canals, the number of roots and morphology. Mandibular molars may sometimes have an additional root located lingually (the radix entomolaris) or buccally (the radix paramolaris). If encountered, an awareness and understanding of this unusual root and its canal morphology can contribute to the successful outcome of root canal treatment. This case report discusses endodontic treatment of a mandibular first molar with a radix entomolaris, which is a rare entity and poses as an endodontic dilemma for the clinician with respect to diagnosis and subsequent treatment. Clinicians should be aware of these unusual root morphologies in the mandibular first molar which needs strategic treatment as unfilled canals remain a nidus for infection and can compromise treatment outcome.
Sarangi, Priyanka; Uppin, Veerendra M
It is known that the mandibular first molar can display significant anatomical variations namely the number of root canals, the number of roots and morphology. Mandibular molars may sometimes have an additional root located lingually (the radix entomolaris) or buccally (the radix paramolaris). If encountered, an awareness and understanding of this unusual root and its canal morphology can contribute to the successful outcome of root canal treatment. This case report discusses endodontic treatment of a mandibular first molar with a radix entomolaris, which is a rare entity and poses as an endodontic dilemma for the clinician with respect to diagnosis and subsequent treatment. Clinicians should be aware of these unusual root morphologies in the mandibular first molar which needs strategic treatment as unfilled canals remain a nidus for infection and can compromise treatment outcome. PMID:24910685
Sarangi, Priyanka; Uppin, Veerendra M
Study Objectives: To characterize tongue and lateral upper airway movement and to image tongue deformation during mandibular advancement. Design: Dynamic imaging study of a wide range of apnea hypopnea index (AHI), body mass index (BMI) subjects. Setting: Not-for-profit research institute. Participants: 30 subjects (aged 31-69 y, AHI 0-75 events/h, BMI 17-39 kg/m2). Interventions: Subjects were imaged using dynamic tagged magnetic resonance imaging during mandibular advancement. Tissue displacements were quantified with the harmonic phase technique. Measurements and Results: Mean mandibular advancement was 5.6 ± 1.8 mm (mean ± standard deviation). This produced movement through a connection from the ramus of the mandible to the pharyngeal lateral walls in all subjects. In the sagittal plane, 3 patterns of posterior tongue deformation were seen with mandibular advancement—(A) en bloc anterior movement, (B) anterior movement of the oropharyngeal region, and (C) minimal anterior movement. Subjects with lower AHI were more likely to have en bloc movement (P = 0.04) than minimal movement. Antero-posterior elongation of the tongue increased with AHI (R = 0.461, P = 0.01). Mean anterior displacements of the posterior nasopharyngeal and oropharyngeal regions of the tongue were 20% ± 13% and 31% ± 17% of mandibular advancement. The posterior tongue compressed 1.1 ± 2.2 mm supero-inferiorly. Conclusions: Mandibular advancement has two mechanisms of action which increase airway size. In subjects with low AHI, the entire tongue moves forward. Mandibular advancement also produces lateral airway expansion via a direct connection between the lateral walls and the ramus of the mandible. Citation: Brown EC; Cheng S; McKenzie DK; Butler JE; Gandevia SC; Bilston LE. Tongue and lateral upper airway movement with mandibular advancement. SLEEP 2013;36(3):397-404.
Brown, Elizabeth C.; Cheng, Shaokoon; McKenzie, David K.; Butler, Jane E.; Gandevia, Simon C.; Bilston, Lynne E.
Among mammals, Carnivora presents an ideal group for investigating the complex interplay between functional adaptation and\\u000a phylogenetic history. Here we explore mandibular form and its relationship to ecology and phylogeny using geometric morphometrics\\u000a applied to mandibles of extant Carnivora. Both mandibular size and shape discriminate carnivoran ecological adaptations (diet,\\u000a membership to small or large predatory guilds), but the interplay of
C. Meloro; P. O’Higgins
We successfully treated a nonsyndromic oligodontia patient with implant-anchored orthodontics and prosthetic restorations. A woman, age 18 years 11 months, had a straight profile and a skeletal Class I jaw-base relationship but had spaced arches because of 7 congenitally missing teeth. After leveling and alignment of the dentition, a titanium miniscrew was temporarily placed at the distal alveolus of the mandibular right first premolar, and the posterior teeth were mesialized to reduce the restorative spaces. After determination of the incisor positions, 3 dental implants were respectively inserted at the sites of the maxillary canines and the mandibular left lateral incisor with guided bone regeneration procedures. Then, screw-retained temporary prostheses were delivered after subepithelial connective tissue grafting and used for molar mesialization as absolute anchorage. After 36 months of active orthodontic treatment, an acceptable occlusion was achieved, both functionally and esthetically, with the 3 dental implants. The maxillary and mandibular molars were mesialized, but the changes of incisor position were minimal. As a result, a proper facial profile was maintained, and an attractive smile was achieved. The resultant occlusion was stable throughout a 3-year retention period. In conclusion, interdisciplinary treatment combined with orthodontics, implant surgery, and prosthodontics was useful for a nonsyndromic oligodontia patient. Especially, the new strategy-implant-anchored orthodontics-can facilitate the treatment more simply with greater predictability. PMID:24680022
Kuroda, Shingo; Iwata, Mitsuhiro; Tamamura, Nagato; Ganzorig, Khaliunaa; Hichijo, Natsuko; Tomita, Yuko; Tanaka, Eiji
This patient report describes the treatment of a 45-year-old Caucasian woman with cleidocranial dysplasia who had significant dental problems that greatly affected her quality of life. The patient had orthodontic treatment in her earlier years along with surgical removal of supernumerary teeth. Using implants, the maxillary and mandibular arches were restored with fixed screw-retained prostheses. Eight implants and six implants were placed in the maxilla and mandible, respectively. Both arches were immediately loaded following the Teeth in a Day™ protocol using an all-acrylic resin provisional prosthesis. Five months later, definitive maxillary and mandibular prostheses were fabricated. The patient has been followed for a period of 5 years, and all postoperative evaluations have been uneventful. PMID:22003879
Petropoulos, Vicki C; Balshi, Thomas J; Wolfinger, Glenn J; Balshi, Stephen F
Treatment planning for the placement of an implant in a site with a thin crestal ridge should address the probability that a buccal dehiscence will result. The aim of the present investigation was to perform guided bone regeneration (GBR) around implants with buccal dehiscences and evaluate the outcomes of using autogenous bone grafts harvested from three different intraoral sites. Forty-six Osseotite implants, 4 mm in diameter, were placed in thin crestal ridges, resulting in an uncovered implant surface from the buccal aspect. The lengths of the buccal dehiscences ranged from 3 to 7 mm as measured from the implant cervix to the most apical extent of the uncovered threads. A standard GBR technique was carried out to augment the bone defect around the buccal implant surface immediately after implant placement. The cases were divided into three groups according to receipt of an autogenous bone graft from the ramus, tuberosity, or mandibular symphysis. In all cases, e-PTFE membranes were used to cover the grafted areas. Grafted sites were exposed after 6 months, membranes were removed, and residual distance between the implant cervix and most uncovered thread was recorded. All grafting materials were able to produce a certain degree of bone regeneration. In terms of bone change level, the three groups were not equal. The mandibular symphysis group exhibited the highest mean bone growth level, followed by the ramus group. The tuberosity produced the poorest result. Mandibular and ramus autogenous bone grafts represent the best choice in materials for GBR procedures around implants, while tuberosity bone grafts can be used as an alternative. PMID:15119886
Veis, Alexander A; Tsirlis, Anastasios T; Parisis, Nikolaos A
Human jaw dysmorphologies are frequent and often affect young patients, resulting in malocclusion of teeth and inappropriate jaw relationships. Treatment is performed by means of orthodontics with orthognathic surgery as required. Mandibular asymmetry is one of the most frequent dysmorphologies, but in many cases, the specific cause is unknown. In healthy patients who were undergoing orthognathic surgery for correction of malocclusion, we tested the hypothesis that masseter muscle phenotype composition, which determines contractile properties, was different between sides in patients with mandibular asymmetry but not in those without mandibular asymmetry. After cephalometric analysis, 50 patients from whom we obtained samples of both right and left masseter muscles were separated into 2 groups: with or without mandibular lateral deviation. Samples were immunostained with myosin-isoform–specific antibodies to identify 4 skeletal muscle fiber types, and their fiber areas and proportions were measured. Two-tailed Wilcoxon test for paired samples was used to compare the 4 fiber-type compositions by means of percent occupancy and mean fiber area on both sides. Patients with mandibular asymmetry were associated with a significant increase of type II fiber occupancy (P = 0.0035) on the same side as the deviation. This finding that masseter muscle phenotype is significantly linked to mandibular asymmetry is of relevance to physiotherapeutic and surgical managements of jaw discrepancies and merits further investigation in the light of its possible role in the etiology of this condition.
Raoul, Gwenael; Rowlerson, Anthea; Sciote, James; Codaccioni, Emmanuel; Stevens, Laurence; Maurage, Claude-Alain; Duhamel, Alain; Ferri, Joel
Introduction Mandibular first molar is the most important tooth with complicated morphology. In finite element (FE) studies, investigators usually prefer to model anterior teeth with a simple and single straight root; it makes the results deviate from the actual case. The most complicated and time-consuming step in FE studies is modeling of the desired tooth, thus this study was performed to establish a finite element method (FEM) of reconstructing a mandibular first molar with the greatest precision. Materials and Methods An extracted mandibular first molar was digitized, and then radiographed from different aspects to achieve its outer and inner morphology. The solid model of tooth and root canals were constructed according to this data as well as the anatomy of mandibular first molar described in the literature. Result A three-dimensional model of mandibular first molar was created, giving special consideration to shape and root canal system dimensions. Conclusion This model may constitute a basis for investigating the effect of different clinical situations on mandibular first molars in vitro, especially on its root canal system. The method described here seems feasible and reasonably precise foundation for investigations.
Ehsani, Sara; Mirhashemi, Fatemeh Sadat; Asgary, Saeed
49 patients participated in a prospective study of treatment of total or partial edentulism with fixed prosthodontics supported by Bioceram sapphire implants. 15 patients were treated for maxillary or mandibular edentulism, and 7 for a missing maxillary anterior tooth. The remaining 27 patients, with Applegate-Kennedy Class I-IV residual dentitions, were treated with fixed bridges supported by free-standing implants, or bridges supported by teeth and implants. Implant success, prosthesis stability, radiographic marginal bone level as well as parameters for peri-implant health were evaluated. The study began in 1982, and clinical treatment of the last patients was completed in 1988, i.e., a follow-up period ranging from 7 to 13 years. Of the patients treated for total mandibular edentulism, one implant fractured after 6 years in situ. The bone implant score (BIS) values for those implants were at the time for the bridge cementation 63.5 +/- 1.4 and at 1, 2, 3 and 5 year follow-ups 62.1 +/- 1.4, 61.9 +/- 1.5, 61.5 +/- 1.6, and 60.95 +/- 1.3, respectively. The success rate was 100%, 100% and 97.7% for the mandible at 3, 5 and 10 years, respectively. Of the 7 edentulous patients treated with maxillary fixed bridges, 6 implants in 1 patient had to be removed after 1 year in service. Another 2 patients lost all their implants, 6 each, after 36 months. 6 implants in the 4th patient did not fulfil the criteria for success and were rated as failures at the four year follow-up. The success rate was thus 58.1%, 44.2% and 44.2% for the maxilla at 3, 5 and 10 year follow-ups, respectively. Of the 7 patients in whom single missing teeth were replaced, 1 implant in the premolar region was lost during the 1st year post-operatively, but no other complications or changes in BIS were observed. Of the 27 patients treated for partial edentulism (56 implants total) 1 implant, of a 4-unit free standing maxillary bridge fractured after 6 years and was later replaced. There were no statistically significant differences in BIS changes for the implants when used as abutments for partial maxillary or mandibular edentulism. The cumulative success rates for the implants in the partially maxilla were 96.3, 92.6 and 92.6 at the 3, 5 and 10 years respectively and 100% in the mandible over the whole period. PMID:9586457
Fartash, B; Arvidson, K
One piece mini implants are viable and predictable options to conventional implants in areas of deficit bone width. These can be placed without complex surgical augmentation procedures and are cost effective. Four mini implants were placed in a 40 year old female patient replacing her mobile mandibular anterior teeth. Provisional restoration was given after 2 weeks followed by individual ceramic crowns after 6 months. 5 year follow-up showed aesthetic soft tissue contours and successful osseointegration. One piece mini implants are viable treatment option in the aesthetic management of partial edentulism especially in the mandibular anterior region. How to cite the article: Mohan CS, Harinath P, Cholan PK, Kumar DL . Predictable aesthetic outcome with immediate placement and early loading of one piece mini implant - A 5 year follow-up case report. J Int Oral Health 2014;6(2):132-5.
Mohan, C S Anand; Harinath, P; Cholan, Priyanka K; Kumar, D Lokesh
One piece mini implants are viable and predictable options to conventional implants in areas of deficit bone width. These can be placed without complex surgical augmentation procedures and are cost effective. Four mini implants were placed in a 40 year old female patient replacing her mobile mandibular anterior teeth. Provisional restoration was given after 2 weeks followed by individual ceramic crowns after 6 months. 5 year follow-up showed aesthetic soft tissue contours and successful osseointegration. One piece mini implants are viable treatment option in the aesthetic management of partial edentulism especially in the mandibular anterior region. How to cite the article: Mohan CS, Harinath P, Cholan PK, Kumar DL . Predictable aesthetic outcome with immediate placement and early loading of one piece mini implant - A 5 year follow-up case report. J Int Oral Health 2014;6(2):132-5. PMID:24876715
Mohan, C S Anand; Harinath, P; Cholan, Priyanka K; Kumar, D Lokesh
Iatrogenic injury to the marginal mandibular branch is an important reason for medicolegal actions. The aim of this study was to determine the distance of the marginal mandibular branch to the inferior border of the mandible as well as variation of nerve position in relation to this border. The marginal mandibular branch was dissected carefully in a number of 36 facial halves. Three points were identified on the inferior border of the mandibular ramus: Point A at the angle of the mandible, Point B just anterior to the facial artery, and Point C, 2 cm anterior to Point B. A metric and geometric morphometric analysis, including thin-plate spline and relative warp analysis was done to determine the variation of nerve position in relation to these three bony landmarks. The metric study indicated a median distance from Point A to the nerve 2.3 mm inferior to Point A, 2.4 mm superior to Point B, and 10.7 mm superior to Point C. The shape analysis indicated that variation in the position of the nerve occurs most commonly at Points A and B. We conclude that these mandibular landmarks may assist surgeons in minimizing marginal mandibular branch injury and patient discomfort. PMID:15768421
Potgieter, W; Meiring, J H; Boon, J M; Pretorius, E; Pretorius, J P; Becker, P J
After recalling Michelet's principles of mandibular osteosynthesis, the authors relate their experiences after 18 months of biomechanical analysis. They define the best locations for osteosyntheses according to calculations of when flexion and torsion occur, taking anatomical conditions into account. Details are given of the position of the plate or plates according to the location of the fracture or osteotomy (horizontal branch, symphysal and para-symphysal region and angle). Analysis of stresses within the osteosynthesized mandible has resulted in the development of what seems to be a reliable medium. One hundred anf forty facial osteosyntheses they have carried out confirm their faith in the safety of the method. PMID:1071237
Champy, M; Lodde, J P
Fixed implant hybrid prostheses have been used for the last 40+ years in the treatment of edentulous patients. These prostheses have provided long-term masticatory function for thousands of patients. The original treatment protocol included fabrication of cast metal frameworks that fit accurately on the restorative platforms or abutments and/or endosseous implants. Frameworks were designed to splint implants together; they also provided retention and support for the functional and esthetic portions of the fixed hybrid prostheses. Initially, edentulous patients were treated with maxillary complete dentures and mandibular fixed, hybrid prostheses. Denture teeth were used in both prostheses. Over the span of many years, occlusal surfaces of the denture teeth in the mandibular prostheses exhibited signs of occlusal abrasion and wear, sometimes completely abrading the teeth and denture bases, resulting in framework exposures. Ultimately, this resulted in decreased chewing efficiency and loss of vertical facial height. Patients would then return to clinicians and ask for retreatment. In certain instances, the underlying frameworks would have to be remade. This involved replicating the original series of appointments and significant additional expense to patients and clinicians alike. The protocol presented in this article avoids having to remake the most expensive portion of fixed implant prostheses--the frameworks. The protocol identifies the clinical and laboratory procedures involved in using existing frameworks and replacing preexisting denture bases and denture teeth, with minimal inconvenience to patients. PMID:22938189
Drago, Carl; Gurney, Lynn
The purpose of this study was to evaluate biomechanical loading of the temporomandibular joint when using a biodegradable laminate implant to replace the articular disc and to test the hypothesis that the use of the implant reduces stress distribution in the condyle, implant, and glenoid fossa. A finite element model of a female human mandible, including the temporomandibular joint, which had two standard endosseous implants inserted bilaterally in the premolar region, was constructed from computed tomography scan images using a commercially available finite element software. The disc, condyle, and glenoid fossa were arbitrarily divided into five regions: the anterior, posterior, medial, lateral, and central. The disc was then replaced with a poly-L/DL-lactide biodegradable laminate. The finite element model was then used to predict principal and Von Mises stresses. The use of poly-L/DL-lactide implant resulted in remarkable reduction in Von Mises stresses (approximately threefold) in the anterior, central, and medial regions of the mandibular condyle in comparison with slight to moderate stress reductions in the corresponding regions of the implant and glenoid fossa. The mandibular condyle also demonstrated the largest total displacement in all directions followed by the implant and glenoid fossa. The use of an alloplastic implant such as the bioresorbable, poly-L/DL-lactide laminate to replace the articular disc reduces loading of the mandibular condyle rather than the implant and glenoid fossa. These findings lead to support the hypothesis that the mandibular condyle more likely functions as a shock absorber than the disc. The use of bioresorbable laminate implants might prove an efficient technique to replace the articular disc and promote normal function of the temporomandibular joint. PMID:17667665
Al-Sukhun, Jehad; Ashammakhi, Nureddin; Penttila, Heikki
A surgical guiding system with simulation software has recently been used for safe implant treatment. We report a clinical case in which we successfully used this system for implant treatment of a congenital tooth missing region with severely restricted mesiodistal space. The patient was a 19-year-old female whose mandibular right deciduous canine was wobbling without a successional permanent tooth and who desired implant treatment. CT images showed that this site was narrow buccal-lingually and only five millimeters in mesiodistal width. The implant position was planned using simulation software (SimPlant : Materialise Dental) based on CT data and a surgical guide template (SurgiGuide : Materialise Dental) was fabricated prior to the implant surgery. During the implant surgery, the deciduous canine was extracted under local anesthesia. The implant bed was prepared with the surgical guide template and an implant was installed. One month after surgery, the position of the implant was examined with a cone-beam CT, which demonstrated that the implant position was exactly the same as planned. At 5 months, a provisional prosthesis was delivered and optimal soft-tissue condition was formed by modifying the provisional prosthesis. Then, the final impression was taken and a ceramo-metal implant-supported crown was delivered. In this case of a congenital tooth missing region with narrow space, implant treatment with simulation software and the surgical guide system provided excellent clinical results. PMID:19938675
Shiota, Makoto; Kihara, Hidemichi; Fujii, Masaki; Kasugai, Shohei
Background Talon cusp is a supernumerary structure projecting from the dento-enamel junction to a variable distance towards the incisal edge of an anterior tooth. Studies have shown that it consists of enamel, dentine and a variable amount of pulp tissue. Hyperactivity of the enamel organ during morphodifferentiation has been attributed to its formation. Most previous reports have been made concerning the occurrence of this structure on primary and permanent teeth and mostly on the palatal aspect. Only few have been reported on the facial aspect of the teeth. When it occurs, the effects are mainly aesthetic and functional and so early detection and treatment is essential in its management to avoid complications. Case presentation An unusual case of talon cusp on the facial aspect of a mandibular central incisor is reported. Its presence resulted in attrition of the opposing tooth. Reduction of the cusp and topical application of fluoride gel was initiated. Conclusion The management and treatment outcome of talon cusp depends on the size, presenting complications and patient cooperation.
Oredugba, Folakemi A
The paresthesias of the inferior dental nerve consists of a complication that can occur after performing various dental procedures such as cystectomies, extraction of impacted teeth, apicoectomies, endodontic treatments, local anesthetic deposition, preprosthetic or implantologic surgery. The possible mechanisms of nervous lesions are mechanical, chemical and thermal. Mechanical injury includes compression, stretching, partial or total resection and laceration. The lesion can cause a discontinuity to the nerve with Wallerian degeneration of the distal and integrated fibers of the covering (axonotmesis) or can cause the total sectioning of the nerve (neurotmesis). Chemical trauma can be due to certain toxic components of the endodontic filling materials (paraformaldehyde, corticoids or eugenol) and irrigating solutions (sodium hypochlorite) or local anesthetics. Thermal injury is a consequence of bone overheating during the execution of surgical techniques. We present a clinical case of paresthesia of the inferior dental nerve after the introduction of a gutta-percha point in the mandibular canal during the performance of a root canal therapy of the inferior first molar. The etiology and the treatment of this endodontic complication are described. PMID:12937392
Gallas-Torreira, M Mercedes; Reboiras-López, M Dolores; García-García, Abel; Gándara-Rey, José
The in vitro mechanical behavior of identical geometry LTI carbon, carbon-coated aluminum oxide, and uncoated aluminum oxide blade-type dental implants has been evaluated using rosette type strain gauges and a LVDT system. The implants served as a distal abutment for a three-unit fixed prosthesis and functioned for a period of 2 years in female baboons. The comparison of the LTI carbon implants to the carbon-coated aluminum oxide implants allowed for a study of the effect of implant elastic modulus on the mechanical behavior, while the comparison of the carbon-coated and uncoated aluminum oxide implants allowed for a study of the effect of chemical composition at the tissue-implant interface. The results of the mechanical testing indicate that the implant displacement response of the LTI carbon implants was greater than that of the carbon-coated and uncoated aluminum oxide implants. Little difference in displacement response was observed for the carbon-coated and uncoated aluminum oxide implants. No clear trend in the strain response of the buccal mandibular bone was observed for the three implant systems. The greatest differences in strain response, however, was observed between the uncoated aluminum oxide implants and the LTI carbon and carbon-coated aluminum oxide implants. PMID:6352708
Cook, S D; Weinstein, A M; Klawitter, J J
Maxillary and mandibular fractures are a relatively frequent occurrence due to the exposed location of the jaws and are caused mainly by acts of violence, traffic and recreational accidents. Mandibular fractures can be treated conservatively with dental splints and intermaxillary fixation. Since Michelet, miniplate osteosynthesis via intraoral access has become the method of choice. Champy showed that the monocortical fixation of miniplates at the level of the linea obliqua results in stable osteosynthesis, despite postoperative micro-movements in the fracture gap, and postulated the principle of dynamic compression. Dislocated fractures of the mandibular collum are treated with stable osteosynthesis via an intra- or extraoral approach, while fractures of the mandibular joint are usually treated conservatively and early functional rehabilitation is favored. For mandibular fractures, the principle of load-bearing and load-sharing should be considered, i.e. in the case of sufficient bone and uncomplicated fractures, the bone can bear most of the force, such that miniplates are sufficient (load-sharing). If bones are weakened by atrophy or in the case of infected, comminuted or defect fractures osteosynthesis plates must bear the load alone (load-bearing). PMID:22012486
Waiss, W; Gosau, M; Koyama, K; Reichert, T E
The majority of the paediatric oral and maxillofacial tumours are benign and the mandible is involved in one-third of these cases. A review of the literature reveals only a handful of studies pertaining exclusively to benign paediatric mandibular tumours. The basis of this study was to fulfil the need to assess the suitability of major mandibular reconstructions using a vascularised fibular graft in cases of benign tumours in children. From April 1999 to April 2011 we have managed 18 cases of benign paediatric mandibular tumours. All the reconstructions were done using vascularised fibular graft. The age of these patients ranged from 8 to 16 years. The most common pathology seen in our series was Ameloblastoma, followed by Giant Cell Granuloma and vascular malformation. Other cases included fibrous dysplasia, aneurysmal bone cyst and odontogenic myxoma. Five of these were recurrent lesions. The mean length of the fibula harvested was 12 ± 2 cm. All the flaps in this series survived. Bone union occurred in all cases by 6 weeks. All the patients have maintained a satisfactory chin contour of the mandible during the follow-up period with minimal distortion occurring secondary to contralateral native mandibular growth in two cases. We conclude that, for benign paediatric mandibular tumours requiring major bone resection, the vascularised fibula is an excellent reconstructive option with the advantages of having a good bone stock, possibility for osteotomy, long pedicle length and potential for growth along with the possibility of dental rehabilitation. PMID:22884679
Rashid, Mamoon; Tamimy, Muhammad Sarmad; Ehtesham-Ul-Haq; Sarwar, Saad Ur Rahman; Rizvi, Syed Taokeer Ahmed
The position of mandible in centric relation is the initial position in prosthodontic rehabilitation. This fact is especially significant today when, due to development of implantology, the use of osseointegrated prostheses is increasingly discussed. The aim of the study is to define if the peak of the articulating surface of mandible in centric relation position is directed towards the zenith of madibular fossa, or is in the retroposition. The research was conducted on macerated human sculls in anthropometric system, based on objective measuring techniques and methods. The results showed that if the zenith of mandibular fossa is determined according to the vertical line of the Frankfurt horizontal, the peak of the mandibular caput articulating surface is in retroposition. The relation of the lower joint surface to the mandibular fossa zenith is the same on both right and left side. The correlation coefficient demonstrates a high correlation between the sides, highly significant with probability level of p<0,01. If the peak of mandibular fossa is determined according to the vertical line of the Frankfurt horizontal, the peak of the articulating surface of mandibular caput is in retroposition in relation to the peak of the upper jaw surface. This original scientific work will help better understanding of x-ray analysis and understanding of relationship of TMJ surfaces, what is necessary for treatment of TMD and occlusal imbalances. PMID:16995856
Suljak-Loncarevi?, Azijada; Ajanovi?, Muhamed
Mandibular setback reduces space in the pharyngeal airway, and it has been suggested that it might induce sleep-disordered breathing. We report on its effects on space in the pharyngeal airway and respiratory function during sleep. We studied 78 patients (29 men and 49 women) in whom skeletal class III malocclusions had been corrected. The mean (range) age at operation was 24 (16-38) years and body mass index (BMI) 21.4 (16.1-30 .9)kg/m(2). Morphological changes were evaluated on lateral cephalograms taken three times: preoperatively, a few days postoperatively, and more than 6 months postoperatively. Overnight arterial oxygen saturation (SpO2) was measured by pulse oximetry 6 times: preoperatively, and on days 1, 3, 5, and 7, and 6 months postoperatively; oximetric indices were calculated. Those immediately after mandibular setback were significantly worse than those preoperatively, although they gradually improved. There were positive correlations between BMI and oximetric indices, and little association between changes in mandibular position and oximetric indices. There was no evidence of sleep-disordered breathing 6 months after mandibular setback because most patients adapt to the new environment for respiratory function during sleep. However, some (particularly obese) patients may develop sleep-disordered breathing just after mandibular setback. In such patients attention should be paid to respiratory function during sleep in the immediate postoperative period, and careful postoperative follow-up is needed. PMID:22853977
Kobayashi, Tadaharu; Funayama, Akinori; Hasebe, Daichi; Kato, Yusuke; Yoshizawa, Michiko; Saito, Chikara
Aplasia of the mandibular condyle alone without any other facial malformation and medical history is a very rare condition. This clinical report describes treatment with a functional appliance in a young patient with aplasia of the mandibular condyle alone without any other facial malformation, which is a very rare condition. The patient, a 6(1/2)-year-old girl, was referred for treatment of mandibular asymmetry. There was no relevant family history. The patient showed early mixed dentition with a II molar relationship on the right and II on the left side, 5 mm of overbite and 5 mm of overjet, and a lower midline discrepancy of 3 mm. According to the Pruzansky-Kaban classification of mandibular deformity, the patient was a type IIA; according to Vento and his classification, the mandible of the patient was M2B. The patient was given a Haupl-Andresen activator, which had been modified to reposition the right mandible downward and forward. The functional appliance therapy lasted for approximately 4 years. The affected side showed remarkable condylar growth compared with the normal side. Seven years later, the correction of the mandibular asymmetry was stable and no relapse had occurred. PMID:17667690
Leonardi, Rosalia; Barbato, Ersilia
The purpose of this study is to solve the problems that lie in the current research on mandibular movement and dynamic occlusion of complete denture in the field of dental restoration. On the basis of the theory of spatial mechanisms, the displacement matrix of mandibular movement on Hanau articulator is established through the method of direction cosine matrix. By adopting techniques such as laser scanning, computer graphics, and computer database, a 3D digitized model of maxillary and mandibular body is reconstructed, and then a computerized simulation system of mandibular movement is developed. With the aid of this software, the geometrical locus of an arbitrary landmark on maxillary denture can be plotted, the visualization and diagnosis of mandibular movement can be easily realized and the information concerned with the positions and number of the occlusal contacts can be obtained. One edentulous case is taken as an example in this article. The results show this study provides a useful tool to deal with the functional aspects of occlusal morphology in a diagnostical and therapeutical sense. PMID:17281403
Xiaojun, Chen; Rubo, Leng; Eryi, Lu; Chengtao, Wang
The purpose of this study was to describe our technique of bilateral mandibular distraction for micrognathia and to highlight the ultrasonic scalpel as an alternative to conventional saws in performing osteotomies for mandibular distraction osteogenesis. To do so, we retrospectively reviewed all patients who underwent mandibular distraction with an ultrasonic scalpel for tongue-based upper airway obstruction due to micrognathia between 2010 and 2011. Study outcome measures include operative blood loss, length of surgery, postoperative complications, and avoidance of a tracheostomy. Excel (Microsoft) was used to calculate averages, P values (2-tailed Student t test), and SDs for operative data, sleep studies, and cephalometric analysis. Nine patients--7 females and 2 males--were distracted for a mean distance of 17 ± 6 mm. Mean blood loss was 15 ± 7 mL, and the average length of surgery was 111 ± 27 minutes. One patient returned to the operating room for debridement/washout of a wound infection, but distraction was continued without sequelae. There were no other postoperative complications. Resolution of airway obstruction was evidenced by clinical examination and avoidance of a tracheostomy in all cases. Based on these data, we feel that mandibular distraction with univector, internal distractors, and ultrasonic osteotomies at the mandibular angle is safe and efficacious at relieving tongue-based upper airway obstruction and avoiding a tracheostomy. PMID:22948652
Chung, Cyndi Uy; Yu, Jason W; Bastidas, Nicholas; Bartlett, Scott P; Taylor, Jesse Adam
We performed a Le Fort I osteotomy and sagittal split ramus osteotomy (Obwegeser-Dal Pont) combined with mandibular anterior segmental osteotomy without tooth extraction for a patient with severe mandibular prognathism accompanied by a hypoplastic maxilla, anterior open bite and normal anterior mandibular vertical dimension. The results of facial appearance and occlusion were excellent. This combined surgical method appears to be satisfactory for treating severe mandibular prognathism with hypoplastic maxilla. PMID:12231203
Ogasawara, Toshiyuki; Kitagawa, Yoshimasa; Ogawa, Toru; Yamada, Tetsushi; Nakamura, Mikiko; Sano, Kazuo
Mandibular premolars have earned a reputation for having aberrant anatomy. The occurrence of three canals with three separate foramina in mandibular premolars is very rare. If predictable treatment of a three rooted mandibular premolar is planned, precise knowledge of clinical and radiographic anatomy is absolutely necessary. These teeth may also require special shaping and obturating techniques. This article reports and discusses the treatment recommendations for an unusual occurrence of three canals with three separate foramina in a second mandibular premolar.
Saberi, Eshagh Ali; Rasooli, Hossein; Movassagh, Zeinab
Mandibular premolars have earned a reputation for having aberrant anatomy. The occurrence of three canals with three separate foramina in mandibular premolars is very rare. If predictable treatment of a three rooted mandibular premolar is planned, precise knowledge of clinical and radiographic anatomy is absolutely necessary. These teeth may also require special shaping and obturating techniques. This article reports and discusses the treatment recommendations for an unusual occurrence of three canals with three separate foramina in a second mandibular premolar. PMID:24688588
Saberi, Eshagh Ali; Rasooli, Hossein; Movassagh, Zeinab
Our aim was to evaluate the function of a new optimised distraction implant. Six dogs with alveolar bone defects had a total of 18 distraction, and 6 normal, implants inserted into edentulous mandibular ridges after osteotomy. Five days after insertion the distraction implants were activated at a rate of 1 mm/2 days to achieve a distraction height of 6mm. Radiographs were taken at 0, 1, 2, and 3 months after distraction. Two dogs were killed after 1, 2, and 3 months, respectively, and 12 distraction implants taken from the different time points were evaluated by microcomputed tomographic (MicroCT) scanning and histological examination. The other 6 distraction, and the 6 normal, implants were compared after osseointegration with a fatigue test. The results showed that all the distraction implants had successfully distracted the bone to the anticipated height. Radiographs showed that the density of the regenerated bone increased steadily during the consolidation period. MicroCT showed that the regenerated bone was comparable with the native bone 3 months after distraction. Both native and regenerated bone had osseointegrated histologically by 1 month and 3 months after distraction. The experiment successfully confirmed the usefulness and feasibility of this new distraction implant, and suggests interesting clinical uses. PMID:23601834
Shao, Bo; Sun, Yingying; Gao, Yuan; Li, Tao; Li, Yongfeng; Zhang, Yongqiang; Ge, Xu; Liu, Baolin; Kong, Liang
Objectives The aim of this study was to assess the reliability of four panoramic radiographic findings, both individually and in association, in predicting the absence of corticalization between the mandibular canal and the third molar on cone beam CT (CBCT) images. Methods The sample consisted of 72 individuals (142 mandibular third molars) who underwent pre-operative radiographic evaluation before extraction of impacted mandibular third molars. On panoramic radiographs, the most common signs of corticalization (darkening of roots, diversion of mandibular canal, narrowing of mandibular canal and interruption of white line) and the presence or absence of corticalization between the mandibular third molar and the mandibular canal on CBCT images were evaluated. Results Darkening of roots and interruption of white line associated with the absence of corticalization between the mandibular third molar and the mandibular canal on CBCT images were statistically significant, both as isolated findings (p = 0.0001 and p = 0.0006, respectively) and in association (p = 0.002). No statistically significant association was observed for the other panoramic radiographic findings, either individually or in association (p > 0.05). Conclusion Darkening of roots and interruption of white line observed on panoramic radiographs, both as isolated findings and in association, were effective in determining the risk relationship between the tooth roots and the mandibular canal, requiring three-dimensional evaluation of the case.
Neves, F S; Souza, T C; Almeida, S M; Haiter-Neto, F; Freitas, D Q; Boscolo, F N
A cow, presented after being struck by a motor vehicle, continued to have difficulty eating after mandibular fracture repair. Imaging showed a temporomandibular luxation and a mandibular condylectomy was performed. Mastication improved greatly but the cow was euthanized due to infection. This is the first report of mandibular condylectomy in cattle. PMID:24891643
Sparks, Holly D; Roquet, Imma; MacKay, Angela; Barber, Spencer
The modified Michelet's (1973) technique of mandibular osteosynthesis, which consists of monocortical juxta-alveolar and sub-apical osteosynthesis, without compression and without inter-maxillary fixation, is described. This technique can be used in many types of mandibular fracture, single or multiple, associated or isolated, except in the case of a fracture of the condylar neck and in the presence of pre-existing infection. Infected fractures are treated by orthopaedic methods. Materials used (plates and screws) and particulars of the method have been tested by multi-disciplinary experimentation, particularly by anatomical verification and biomechanical studies. The ideal line of osteosynthesis is described. For the author, this technique is a routine treatment of any type of mandibular fracture. PMID:274501
Champy, M; Loddé, J P; Schmitt, R; Jaeger, J H; Muster, D
Abnormal elongation of the mandibular coronoid process is rare and its etiology is not yet elucidated. The aim of this report is to demonstrate and discuss the relationship between elongated mandibular coronoid process and limitation of mouth opening with cone beam computed tomography. Although the clinical characteristic of elongation of the coronoid process is mandibular limitation, in this report, one case had problem with mouth opening. Axial scans revealed that the distance between the coronoid process and the inner face of the frontal part of the zygomatic bone may cause limitation in mouth opening. In conclusion, instead of the length, the distance between the coronoid process and the inner face of the frontal part of the zygomatic bone may be the actual reason for limitation of mouth opening. This may prevent misdiagnosis.
Ilguy, Mehmet; Kursoglu, Pinar; Ilguy, Dilhan
A talon cusp is a supernumerary structure projecting from the dento-enamel junction to a variable distance towards the incisal edge of an anterior tooth. It consists of enamel, dentine and a variable amount of pulp tissue. Hyperactivity of the enamel organ during morpho-differentiation has been attributed to its formation. It has esthetic and functional concerns. Reports of a mandibular talon cusp are rare in the literature. To the best of our knowledge, only 14 cases have been reported, of which only 2 cases in mandibular left central incisors. We report the second instance of a talon cusp in the lingual aspect of the mandibular left central incisor and the first such report in a patient of Libyan origin. A talon cusp is an odontogenic anomaly, which can cause occlusal interferences, displacement of the affected tooth and speech difficulties. Early diagnosis of a talon cusp helps in selecting the appropriate treatment procedure and to avoid future complications.
Ramalingam, Karthikeyan; Gajula, Prathima
Mandibular incisor extraction for orthodontic treatment is considered an unusual treatment option because of the limited number of patients that meet the criteria for such treatment. Accurate diagnosis and treatment planning is essential to achieve the desired results. Adult orthodontic patients are increasingly motivated by esthetic considerations and reject the idea of conventional fixed appliances. In recent years, Invisalign appliances have gained tremendous attention for orthodontic treatment of adult patients to meet their esthetic demands. In this case report, a case of Class I malocclusion was treated with mandibular incisor extraction using the Invisalign appliance system. Successful tooth alignment of both arches was achieved. The use of Invisalign appliance is an effective treatment option in adult patients with Class I malocclusion that requires incisor extraction due to moderate to severe mandibular anterior crowding.
Zawawi, Khalid H.
Objective To examine the effect of bite force on the displacement and stress distribution of orthodontic mini-implants (OMIs) in the molar region according to placement site, insertion angle, and loading direction. Methods Five finite element models were created using micro-computed tomography (microCT) images of the maxilla and mandible. OMIs were placed at one maxillary and two mandibular positions: between the maxillary second premolar and first molar, between the mandibular second premolar and first molar, and between the mandibular first and second molars. The OMIs were inserted at angles of 45° and 90° to the buccal surface of the cortical bone. A bite force of 25 kg was applied to the 10 occlusal contact points of the second premolar, first molar, and second molar. The loading directions were 0°, 5°, and 10° to the long axis of the tooth. Results With regard to placement site, the displacement and stress were greatest for the OMI placed between the mandibular first molar and second molar, and smallest for the OMI placed between the maxillary second premolar and first molar. In the mandibular molar region, the angled OMI showed slightly less displacement than the OMI placed at 90°. The maximum Von Mises stress increased with the inclination of the loading direction. Conclusions These results suggest that placement of OMIs between the second premolar and first molar at 45° to the cortical bone reduces the effect of bite force on OMIs.
Lee, Hyeon-Jung; Lee, Kyung-Sook; Kim, Min-Ji
Purpose: To retrospectively compare the outcomes of implants placed in posterior mandibles vertically regenerated with onlay autogenous block bone grafts and short dental implants. Materials and Methods: Consecutive patients with vertical bone atrophy in edentulous mandibular posterior regions (7 to 8 mm of bone above the inferior alveolar nerve) were treated with either implants placed in regenerated bone using autologous block bone grafts (group 1) or short implants (with 5.5-mm intrabony length) in native bone (group 2) between 2005 and 2010 and followed for 12 months after loading. The procedure used was the established treatment protocol for this type of patient at the Oral Surgery Unit (University of Valencia, Spain) at the time of surgery. All grafts were obtained using piezosurgery. The outcomes assessed were: complications related to the procedure, implant survival, implant success, and peri-implant marginal bone loss. Statistical analysis was done using the Fisher exact test and the Mann-Whitney test. Results: Thirty-seven patients were included, 20 (45 implants) in group 1 and 17 (35 implants) in group 2. In group 1, 13 implants were less than 10 mm long (2 were 7 mm and 11 were 8.5 mm), and 32 were 10 mm or longer; the diameter was 3.6 mm in 6 implants, 4.2 mm in 31, and 5.5 mm in 8. In group 2 all implants were 7 mm long; the diameter measured 4.2 mm in 14 implants and 5.5 mm in 21 implants. Complications related to the block bone grafting procedure were temporary hypoesthesia in one patient, wound dehiscence with graft exposure in three patients, and exposure of the osteosynthesis screw without bone graft exposure in one patient. After 12 months, implant survival rates were 95.6% in group 1 and 97.1 % in group 2; success rates were 91.1% and 97.1%, respectively. The average marginal bone loss was 0.7 ± 1.1 mm in group 1 and 0.6 ± 0.3 mm in group 2. Conclusions: When residual bone height over the mandibular canal is between 7 and 8 mm, short implants (with 5.5-mm intrabony length) might be a preferable treatment option over vertical augmentation, reducing chair time, expense, and morbidity. PMID:24818205
Peñarrocha-Oltra, David; Aloy-Prósper, Amparo; Cervera-Ballester, Juan; Peñarrocha-Diago, Maria; Canullo, Luigi; Peñarrocha-Diago, Miguel
The ramus sagittal split osteotomy or mandibular body is an established technique for correction of dentofacial deformities but can have an accurate indication in cases requiring surgical access to remove lesions or more teeth included in the region of the mandibular angle. The main advantages of this technique are the possibility of preservation of the inferior alveolar nerve bundle and significant reduction in postoperative morbidity. In this article, the authors show a case in which the sagittal osteotomy of the mandible was used to gain access for removal of a lesion (complex odontoma). PMID:24820725
de Oliveira, Júlio César Silva; Garcia, Idelmo Rangel; de Melo, Willian Morais; de Matos Barbosa, Saulo; Rabêlo, Paulo Maria Santos; Bastos, Eider Guimarães
In this paper, an archaeological case of unilateral bifid mandibular condyle is presented. This uncommon anomaly is characterized by a division of the mandibular condylar head. In this case, the left condyle was divided into two articulating surfaces oriented mediolaterally; two articular facets on the anterior wall of the glenoid fossa for the double condyle were observed. The morphological and radiological analysis do not show any evidence of injuries or degenerative pathology. Taking into account the two main causes of bifid condyle suggested in the literature (traumatic and developmental), an embryopathy by teratogenic agents is proposed as a possible aetiology of the bifid condyle reported here. PMID:15533986
Jordana, X; García, C; Palacios, M; Chimenos, E; Malgosa, A
Bifid condyle is a rare anatomic variation of mandibular condyle. It can be symptomatic or diagnosed incidentally on routine radiographic examination. No definite etiologic factor has been identified. It is suggested that bifid condyle could be a developmental anomaly or secondary to trauma. We are reporting two cases of bifid mandibular condyle. Both were diagnosed using computed tomography scan, which additionally revealed the associated pathosis in the angle of the mandible in first patient and the ankylosis of temporomandibular joint in the second patient. PMID:22442558
Faisal, Mohammad; Ali, Iqbal; Pal, U S; Bannerjee, Kalyan
Bifid mandibular condyle is an infrequent and normally asymptomatic morphological alteration of the mandibular condyle. Although the underlying cause is not clear, a number of theories have been proposed, including teratogenic effects in the embryo, vascular alterations during condyle development, and condylar remodeling following fracture. Since Schier first described this anomaly in 1948 in live individuals, further cases have been documented in the literature. We present a new case of bilateral bifid condyle. The disorder was asymptomatic and constituted a casual finding in a young male presenting for the surgical extraction of two impacted molars. PMID:16711276
Espinosa-Femenia, Mireia; Sartorres-Nieto, Marta; Berini-Aytés, Leonardo; Gay-Escoda, Cosme
A group of eight people, including all members of one Florida family, had an implant chip, roughly the size of a grain of rice, injected under their skin on Friday, May 10. Manufactured by Applied Digital Solutions (ADS), the chips store a special identification number that enables the retrieval of personal and medical information. In the event of a medical emergency, a special handheld scanner activates the dormant digital implant, which provides identification data with which medical personnel can query ADS's database, the location of the patient's medical records. Alzheimer's patients seem to be the most promising market for this technology, even though other people, like the Florida family, hope to benefit from it as well. Another product that ADS offers is called Digital Angel, a wearable global positioning system (GPS) device that, among other things, can track in real time the wearer's physical movements. In the future, ADS is planning to release a product that will utilize both of these technologies: an implanted GPS-enabled chip. Unlike VeriChip, though, the GPS-enabled implant would require Food and Drug Administration (FDA) approval, meaning the US market won't see its introduction until after FDA testing. Many organizations, ranging from privacy advocates to religious groups, have already denounced VeriChip and its eventually successors, associated them with "Big Brother" and the biblical "Mark of the Beast."To read about the eight people that received their implants, look at the first and second sites, articles from the Los Angeles Times and Miami Herald respectively. For a non-US perspective, view the news story posted by the British Broadcasting Company (BBC). The fourth site, an extensive analysis of the subject from ABC News, should give readers a broader understanding of implanted chips and their potential uses. Two sites from ADS are next -- VeriChip's product pages and the press release that details a FDA's decision regarding VeriChip in April, 2002. Finally, the last two sites give more information on Digital Angel and a sample of GPS technology already in use.
This case report demonstrates a technique that is useful for precompressing mandibular fractures and obtaining anatomical reduction of the fracture edges without the use of peroperative intermaxillary fixation (IMF) in a mandibular fracture by using two modified reduction forceps. The first forcep is positioned at the inferior mandibular border and the other in the neutral zone where it is an ideal location to place a fixation plate in mandibular fractures. This technique is indicated for the anatomic reduction in mandibular fractures of the partial dentate patient. PMID:16491158
Shinohara, Elio Hitoshi; Mitsuda, Sérgio Takeji; Miyagusko, José Massayoshi; Horikawa, Fernando Kendi
This following case report describes the open reduction, internal fixation and the reconstruction of an extensive comminuted mandibular fracture with bilateral condylar fractures in a 19-year-old male patient with an intellectual disability and autistic disorder. He suffered fall trauma, resulting in shattered bony fragments of the alveolus and mandibular body between both mandibular rami, the fracture of both condyles and the avulsion or dislocation of every posterior tooth of the mandible. The patient underwent open reduction and internal fixation between both mandibular rami using a reconstruction plate, open reduction and internal fixation of the shattered fragments using miniplates and screws, and the closed reduction of the bilateral condylar fractures.
Lee, Kwonwoo; Yoon, Kyuho; Cheong, Jeongkwon; Shin, Jaemyung; Bae, Jungho; Ko, Inchan; Park, Hyungkoo
So now it may be seen what is meant by the term "The MAS Difference". The American orthodontic specialty has for the most part been slow, or even in isolated pockets, willfully resistant to expansion of orthodontic technique up out of the "Procrustean bed" of fixed appliance limitations to the panorama of attacking the teeth-bone-muscle triangle of malocclusion with separate techniques and appliance systems designed specifically for each. What makes this anathema to those of a broader view is that it is only with those expanded, combined fixed AND functional techniques, that one has any chance at all of rendering anything close to significantly successful treatment of major TMJ-pain-headache-dysfunction chronic pain problems. And that is serious stuff. So, if you want to do "ortho" you had better know "TMJ". And, if you want to do "TMJ", at least TMJ to any meaningful degree, you had better know "ortho", and that means the discipline of functional orthodontics (or "maxillofacial orthopedics" if you will). The "why" of it is easily understandable once one truly understands the orthopedic (condylar displacement), myofunctional (Class II neuromuscular sling), and neurological (chronic repetitive compression nerve damage) aspects of the common functionally induced TMJ problem. The "how" of it all is another matter. That is why knowledge of a broad variety of various specific orthodontic techniques is required for the clinician because there are a vast variety of malocclusive situations with their own unique demands. But in the broadest sense, since a major portion of the orthodontic patient population suffers from somewhat of a skeletal Class II relationship, or "Class II effect" with respect to the joint, somewhere in the proposed treatment plan for these patients the clinician will have to consider some form of mandibular advancement series, whatever that series may be. But it is that MAS difference that sets that clinician and his or her specific treatment plan apart from the older, more restricted ways. It is a difference we must pay attention to, for Nature surely will. PMID:11887674
Spahl, T J
Background Many novel approaches to mandibular condyle fracture have been reported, but there is a relative lack of reports on the Risdon approach. In this study, the feasibility of the Risdon approach for condylar neck and subcondylar fractures of the mandible is demonstrated. Methods A review of patients with mandibular condylar neck and subcondylar fractures was performed from March 2008 to June 2012. A total of 25 patients, 19 males and 6 females, had 14 condylar neck fractures and 11 subcondylar fractures. Results All of the cases were reduced using the Risdon approach. For subcondylar fractures, reduction and fixation with plates was done under direct vision. For condylar neck fractures, reduction and fixation was done with the aid of a trochar in adults and a percutaneous threaded Kirschner wire in children. There were no malunions or nonunions revealed in follow-up care. Mild transient neuropraxia of the marginal mandibular nerve was seen in 4 patients, which was resolved within 1–2 months. Conclusions The Risdon approach is a technique for reducing the condylar neck and subcondylar fractures that is easy to perform and easy to learn. Its value in the reduction of mandibular condyle fractures should be emphasized.
The purpose of this study was to measure the forces produced by a lip bumper on the mandibular permanent first molars. The forces in a simple of 38 patients were measured bilaterally with specially designed gauges at rest but with their lips lightly touching, speaking the words church, phone, and pop, and swallowing water. Forces were compared between two types
John J. Hodge; Ram S. Nanda; Joydeep Ghosh; David Smith
Standard treatment of mandibular angle fractures with miniplates, according to the recommendations of Champy et al. (1976), consists of fixation with one plate at the superior border of the mandible ventral to the external oblique line. In certain constellations, a second miniplate at the lower mandibular margin may provide additional stability. In contrast, extremely high complication rates following two-plate fixation of mandibular angle fractures were reported by Ellis and Walker (1994). In a prospective randomized study, 31 consecutive patients were treated with 2.0 mm (mini) plates (Synthes Co., Switzerland). One group was treated with one plate, the other one with two plates. In none of the patients was intermaxillary immobilization used. Follow-up was performed 6 months postoperatively, consisting of clinical and radiographic examination. No significant differences (P = 0.74 for infection, and P = 1.0 for occlusal and postoperative sensory disturbance) in postoperative short- or long-term complications were found between the two groups. The results are compared with our experimental investigations presented at the annual congress of the Germany Society of Oral and Maxillofacial Surgery, 1995. Two-plate fixation may not offer advantages over single-plate fixation in general. However, individual fracture constellations may benefit from variation in plate(s) localization. Factors contributing to complications in mandibular angle fractures are discussed. PMID:9234097
Schierle, H P; Schmelzeisen, R; Rahn, B; Pytlik, C
This paper presents the results of the treatment of fractures of the mandibular angle using miniplate osteosynthesis. From 1984 to 1993 347 patients with 358 fractures were operated in the department of Maxillofacial Surgery at the University of Cologne. In all cases total bone healing could be observed while complications were rare. PMID:8755411
Pape, H D; Schippers, C G; Gerlach, K L; Walz, C
Objective. The purpose of this study was to reassess Champy's findings, which were instrumental in justifying the theory of tension band plating for mandibular angle fractures.Study design. Ten anatomically correct mandibles were fabricated with a photoelastic resin. In five mandibles, angle fractures were created and fixated with a superior border miniplate; five uncut mandibles served as controls. Each mandible was
Robert A Rudman; Sidney C Rosenthal; Chiayi Shen; James D Ruskin; Peter G Ifju
Objective. To inform the reader of the history of the Christensen mandibular and temporomandibular joint devices and the usefulness of the more recent generation of devices in the typical and atypical temporomandibular joint patient. Methods. The larger amount of data will involve the younger female patient who represents some 88% to 90% of patients with early to late TMJ disease
Robert W. Christensen
Cultural reshaping (artificial deformation or modification) of the neurocranial vault provides an artificially increased range of morphological variability within which the relationship between the growing neurocranium and face can be investigated. We analyze crania which have been fronto-occipitally compressed to ascertain possible morphological effects on the mandible. We collected measures of mandibular breadth, length, and height from 82 modified (N = 48) and unmodified (N = 34) crania from a Peruvian Ancon series. Angle classification was also scored in order to investigate whether or not occlusal relationships were affected by neurocranial reshaping. Only intercondylar distance (posterior mandibular breadth) exhibited significant differences between unmodified and modified groups, though this difference was relatively small compared with vault deformation. The modified crania had a higher frequency of normal occlusion (Class I) than the unmodified crania. Increased intercondylar breadth in modified skulls is due to a cascade of effects which begin with a direct effect of the fronto-occipital deforming device on neurocranial shape (increased neurocranial width). The increase in mandibular breadth may be a compensatory response to increased cranial base breadth and maintains articulation between the cranial base and mandible. The increased posterior breadth, coupled with a slight decrease in mandibular depth, may contribute to the change in occlusal relationships suggested for this sample. PMID:1543243
Cheverud, J M; Midkiff, J E
Purpose: The purpose of the study was to review the literature regarding the evolution of current thoughts on management of mandibular condylar fractures (MCFs) in children. Methods: An electronic search in PubMed was undertaken in May 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies published in English
Bruno Ramos Chrcanovic
An algorithm for the treatment of noncondylar mandibular fractures is presented based on outcomes from studies that have been performed during the past 30 years. It is designed to assist clinicians in formulating a treatment plan that can be expected to provide the patient with a predictable outcome. PMID:24480758
The method of strain tensor (ST) analysis efficiently demonstrates the morphological differences in skeletal jaw growth and provides more information for orthodontic diagnosis and orthopedic therapy of jaw disharmonies. The purpose of this study was to investigate midfacial and mandibular size and shape differences in a sample of normal Class I molar occlusion and Class III malocclusion. Fifty Chinese boys
Alveolar ridge atrophy poses a clinical challenge toward the fabrication of successful prosthesis. Resorption of mandibular denture bearing areas results in unstable non-retentive dentures associated with pain and discomfort. This article describes rehabilitation procedure of a patient with resorbed ridge with maximal areas of coverage to improve support and neutral zone arrangement of teeth to improve stability of denture.
Devaki, Veeramalai N.; Manonmani, Paramasivam; Balu, Kandasamy; Aravind, Ramraj Jayabalan
Mandible is the second most common facial fracture. There has been a significant increase in the number of cases in recent years with the advent of fast moving automobiles. Mandibular fractures constitute a substantial proportion of maxillofacial trauma cases in Lucknow. This study was undertaken to study mandibular fractures clinicoradiologically with an aim to calculate incidence and study pattern and the commonest site of fractures in population in and around Lucknow. Patient presenting with history of trauma at various centers of maxillofacial surgery in and around Lucknow were included in this study. Detailed case history was recorded followed by thorough clinical examination, and radiological interpretation was done for establishing the diagnosis and the data obtained was analyzed statistically. Out of 66 patients with mandibular fractures, highest percentage was found in 21–30 years of age with male predominance. Road traffic accidents were the most common cause of fracture with parasymphysis being commonest site. Commonest combination was parasymphysis with subcondyle. There was no gender bias in etiology with number of fracture sites. The incidence and causes of mandibular fracture reflect trauma patterns within the community and can provide a guide to the design of programs geared toward prevention and treatment.
Natu, Subodh S.; Pradhan, Harsha; Gupta, Hemant; Alam, Sarwar; Gupta, Sumit; Pradhan, R.; Mohammad, Shadab; Kohli, Munish; Sinha, Vijai P.; Shankar, Ravi; Agarwal, Anshita
A rare case of aneurysmal bone cyst (ABC) located in the mandibular condyle in a 10-year-old boy is presented. The patient came to our attention for a sudden swelling in the right temporomandibular region, the mouth opening was not reduced. A rapid growing mass, depicting soft tissue invasion, in the right condyle of the mandible was found. Clinically and radiographically
Sandro Pelo; Giulio Gasparini; Roberto Boniello; Alessandro Moro; Pier Francesco Amoroso
Microvascular temporomandibular joint (TMJ) and mandibular ramus reconstruction was performed in a 4-year-old hemifacial microsomia patient with multiple craniofacial and extracranial anomalies (Goldenhar syndrome). Her major craniofacial anomalies included bilateral cleft lip and palate, left macrostomia, left microtia, and complete absence of the left vertical mandibular ramus and TMJ. Most of her other anomalies had been corrected surgically before TMJ and vertical mandibular ramus reconstruction, which was accomplished with a metatarsophalangeal (MTP) joint transplantation. The MTP joint was placed in hyperextended position in the skull base inserting the proximal phalanx under the remnants of the zygomatic arch and replacing the vertical mandibular ramus with the metatarsal bone. Straight mouth opening, correction of the midline, and normalized lateral movements of the mandible were accomplished. The graft includes two epiphyseal plates, which should maintain growth of the transplant. During the follow-up period (16 months) the achieved results have been maintained without adverse effects. The present technique appears to be a promising alternative in the treatment of children with Pruzansky type 3 hemifacial microsomia. PMID:12457098
Vilkki, S K; Hukki, J; Nietosvaara, Y; Hurmerinta, K; Suominen, E
The purposes of this study were (1) to compare the direction of mandibular growth (MGD) during treatment and retention for a group of treated Class II patients with untreated controls, and (2) to investigate the relationship between the MGD during treatment and the pretreatment skeletal structure. Pretreatment, posttreatment, and 2 years posttreatment lateral cephalograms of 26 Class II, Division 1 subjects who were treated "nonextraction" with low- or straight-pull headgears were compared with an untreated control group of 15 subjects. Mandibular growth direction was interpreted as the movement of the point gnathion relative to the S-N line when successive tracings were superimposed on the S-N line at S. On average, MGD appeared more vertical during treatment. Posttreatment MGD was generally more horizontal than that during treatment but was also extremely variable. Three of the pretreatment skeletal measures studied, especially the articular angle (SArGo), were significantly related to MGD during treatment. The inclination of the mandibular ramus is apparently an important indicator of how mandibular growth will respond to Class II treatment mechanics. PMID:1598894
Mair, A D; Hunter, W S
Tori (singular: torus) are among the most common benign jaw lesions. The magnetic resonance imaging (MRI) characteristics have not been reported yet. We present a 72-year-old patient with mandibular tori, which were detected as an incidental finding on MRI and provide an overview of the imaging features of tori.
Schubert, Marika; Sieron, Dominik; Laniado, Michael
Oriental women, in general, greatly desire a more delicate and feminine facial shape. This can be obtained by contouring the prominent mandibular aangles that give a strong, masculine image. Western authors regarded masseteric muscular hypertrophy the main cause of a square facial appearance, so they usually corrected it by partially excising the masseter muscle. In the authors' view, a square
Se-Min Baek; Rong-Min Baek; Myoung-Soo Shin
This case report illustrates the nonsurgical endodontic management of a seven-canaled mandibular second molar. The root canal configuration presented as four mesial and three distal canals. Identification of the canal system was made with the aid of magnification, ultrasonics, and multiple angulated radiographs. Postoperative examination at 18 months showed a clinically asymptomatic tooth with resolution of the periapical pathology. PMID:24634902
Kottoor, Jojo; Paul, Kuriachan Kottanathu; Mathew, Joy; George, Saira; Mathew, Jain; Roy, Arun
Purpose Calcium phosphate (CaP)-coated implants promote osseointegration and survival rate. The aim of this study was to (1) analyze the dissolution behavior of the residual CaP particles of removed implants and (2) evaluate bone apposition of CaP-coated machined surface implants at the early healing phase. Methods Mandibular premolars were extracted from five dogs. After eight weeks, the implants were placed according to drilling protocols: a nonmobile implant (NI) group and rotational implant (RI) group. For CaP dissolution behavior analysis, 8 implants were removed after 0, 1, 2, and 4 weeks. The surface morphology and deposition of the coatings were observed. For bone apposition analysis, block sections were obtained after 1-, 2-, and 4-week healing periods and the specimens were analyzed. Results Calcium and phosphorus were detected in the implants that were removed immediately after insertion, and the other implants were composed mainly of titanium. There were no notable differences between the NI and RI groups in terms of the healing process. The bone-to-implant contact and bone density in the RI group showed a remarkable increase after 2 weeks of healing. Conclusions It can be speculated that the CaP coating dissolves early in the healing phase and chemically induces early bone formation regardless of the primary stability.
Hwang, Ji-Wan; Lee, Eun-Ung; Lee, Jung-Seok; Jung, Ui-Won; Lee, In-Seop
The purpose of this retrospective study was to determine the outcome of Brånemark System TiUnite® implants (Nobel Biocare/Sweden), and to identify the risk factors associated with implant failure. A total of 151 patients (83 maxillae and 91 mandibles) received 619 implants from July 2003 until May 2010. The patients included 86 males and 65 females, with a median age of 51.6 years and an age range of 16 to 90 years at the time of implant surgery. Seventeen maxillae and 16 mandibles were completely edentulous, and 66 maxillae and 75 mandibles were partially edentulous. All the patients were followed until June 2011. Among the 619 implants, 9 maxillary implants and 8 mandibular implants were unsuccessful. The overall survival rate was 96.82%. A logistic regression analysis identified that a history of steroid treatment, application of a dento-maxillary prosthesis, a lack of mechanical coupling between the implants, and the length of the implants (?8.5mm) were significant predictors of implant failure. PMID:22972026
Shibuya, Yasuyuki; Takata, Naoki; Takeuchi, Junichiro; Tsuji, Kazuyuki; Ishida, Suguru; Kobayashi, Masaki; Suzuki, Hiroaki; Hasegawa, Takumi; Kamae, Isao; Komori, Takahide
The skeletal anchorage system (SAS) consists of titanium anchor plates and monocortical screws that are temporarily implanted in either the maxilla or the mandible as absolute orthodontic anchorage. With SAS, anterior open bite can be improved by the counterclockwise rotation of the mandible, accompanied by the intrusion of molars. The present study was designed to evaluate treatment and posttreatment dentoalveolar changes following the intrusion of mandibular molars. Nine adult open bite patients (7 women and 2 men) successfully treated with SAS were included in the following study. The amount of intrusion, relapse, and dentoalveolar changes were measured on cephalometric radiographs, panoramic radiographs, and dental casts. The results of this study were as follows: (1) the average amount of intrusion of the mandibular first and second molars was 1.7 mm and 2.8 mm, respectively; (2) the average relapse rates were 27.2% at the first molars and 30.3% at the second molars; (3) there were no significant changes in crestal bone heights, clinical crown length, or root length; and (4) counterclockwise rotation of the mandible and decrease of anterior facial height were observed during treatment. Thus, it was concluded that SAS would be a valid modality to intrude mandibular molars for correction of open bite. PMID:12592995
Sugawara, Junji; Baik, Un Bong; Umemori, Mikako; Takahashi, Ichiro; Nagasaka, Hiroshi; Kawamura, Hiroshi; Mitani, Hideo
... and Knee Replacement Rehabilitation News News Multimedia Resources Knee Replacement Implants Introduction | Implant Design | Implant Components | Fixed- ... Article Text Size: + | - Next Your doctor may recommend knee replacement surgery if you have severe knee pain ...
The association between skeletal bone mineral density (BMD) and mandibular alveolar bone mass has been reported to be rather weak, probably due to local functional factors. Many new investigations are therefore focused on assessing the mandibular bone structure. No long-term structural alterations have been reported in human mandibular bone with the exception of alveolar crest changes related to periodontal disease. The aim of this prospective study was to investigate dentate women to see if possible alterations in the radiographic characteristics of the mandibular alveolar bone are related to changes in BMD. The BMD of 131 women (initial age 22-75 years) was determined in the distal forearm with dual energy X-ray absorptiometry on two occasions separated by an interval of 5 years. Mandibular alveolar bone mass (MABM) was assessed both by the optical density and by the grey-level value on digitized, calibrated, periapical radiographs. The radiographic alveolar bone structure was evaluated with a visual index [Lindh C, Petersson A, Rohlin M. Assessment of the trabecular pattern before endosseous implant treatment: diagnostic outcome of periapical radiography in the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:335-43. ] and digitally by the alveolar bone texture. MABM decreased significantly during the 5-year period. Changes in MABM, evaluated by the mean grey-level value of a bone segment between the premolars, were correlated to changes in skeletal BMD (r = 0.33, P < 0.001). Changes in MABM, evaluated by the optical density, did not correlate to changes in skeletal BMD. The overall trabecular pattern did not change during the study period, but small changes in the bone texture were measured. The changes in the bone texture were correlated with BMD change (r = 0.39, P < 0.001). We conclude that changes in the mandibular alveolar bone do reflect changes in the skeletal BMD, and these may be estimated on periapical radiographs by changes in their grey-level value and their texture. PMID:16326156
Jonasson, Grethe; Jonasson, Lisa; Kiliaridis, Stavros
Contents: History of Breast Implants; Availability of Implants; The Surgery; Surgical Risks of Implants; Other Implant-Related Risks; Illness and Conditions Elsewhere in The Body and Breast Implants; Special Medical and Physical Considerations; Breast Imp...
Extensive resorption of the mandible increases the interarch space and rehabilitation with traditional dentures is often unsatisfactory due to the superficialization of intraoral muscles. A study of 19 patients who underwent augmentation of an atrophic mandible using a bilateral two-step osteotomy and interpositional bone graft technique is presented. Three horizontal bone cuts (one in the intraforamina and two in the molar region) were made and jointed together by two short vertical bone cuts mesialy to the mental nerve. The cranial fragment was lifted and the iliac bone graft was interposed recreating the correct intermaxillary relationship. A broad vascular pedicle was maintained during surgery, ensuring nutrition from the lingual side, essential to reduce resorption of the bone graft and cranial fragment. 141 Biomet 3i Osseotite((R)) implants were placed. Patients were rehabilitated with a full-arch implant-supported fixed prosthesis or an implant-supported overdenture. This clinical study describes the resorption process over a 4 year follow-up. 3 of 19 suffered from persistent neurosensitive disturbances. In conclusion, bilateral two-step osteotomy in association with interpositional bone graft is a reliable surgical means to recreate the anatomical morphology of the mandible. PMID:20022217
Pelo, S; Boniello, R; Moro, A; Gasparini, G; Amoroso, P F
Information concerning the effects of the implant cutting flute design on initial stability and its influence on osseointegration in vivo is limited. This study evaluated the early effects of implants with a specific cutting flute design placed in the sheep mandible. Forty-eight dental implants with two different macro-geometries (24 with a specific cutting flute design - Blossom group; 24 with a self-tapping design - DT group) were inserted into the mandibular bodies of six sheep; the maximum insertion torque was recorded. Samples were retrieved and processed for histomorphometric analysis after 3 and 6 weeks. The mean insertion torque was lower for Blossom implants (P<0.001). No differences in histomorphometric results were observed between the groups. At 3 weeks, P=0.58 for bone-to-implant contact (BIC) and P=0.52 for bone area fraction occupied (BAFO); at 6 weeks, P=0.55 for BIC and P=0.45 for BAFO. While no histomorphometric differences were observed, ground sections showed different healing patterns between the implants, with better peri-implant bone organization around those with the specific cutting flute design (Blossom group). Implants with the modified cutting flute design had a significantly reduced insertion torque compared to the DT implants with a traditional cutting thread, and resulted in a different healing pattern. PMID:24583140
Jimbo, R; Tovar, N; Marin, C; Teixeira, H S; Anchieta, R B; Silveira, L M; Janal, M N; Shibli, J A; Coelho, P G
This study reports on the histologic characteristics of the early phases of implant osseointegration, focusing on osteopontin concentrations in the coronal area of implants placed with marginal defects and in control sites without defect preparation. In the mandibular right area of 12 dogs, two recipient sites were prepared and the margins were widened to obtain a gap of 0.5 mm at one site (small defect) and 1.25 mm at another site (large defect). Implants were placed and allowed a fully submerged healing. The procedure was subsequently performed in the left side in such a way as to obtain healing times of 5, 10, 20, and 30 days. Paraffin sections were stained with osteopontin antibodies and analyzed. At control implants, scarcely organized collagen fibers were observed in the space between the pristine bone and implant and were quickly replaced by mineralized tissue. In the small and large defects, the collagen fibers were organized in a layer that ran parallel to the implant at day 10 and became denser and thicker with time. Osteopontin was evenly distributed in the peri-implant tissue at control implants, while it was mainly located in the collagen bundle section around the implants placed in the defects. PMID:24804295
Carmagnola, Daniela; Botticelli, Daniele; Canciani, Elena; Rossi, Fabio; Milani, Stefano; Dellavia, Claudia
Traditional orthodontic treatments do not adequately address the skeletal problems of retrognathic, hyperdivergent, Class II adolescents; the few approaches that do require long-term patient compliance. This paper introduces a novel approach using miniscrew implants (MSIa) and growth to treat retrognathic hyperdivergent adolescents. Nine consecutive patients were evaluated at the start of treatment (13.2 ±1.1 years of age) and again at the end of the orthopedic phase (after 1.9 ±0.3 years). Each patient had two MSIs placed in either side of the palate. Coil springs (150 g) extended from the MSIs to a RPE, which served as a rigid segment for intruding the maxillary premolar and molars. Two additional MSIs were placed between the first mandibular molars and second premolars; coil spring (150 g) extended from the MSIs to hold or intrude the mandibular molars. Prior to treatment, the patients exhibited substantial and significant mandibular retrusion (Z-score=?1.0), facial convexity (Z-score=0.7), and hyperdivergence (Z-score=1.6). Treatment produced consistent and substantial orthopedic effects. The chin was advanced an average of 2.4 mm, the SNB angle increased by 2.1°, the mandibular plane angle decreased 3.9°, and facial convexity decreased by approximately 3.2°. Questionnaires showed that this treatment approach was not painful or uncomfortable; the majority of the patients indicated that they were very likely to recommend the treatment to others. Treatment was accomplished by titrating the amount of orthodontic intrusion performed based on the individuals’ growth potential.
Buschang, Peter H.; Carrillo, Roberto; Rossouw, P. Emile
Implantation of a porous scaffold with a large volume into the body in a convenient and safe manner is still a challenging task in the repair of bone defects. In this study, we present a porous smart nanocomposite scaffold with a combination of shape memory function and controlled delivery of growth factors. The shape memory function enables the scaffold with a large volume to be deformed into its temporal architecture with a small volume using hot-compression and can subsequently recover its original shape upon exposure to body temperature after it is implanted in the body. The scaffold consists of chemically cross-linked poly(?-caprolactone) (c-PCL) and hydroxyapatite nanoparticles. The highly interconnected pores of the scaffold were obtained using the sugar leaching method. The shape memory porous scaffold loaded with bone morphogenetic protein-2 (BMP-2) was also fabricated by coating the calcium alginate layer and BMP-2 on the surface of the pore wall. Under both in vitro and in vivo environmental conditions, the porous scaffold displays good shape memory recovery from the compressed shape with deformed pores of 33 ?m in diameter to recover its porous shape with original pores of 160 ?m in diameter. In vitro cytotoxicity based on the MTT test revealed that the scaffold exhibited good cytocompatibility. The in vivo micro-CT and histomorphometry results demonstrated that the porous scaffold could promote new bone generation in the rabbit mandibular bone defect. Thus, our results indicated that this shape memory porous scaffold demonstrated great potential for application in bone regenerative medicine. PMID:24467335
Liu, Xian; Zhao, Kun; Gong, Tao; Song, Jian; Bao, Chongyun; Luo, En; Weng, Jie; Zhou, Shaobing
The combination of a total lower lip, chin, and anterior mandibular defect following cancer resection is an extremely complex problem that requires a sequence of operations to optimize functional and aesthetic results. One patient is presented in whom the defect was reconstructed with a free fibular flap followed by a series of ancillary procedures using both modern and traditional techniques. At the time of tumor ablation, the through-and-through oromandibular defect was reconstructed with a fibular osteocutaneous flap. The lower lip and gingivolabial sulcus was reconstructed later with a tongue flap. Tissue expansion was subsequently used to replace the fibular skin with expanded submental hair-bearing skin. A polyethylene implant was added later to the fibular bone for chin augmentation. Subsequently the lower lip was supported with a tendinous graft suspended to the anterior masseter bilaterally. Lastly, the vermilion border was elevated by removing a rim of the tongue flap and covering the secondary wound with a full-thickness skin graft. At the end of the reconstructive procedures, lip seal and oral aperture were good with no drooling and excellent speech. PMID:9523616
Yuen, J C; Zhou, A; Shewmake, K
The surgical removal of supernumerary teeth is necessary in some cases, especially before the commencement of any orthodontic or implant treatment procedure. In the mandibular supernumerary premolar, a more conservative approach is required because of the presence of complications associated with conventional surgery due to the close proximity of the said premolar to the alveolar inferior and mental nerves, and the need for bone conservation for implant placement. The endoscopic surgical approach has been used for the removal of the maxillary supernumerary tooth, impacted third molar, and implants. In this case report, we present an endoscopically assisted surgical technique for the removal of an unerupted supernumerary premolar in the mandible associated with a dental implant placement procedure. PMID:24772355
Beltrán, Víctor; Cantín, Mario; Borie, Eduardo; Fuentes, Ramón; Engelke, Wilfried
A bio-degradable scaffold incorporating osteoinductive factors is one of the alternative methods for achieving the regeneration of a mandibular bone defect. The current pilot study addressed such a bone reconstruction in a non-human primate model, Macaca fascicularis monkeys, with an engineered poly(?-caprolactone) (PCL) scaffold, provided with a carbonate-substituted hydroxyapatite coating. The scaffolds were implanted into unilaterally created mandibular segmental defects in 24 monkeys. Three experimental groups were formed: (1) scaffolds with rhBMP-2 (n = 8), (2) scaffolds with autologous mixed bone marrow cells (n = 8), and (3) empty scaffolds as a control group (n = 8). Evaluation was based on clinical observation as well as micro-CT, mechanical, and histological analyses. Despite a high infection rate, the overall results showed that the currently designed PCL scaffolds had insufficient load-bearing capability, and complete bone union was not achieved after 6 months of implantation. Nevertheless, the group of PCL scaffolds loaded with rhBMP-2 showed evidence of bone-regenerative potential, in contrast to PCL with autologous mixed bone marrow cells and the control group. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 102B: 962-976, 2014. PMID:24259321
Chanchareonsook, Nattharee; Tideman, Henk; Feinberg, Stephen E; Jongpaiboonkit, Leenaporn; Lee, Shermin; Flanagan, Colleen; Krishnaswamy, Gita; Jansen, John
Objective: We propose and validate a computer—aided system to measure three different mandibular indexes: cortical width, panoramic mandibular index and, mandibular alveolar bone resorption index. Study Design: Repeatability and reproducibility of the measurements are analyzed and compared to the manual estimation of the same indexes. Results: The proposed computerized system exhibits superior repeatability and reproducibility rates compared to standard manual methods. Moreover, the time required to perform the measurements using the proposed method is negligible compared to perform the measurements manually. Conclusions: We have proposed a very user friendly computerized method to measure three different morphometric mandibular indexes. From the results we can conclude that the system provides a practical manner to perform these measurements. It does not require an expert examiner and does not take more than 16 seconds per analysis. Thus, it may be suitable to diagnose osteoporosis using dental panoramic radiographs. Key words:Osteoporosis, panoramic mandibular index, cortical width, mandibular alveolar bone resorption index.
Alvarez-Lopez, Jose M.; Jane-Salas, Enrique; Estrugo-Devesa, Albert; Ayuso-Montero, Raul; Velasco-Ortega, Eugenio; Segura-Egea, Juan J.
Mandibular bone transport (MBT) distraction osteogenesis devices are used for achieving reconstruction of mandibular defects in a predictable way, with few complications, less complexity than other alternative surgical procedures, and minimal tissue morbidity. However, selection of appropriate MBT device characteristics is critical for ensuring both their mechanical soundness and their optimal distraction function for each patient's condition. This article assesses six characteristics of currently available MBT devices to characterize their design and function and to classify them in a way that assists the selection of the best device option for each clinical case. In addition, the present work provides a framework for both the biomechanical conception of new devices and the modification of existing ones.
Zapata, Uriel; Elsalanty, Mohammed E.; Dechow, Paul C.
A thorough anatomical knowledge is very essential for clinical practice and any surgical procedure. Unfortunately anatomical variations can lead to hazards in medical and dental diagnosis and treatment. Such knowledge is very essential even in effective local anesthesia which is an essential part of treatment in patients with many oral disorders. Therefore a normal anatomy and its possible variations are utmost important aspects also in dentistry. One of the structures that dentists very often deal with is the mandibular nerve which therefore needs a thorough review. However, there are not many consolidated literature reviews available regarding its variations and clinical applications. Keeping this in mind, in this article, the authors have brought together available literature on various aspects of mandibular nerve. The final review will be of benefit to clinicians (Fig. 2, Ref. 63). PMID:22794519
Somayaji, S Krishnaraj; Acharya, S Rashmi; Mohandas, K G; Venkataramana, V
Osteoradionecrosis can involve the mandible following radical irradiation for treatment of oral cavity cancer. The radionecrosis of the mandible is often associated with severe intractable pain, local or extensive deformity, including pathologic fracture, orocutaneous fistula formation, and frequent loss of function. Treatment has ranged from analgesia and antibiotics to hyperbaric oxygen treatments to local or extensive sequestrectomies with partial or total mandibulectomy and restoration of tissue losses with unirradiated tissue. To our knowledge, this is the first report of the successful use of a free greater omental flap for immediate treatment of mandibular osteoradionecrosis and concomitant reconstruction. We found the omentum to be an excellent vascular bed that rapidly resolved the osteoradionecrosis and pain, promoted healing, and restored mandibular function with minimal discomfort to the patient.
Moran, W.J.; Panje, W.R.
Reliable profound mandibular block anesthesia is questionable when depositing the anesthetic solution at the lingula. Complications can occur and the needle may impact a number of important anatomical structures by deep penetration. The Gow-Gates technique for mandibular anesthesia obviates these problems. In this paper the Gow-Gates technique is reinterpreted using a geometrical approach based on lines and planes and is proved mathematically. In so doing a simple yet concise method of reaching the injection site is presented with a definite relationship between the anatomical pathway of the needle and a formal geometrical and mathematical pattern. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7
Kafalias, Michael C.; Gow-Gates, George A.E.; Saliba, Gary J.
Objective To gain basic information regarding the biologic stability of plasma ion-implanted miniscrews and their potential clinical applications. Methods Sixteen plasma ion-implanted and 16 sandblasted and acid-etched (SLA) miniscrews were bilaterally inserted in the mandibles of 4 beagles (2 miniscrews of each type per quadrant). Then, 250 - 300 gm of force from Ni-Ti coil springs was applied for 2 different periods: 12 weeks on one side and 3 weeks contralaterally. Thereafter, the animals were sacrificed and mandibular specimens including the miniscrews were collected. The insertion torque and mobility were compared between the groups. The bone-implant contact and bone volume ratio were calculated within 800 µm of the miniscrews and compared between the loading periods. The number of osteoblasts was also quantified. The measurements were expressed as percentages and analyzed by independent t-tests (p < 0.05). Results No significant differences in any of the analyzed parameters were noted between the groups. Conclusions The preliminary findings indicate that plasma ion-implanted miniscrews have similar biologic characteristics to SLA miniscrews in terms of insertion torque, mobility, bone-implant contact rate, and bone volume rate.
Cho, Young-Chae; Cha, Jung-Yul; Hwang, Chung-Ju; Park, Young-Chel; Jung, Han-Sung
Recent observations in man of concomitant mandibular and head movements during single maximal jaw-opening\\/-closing tasks suggest a close functional relationship between the mandibular and the head-neck motor systems. This study was aimed at further testing of the hypothesis of a functional integration between the human jaw and neck regions. Spatiotemporal characteristics of mandibular and associated head movements were evaluated for
P.-O. Eriksson; B. Häggman-Henrikson; E. Nordh; H. Zafar
Trifid mandibular condyle is an exceedingly rare entity with only 5 cases reported to date. The etiology of the disorder is unknown, though like bifid mandibular condyle, a correlation with prior trauma is usually seen. We present a case of a 6-year-old child who presented with severe restriction of movements at the temporomandibular joint, with a history of trauma 2 years back. Imaging revealed bilateral temporomandibular joint ankylosis with trifid and bifid mandibular condyles. PMID:23524825
Jha, Abhishek; Khalid, Mohd; Sahoo, Biswajit
Objectives: The aim of this study was to determine and compare the reliability to accomplish of common mandibular landmarks and to determine the incidence of incisive canals, anterior looping, and lingual foramina in children from panoramic and CBCT images. Study Design: Panoramic and CBCT images from 100 children and adolescent patients were randomly selected. In order to grade the visibility of mandibular anatomical landmarks, a four-point rating scale was used. Results: In panoramic images, the mandibular canal could be observed in 92.5% of cases, with good visibility in 12.0%. The mental foramen could be observed in 44.5% of cases, while none had good visibility. Anterior looping of the mental nerve was present in 16.5% of the cases, and none had good visibility. An incisive canal could be identified in 22.5% of cases, with only 1.5% showing good visibility. The lingual foramen could be visualized in 61.0% of cases, with good visibility in 6%. In CBCT images, the mandibular canal, the mental foramen, and the lingual foramen could be observed in 100% of the cases, with good visibility in 51.0%, 98.5%, and 45.0% of cases, respectively. Anterior looping of the mental nerve was present in 26% of cases, with 2% having good visibility. An incisive canal could be identified in 49.5% of cases, with only 75% showing good visibility. Conclusions: This study confirms the applicability of CBCT images to visualize critical structures in children. Key words:Panoramic radiography, cone beam computed tomography, anatomical landmark.
Sekerci, Ahmet E.; Miloglu, Ozkan; Buyuk, Suleyman K.
Context: In this prospective study, 13 randomly selected patients underwent treatment for zygomatic–complex fractures (2 site fractures) and mandibular fractures using 1.5 / 2 / 2.5-mm INION CPS biodegradable plates and screws. Aims: To assess the fixation of zygomatic-complex and mandibular fractures with biodegradable copolymer osteosynthesis system. Materials and Methods: In randomly selected 13 patients, zygomatic-complex and mandibular fractures were plated using resorbable plates and screws using Champy's principle. All the cases were evaluated clinically and radiologically for the type of fracture, need for the intermaxillary fixation (IMF) and its duration, duration of surgery, fixation at operation, state of reduction at operation, state of bone union after operation, anatomic reduction, paresthesia, occlusal discrepancies, soft tissue infection, immediate and late inflammatory reactions related to biodegradation process, and any need for the removal of the plates. Statistical Analysis Used: Descriptives, Frequencies, and Chi-square test were used. Results: In our study, the age group range was 5 to 55 years. Road traffic accidents accounted for the majority of patients six, (46.2%). Postoperative occlusal discrepancies were found in seven patients as mild to moderate, which resolved with IMF for 1-8 weeks. There were minimal complications seen and only as soft tissue infection. Conclusions: Use of biodegradable osteosynthesis system is a reliable alternative method for the fixation of zygomatic-complex and mandibular fractures. The biodegradable system still needs to be refined in material quality and handling to match the stability achieved with metal system. Biodegradable plates and screws is an ideal system for pediatric fractures with favorable outcome.
Degala, Saikrishna; Shetty, Sujeeth; Ramya, S
The aim of this paper is to bring into focus the literature on the choice of the mandibular reference position in orthodontic treatment; of a particular reference to this paper is intercuspal position, centric relation position, or therapeutic position. To give a comprehensive account of the literature review on craniomandibular disorders (CMD), we have relied on books and articles using both Google Scholar and PubMed. Selection criteria included a combination of Mesh and type of article. Article classification was made by two authors, using the following structure outline: prevalence of craniomandibular disorders, its etiology and pathophysiology, occlusion and craniomandibular disorders, orthodontic treatment and CMD, and the mandibular reference position in orthodontics. An important conclusion that emerged from the present literature review is that CMD do not seem to be directly related to orthodontic treatment, and their appearance cannot be predicted or prevented by any means. Therefore, orthodontists must adopt a mandibular reference suitable to their patients and which best respects the balance existing in the stomatognathic system. PMID:24101929
Bourzgui, Farid; Aghoutan, Hakima; Diouny, Samir
There has been much discussion regarding the ideal position of the condyle in the mandibular fossa. Although the centric relation position (CR) is used as a reference, some authors do not believe that it is physiologic. Thus, the aim of this study was to evaluate in a group of asymptomatic individuals the position of the condyle in the mandibular fossa at maximum intercuspation (MI), with a occlusal splint and with a Lucia jig between the teeth. It was analyzed by means of magnetic resonance imaging (MRI), transcranial radiography imaging and analysis of horizontal axis of rotation from casts mounted on an articulator. The results showed that even if patients had mandibular displacement in positions of CR, habitual maximum intercuspation and with the occlusal splint, confirmed by means of the analysis of the horizontal axis of rotation, the images showed no statistically significant differences among condylar positions. It can therefore be concluded that the positions analyzed were similar and that transcranial radiography seems to be a reliable method for analyzing condylar position. PMID:20302213
Venturelli, Farley Augusto; Zuim, Paulo Renato Junqueira; Antenucci, Rosse Mary Falcón; Garcia, Alício Rosalino
Management of the growing patient with mandibular dentofacial deformities presents a unique and challenging problem for orthodontists and surgeons. The surgical procedures required for correction of the deformity may affect postsurgical growth and dentofacial development. Further, facial growth may continue postoperatively and negate the benefits of surgery performed, resulting in treatment outcomes that are less than ideal. From individual patient characteristics, the type of deformity, and the indications for early surgical intervention, it is possible to effectively treat many cases during growth. A thorough understanding of facial growth patterns is essential, and each case needs to be evaluated individually. Surgery is often undertaken with the expectation that additional treatment, including more surgery, may be required after the completion of growth. The material presented here is based on the available research and the senior author'ss clinical experience of more than 25 years in the correction of mandibular deformities in the growing patient. Advantages and disadvantages of specific surgical techniques for correction of common mandibular deformities and pertinent age and surgical considerations are discussed. The material should be viewed as a general outline that provides broad guidelines for management of these patients. The management of maxillary deformities will be discussed in Part 2 of this article. PMID:11174553
Wolford, L M; Karras, S C; Mehra, P
Mandibular position is an important parameter used for the diagnosis of dentofacial deformities, as well as for orthognathic surgery planning and execution. Centric relation (anterior and superior relationship of the mandibular condyles interposed by the thinnest portion of their disks against the articular eminencies), centric occlusion (when lower teeth contact upper teeth at centric relation), and maximal intercuspation (complete interdigitation of lower and upper teeth) are not often addressed as factors that influence the results of orthognathic surgery, although these relationships are critical to ensure accuracy during the surgery. The present study assessed occlusal measurements taken before and after the induction of general anaesthesia from consecutive orthognathic surgery subjects. The variables assessed included the differences between these occlusal measurements, patient age, gender, type of deformity, and type of proposed orthognathic surgical procedure. The results demonstrated statistically significant differences for mandibular retrusion from maximal intercuspation to centric occlusion position, whereas the mandible appeared not to change significantly from centric occlusion after the induction of general anaesthesia. Patient age and the type of deformity appeared to influence the results. While in most instances centric occlusion can be adequately reproduced under general anaesthesia, for some specific orthognathic cases more accurate results might be obtained if the mandible-first sequence is used. PMID:24880211
Borba, A M; Ribeiro-Junior, O; Brozoski, M A; Cé, P S; Espinosa, M M; Deboni, M C Z; Miloro, M; Naclério-Homem, M G
Tooth grinding and tooth clenching are unvoluntary mainly nocturnal habits that result in an hypertrophy of masseter and temporalis muscles with an unbalance between opening and closing muscles of the jaw and lead to an alteration of mandibular condyles movements and to hyper pressure in the temporo-mandibular joints (TMJ) which can generate severe pain. Intra muscular injections of botulinum toxin permit to restablish the balance between closing and opening muscles, to relieve pain, to treat masseteric hypertrophy with improvement of face outline and to recover a normal cinetic of temporo-mandibular joints. Moreover, botulinum toxin injections permit to quit habits of tooth grinding and clenching and one single session of injections is curative for 2/3 of the patients. There are no side effects apart from slight diffusion to superficial muscles of the face resulting in a "fixed" smile for about 6 to 8 weeks. So injections of botulinum toxin in masseter and temporalis muscles are an efficient treatment of bruxism and TMJ dysfunction, cheap with no lasting side effect. PMID:12928140
Chikhani, L; Dichamp, J
The objective of this study was to classify the morphology of bifid mandibular canals and to evaluate their relationship with the roots of third molars, using cone beam computed tomography (CBCT) scans. The CBCT scans of 75 patients were analyzed and the bifurcations were classified according to Langlais et al. (1985). The relationship of bifurcation and third molars was established according to the following classification: class A--uninvolved, class B--close relationship, class C--intimate relationship and class D--absence of third molars. Data were submitted to descriptive statistics, and the results indicated that the patients' mean age was 48.2 (± 13.2) years. Unilateral bifurcation (Type 1) was the most frequent type (72.6%), followed by unilateral Type 2 (19.3%). Class D was the most frequent (57.33%), followed by class C (21.33%), class B (13.33%) and class A (8%). It could be concluded that most cases presented unilateral bifid mandibular canals extending to the third molar or adjacent regions, and when present, the roots seemed to be a continuation of the bifid mandibular canal. PMID:24346049
Correr, Gisele Maria; Iwanko, Daiana; Leonardi, Denise Piotto; Ulbrich, Lucienne Miranda; Araújo, Melissa Rodrigues de; Deliberador, Tatiana Miranda
The advent of stem cell-based therapies makes current models of mandibular distraction osteogenesis unwieldy. We thereby designed an isogenic model of distraction osteogenesis whose purpose was to allow for the free transfer of cells and components between rats. As immune response plays a significant role in healing and prevention of infection, an immune-competent mode is desirable rather than an athymic rat/xenograft model. The purposes of this study were as follows: (1) to replicate established models of distraction osteogenesis in a rodent model using an isogenic rat strain, and (2) to characterize the differences between inbred, isogenic rats and outbred rats in mandibular distraction osteogenesis via radiomorphometry and biomechanical response analysis. We demonstrated successful distraction osteogenesis to 5.1 mm in all Lewis (isogenic) rat mandibles as well as all Sprague-Dawley (outbred) rat mandibles, with no significant difference in volume-normalized radiomorphometrics, trending difference in non-volume-normalized radiomorphometrics and significant differences in biomechanical response parameters. We attribute the differences demonstrated to the decreased size of the Lewis rat mandible in comparison to Sprague-Dawley mandibles. We also provide information with caring with the additional needs of the Lewis rat. Given these differences, we find that Lewis rats function as an excellent model for isogenic mandibular distraction osteogenesis, but data procured may not be comparable between isogenic and nonisogenic models. PMID:23524737
Deshpande, Sagar S; Weiss, Daniela M; Donneys, Alexis; Gallagher, Katherine K; Tchanque-Fossuo, Catherine N; Sarhaddi, Deniz; Buchman, Steven R
Endosseous dental implants use is increasing in patients with systemic conditions that compromise wound healing. Manufacturers recently have redesigned implants to ensure more reliable and faster osseointegration. One design strategy has been to create a porous phosphate-enriched titanium oxide (TiUnite) surface to increase surface area and enhance interactions with bone. In the current study, the corrosion properties of TiUnite implants were studied in cultures of monocytic cells and solutions simulating inflammatory and hyperglycemic conditions. Furthermore, to investigate whether placement into bone causes enough mechanical damage to alter implant corrosion properties, the enhanced surface implants as well as machined titanium implants were placed into human cadaver mandibular bone, the bone removed, and the corrosion properties measured. Implant corrosion behavior was characterized by open circuit potentials, linear polarization resistance, and electrical impedance spectroscopy. In selected samples, THP1 cells were activated with lipopolysaccharide prior to implant exposure to simulate an inflammatory environment. No significant differences in corrosion potentials were measured between the TiUnite implants and the machined titanium implants in previous studies. TiUnite implants exhibited lower corrosion rates in all simulated conditions than observed in PBS, and EIS measurements revealed two time constants which shifted with protein-containing electrolytes. In addition, the TiUnite implants displayed a significantly lower corrosion rate than the machined titanium implants after placement into bone. The current study suggests that the corrosion risk of the enhanced oxide implant is lower than its machined surface titanium implant counterpart under simulated conditions of inflammation, elevated dextrose concentrations, and after implantation into bone. PMID:20024965
Messer, Regina L W; Seta, Francesca; Mickalonis, John; Brown, Yolanda; Lewis, Jill B; Wataha, John C
Context: Mandibular fractures are among the most common of facial fractures. Fractures of the mandibular angle are associated with the highest incidence of postsurgical infection of all mandibular fractures. The treatment of facial fractures has traditionally involved reestablishment of a functional dental occlusion with various types of intermaxillary fixation. Treatment modalities range from simple maxillo-mandibular fixation to rigid internal fixation of the bone fragments. Aims: The aim of this study was to determine the versatility of the single noncompression miniplate to treat the fractures of the mandibular angle with access via an intraoral route. Materials and Methods: Cases of unfavorable fractures of the mandibular angle were selected for the study of intraoral surgical management of mandibular angle fractures using a single 2.0-mm noncompression miniplate. Statistical Analysis and Results: An observational study was carried out on treatment of fractures of the angle of the mandible, and the findings were recorded and presented. Conclusions: We studied the versatility of the single noncompression miniplate to treat the fractures of the mandibular angle and found no complications associated with superior border miniplate fixation of mandibular angle fractures.
Kumaran, P. Satish; Thambiah, Lalitha
Sequential panoramic radiographs were assessed for mandibular third molar development in 47 long-term survivors of childhood Hodgkin's disease after treatment with 37 Gy mantle field radiation. To make a comparison, panoramic radiographs of 149 healthy, nonirradiated children were reviewed for the presence of mandibular third molars. In children between the ages of 7 and 12 years, bilateral agenesis of mandibular third molars was more frequent in patients who had been treated with mantle radiation than in nonirradiated patients. Unilateral agenesis, crown hypoplasia, and root growth impairment of mandibular third molars were also found. Similar, apparent, radiation-induced developmental anomalies were noted in maxillary third molars of the irradiated patients.
McGinnis, J.P. Jr.; Hopkins, K.P.; Thompson, E.I.; Hustu, H.O.
The aim of the present study was to evaluate the effects of horizontally favourable and unfavourable mandibular fracture patterns on the fixation stability of titanium plates and screws by simulating chewing forces. Favourable and unfavourable mandibular fractures on 22 sheep hemimandibles were fixed with 4-hole straight titanium plates and 2.0mm×7mm titanium screws according to the Champy technique. Hemimandibles were mounted with a fixation device in a servohydraulic testing unit for compressive testing. Displacement values under 20, 60, 100, 120, 150, 200N, maximum displacements, and maximum forces the model could resist before breakage were recorded and compared. The authors found no statistically significant differences between the groups for the displacement values in the force range 60-200N (60, 100, 120, 150 and 200N). Statistically significant differences for maximum displacement values (displacement values at the breaking forces) between the groups were found (P<0.05). There was no evidence for the need to apply different treatment modalities to mandibular fractures regardless of whether the factures are favourable or not. PMID:22178275
Pektas, Z O; Bayram, B; Balcik, C; Develi, T; Uckan, S
Skeletal malocclusions may be due to disturbances in the growth of the mandible or maxilla. In most cases, discomfort is the result of tooth-to-tooth malocclusion or tooth-to-soft-tissue contact. Currently, in veterinary medicine, these problems are treated palliatively. In humans, orthognathic surgery is indicated to correct severe skeletal malocclusions, offering aesthetic and functional benefits to the patients. This research evaluated the effects of an intra-oral mandibular sagittal split osteotomy in 20 dog cadavers with skeletal malocclusion. After sagittal osteotomy and mandibular repositioning, the osteotomies were fixed with titanium mini-plates and 1.5 mm diameter screws or 1.5 mm bicortical screws. The statistical analysis revealed a significant occlusion difference in the treated cadavers (Wilcoxon test, p<0.05). In 19/20 cadavers there was correction of the angular osteotomy while the mandibular alveolar vessels and nerve were preserved during osteotomy and fixation in all cadavers. In conclusion, intra-oral mandible sagittal osteotomy allowed correction of malocclusion in cadavers. However, it would be important to prepare a preoperative orthodontic-surgical treatment plan to obtain a satisfactory occlusion during the surgery in clinical patients. PMID:24146021
Carvalho, V G G; Gioso, M A; Carvalho, P E G; Cunha, F P; Martinez, L A V; Lemos, L S
An internal mandibular fenestra and chamber are found in many fossil hyracoids. The internal mandibular fenestra is located on the lingual surface of the mandibular corpus and opens into a chamber within the mandible. The mandibular chamber is maximally developed in late Eocene Thyrohyrax meyeri and early Oligocene Thyrohyrax domorictus from the Fayum Province of Egypt. The function of this chamber is unknown as it is not found in extant hyraxes, nor is it known to occur in any other mammal. In Thyrohyrax, this feature appears to be sexually dimorphic because it is confined to roughly one half of the specimens that otherwise cannot be separated by dental characteristics or measurements. It has been suggested that the chamber is found in females based on the presumed distribution of this character in other fossil hyracoids. Fossils from Fayum Quarry L-41, preserving the sexually dimorphic anterior dentition, show that, in Thyrohyrax meyeri and Thyrohyrax domorictus, the internal mandibular chamber is found in males. In Thyrohyrax litholagus, an internal mandibular fenestra and inflated mandibular chamber occurs in males whereas females show the variable presence of an internal mandibular fossa or fenestra but lack an expanded chamber. Other genera show differing patterns of sexual variation in which some Fayum hyracoids have an internal mandibular fenestra in both sexes but with the greatest development of the mandibular chamber occurring in males. We review functions proposed for the internal mandibular chamber and suggest that it housed a laryngeal air sac that may have had a vocal function by acting as a resonating chamber. ?? 2006 by the Society of Vertebrate Paleontology.
de, Blieux, D. D.; Baumrind, M. R.; Simons, E. L.; Chatrath, P. S.; Meyer, G. E.; Attia, Y. S.
Although mechanical stress is known as being a significant factor in bone remodeling, most implants are still made using materials that have a higher elastic stiffness than that of bones. Load transfer between the implant and the surrounding bones is much detrimental, and osteoporosis is often a consequence of such mechanical mismatch. The concept of mechanical biocompatibility has now been considered for more than a decade. However, it is limited by the choice of materials, mainly Ti-based alloys whose elastic properties are still too far from cortical bone. We have suggested using a bulk material in relation with the development of a new beta titanium-based alloy. Titanium is a much suitable biocompatible metal, and beta-titanium alloys such as metastable TiNb exhibit a very low apparent elastic modulus related to the presence of an orthorhombic martensite. The purpose of the present work has been to investigate the interaction that occurs between the dental implants and the cortical bone. 3D finite element models have been adopted to analyze the behavior of the bone-implant system depending on the elastic properties of the implant, different types of implant geometry, friction force, and loading condition. The geometry of the bone has been adopted from a mandibular incisor and the surrounding bone. Occlusal static forces have been applied to the implants, and their effects on the bone-metal implant interface region have been assessed and compared with a cortical bone/bone implant configuration. This work has shown that the low modulus implant induces a stress distribution closer to the actual physiological phenomenon, together with a better stress jump along the bone implant interface, regardless of the implant design. PMID:24656363
Piotrowski, B; Baptista, A A; Patoor, E; Bravetti, P; Eberhardt, A; Laheurte, P
In patients with bony defects, autologous bone grafts are the "gold standard" for reconstruction. In children, autologous bone harvesting is limited but tissue engineering offers an alternative. Next to bone marrow, adipose tissue is a source of mesenchymal stromal cells, and adipose-derived stromal cells (ADSC) can differentiate into osteocytes. The aim of this study was to evaluate the efficacy of bioactive implants (ADSC in fibrin glue) for repair of critical-size mandibular defects in athymic rats. Human adult ADSC embedded in fibrin glue were implanted into a critical-size defect in the rat mandible and their efficacy was compared to those of protected bone healing (pbh), autologous bone graft, and an empty defect. The newly formed bone was quantified using high-resolution flat-panel volumetric CT (fpvCT) during different observation times. After eight weeks, the specimens were assessed histologically and by micro-computed tomography (?-CT). The radiographic examination demonstrated a significantly higher level of ossified defect area in the ADSC side compared with the pbh side. The autologous bone graft side showed significantly enhanced bone formation compared to the empty defect. The histological findings in the specimens with ADSC showed bony bridging of the defect. ADSC were capable of defect reconstruction under our experimental conditions. PMID:23684529
Streckbein, Philipp; Jäckel, Sven; Malik, Christoph-Yves; Obert, Martin; Kähling, Christopher; Wilbrand, Jan-Falco; Zahner, Daniel; Heidinger, Katrin; Kampschulte, Marian; Pons-Kühnemann, Jörn; Köhler, Kernt; Sauer, Heinrich; Kramer, Martin; Howaldt, Hans-Peter
Advanta facial implants represent a new method of expanded polytetrafluoroethylene (ePTFE) technology and appear to be different from previous ePTFE products. The implants appear to work well when used for lip augmentation. The author has 18 months' experience with this implant. Placement of these implants is simple and predictable. The complication rate is low and the implants are serviceable. The procedure is reversible without extensive damage to normal tissue. The Advanta facial implant appears to be a useful option in the armamentarium of the cosmetic oral and maxillofacial surgeon. PMID:18088762
The endeavor towards life-like restoration has helped nurture new vistas in the art and science of implant dentistry. The protocol of "restoration-driven implant placement" ensures that the implant is an apical extension of the ideal future restoration and not the opposite. Meticulous pre-implant evaluation of soft and hard tissues, diagnostic cast and use of aesthetic wax-up and radiographic template combined with surgical template can simplify the intricate roadmap for appropriate implant treatment.By applying the harmony of artistic skill, scientific knowledge and clinical expertise, we can simply master the outstanding implant success in requisites of aesthetics, phonetics and function. PMID:20376237
Luthra, Kaushal K
The aim of this study was to evaluate the efficacy of electro-acupuncture (EAC) on postoperative pain control after mandibular third molar surgery. Twenty four young patients (12 male and 12 female) with symmetrically impacted mandibular third molars were selected. Each patient was submitted to two separate surgical procedures under local anesthesia. At one side, extraction was carried out employing both
Marconi Gonzaga Tavares; Ana Paula Machado; Breno Gutierrez Motta; Maria Cristina Borsatto; Adalberto Luiz Rosa; Samuel Porfírio Xavier
The mandibular glands of Kalotermes were examined in different castes. They show sexual dimorphism in the soldiers and primary reproductives, Moreover, in female soldiers and queens, mandibular gland cells contained numerous crystalline structures of mitochondrial origin. The role of these glands (secretion of saliva or pheromone) is discussed. PMID:922809
Cassier, P; Fain-Maurel, M A; Lebrun, D
Reconstruction procedure for the severely resorbed mandibular edentulous ridge has historically involved the use of a variety of surgical procedures and biologic and nonbiologic materials with limited success. The treatment of three patients with severe mandibular ridge resorption utilizing Brånemark Osseointegrated Prostheses is described. PMID:2701233
The Hoedjiespunt 1 locality is an archaeological and palaeontological site located on the Hoedjiespunt Peninsula at Saldanha Bay, South Africa. In 1996 two human teeth, a left central mandibular incisor and a left lateral mandibular incisor, were discovered during excavations in the late Middle Pleistocene palaeontological layers. These teeth are described and are found to belong to a single subadult
Deano D. Stynder; Jacopo Moggi-Cecchi; Lee R. Berger; John E. Parkington
Mandibular angle osteotomy is commonly used for prominent mandibular angle contouring. Because of difficult control of the line, shape, and amount of osteotomy, many complications such as asymmetry, undercorrection, overcorrection, and formation of a second mandibular angle after surgery occurred commonly. In addition, it is more difficult to implement osteotomy exactly the same as preoperative design in curved osteotomy owing to the arc-shaped osteotomy line. Therefore, further studies are needed to explore ways to make osteotomy accurately identical with preoperative design. In this report, a case of curved osteotomy guided by a stereolithographic template for unilateral prominent mandibular angle is described. We established the osteotomy line, the shape, and the volume with Mimics software for the right prominent mandibular angle; fabricated individual osteotomy template with computer-aided design/computer-aided manufacturing (CAD/CAM) technique; and performed curved osteotomy with the template. A secure fit of the template on the bone surface was found during the operation. Computed tomographic scan after the surgery revealed that bilateral mandibular angles were symmetric, that the right mandibular angle had a natural curve, and that the osteotomy line, shape, and amount were in accordance with the preoperative design. It is suggested that CAD/CAM template could guide curved osteotomy for prominent mandibular angle accurately, improve efficiency, and avoid complications in osteotomy. PMID:23714995
Rong, Qiong; Zhu, Shuangxi; Chen, Songling; Zhang, Xing
Considerable evidence indicates that methyl farnesoate (MF) production by the crustacean mandibular organs is negatively regulated by neuropeptides from the sinus gland (SG) in the eyestalk. In the crab Cancer pagurus , two neuropeptides (MO-IH-1 and -2) have been isolated from the SG that inhibit MF synthesis by mandibular organs of female crabs in vitro. To test their activity in
D. W. Borst; G. Wainwright; H. H. Rees
Purpose: In this study, we examined mandibular width before and 1 year after bilateral sagittal split osteotomy. Patients and Methods: Forty-two patients (28 females and 14 males) underwent bilateral sagittal split osteotomy. Fifty-six points or angles on the lateral cephalogram and 15 points or angles in the posteroanterior cephalogram were obtained before surgery and 1 year after surgery. Mandibular width
Ingeborg M. Watzke; A. Heinrich
BACKGROUND: The traditional Herbst appliance induces mandibular incisor proclination independent of the anchorage system used. The dental effects of the Herbst appliance as an element of a completely customized lingual orthodontic (LO) appliance (Incognito, 3 M) has not been analyzed yet and the aim of this paper was to measure the effect of mandibular incisor proclination using this Herbst-LO device.
Dirk Wiechmann; Rainer Schwestka-Polly; Hans Pancherz; Ariane Hohoff
Statement of problem. Determining mandibular position for an edentulous patient raises the question of whether to emphasize centric relation or muscular position. This challenge results from the lack of a convenient procedure for quantifying the horizontal mandibular position, which can be determined by a variety of methods. Purpose. This study analyzed and evaluated the horizontal mandibular positions produced by different
Primary and metastatic mandibular melanoma are extremely rare. We report the original case of a 55-year-old woman treated 16years before for a cutaneous melanoma, and now presenting with a huge mandibular amelanotic melanoma. Was it an histologically different mandibular metastasis of the previous cutaneous melanoma, or a metachronous oral amelanotic melanoma? PMID:24503521
Vierne, C; Hardy, H; Guichard, B; Barat, M; Péron, J-M; Trost, O
The purpose of this study was to compare the periodontal healing of mandibular second molars after the removal of impacted mandibular third molars using distolingual alveolectomy and tooth division techniques. A total of 120 consecutive healthy patients who presented with bilaterally impacted mandibular third molars were included in this study. The same operator removed the impacted third molars on both
H.-H. Chang; J.-J. Lee; S.-H. Kok; P.-J. Yang
The purpose of this study was to investigate the differences in mandibular morphology between the deviated and nondeviated sides in patients with noncongenital skeletal mandibular asymmetry. Divergences from control values were assessed to determine which region of the mandible contributes most to mandibular asymmetry. We measured various dimensions of the mandible in 20 young patients and 20 controls using noninvasive high-quality three-dimensional (3D) volumetric magnetic resonance imaging. Mandibular dimensions including the length of the condylar process were significantly greater on the nondeviated side of patients than the deviated side. Measurements of the deviated side were similar to control values, but measurements of the nondeviated side including condylar process length differed significantly from control values. These findings strongly suggest that overgrowth of the condylar process on the nondeviated side in these patients results in mandibular asymmetry, and therefore needs attention in orthodontic treatment, orthognathic surgery, and follow-up. PMID:24343856
Goto, Tazuko K; Langenbach, Geerling E J
This case report describes an endodontic treatment of a mandibular second premolar with type IV root canal. A 26-year-old male patient reported pain in right mandibular second premolar. Clinical examination showed a large carious lesion with pulp exposure. Radiographs showed minimal periapical changes and slight widening of periodontal ligament space. Mandibular second premolars usually have one canal. The mandibular second premolar may present large number of anatomic variations. The clinician should be aware of the configuration of the pulp system. This case presents the diagnosis and clinical management of a mandibular second premolar with two distinct canals in the apical third of root (Type IV Wiene's canal configuration), drawing particular attention to tactile examination of all the canal walls and obturating it with calamus 3D obturation system.
Chalil, Noushad Matavan; Kini, Shravan; Jose, Sunil; Narayanan, Arun; Salahudeen, Shahnas; Peedikayil, Faizal C.
This case report describes an endodontic treatment of a mandibular second premolar with type IV root canal. A 26-year-old male patient reported pain in right mandibular second premolar. Clinical examination showed a large carious lesion with pulp exposure. Radiographs showed minimal periapical changes and slight widening of periodontal ligament space. Mandibular second premolars usually have one canal. The mandibular second premolar may present large number of anatomic variations. The clinician should be aware of the configuration of the pulp system. This case presents the diagnosis and clinical management of a mandibular second premolar with two distinct canals in the apical third of root (Type IV Wiene's canal configuration), drawing particular attention to tactile examination of all the canal walls and obturating it with calamus 3D obturation system. PMID:24711930
Chalil, Noushad Matavan; Kini, Shravan; Jose, Sunil; Narayanan, Arun; Salahudeen, Shahnas; Peedikayil, Faizal C
The major connector is the most vital component critically subjected to maximal stress concentration due to various forces acting on it. The main requirement of a major connector is its resistance to deformation by occlusal stresses. This resistance to deformation is a direct consequence of the rigidity of the major connector. Thus rigidity of the major connector is paramount to resist flexing and torquing forces that could be transmitted to the abutment teeth and other structures as destructive forces. The commonly used major connectors for the mandibular arch are lingual bar and lingual plate. In the present study, the deflection of various major connector designs due to occlusal load is assessed by finite element method. They have been analyzed through finite element models. The differences in the deflection behaviour of mandibular major connector used in Kennedy's Class I, Class II, Class III, and Class IV edentulous situations have been compared. A CT scan of human edentulous mandible was taken and each section from symphysis to condylar region was projected on a graph paper and three-dimensional volumes were created from connected successive profiles to define the final solid geometry of cortical bone. Six framework models with different mandibular major connectors, lingual bar and lingual plate for Kennedy's Class I, Class II, Class III, and Class IV situations were created. The three dimensional finite element models corresponding to the geometric model were generated using Ansys's pre-processor. The model was assigned material properties. A vertical biting force of 20 N was applied. The results showed that the maximum deflection was seen in the saddle area when compared to other areas, i.e., major connector and the occlusal rest regions. The lingual bar in Kennedy's Class III situation and lingual plate in Kennedy's Class IV situation showed the least deflection when compared to Class I and Class II (distal extensions) situations. Lingual plate is more rigid major connector than lingual bar. PMID:24431793
Satheesh Kumar, K S; Preeti, S K; Savadi, R; Patel, R; Vinod, V; John, J
Summary The objective of this study was to evaluate retrospectively the stability of mandibular advancement via bilateral sagittal\\u000a split osteotomies. Two fixation methods were compared: intermaxillary fixation (IMF) and rigid internal fixation (RIF). The\\u000a hypothesis was that, in patients with a low to normal mandibular plane angle (MPA) in retrognathia, the bilateral sagittal\\u000a split osteotomy (BSSO) to advance the mandible is
J. P. B. Bouwman; D. B. Tuinzing; P. J. Kostense; R. A. van Teeseling; H. Mokhtari
Body mass estimates for fossil hominin taxa can be obtained from suitable postcranial and cranial variables. However, the nature of the taphonomic processes that winnow the mammalian fossil record are such that these data are usually only available for the minority of the specimens that comprise the hypodigm of a species. This study has investigated the link between species mean body mass and the height and width of the mandibular corpus in a core sample of 23 species of extant simians. The slopes of the least-squares regressions for the whole sample and for the hominoid subset are similar. However, the intercepts differ so that for a given body mass, a hominoid will generally have a smaller mandible than a generalized simian. The same mandibular measurements were taken on 75 early hominin mandibles assigned to eight species groups. When mandibular corpus height- and width-derived estimates of body mass for the fossil taxa were compared with available postcranial and cranial-derived body mass estimates, the eight early hominin species sort into four groups. The first, which includes A. afarensis and A. africanus, has mandibles which follow a "generalized simian" scaling relationship. The second group, which comprises the two "robust" australopithecine species, P. boisei and P. robustus, has mandibles which scale with body mass as if they are "super-simians," for they have substantially larger mandibles than a simian with the same body mass. The two "early Homo" species, H. habilis sensu stricto and H. rudolfensis, make up the third group. It has mandibular scaling relationships that are intermediate between that of the comparative simian sample and that of the hominoid subsample. The last of the four groups comprises H. ergaster and H. erectus; their mandibles scale with body mass as if they were hominoids, so that of the four groups they have the smallest mandibles per unit body mass. These results are related to comparable information about relative tooth size. Their relevance for attempts to interpret the dietary adaptations of early hominins are explored. PMID:9584893
Wood, B; Aiello, L C
Vascularized ameloblastoma is a bewildering entity whose existence is questionable from its origin to nosology and its very characterization as a distinct variant of ameloblastoma. This uncertainty is largely because of a fewer number of documented cases and loss of long-term follow-up. The current paper describes two cases of ameloblastoma in the mandibular anterior region, which had features of so-called "hemangiomatous ameloblastoma" as it was originally described. Understanding its pathophysiology based on various views and clinical implications in terms of its biologic behavior are brought to light in this paper. PMID:23715203
Maheshwari, P; Chandrashekhar, C; Radhakrishnan, R
Cranio-mandibular ankylosis is characterized by the formation of a bony mass, which replaces the normal articulation. Although the bony mass represents the pathology responsible for the ankylosis, it is not a neoplastic process capable of continued growth. For this reason excision of this mass is not necessary for the release of ankylosis. An osteotomy performed inferior to the base of the ankylotic mass converts this into a situation akin to that of a subcondylar fracture. The technical details of this conceptually new approach to the management of TMJ ankylosis is described and the advantage of this technique over the conventional ones, particularly in cases of recurrent ankylosis, is discussed. PMID:11071234
Salins, P C
There is a resurgence of interest in coronectomy for the management of mandibular third molars because it has a low risk of injury to the inferior dental nerve. However, there is concern that the root that is left in place will eventually become a source of infection. We describe the histological evaluation of 26 consecutive symptomatic coronectomy roots in 21 patients. All roots had vital tissue in the pulp chamber and there was no evidence of periradicular inflammation. Persistent postoperative symptoms related predominantly to inflammation of the soft tissue, which was caused by partially erupted roots or failure of the socket to heal. PMID:24684971
Patel, Vinod; Sproat, Chris; Kwok, Jerry; Beneng, Kiran; Thavaraj, Selvam; McGurk, Mark
Ectopic eruption is a developmental disturbance in which the tooth fails to follow its normal eruption pathway. Ectopic eruption of the second molar is relatively rare. This paper presents the case of thirteen-year-old male with an ectopic mandibular second permanent molar. The condition was corrected with surgical exposure and placement of elastic separators. This case report lays emphasis on the practice of basic methods to obtain acceptable results rather than extensive surgical or orthodontic corrections. It is advised that ectopic teeth should not be neglected especially when it concerns developing caries and malocclusion.
Rajesh, R.; Naveen, V.; Amit, S.; Baroudi, Kusai; Sampath Reddy, C.; Namineni, Srinivas
Mandibular fracture, specifically in the symphysis and body regions combined, is the most common facial fracture requiring hospitalization in North America. The primary treatment objective is to restore form and function by achieving anatomic reduction and placing fixation that eliminates mobility of the bone fragments. Several treatment options and surgical techniques are available for performing closed or open reduction. Special considerations are necessary when treating pediatric patients and fractures of the edentulous mandible. Complications relating to the tooth and denture-bearing regions of the mandible include infection, nonunion, and neurosensory changes. PMID:24021623
Goodday, Reginald H B
Background Current reconstructive techniques for continuity defects of the mandible include the use of free flaps, bone grafts, and alloplastic materials. New methods of regenerative medicine designed to restore tissues depend mainly on the so-called extrinsic neovascularization, where the neovascular bed originates from the periphery of the construct. This method is not applicable for large defects in irradiated fields. Methods We are introducing a new animal model for mandibular reconstruction using intrinsic axial vascularization by the Arterio-Venous (AV) loop. In order to test this model, we made cadaveric, mechanical loading, and surgical pilot studies on adult male goats. The cadaveric study aimed at defining the best vascular axis to be used in creating the AV loop in the mandibular region. Mechanical loading studies (3 points bending test) were done to ensure that the mechanical properties of the mandible were significantly affected by the designed defect, and to put a base line for further mechanical testing after bone regeneration. A pilot surgical study was done to ensure smooth operative and post operative procedures. Results The best vascular axis to reconstruct defects in the posterior half of the mandible is the facial artery (average length 32.5 ± 1.9 mm, caliber 2.5 mm), and facial vein (average length 33.3 ± 1.8 mm, caliber 2.6 mm). Defects in the anterior half require an additional venous graft. The defect was shown to be significantly affecting the mechanical properties of the mandible (P value 0.0204). The animal was able to feed on soft diet from the 3rd postoperative day and returned to normal diet within a week. The mandible did not break during the period of follow up (2 months). Conclusions Our model introduces the concept of axial vascularization of mandibular constructs. This model can be used to assess bone regeneration for large bony defects in irradiated fields. This is the first study to introduce the concept of axial vascularization using the AV loop for angiogenesis in the mandibular region. Moreover, this is the first study aiming at axial vascularization of synthetic tissue engineering constructs at the site of the defect without any need for tissue transfer (in contrast to what was done previously in prefabricated flaps).
Purpose This study aimed to clarify the correct localization of the mandibular canal (MC) that is essential in order to avoid injuries\\u000a to the inferior alveolar neurovascular bundle during oral surgical procedures.\\u000a \\u000a \\u000a \\u000a \\u000a Methods We have analyzed the position of the MC using computed tomography data bank examinations of the oral region from 50 partially\\u000a dentulous Brazilian patients aging from 25 to 75 years
Marcello Rodrigues de Oliveira Júnior; André Luis Santos Saud; Debora Rodrigues Fonseca; Bernardo De-Ary-Pires; Mário Ary Pires-Neto; Ricardo de Ary-Pires
Spontaneous bone regeneration is an uncommon condition following traumatic or iatrogenic bone loss. The factors responsible for its occurrence are yet to be fully elucidated. This report presents spontaneous bone regeneration following mandibular resection for a giant odontogenic myxoma in a 16-years-old Nigerian male. New bone formation was observed at the postoperative fourth week and has continued for one year after. Likely factors that favor this occurrence are critically examined. The advantages of spontaneous bone regeneration in resource-poor settings include low biologic and economic costs as compared to bone grafting. PMID:22684138
Adebayo, Ezekiel T; Fomete, Benjamin; Ajike, Sunday O
Bifid mandibular condyles (BMCs) are rare anomalies. The overwhelming majority of prior reports described their predominantly unilateral occurrence diagnosed by panoramic radiography. We present an even rarer case of bilateral BMC initially identified by panoramic radiography and confirmed with colour-enhanced three-dimensional CT. These images substantiate the theory that the secondary condyles arise from the neck of the mandible (Lopez-Lopez et al. Bifid condyle: review of the literature of the last 10 years and report of two cases. Cianio 2010; 28: 136–140).
Tanner, JM; Friedlander, AH; Chang, TI
Bifid mandibular condyles (BMCs) are rare anomalies. The overwhelming majority of prior reports described their predominantly unilateral occurrence diagnosed by panoramic radiography. We present an even rarer case of bilateral BMC initially identified by panoramic radiography and confirmed with colour-enhanced three-dimensional CT. These images substantiate the theory that the secondary condyles arise from the neck of the mandible (Lopez-Lopez et al. Bifid condyle: review of the literature of the last 10 years and report of two cases. Cianio 2010; 28: 136-140). PMID:22241877
Tanner, J M; Friedlander, A H; Chang, T I
With this new method, protrusive mandibular force was studied in a homogeneous group of 69 children with similar occlusions. Maximum protrusive force ranged from 18.5 to 160 N (mean±SD=81.3±31.6 N). Maximum protrusive force was significantly higher in males (90.7±30.2 N) than females (66.6±28.6 N) while fatigue time was not significantly different between the two groups (70.6±38.5 s for males and 65.1±33.6 s
K Chintakanon; K. S Türker; W. J Sampson; G. C Townsend; T. M Wilkinson
Ameloblastomas frequently occur in relatively young people, but are rarely seen in people aged 80 years or older. We report a case of mandibular ameloblastoma in an elderly patient with a review of the literature. The patient was a 82-year-old man who noticed swelling of the gingiva approximately 2 weeks prior to his initial visit. Computed tomography showed a radiolucent area with little radiopacity. Internal uniformity was observed at the site, with thinning of cortical bone which lacked continuity in some areas. The excision and curettage were performed under general anaesthesia. No recurrence has been observed 14 months after surgery.
Nagata, Kokoro; Shimizu, Kasumi; Sato, Chu; Morita, Hiroshi; Watanabe, Yoshihiro; Tagawa, Toshiro
In experiment on 30 corpses of adult people criteria of an operational wound (depth of a wound, a corner of operational action, an axis of operational action, a corner of an inclination of operational action) were studied at preauricularis, intrauricularis, intrauriculo-temporalis and posterior mandibullaris access to temporo-mandibular joint (TMJ). New surgical intrauriculo-temporalis access to the joint is substantrated. On the basis of the analysis of 289 operations at 268 patients the indications to a choice of surgical access were developed at various diseases and damages of TMJ. PMID:18163061
Sysoliatin, P G; Novikov, A I; Sysoliatin, S P; Bobylev, N G; Brega, I N
Mammography in the presence of breast implants is complicated by the opacity of the implants, the displacement of breast tissue by the implant, and the presence of secondary changes such as calcification within a fibrous capsule. A special technique of mammography, known as the displacement technique, has been developed by Eklund in the USA, where it is widely used. The
G. L. Bantick; I. Taggart
The effect of the Fränkel appliance was evaluated in patients with mandibular retrusion who were monitored during an active treatment phase of approximately 14 months in the early mixed dentition. The sample treated with the Fränkel appliance consisted of 120 subjects. In 60, the initial construction bite was taken with the incisors in an end-to-end relationship (Fränkel group A). In 60 patients (Fränkel group B), mandibular position was advanced sequentially in small steps. Fifty untreated subjects of approximately the same age and with almost identical characteristics of skeletal Class II malocclusion served as a comparison group. Permanent teeth were not extracted during the period studied in any of the subjects. For statistical analysis of the difference between the variables used in this study, analysis of variance and the t test were used. The results of this study indicate that the distances between pogonion and condylion or articulare increased in both Fränkel groups A and B significantly more than in the untreated sample. However, the anteroposterior position of pogonion relative to the maxillary landmarks remained unchanged in Fränkel group A. The increase in the distance between pogonion and articulare or condylion primarily resulted from a positional change of pogonion inferiorly, which was accompanied by a significant increase of the mandibular plane angle and the gonial angle. In contrast, pogonion moved anteriorly in Fränkel group B significantly more than in the untreated group, that is, the sagittal discrepancy between maxilla and mandible significantly improved in Fränkel group B, whereas it remained unchanged in Fränkel group A.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2801639
Falck, F; Fränkel, R
The use of mandibular subperiosteal implants was first reported by Dahl in the 1940s. It was followed by a more comprehensive report by Goldberg and Gershkoff, who published the first case series in the United States. We describe a case of an orocutaneous fistula that developed secondary to a chronic infection attributed to a failing subperiosteal implant. Elemental analysis of the metal framework revealed an implant composed of mainly a cobalt-chromium alloy. Cobalt, which was frequently used in subperiosteal implant manufacturing, is associated with a higher corrosion rate than other metals and is no longer used to fabricate subperiosteal implants. The strength of subperiosteal implants is their ability to be used in a mandible with an atrophic alveolar ridge. Unfortunately, this feature of the hardware is also its weakness in that reconstructive procedures after their removal are difficult. The failing subperiosteal implant in our patient was subsequently removed, and primary closure of the intraoral wound and extraoral fistula as well as resolution of the patient's symptoms was obtained with no lasting complications. PMID:18240795
Markiewicz, Michael R; Nishiyama, Kazuhide; Yago, Kaori; Okada, Meiko; Asanami, Soichiro; Yoshinari, Masao; Hirayama, Muneki; Margarone, Joseph E; Chuang, Sung-Kiang
Contemporary plasma-sprayed hydroxylapatite (HA) coatings with high crystalline content are much more resistant to in vivo degradation than HA coatings of a decade ago but reportedly exhibit reduced wettability, which could potentially negatively affect tissue adhesion and long-term clinical outcome. The present prospective study was undertaken to determine if highly crystalline HA MP-1-coated implants could meet a minimum 5-year implant success rate standard of 85% in view of their previously reported decreased wettability. Study subjects were consecutive patients with 1 or more missing teeth in the maxillary and/or mandibular jaw who presented in 3 university dental clinics and 1 private dental practice. A total of 120 patients were treated per protocol and successfully restored with implant-supported prostheses. Four implants failed in 3 patients and were withdrawn from the study. There were no other irresolvable adverse events. Cumulative implant success at 5 years was 97% (n = 184 implants in 88 patients), which exceeded the 85% standard for implant success after 5 years of clinical function. PMID:18390242
Thierer, Todd; Davliakos, John P; Keith, J Daulton; Sanders, John J; Tarnow, Dennis P; Rivers, James A
Statement of problem. Different implant geometries present different biomechanical behaviors and in this context, one arising question is how cuneiform implant geometry compares to clinical successful cylindrical threaded implant geometry. Purpose. The purpose of this work was to study stress distribution around cuneiform and cylindrical threaded implant geometries using three-dimensional finite element stress analysis taking the latter as a reference. Material and methods. A model was generated from a computerized tomography of a human edentulous mandible with implants placed in the left first premolar region. The model was supported by the mastication muscles and by temporomandibular joint. A vertical load of 100N was applied at the top of each implant in the direction of their long axes. The mandibular boundary conditions were modeled considering the actual muscle supporting system. Taking muscle forces intensities and directions, balance moment equations were employed to assess the system equilibrium. Cortical and medullary bones were assumed to be homogeneous, isotropic and linearly elastic. Results. The analysis provided results for maximum (S1) and minimum (S2) principal stress and Von Mises (SEQV) stress field. For both geometries, the results showed concentration on one side of the neck, smooth stress distribution along the body and no considerable concentration at the apical area. Conclusion. Results showed similar stress distribution pattern for cuneiform and cylindrical threaded geometries. The stresses profiles along the implants length reproduced their morphology. In both occurred stress concentration at one side of the neck and no body or apical stress concentration. PMID:17065763
Cruz, Mauro; Lourenço, Adelino Francisco; Toledo, Elson Magalhães; da Silva Barra, Luis Paulo; de Castro Lemonge, Afonso Celso; Wassall, Thomaz
Objectives: To report on the use of lateral transport osteogenesis in cancer patients after maxillo/mandibular resections and on the implant survival rate in the generated bone Material and Methods: Four patients treated using lateral transport osteogenesis entered this descriptive study and were retrospectively studied (mean age 55; range 41-62). Results: Reconstruction of segmentary defects after surgical and radiological cancer treatment on maxilla and mandible was achieved. No relevant intra- or post-operative complications occurred. No differences on implant survival were observed between patients who had received radiotherapy and those who had not. Conclusions: This approach can be considered a recommendable reconstructive option after oral cancer treatment –including radiotherapy- particularly for high-surgical-risk, collaborative patients. Key words:Distraction osteogenesis, oral cancer, radiotherapy, reconstruction, dental implants.
Bilbao-Alonso, Arturo; Garcia-Rielo, Jose M.; Varela-Centelles, Pablo
The free fibular flap is commonly used for mandibular reconstruction because of its length, consistent blood supply, and relative ease of harvest. The bone has been shown to maintain mass over time, which confers a potential advantage over other osseous flaps. We know of no published papers on changes in height of fibular bone in patients treated for osteoradionecrosis (ORN). We measured the change in bony height over time as an indirect measure of bone mass. We identified 17 patients (mean age 65, range 49-80 years) who had had reconstruction with a free fibular flap for mandibular ORN. Of them, 10 had fixation with a reconstruction plate, and serial radiographs were available for inclusion in the study. Three measurements were taken on at least 2 rotational tomograms for each patient. Two observers recorded measurements at 25, 50, and 75% of the distance along the bone. Mean change in fibular height (mm) and percentage change were calculated. The interval between radiographs ranged from 5 months 4 days to 20 months 14 days. There was a reduction in fibular height in 8/10 cases, with a mean reduction of 1.5mm (range 2.6-0.3), or 11%. Our results show a moderate reduction in fibular height, which is comparable with a previously published series of patients without ORN who had reconstruction with miniplates. The stress shielding effects of reconstruction plates were less evident in our patients than in previously published material. PMID:24613371
Powell, Harry R F; Jaafar, Mustafa; Bisase, Brian; Kerawala, Cyrus J
An investigation of bone microstructure of nonmammalian therapsids has revealed distinctive signals pertaining to their ontogenetic growth and biology. Until now, histological studies of the nonmammaliaform cynodonts have focused only on postcranial material. Through the examination of micro-computed tomography (micro-CT) scans and serial thin sections, the current study provides a novel perspective on the structure and growth of the mandible of Tritylodon, a derived herbivorous cynodont from southern Africa. By tracking histological features across the serial thin sections, trends in relocation and modelling are documented for the growing Tritylodon mandible. For example, during growth, localized changes in the cross-sectional shape of the mandible occurred. Localized deposits of new lamellar and fibrolamellar bone on the lateral edge indicate widening of the mandible during different episodes of growth. The presence of radial channels indicates the deepening of the mandible at its anterior and posterior ends. The relocation of the paired mental foramina suggests that the mandibular body lengthened mainly in the posterior direction. The medial movement of a posterior postcanine tooth during growth and eruption is recorded in the histology. This histological assessment also documents the presence of Sharpey’s fibres in the cellular cementum of the first incisor, providing novel and unequivocal evidence that it was attached to the Tritylodon jaw by a periodontal ligament. This is the first comprehensive study that uses histological analysis to document the growth dynamics of the mandible of a nonmammalian therapsid, thus providing a unique perspective of localized mandibular growth in a fossil animal.
Jasinoski, Sandra C; Chinsamy, Anusuya
Introduction: In open reduction and internal fixation for the treatment of mandibular fracture, the fixation technique used is very important in reducing post-operative complications and promoting the healing process. This study assessed the results of fixation of the mandible using two mini-plates perpendicular to each other in the lower border of the mandible for fracture treatment. Materials and Methods: Access to the fractures was via an extraoral approach (through existing scars or incisions). After reductions of mandibular fractures, the fracture line fixation was accomplished using two mini-plates perpendicular to each other. One-week intermaxillary fixation (IMF) was applied and 3 weeks of soft diet was recommended in the post-operative period. All patients were followed up for at least 1 year regarding infection and malocclusion. Results: Twenty-five patients (28 fracture lines) underwent this technique. Most (81.8%) patients were male and the mean age was 41.3±7.59 years (range, 17–73 years). Symphyseal fracture (frequency, 52%) was the most prevalent followed by angle (32%) and body (16%) fractures. Among the patients who underwent surgery, only one malocclusion and no cases of infection were observed. No cases of facial nerve weakness or damage were observed in this study. Conclusion: This method can be used in specific cases to replace treatment with one mini-plate, which necessitates a more intensive fixation or reconstruction plate therapy.
Rahpeyma, Amin; Khajehahmadi, Saeedeh; Barkhori Mehni, Sadegh
The aim of this study was to evaluate the oropharyngeal (OP) and nasal passage (NP) volumes along with various airway variables of patients with normal nasorespiratory functions having different dentofacial skeletal patterns and to evaluate the correlations between different variables and the airway. One hundred and one patients (57 males and 44 females, aged 14-18 years) having pre-treatment cone beam computed tomography images and complete medical records were selected. The patients were divided into five groups as Class I (CI, 81 ? SNA ? 77; 80 ? SNB ? 76; 3 ? ANB ? 1), Class II maxillary protrusion (CIIMaxP, SNA > 81; 80 ? SNB ? 76; ANB > 3), Class II mandibular retrusion (CIIMandR, 81 ? SNA ? 77; SNB < 76; ANB > 3), Class III maxillary retrusion (CIIIMaxR, SNA < 77; 80 ? SNB ? 76; ANB < 1), and Class III mandibular protrusion (CIIIMandP, 81 ? SNA ? 77; SNB > 80; ANB < 1). Posterior airway space, area of the most constricted region at the base of the tongue (minAx), and OP volume were significantly higher for the CIIIMandP group, whereas CIIMandR subjects had the lowest values. The only significant difference for the NP volume was between CI and CIIMandR groups where a smaller volume for the CIIMandR group was observed. The minAx was the variable that presented the best correlation with the OP airway volume. It seems that a detailed analysis of airway may prove to be a valuable diagnostic addition in orthodontics. PMID:22045695
El, Hakan; Palomo, Juan Martin
We report the case of a 75-year-old man who presented for evaluation of painless hematuria persisting for more than 1 month. At the time of presentation, the patient did not report any systemic symptoms and had no fever, weight loss, or dysuria. Computed tomography showed several enhancing, sessile polyps in the gall bladder (1.5 cm or smaller). There was no associated stone or biliary dilation. Since no other abnormality was evident, we performed laparoscopic cholecystectomy. He was diagnosed as having B-cell lymphoblastic lymphoma (B-LBL) after surgical resection of the gall bladder (GB). As the left mandibular swelling was developed after the diagnosis of the B-LBL involving GB, facial magnetic resonance imaging (MRI) was added to the imaging scan. Facial MRI revealed mass formation in the left mandible, left medial pterygoid, masticator, and buccinator muscles. The biopsy samples from the mandibular bone were also diagnosed as B-LBL. The definitive pathological diagnosis was B-LBL, stage IV. Systemic chemotherapy was done with subsequent response in size of the left mandible mass. PMID:24789124
Kim, Hee-Jun; Lee, Tae Jin; Choi, Yoo Shin
The fate was examined of poly(lactic acid) microbeads implanted in large artificial defects created in cortical bone of dog mandibles. Two poly(lactic acid) polymers--poly(L-lactic acid) (PLA 100) and poly(DL-lactic acid) (PLA 50)--were used to make microbeads by solvent evaporation with poly(vinyl alcohol) as surfactant. Histological observation of non-decalcified mandibular bone showed that no real bone regeneration existed in the experimental bone defects 18 months after PLA 100 microbeads implantation. The same observation was made 6 months after implantation of PLA 50 microbeads. PLA 100 and PLA 50 microbeads appeared unable to induce regeneration of cortical bone defects of dog mandible, in contrast to previous observations in man for PLA 50 large implants. The failure is tentatively assigned to the presence of poly(vinyl alcohol) at the surface of microbeads. PMID:8425024
Anselme, K; Flautre, B; Hardouin, P; Chanavaz, M; Ustariz, C; Vert, M
Since the introduction of the first coralline hydroxyapatite porous orbital implant as eye replacement in the early 1980s, numerous other modified porous implants have been developed. Due to the different design of the existing studies concerning long-term safety with, in some cases, relatively short follow-up, a comparison is difficult and none of the implant types can be clearly identified as being superior. Factors affecting the exposure rate of the implant seem to be the implant coating, the surgical technique and the condition of the patient's tissue at the beginning of surgery. PMID:24942122
Cleres, B; Meyer-Rüsenberg, H W
The neurovascular bundle may be vulnerable during surgical procedures involving the mandible, especially when anatomical variations are present. Increased demand of implant surgeries, wider availability of three-dimensional exams, and lack of clear definitions in the literature indicate that features of anatomical variations should be revisited. The objective of the study was to evaluate features of anatomical variations related to mandibular canal (MC), such as bifid canals, anterior loop of mental nerve, and corticalization of MC. Additionally, bone trabeculation at the submandibular gland fossa region (SGF) was assessed and related to visibility of MC. Cone beam computed tomography exams from 100 patients (200 hemimandibles) were analyzed and the following parameters were registered: diameter and corticalization of MC; trabeculation in SGF region; presence of bifid MC, position of bifurcations, diameter, and direction of bifid canals; and measurement of anterior loops by two methods. Corticalization of the MC was observed in 59% of hemimandibles. In 23%, MC could be identified despite absence of corticalization. Diameter of MC was between 2.1 and 4 mm for nearly three quarters of the sample. In 80% of the sample trabeculation at the SGF was either decreased or not visible, and such cases showed correlation with absence of MC corticalization. Bifid MC affected 19% of the patients, mostly associated with additional mental foramina. Clinically significant anterior loop (>2 mm of anterior extension) was observed in 22-28%, depending on the method. Our findings, together with previously reported limitations of conventional exams, draw attention to the unpredictability related to anatomical variations in neurovascularization, showing the contribution of individual assessment through different views of three-dimensional imaging prior to surgical procedures in the mandible. PMID:21448636
de Oliveira-Santos, Christiano; Souza, Paulo Henrique Couto; de Azambuja Berti-Couto, Soraya; Stinkens, Lien; Moyaert, Kristin; Rubira-Bullen, Izabel Regina Fischer; Jacobs, Reinhilde
The risk of developing peri-implantitis seems to be more pronounced in patients with a history of periodontitis. Pretreatment to eliminate periodontal pathogens from the patient's oral cavity before dental implant treatment therefore is important to reduce the risk of peri-implantitis. Smoking has been shown to be a negative risk factor for treatment success. Several protocols have been used in the treatment of peri-implantitis. Mechanical infection control following surgical flap procedures, particularly in conjunction with antimicrobial therapy, is the most successful concept. There is no reliable evidence that suggests which intervention is the most effective for treating peri-implantitis. This article includes background information on the biology of tissue-destructive periodontitis and peri-implantitis to help clinicians interpret the clinical manifestation of the risk for peri-implantitis. PMID:15978246
Klinge, Björn; Hultin, Margareta; Berglundh, Tord
The objective of this study was to determine the prevalence of taurodontism in primary mandibular first molars in ethnic Indian children using periapical radiographs. Periapical radiographs of 274 children obtained from December 2008 to August 2010 were retrospectively screened and examined. Radiographs of 196 patients (99 boys and 97 girls; ages 2.5-10.5) with bilateral primary mandibular first molars were randomly selected and evaluated. The gender, symmetry, and frequencies of occurrence of taurodont primary mandibular first molars were compared and the obtained data were statistically analyzed using the x2 test. Eight (4.08%) taurodont primary mandibular first molars were found with a bilateral incidence of a symmetrical distribution of 38% (3/8). The prevalence of taurodontism in primary mandibular first molars did not differ significantly between right and left sides or with gender (P ? 0.05). The results of the present study indicate that approximately 4% of Indian children had taurodontism in primary mandibular first molars. Clinicians should be aware of the prevalence of this anatomic variant in primary mandibular first molars among the Indian population for early identification of taurodonts and for rendering the best care during dental treatment. PMID:23032243
Nagaveni, N B; Radhika, N B
This study evaluated the electromyographic (EMG) characteristics of masticatory muscles in patients with fixed implant-supported prostheses according to All-on-Four(®) principles and in control healthy dentate subjects. Twenty-six subjects aged 50-74 years were examined. Eighteen were edentulous and had been successfully rehabilitated with (i) mandibular All-on-Four(®) implant-supported fixed prostheses and maxillary complete dentures (10 patients) and (ii) mandibular and maxillary All-on-Four(®) implant-supported fixed prostheses (eight patients). Eight reference subjects had natural dentition. Surface EMG recordings of the masseter and temporalis muscles were performed during maximum voluntary teeth clenching and during unilateral gum chewing. All values were standardised as percentage of a maximum clenching on cotton rolls. During clenching, a good global neuromuscular equilibrium was found in all participants. During chewing, all groups had similar values of working-side muscle activities and of chewing frequency. No significant differences in the analysed EMG parameters were found between the patients with mandibular and maxillary All-on-Four(®) implant-supported prostheses and the reference subjects. In contrast, standardised pooled muscle activities and standardised muscular activities per cycle were larger in patients with a maxillary removable prosthesis than in control subjects (Kruskal-Wallis test, P < 0·01). Also, patients wearing a complete maxillary denture showed a poor neuromuscular coordination with altered muscular pattern and lower values of the index of masticatory symmetry than dentate control subjects (P < 0·01). EMG outcomes suggest that All-on-Four(®) implant-supported prostheses may be considered a functionally efficient treatment option for the rehabilitation of edentulous patients with reduced residual bone volume. PMID:22957827
Dellavia, C; Francetti, L; Rosati, R; Corbella, S; Ferrario, V F; Sforza, C
The purpose of this study was to evaluate the effect of early loading of Osseotite dual acid-etched commercially pure titanium dental implants in an established baboon model. Implant sites were prepared by removal of premolars and first molars at maxillary and mandibular sites in 10 adult female baboons (Papio anubis). The resultant edentulous ridges were allowed to heal for 6 weeks. Following the placement of 80 implants, 2-mm healing abutments were placed on each implant and protruded through the mucosa after flap closure. Each implant was functionally loaded with a single crown after either 1 month (n = 40) or 2 months (n = 40) of implant healing. All implants were removed in block section after 3 months of functional loading and prepared for histologic evaluation. Photographs of histologic slides were digitized for data collection. The amount of osseous tissue contact along the implant surface in the buccolingual plane was determined using image analysis. The fraction of direct bone-tissue contact along a standardized region of each implant perimeter was calculated and compared using analysis of variance. Implants loaded after 1 month of healing had a mean of 76.6% + 14.4% bone contact, and implants loaded after 2 months of healing had a mean of 77.2% +/- 12.2% bone contact. Statistically, the 1- and 2-month groups were similar (P = .81). No implant failures were observed in either treatment group. Reducing the surgical healing time from 2 months to 1 month did not statistically affect the amount of bone observed at the tissue-implant interface in baboons under functionally loaded conditions. PMID:12212687
Vernino, Arthur R; Kohles, Sean S; Holt, Raleigh A; Lee, Hsuch-Ming; Caudill, Richard F; Kenealy, James N
Background: Full fixed prosthesis on a limited number of implants (FFP) are a viable treatment option for edentulous patients with a reduced amount of residual bone. Jaw muscular function in FFP patients has been evaluated in several studies, however heterogeneous data emerge from literature. Purpose: The aim of this review of the literature was to assess the function of jaw muscles in edentulous patients restored with full fixed prostheses on a limited number (? 6) of implants, as compared to dentate subjects and edentulous subjects wearing dentures, implant-supported overdentures or full fixed prostheses supported by more than six implants. Materials and methods: An electronic search of databases up to December 2013 was performed. The articles were selected using specific inclusion criteria, independent of the study design. Results: A total of 1598 records were identified. After removing the duplicates and excluding records based on title and abstract, only 37 eligible records were identified. After full-text review, seventeen studies were selected for analysis according to the inclusion criteria. From the included studies, only one evaluated masseter muscle thickness in a cross sectional study by means of ultrasound, while the 16 remaining papers evaluated muscular function by using electromyography (EMG). Those studies analysed several heterogeneous parameters throughout the execution of five functional tests and were therefore described and pooled according to the following task categories: clenching; swallowing; reflex and fatigue for statics; and chewing for dynamics. Conclusions: The results of selected studies seem to indicate that, compared to dentate controls, FFP patients display a global satisfactory neuromuscular equilibrium in static activities, but still have some impairment during chewing. Conflict-of-interest statement: The authors declare that they have no conflict of interest. PMID:24977251
Dellavia, Claudia; Rosati, Riccardo; Del Fabbro, Massimo; Pellegrini, Gaia
The purpose of this study was to compare clinical, radiographic and histological differences around titanium oral implants loaded with either acrylic-veneered metal or ceramo-metal fixed prostheses. Five beagle dogs were used in this investigation. At the beginning of the study, all mandibular premolars and first molars were extracted. After 3 months of healing, 2 Brånemark implants were installed on each side of the mandibles. Three months later, abutments were inserted on each implant and a daily oral hygiene regime was initiated. One month after abutment connection, the implants on one side of the mandible were restored with an acrylic-veneered metal fixed prosthesis, whereas, on the other side a ceramo-metal fixed prosthesis was inserted. The prostheses were constructed in occlusion with the maxillary first molars. The following clinical parameters were measured around each implant at this time (i.e., baseline), and thereafter, at monthly intervals up to 5 months: Plaque Index; Gingival Index; implant mobility (using the Periotest); probing depth and clinical attachment level (using the Florida Probe). In addition, standardized radiographs were taken at baseline and 5 months after insertion of the prostheses and evaluated by subtraction radiography. Another Brånemark fixture was installed on each side of the mandibles 3 months before the end of the study. These implants remained unloaded and submerged for the entire study period. Five months after prosthesis insertion, the animals were killed, and implants with their supporting peri-implant tissues were processed for histological evaluation. Analyses of the clinical, radiographic and histometric parameters revealed no significant differences between the acrylic-veneered and ceramometal loaded implants.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7578789
Hürzeler, M B; Quiñones, C R; Schüpbach, P; Vlassis, J M; Strub, J R; Caffesse, R G
This case report describes the treatment of a 25-year-old woman with a Class II malocclusion, secondary to mandibular skeletal deficiency, and mild overclosure. Inferior surgical repositioning of the maxilla is often the treatment of choice for patients with maxillary vertical deficiency; however, this patient had borderline vertical deficiency that was treated with a mandibular "tripod" advancement (leveling of the mandibular arch after surgery) coupled with a setback and down-grafting genioplasty. The surgical-orthodontic treatment plan, combined with cosmetic dentistry, resulted in dramatically improved facial esthetics and occlusal relationships. PMID:20152687
Low, Laura E; Moore, Theodore E; Austin, Kevin R; Burton, Richard G; Marshall, Steve D; Southard, Karin A; Southard, Thomas E
Common complications of neurolytic mandibular nerve block are hypoesthesia, dysesthesia, and chemical neuritis. We report a rare complication, prolonged severe vertigo and ataxia, after neurolytic mandibular blockade in a patient suffering from trigeminal neuralgia. Coronoid approach was used for right sided mandibular block. After successful test injection with local anesthetic, absolute alcohol was given for neurolytic block. Immediately after alcohol injection, patient developed nausea and vomiting along with severe vertigo, ataxia and hypertension. Neurological evaluation was normal except for the presence of vertigo and ataxia. Computerised tomography scan brain was also normal. Patient was admitted for observation and symptomatic treatment was given. Vertigo and ataxia gradually improved over 24 hours.
Chaturvedi, Arvind; Dash, HH
Bifid mandibular condyle is an uncommon entity described in the literature as having a controversial etiology. Despite the absence of clinical symptomatology, the radiologist must be aware and should have some knowledge of this abnormality, as well its implications regarding functional and morphological changes. TMJ ankylosis is a disabling disease with involvement of the mandibular condyle, articular fossa and base of the skull. The association of bifid condyle with temporomandibular joint ankylosis is rare and must be carefully evaluated. The purpose of this paper is to report a case of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis and to describe its computed tomography imaging findings. PMID:17639206
Sales, Marcelo Augusto Oliveira; Oliveira, Jefferson Xavier; Cavalcanti, Marcelo Gusmão Paraíso
The most common clinical features of tempero-mandibular joint internal derangement are correlated with the MRI findings of shape of the disc in an attempt to find the etiology of tempero-mandibular joint internal derangement. In this study, the clinical parameters of pain, muscle tenderness, clicking with in the joint (like early, middle and late) are correlated with the MRI findings of disc shapes. (like biconcave, thick, lengthened, folded, adhesion). The study reveals any trauma that leads to muscle tenderness results in internal derangement of tempero-mandibular joint. PMID:16900891
Chowdary, U V; Rajesh, P; Neelakandan, R S; Nandagopal, C M
The success of endodontic treatment requires the knowledge of tooth morphology and its variations. Mandibular incisor’s anatomy presents a challenge when an endodontic access is made, because of its small size and high prevalence of two canals. We are describing a Weine’s Type IV root canal configuration that was detected in a mandibular central incisor, which was demonstrated by a radiographic examination. This article also focuses on the successful endodontic treatment of a mandibular central incisor with a single canal at the pulp chamber, which divided into two distinct and separate canals (buccolingual) at the middle third of the root.
Mittal, Sunandan; Kumar, Tarun; Sharma, Jyotika; Mittal, Shifali; Ahuja, Tarun
This case report describes the orthodontic treatment of an adult patient with iatrogenic absence of the maxillary canines, moderate maxillary and severe mandibular dental crowding, a Bolton discrepancy with a large mandibular anterior excess, a maxillary right lateral incisor crossbite, and Angle Class II molar relationships. The treatment consisted of fixed appliance therapy, mandibular incisor extraction, tooth bleaching, and dental recontouring. This method of treatment maintained the patient's good facial appearance, improved the dental esthetics, and provided a good functional occlusion, eliminating the arch length and Bolton discrepancies and providing a good outcome with minimal undesirable effects. PMID:23631973
Simão, Tassiana Mesquita; Valladares-Neto, José; Rino-Neto, José; de Paiva, João Batista
The results of the study show whether the classification of mandibular growth potential, as proposed by Petrovic, Lavergne and Stutzmann has any influence on the treatment with a function regulator. X-rays of 140 class II patients were analysed after a treatment time of approximately 2 years. In comparison with 133 class II children without any treatment, a significant increase of mandibular length was observed in almost all children treated. There was no significant difference in the increase of mandibular length between category 2 (low growth potential) and category 5 (high growth potential). PMID:2066043
Falck, F; Zimmermann, K
The long-term clinical success of dental implants is related to their early osseointegration. This paper reviews the different steps of the interactions between biological fluids, cells, tissues, and surfaces of implants. Immediately following implantation, implants are in contact with proteins and platelets from blood. The differentiation of mesenchymal stem cells will then condition the peri-implant tissue healing. Direct bone-to-implant contact is desired for a biomechanical anchoring of implants to bone rather than fibrous tissue encapsulation. Surfaces properties such as chemistry and roughness play a determinant role in these biological interactions. Physicochemical features in the nanometer range may ultimately control the adsorption of proteins as well as the adhesion and differentiation of cells. Nanotechnologies are increasingly used for surface modifications of dental implants. Another approach to enhance osseointegration is the application of thin calcium phosphate (CaP) coatings. Bioactive CaP nanocrystals deposited on titanium implants are resorbable and stimulate bone apposition and healing. Future nanometer-controlled surfaces may ultimately direct the nature of peri-implant tissues and improve their clinical success rate.
Lavenus, Sandrine; Louarn, Guy; Layrolle, Pierre
The purposes of this study were to determine success and survival rates for implants and teeth adjacent to implants and the incidence of endodontic implantitis (E-I) (endodontic involvement in adjacent teeth causing implant failure) and implant endodontitis (I-E) (implant placement causing endodontic failure). The data were from 233 single-tooth implants placed in 116 subjects by postgraduate periodontal students with recall
Bradley S. Laird; Michael S. Hermsen; Tom G. Gound; Fahd Al Salleeh; Matthew R. Byarlay; Merlyn Vogt; David B. Marx
Myosseous-cutaneous flaps were used for mandibular reconstruction in 16 irradiated patients. Three of six sternomastoid-clavicle flaps failed (all in conjunction with a neck dissection), as did one of 10 pectoralis major-anterior-fifth rib flaps. One trapezius-scapular flap was used and it succeeded. We found the blood supply of the sternomastoid-clavicle flap too tenuous for use in conjunction with a neck dissection. The trapezius-scapular flap had too short an arc of rotation to be used for defects other than those in the horizontal ramus. In addition, this flap required a change of position and created an undesirable functional deformity. The pectoralis major-fifth rib flap, in contrast, could be used for a variety of defects, in conjunction with a neck dissection, and did not require a change of position during operation. We found it to be the most versatile and dependable of the flaps employed in this series.
Pearlman, N.W.; Albin, R.E.; O'Donnell, R.S.