A study of the utility of measuring mandibular mobility by means of the interincisal dimension.

PubMed

Ellis, E; Fonseca, R J; Upton, L G; Scott, R F

1989-02-01

The purpose of this investigation was to determine the reliability of using the interincisal dimension as a measure of mandibular range of motion. Thirty patients who underwent mandibular advancement and 15 patients who underwent mandibular setback were included in this study. Preoperatively, a lateral cephalogram in centric relation and a second cephalogram with the mandible at maximum voluntary gape were obtained. Immediately following surgery, another centric relation cephalogram was obtained. A composite tracing of the two preoperative tracings was made to show how the mandible changed in position from the closed-mouth to the open-mouth radiographs. The proximal segment (ramus) of the postoperative cephalogram was then superimposed on the open-mouth mandibular ramus, and the distal segment of the postoperative mandible was drawn. This composite produced a tracing of what the postoperative maximal gape cephalogram would be if the same amount of condylar rotation and translation as in the preoperative tracing had occurred. The preoperative interincisal dimension was recorded on the composite tracings (factoring in any overbite or openbite) as was the would-be postoperative interincisal dimension. These measures were compared using the paired t test and Pearson's correlations to determine if there were any significant differences between them. The results showed that the interincisal dimension is a fairly reliable measure of mandibular mobility even when the length of the mandible is altered with surgery.

Professionals' and laypersons' appreciation of various options for Class III surgical correction.

PubMed

Fabré, M; Mossaz, C; Christou, P; Kiliaridis, S

2010-08-01

The objectives of this study were to evaluate the assessments of maxillofacial surgeons, orthodontists, and laypersons on the predicted aesthetic outcome of various surgical options in Class III correction and the associations between certain initial cephalometric values and the judges' preferred option. Pre-surgical lateral headfilms and coloured profile photographs of 18 skeletal Class III Caucasian adult patients (10 males and 8 females) with a mean age of 24.5 years were used. The headfilms were hand traced and digitized. Conventional cephalometric analysis was performed. Computerized predictions of three surgical options, mandibular setback, Le Fort I advancement, and bimaxillary surgery, were made. For each case, the pre-surgical profile photograph with the three predictions was presented on a printed page. The questionnaire was sent to 51 maxillofacial surgeons (response rate 45.1 per cent), 78 orthodontists (response rate 71.8 per cent), and 61 laypersons (response rate 100 per cent) to aesthetically evaluate the pre-surgical photographs and the surgical predictions by placing a mark along a 10-graded visual analogue scale (VAS) using a standard profile for calibration. Confidence interval was calculated for each patient. An independent samples t-test was used to detect initial cephalometric values associated with the judges' preferred option and analysis of variance/Tukey's honestly significant differences to evaluate differences between judges. Intra-observer reliability was assessed with a paired t-test. All treatment predictions led to improved scoring of facial aesthetics with the exception of the setback option for three patients. For 14 patients, general agreement for the preferred option existed between the three groups of judges. Laypersons tended to give lower improvement scores than professionals. Overjet, nasofacial, and nasomental angles were important in decision making between the mandibular setback and Le Fort I options (the more negative the overjet, the larger the nasofacial angle, the smaller the nasomental angle, the greater the preference for the Le Fort I option). Wits appraisal seemed to be important in decision making between the mandibular setback and bimaxillary options (the more negative the Wits appraisal, the greater the preference for the latter option).

Volumetric changes in the upper airway after bimaxillary surgery for skeletal class III malocclusions: a case series study using 3-dimensional cone-beam computed tomography.

PubMed

Lee, Yoonjung; Chun, Youn-Sic; Kang, Nara; Kim, Minji

2012-12-01

Postsurgical changes of the airway have become a great point of interest and often have been reported to be a predisposing factor for obstructive sleep apnea after mandibular setback surgery. The purpose of this study was to evaluate the 3-dimensional volumetric changes in the upper airway space of patients who underwent bimaxillary surgery to correct Class III malocclusions. This study was performed retrospectively in a group of patients who underwent bimaxillary surgery for Class III malocclusion and had full cone-beam computed tomographic (CBCT) images taken before surgery and 1 day, 3 months, and 6 months after surgery. The upper and lower parts of the airway volume and the diameters of the airway were measured from 2 different levels. Presurgical measurements and the amount of surgical correction were evaluated for their effect on airway volume. Data analyses were performed by analysis of variance and multiple stepwise regression analysis. The subjects included 21 patients (6 men and 15 women; mean age, 22.7 yrs). The surgeries were Le Fort I impaction (5.27 ± 2.58 mm impaction from the posterior nasal spine) and mandibular setback surgery (9.20 ± 4.60 mm set back from the pogonion). No statistically significant differences were found in the total airway volume for all time points. In contrast, the volume of the upper part showed an increase (12.35%) and the lower part showed a decrease (14.07%), with a statistically significant difference 6 months after surgery (P < .05). Predictor variables affecting the upper and lower parts of the airway volume were presurgical A point to Nasion-perpendicular (A to N-perp) and vertical surgical correction of the pogonion and the posterior nasal spine (P < .05). Bimaxillary surgery for the correction of Class III malocclusion affected the morphology by increasing the upper part and decreasing the lower part of the airway, but not the total volume. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Skeletal stability in bimaxillary orthognathic surgery: P(L/DL)LA-resorbable versus titanium osteofixation.

PubMed

Landes, Constantin A; Ballon, Alexander

2006-09-01

One-year skeletal stability following bimaxillary orthognathic surgery was assessed by comparing poly(L-lactide-co-DL-lactide) to titanium osteofixation. Thirty patients underwent osteofixation with poly(L-lactide-co-DL-lactide) copolymer and 30 had 2.0-mm titanium-miniplate osteosyntheses. Lateral cephalograms were analyzed preoperatively, postoperatively, and at 1-year follow-up. Average +/- SD values were as follows in resorbable plate-osteosyntheses (number of cases/titanium controls): for maxillary advancement, 3.5 +/- 4.1 mm (n = 19)/5.4 +/- 3.5 mm (n = 21); setback, 2.8 +/- 3.7 mm (n = 9)/1.9 +/- 1.8 mm (n = 8); elongation, 4.2 +/- 3.6 mm (n = 18)/3.7 +/- 5.2 mm (n = 14); and intrusion, 1.9 +/- 1.7 mm (n = 12)/3.3 +/- 2.7 mm (n = 13); for mandibular advancement, 4.6 +/- 3.6 mm (n = 10)/6.3 +/- 8.8 mm (n = 18); setback, 7.5 +/- 8.3 mm (n = 20)/7.2 +/- 3.2 mm (n = 12); enlargement of the mandibular angle, 11.8 +/- 9.9 degrees (n = 19)/7.9 +/- 6.6 degrees (n = 21); and reduction, 4.5 +/- 3.2 degrees (n = 9)/6.3 +/- 6.6 degrees (n = 9). Preoperative to postoperative landmark positions within the study and control groups differed highly significantly (p = 0.008, paired t test), yet the amount of operative movement was comparable between the study and control groups (p = 0.5, two-sided t test). Absolute instability at the advanced A-point was (study group/controls) 2.3 +/- 1.8/2.4 +/- 2 mm, setback was 2.3 +/- 1.9 mm/2.5 +/- 1.7 mm, elongation at the anterior nasal spine was 3.8 +/- 3.1 mm/3.1 +/- 3.6 mm, intrusion was 2.1 +/- 1.9 mm/2.2 +/- 1.5 mm, advancement instability at the B-point was 4.9 +/- 4.3 mm/5.1 +/- 8.2 mm, setback was 3.0 +/- 2 mm/1.7 +/- 2 mm, mandibular angle enlargement instability was 6.7 +/- 8.9 degrees/8.2 +/- 9.6 degrees, and angle narrowing was 6.8 +/- 5.2 degrees/4.2 +/- 5.9 degrees. Absolute postoperative instability did not differ significantly between the study and control groups (p = 0.6). Resorbable osteofixation as tested proved to be as reliable as titanium, but as the study and control groups were not matched, the results have to be interpreted as preliminary. Resorbable materials permitted clinically faster occlusal and condylar settling than standard titanium osteosyntheses, as bone segments showed slight clinical mobility up to 6 weeks postoperatively.

Management of severe skeletal Class III malocclusion with bimaxillary orthognathic surgery

PubMed Central

Haryani, Jitesh; Nagar, Amit; Mehrotra, Divya; Ranabhatt, Rani

2016-01-01

Orthognathic surgery in conjunction with fixed orthodontics is a common indication for interdisciplinary management of severe skeletal Class III malocclusion. A thorough analysis of pretreatment investigations and development of a surgical visual treatment objective is essential to plan the type of surgical technique required. Bimaxillary orthognathic surgery is the most common type of surgical procedure for severe skeletal discrepancies. The present case report is a combined ortho-surgical team management of a skeletally Class III patient. The severity of the case required bilateral upper first premolar extraction for dentoalveolar decompensation and simultaneous “Two-jaw surgery” with maxillary advancement of 4 mm and mandibular setback of 7 mm. Postsurgery, a pleasing good facial profile was achieved with Class II molar relation and positive overjet. PMID:27994433

Orthognathic surgery for the Asian patient and the influence of the surgeon's background on treatment.

PubMed

Lee, L H; Jun, J H; Danganan, M; Pogrel, M A; Kushner, H; Lee, J S

2011-05-01

The aim of this study was to determine whether there are differences in esthetic preferences and orthognathic treatment for Asian patients between US- and Asian-trained surgeons. Twenty-five Caucasian-American, 23 Asian-American, 24 Asian oral and maxillofacial surgeons (OMFS) completed an Institutional Review Board (IRB)-approved survey. They were asked to rate seven Asian male and female profiles from most attractive to least attractive and to choose maxillary advancement, mandibular setback, or no treatment for an Asian male and female patient with a maxillomandibular discrepancy. There was no statistical difference for the most and least attractive rankings among the OMFS. Variations in ranking for intermediate profiles showed a statistical difference between the Asian- and US-trained OMFS. These intermediate profile rankings appeared to explain the differences in surgical treatment. Treatment recommendations for the Asian male among the OMFS, regardless of ethnicity, preferred maxillary advancement. For the Asian female, all Asian-trained OMFS preferred mandibular setback, while nearly 40% of US-trained OMFS preferred maxillary advancement (p=0.003). Differences in surgical management of the Asian patient were dependent on whether the surgeon trained in the US or in Asia and the gender of the patient. There was concordance between the Asian-American and Caucasian-American surgeons. Published by Elsevier Ltd.

Self-reinforced bioresorbable poly-L/DL-lactide [SR-P(L/DL)LA] 70/30 miniplates and miniscrews are reliable for fixation of anterior mandibular fractures: a pilot study.

PubMed

Ylikontiola, Leena; Sundqvuist, Kai; Sàndor, George K B; Törmälä, Pertti; Ashammakhi, Nureddin

2004-03-01

Bioresorbable osteofixation devices are being increasingly used in orthognathic surgery and in cases of trauma to avoid problems associated with conventional metal osteofixation devices. The aim of this clinical study was to assess the reliability and efficacy of bioresorbable self-reinforced poly-L/DL-lactide (SR-P(L/DL)LA 70/30) plates and screws in the fixation of mandibular fractures in adults. Ten patients (20 to 49 years old) with isolated anterior mandibular parasymphyseal fractures were treated by means of open reduction and internal fixation using SR-P(L/DL)LA 70/30 bioresorbable plates and screws. During the minimum of 6 months of follow-up, no problems were encountered except for 1 case where a plate became exposed intraorally and infected. This required debridement and later excision of the exposed part of the plate. Despite this setback the fractured bone healed well. SR-P(L/DL)LA 70/30 plates and screws are reliable for internal fixation of anterior mandibular fractures in adults. Proper soft tissue coverage should be ensured to avoid plate exposure. Should implant exposure occur, it might be necessary to excise the exposed part after fracture healing (6-8 weeks postoperatively).

Three-dimensional analysis of postoperative returning movement of perioperative condylar displacement after bilateral sagittal split ramus osteotomy for mandibular setback with different fixation methods.

PubMed

Han, Jeong Joon; Hwang, Soon Jung

2015-11-01

This study aimed to evaluate postoperative returning movement of perioperative condylar displacement after bilateral sagittal split ramus osteotomy (BSSRO) depending on a fixation method using three-dimensional (3D) analysis of computed tomography (CT). Twenty-five mandibular prognathic patients (50 condyles) who underwent orthognathic surgery with BSSRO were divided into three groups depending on the fixation method, which consisted of miniplate only (Group A), combined with single bicortical screw (Group B), or with more than one bicortical screw (Group C). CT data taken before, immediately after, and 3 to 6 months after surgery were analyzed. The condyle exhibited mainly lateral bodily displacement and inward and inferior rotation immediately after surgery. The amount of perioperative lateral displacement of the condyle increased according to the increasing number of fixation screws, but the mean displacements were not significantly different among the three groups. During the postoperative follow-up period, the amount of medial returning of the condyle was 102.2% of the intraoperative lateral displacement in Group A. In contrast, Group B and C exhibited partial returning movement by 71.3% and 38.9% of cases, respectively. In conclusion, stronger rigid internal fixation in orthognathic surgery using BSSRO is associated with reduced flexibility of postoperative functional adjustment of displaced condyle to the preoperative condylar position. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Two-year follow-up of changes in bite force and occlusal contact area after intraoral vertical ramus osteotomy with and without Le Fort I osteotomy.

PubMed

Choi, Y J; Lim, H; Chung, C J; Park, K H; Kim, K H

2014-06-01

This study was performed to examine the longitudinal changes in bite force and occlusal contact area after mandibular setback surgery via intraoral vertical ramus osteotomy (IVRO). Patients with mandibular prognathism who underwent IVRO (surgical group: 39 men and 39 women) were compared with subjects with class I skeletal and dental relationships (control group; 32 men and 35 women). The surgical group was divided into two subgroups: 1-jaw surgery (n = 30) and 2-jaw surgery (n = 48). Bite force and contact area were measured in maximum intercuspation with the Dental Prescale System before treatment, within 1 month before surgery, and at 1, 3, 6, 9, 12, and 24 months postsurgery. A linear mixed model was used to investigate the time-dependent changes and associated factors. Bite force and contact area decreased during presurgical orthodontic treatment, were minimal at 1 month postsurgery, and increased gradually thereafter. The 1-jaw and 2-jaw subgroups showed no significant differences in bite force. The time-dependent changes in bite force were significantly different according to the contact area (P < 0.05). The results of this study suggest that bite force and occlusal contact area gradually increase throughout the postsurgical evaluation period. Increasing the occlusal contact area may be essential for improving bite force after surgery. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

[Osteosynthesis in the Surgical Treatment of Prognathism: State of The Art].

PubMed

Durão, Nuno; Amarante, José

2017-03-31

Prognathism is a common skeletal facial abnormality, associated with class III malocclusion, often with repercussions in quality of life. In addition to orthodontic treatment, sagittal split ramus osteotomy is the most common technique for its correction, and segment osteosynthesis is an important element of the post-surgical outcome. A search for relevant literature was conducted in the PubMed/MEDLINE database and in other relevant sources. The stability of different fixation methods, their repercussions on inferior alveolar nerve lesions, and the type of material are among the most researched subjects. Recent research about the type of osteosynthesis applied in the sagittal split ramus osteotomy for mandibular setback is discussed. Miniplates appear to be the better option for fixation of sagittal split osteotomy for mandibular setback. Bioabsorbable osteosynthesis may be an acceptable alternative to titanium.

Acculturation levels and personalizing orthognathic surgery for the Asian American patient.

PubMed

Sy, A A; Kim, W S; Chen, J; Shen, Y; Tao, C; Lee, J S

2016-10-01

This study was performed to investigate whether the level of acculturation among Asians living in the USA plays a significant role in their opinion of facial profiles. One hundred and ninety-eight Asian American subjects were asked to complete a pre-validated survey to measure their level of acculturation and to evaluate four sets of pictures that displayed a class II male, class II female, class III male, and class III female. Each set consisted of three lateral profile pictures: an initial unaltered photo, a picture simulating a flatter profile (orthodontic camouflage in class II; mandibular setback in class III), and a picture simulating a fuller profile (mandibular advancement in class II; maxillary advancement in class III). For the class II male, subjects who were more acculturated indicated that a flatter profile (orthodontic camouflage) was less attractive. For the class II female, higher acculturated subjects chose expansive treatment (mandibular advancement) as more aesthetic compared to the less acculturated subjects. Each of these scenarios had statistically significant odds ratios. In general, highly acculturated subjects preferred a fuller facial profile, while low acculturated subjects preferred a flatter facial profile appearance, except for the class III female profile, which did not follow this trend. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Comparison of Actual Surgical Outcomes and 3D Surgical Simulations

PubMed Central

Tucker, Scott; Cevidanes, Lucia; Styner, Martin; Kim, Hyungmin; Reyes, Mauricio; Proffit, William; Turvey, Timothy

2009-01-01

Purpose The advent of imaging software programs have proved to be useful for diagnosis, treatment planning, and outcome measurement, but precision of 3D surgical simulation still needs to be tested. This study was conducted to determine if the virtual surgery performed on 3D models constructed from Cone-beam CT (CBCT) can correctly simulate the actual surgical outcome and to validate the ability of this emerging technology to recreate the orthognathic surgery hard tissue movements in 3 translational and 3 rotational planes of space. Methods Construction of pre- and post-surgery 3D models from CBCTs of 14 patients who had combined maxillary advancement and mandibular setback surgery and 6 patients who had one-piece maxillary advancement surgery was performed. The post-surgery and virtually simulated surgery 3D models were registered at the cranial base to quantify differences between simulated and actual surgery models. Hotelling T-test were used to assess the differences between simulated and actual surgical outcomes. Results For all anatomic regions of interest, there was no statistically significant difference between the simulated and the actual surgical models. The right lateral ramus was the only region that showed a statistically significant, but small difference when comparing two- and one-jaw surgeries. Conclusions Virtual surgical methods were reliably reproduced, oral surgery residents could benefit from virtual surgical training, and computer simulation has the potential to increase predictability in the operating room. PMID:20591553

Incomplete mobilization of the maxilla resulting in failed maxillary distraction: a case report.

PubMed

Alkan, Alper; Inal, Samet; Baş, Burcu; Ozer, Mete

2007-12-01

Maxillary distraction osteogenesis has become an accepted alternative method in the treatment of patients with severe maxillary hypoplasia in craniofacial syndromes and cleft-related deformities. Insufficient distraction, undesirable soft tissue changes, and occurrence of defective distraction vectors are among the potential complications of intraoral maxillary distraction osteogenesis. A 2-stage procedure combining maxillary advancement by distraction technique with genioplasty and mandibular setback surgery was planned to correct jaw deformities in a 22-year-old patient with severe maxillary retrusion, mandibular prognathism, and excessive lower facial height. In the first stage, osteotomies were performed and maxilla was lightly mobilized after down-fracture. Distractors were placed to the maxilla intraorally. During activation period, the maxilla rotated in a clockwise direction, producing a discrepancy between the planned and the actual vectors. Complete distraction was unsatisfactory and the complication was due to surgical technique. This case report presents the failure of maxillary distraction due to incomplete mobilization of the maxilla. Treatment of the case was achieved by the conventional osteotomy techniques at final operation. The maxilla was successfully advanced to the desired position producing good occlusion and an improved facial profile.

Evaluation of treatment modality for skeletal Class III malocclusion with labioversed upper incisors and/or protrusive maxilla: surgical movement and stability of rotational maxillary setback procedure.

PubMed

Baek, Seung-Hak; Kim, Keunwoo; Choi, Jin-Young

2009-11-01

The purpose of this study was to evaluate the range of surgical movement and stability of rotational maxillary setback (MXS) procedure as treatment modality for skeletal class III malocclusion with labioversed upper incisors and/or protrusive maxilla (CIII/LUI-PM). The samples consisted of 20 adult patients (mean [SD] age, 23.55 [4.30] y) who had CIII/LUI-PM and were treated with rotational MXS and mandibular setback using LeFort I osteotomy and bilateral sagittal split ramus osteotomy. The lateral cephalograms were obtained 1 week before (T0), 1 week after (T1), and 1 year after surgery (T2). The amounts of surgical movement, relapse, and stability rate of the upper central incisor (UIE), upper first molar (U6MBC), point A (A), incisive canal point, and posterior nasal spine (PNS) in relation to the reference planes were statistically analyzed. During T1 - T0, there were backward and downward movements of UIE and A, backward and upward movements of U6MBC, and upward and slight forward movements of PNS due to rotational MXS. The center of rotation of the maxilla was placed between A and the upper premolar area. During T2 - T1, skeletal landmarks showed clinically insignificant counterclockwise rotational relapse (<0.5 mm). The anteroposterior (AP) and vertical positions of skeletal landmarks were more stable than dental landmarks. The U6MBC was more stable in the vertical aspect than UIE (P < 0.01). Posterior nasal spine showed significantly higher stability rate in both vertical and AP aspects (P < 0.01, respectively), whereas UIE showed a lower value in the vertical aspect (P < 0.05). Rotational MXS procedure in cases with CIII/LUI-PM can be regarded as a stable one, especially in the vertical and AP positions of PNS. Vertical relapse in UIE should be managed with postoperative orthodontic treatment.

Orthognathic Surgery in Patients With Congenital Myopathies and Congenital Muscular Dystrophies: Case Series and Review of the Literature.

PubMed

Bezak, Brett J; Arce, Kevin A; Jacob, Adam; Van Ess, James

2016-03-01

This case series examined preoperative findings and the surgical, anesthetic, and postoperative management of 6 patients with congenital myopathies (CMs) and congenital muscular dystrophies (CMDs) treated at a tertiary medical institution with orthognathic surgery over 15 years to describe pertinent considerations for performing orthognathic surgery in these complex patients. According to the institutional review board-approved protocol, chart records were reviewed for all orthognathic surgical patients with a clinical, genetic, or muscle biopsy-proved diagnosis of CM or CMD. Six patients (5 male, 1 female) qualified, and they were treated by 4 surgeons in the division of oral and maxillofacial surgery from 1992 through 2007. Average age was 19.5 years at the time of orthognathic surgery. Five patients had Class III malocclusions and 1 patient had Class II malocclusion. All 6 patients had apertognathia with lip incompetence. Nasoendotracheal intubation with a difficulty of 0/3 (0=easiest, 3=most difficult) was performed in all cases. Routine induction and maintenance anesthetics, including halogenated agents and nondepolarizing muscle relaxants, were administered without malignant hyperthermia. All 6 patients underwent Le Fort level osteotomies; 4 also had mandibular setback surgery with or without balancing mandibular inferior border osteotomies. Five patients required planned intensive care unit care postoperatively (average, 18.4 days; range, 4 to 65 days). Postoperative respiratory complications resulting in major blood oxygen desaturations occurred in 5 patients; 4 of these patients required reintubation during emergency code response. Five patients required extended postoperative intubation (average, 4.2 days; range, 3 to 6 days) and ventilatory support. Average hospital length of stay was 21.8 days (range, 6 to 75 days). Average postoperative follow-up interval was 29.8 weeks (range, 6 to 128 weeks). Patients with CMs or CMDs often have characteristic dentofacial malocclusions that contribute to functional problems with feeding and drooling and psychosocial problems. Orthognathic surgery, usually bimaxillary, can be judiciously considered in these patients; these procedures typically require multidisciplinary pre- and postoperative evaluation and care over lengthy hospital stays with a high risk of respiratory complications that bear consideration in treatment planning. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Blood-flow change and recovery of sensibility in the maxillary dental pulp during and after maxillary distraction: a pilot study.

PubMed

Harada, Kiyoshi; Sato, Masaru; Omura, Ken

2004-11-01

To examine the change in blood flow and recovery of sensibility in the maxillary dental pulp during and after maxillary distraction. The subjects included 5 patients undergoing high Le Fort I osteotomy and maxillary distraction (D-group) and a reference group of 14 patients who underwent a common single-segment Le Fort I osteotomy, 1-stage maxillary advancement, and mandibular setback surgery (C-group). Eleven (D-group) and 54 (C-group) maxillary incisors were assessed preoperatively and at 1-7 days, 14 days, and 3 months postoperatively. Pulpal blood flow (PBF) was measured by laser Doppler flowmetry, and pulpal sensibility (PS) was investigated by electrodiagnostics. From postoperative days 1 to 5 (the latency period), the PBF tended to be higher in the D-group than in the C-group. From day 6 to 3 months postoperatively (during and after maxillary distraction), the PBF values of the 2 groups were similar. The PS remained negative up to 14 days postoperatively in both groups. However, at 3 months after the operation, a higher proportion (90.9%) of teeth in the D-group was positive for PS. These results suggest that maxillary distraction is a favorable technique for maintenance of PBF and recovery of PS in the maxillary teeth after surgery.

[Maxillo-facial surgery in skeletal Class II: repercussions on the temporo-mandibular joints].

PubMed

Manière-Ezvan, Armelle; Savoldelli, Charles; Busson, Floriant; Oueiss, Arlette; Orthlieb, Jean-Daniel

2016-03-01

These interventions usually aimed at the correction of the skeletal discrepancy by mandibular retrognatism with an advancement of the distal portion of the mandible after mandibular osteotomy. The position of the condyle is determined during the osteosynthesis with miniplates. Condyles are set back in relation with the supine position of the patient and the weakness of his (her) curarized muscle. All studies show that surgery of mandibular advancement causes a lateral, torque and backward movement of the condyles, all harmful to the condyles. Factors that predispose to condylar resorption are "the patient": a woman, young (between 15 and 40), high mandibular angle, with a history of temporo-mandibular disorders and surgical overload applied to the condyles. What are the possible solutions to avoid failures? Patient preparation before surgery and surgery simulation with an articulator, condylar position control during surgery, working with surgeons to achieve a condylar portion stabilization system (with the CAD), quickly set up a mobilization of the mandible by physiotherapy. © EDP Sciences, SFODF, 2016.

Impact of the Distance of Maxillary Advancement on Horizontal Relapse After Orthognathic Surgery.

PubMed

Fahradyan, Artur; Wolfswinkel, Erik M; Clarke, Noreen; Park, Stephen; Tsuha, Michaela; Urata, Mark M; Hammoudeh, Jeffrey A; Yamashita, Dennis-Duke R

2018-04-01

The maxillary horizontal relapse following Le Fort I advancement has been estimated to be 10% to 50%. This retrospective review examines the direct association between the amounts of maxillary advancement and relapse. We hypothesize that the greater the advancement, the greater the relapse amount. Patients with class III skeletal malocclusion underwent maxillary advancement with either a Le Fort I or a Le Fort I with simultaneous mandibular setback (bimaxillary surgery) from 2008 to 2015. Patients were assessed for a history of cleft lip or cleft palate. Patients with known syndromes were excluded. Cephalometric analysis was performed to compare surgical and postsurgical changes. Of 136 patients, 47.1% were males and 61.8% had a history of cleft. The mean surgery age was 18.9 (13.8-23) years and 53.7% underwent a bimaxillary procedure. A representative subgroup of 35 patients had preoperative, immediate postoperative, and an average of 1-year postoperative lateral cephalograms taken. The mean maxillary advancement was 6.3 mm and the horizontal relapse was 1.8 mm, indicating a 28.6% relapse. A history of cleft and amount of maxillary advancement were directly correlated, whereas bone grafting of the maxillary osteotomy sites was inversely correlated with the amount of relapse ( P < .05). Our data suggest positive correlation between amount of maxillary advancement and horizontal relapse as well as a positive correlation between history of cleft and horizontal relapse. Bone grafting of the maxillary osteotomy sites has a protective effect on the relapse.

The Application of 3D Printing Technology for Simultaneous Orthognathic Surgery and Mandibular Contour Osteoplasty in the Treatment of Craniofacial Deformities.

PubMed

Xiao, Yanju; Sun, Xiumei; Wang, Lin; Zhang, Yaoyao; Chen, Kai; Wu, Guomin

2017-12-01

Because of the limitation of specific preoperative design and surgical templates, orthognathic surgery and mandibular contour osteoplasty are generally performed in two stages. Three-dimensional printing technology has improved the accuracy of the surgery and results in good surgical predictability easily. This study aims to confirm the effectiveness, feasibility and precision of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology. Ten patients, who were diagnosed with mandibular hypertrophy and bimaxillary deformities, were included in the study. In addition to conventional orthognathic surgery, mandibular angle ostectomy, mandibular outer cortex grinding or mandibular border ostectomy was designed for mandibular hypertrophy. Optimal osteotomy lines and simulated surgeries were designed according the 3D printing model of the mandible. Then, surgical templates were made on the 3D printing model. No muscle excision was performed in any patient. Preoperative, predicted and postoperative measurements were taken, including the gonial angle (Ar-Go-Me) and the mandibular width (Go-Go). All the patients had a reposeful postoperative recovery, with no indication of obvious infection, facial paralysis, osteonecrosis or bone displacement. The gonial angle was improved from 110.3° ± 11.1 to 121.3° ± 2.9, and the mandibular width was improved from 117.5 mm ± 6.8 to 111.9 mm ± 4.2. The discrepancies between simulation and postoperation of the left gonial angle, the right gonial angle and the mandibular width were 0.56° ± 0.22, 0.65° ± 0.3 and 0.49 mm ± 0.43, respectively. The results of our study illustrated the predictability, feasibility and reliability of simultaneous mandibular contour osteoplasty and orthognathic surgery with the assistance of 3D printing technology. Our technique could achieve functional improvement and an aesthetic profile at the same time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Mandibular osteoradionecrosis in squamous cell carcinoma of the oral cavity and oropharynx: incidence and risk factors.

PubMed

Monnier, Yan; Broome, Martin; Betz, Michael; Bouferrache, Kahina; Ozsahin, Mahmut; Jaques, Bertrand

2011-05-01

Mandibular osteoradionecrosis (ORN) is a serious complication of radiotherapy (RT) in head and neck cancer patients. The aim of this study was to analyze the incidence of and risk factors for mandibular ORN in squamous cell carcinoma (SCC) of the oral cavity and oropharynx. Case series with chart review. University tertiary care center for head and neck oncology. Seventy-three patients treated for stage I to IV SCC of the oral cavity and oropharynx between 2000 and 2007, with a minimum follow-up of 2 years, were included in the study. Treatment modalities included both RT with curative intent and adjuvant RT following tumor surgery. The log-rank test and Cox model were used for univariate and multivariate analyses. The incidence of mandibular ORN was 40% at 5 years. Using univariate analysis, the following risk factors were identified: oral cavity tumors (P < .01), bone invasion (P < .02), any surgery prior to RT (P < .04), and bone surgery (P < .0001). By multivariate analysis, mandibular surgery proved to be the most important risk factor and the only one reaching statistical significance (P < .0002). Mandibular ORN is a frequent long-term complication of RT for oral cavity and oropharynx cancers. Mandibular surgery before irradiation is the only independent risk factor. These aspects must be considered when planning treatment for these tumors.

Repair of complete bilateral cleft lip with severely protruding premaxilla performing a premaxillary setback and vomerine ostectomy in one stage surgery

PubMed Central

Sanchez-Sanchez, Marta; Iglesias-Martin, Fernando; Garcia-Perla-Garcia, Alberto; Belmonte-Caro, Rodolfo; Gonzalez-Perez, Luis-Miguel

2015-01-01

Background The authors present a technique for selected cases of CBCL. The primary repair of the CBCL with a severely protruding premaxilla in one stage surgery is very difficult, essentially because a good muscular apposition is difficult, forcing synchronously to do a premaxillary setback to facilitate subsequent bilateral lip repair and, thus, achieving satisfactory results. We achieve this by a reductive ostectomy on the vomero-premaxillary suture. Material and Methods 4 patients with CBCL and severely protruding premaxilla underwent premaxillary setback by vomerine ostectomy at the same time of lip repair in the past 24 months. The extent of premaxillary setback varied between 9 and 16 mm. The required amount of bone was removed anterior to the vomero-premaxillary suture. The authors did an additional simultaneous gingivoperiosteoplasty in all patients, achieving an enough stability of the premaxilla in its new position, to be able to close the alveolar gap bilaterally. The authors have examined the position of premaxilla and dental arch between 6 and 24 months. We did not do the primary nose correction, because this increased the risk of impairment of the already compromised vascularity of the philtrum and premaxilla. Results The follow-up period ranged between 6 and 24 months. None of the patients had any major complication. During follow-up, the premaxilla was minimally mobile. We achieved a good lip repair in all cases: adequate muscle repair, symmetry of the lip, prolabium and Cupid’s bow, as well as good scars. Conclusions To our knowledge, there are few reports of one stage surgery with vomerine ostectomy to repair CBCL with severely protruding premaxilla. Doing this vomerine ostectomy, we don’t know how it will affect the subsequent growth of the premaxila and restrict the natural maxillary growth. Applying this alternative treatment for children with CBCL and protruded premaxilla without any preoperative orthopedic, we can successfully perform, in a single-stage surgery, a good primary lip repair at our center. Further confirmations of this surgery with follow up and anthropometric studies of these patients during childhood and adolescence are required. Key words: Protruding premaxilla, bilateral cleft lip, vomerine ostectomy, one stage surgery, Millard II technique. PMID:26034932

Risk Factors and Dose-Effect Relationship for Mandibular Osteoradionecrosis in Oral and Oropharyngeal Cancer Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Ik Jae; Koom, Woong Sub; Lee, Chang Geol, E-mail: cglee1023@yuhs.a

2009-11-15

Purpose: To analyze risk factors and the dose-effect relationship for osteoradionecrosis (ORN) of the mandible after radiotherapy of oral and oropharyngeal cancers. Materials and Methods: One-hundred ninety-eight patients with oral (45%) and oropharyngeal cancer (55%) who had received external radiotherapy between 1990 and 2000 were retrospectively reviewed. All patients had a dental evaluation before radiotherapy. The median radiation dose was 60 Gy (range, 16-75 Gy), and the median biologically effective dose for late effects (BED{sub late}) in bone was 114 Gy{sub 2} (range, 30-167 Gy{sub 2}). Results: The frequency of ORN was 13 patients (6.6%). Among patients with mandibular surgery,more » eight had ORN at the surgical site. Among patients without mandibular surgery, five patients had ORN on the molar area of the mandible. The median time to ORN was 22 months (range, 1-69 months). Univariate analysis revealed that mandibular surgery and Co-60 were significant risk factors for ORN (p = 0.01 and 0.04, respectively). In multivariate analysis, mandibular surgery was the most important factor (p = 0.001). High radiation doses over BED 102.6 Gy{sub 2} (conventional dose of 54 Gy at 1.8 Gy/fraction) were also a significant factor for ORN (p = 0.008) and showed a positive dose-effect relationship in logistic regression (p = 0.04) for patients who had undergone mandibular surgery. Conclusions: Mandibular surgery was the most significant risk factor for ORN of mandible in oral and oropharyngeal cancers patients. A BED of 102.6 Gy{sub 2} or higher to the mandible also significantly increases the risk of ORN.« less

[Combined orthodontic-orthoganthic surgery to treat asymmetric mandibular excess malocclusions].

PubMed

Li, Xiao-Bing; Chen, Song; Chen, Yang-Xi; Li, Jun

2005-06-01

To discuss the skeletal and dentoalveolar characteristics of asymmetric mandibular excess malocclusions and to discuss the procedures of combined orthodontic-orthonganthic surgery treatments of asymmetric mandibular excess malocclusions. 25 cases treated by combined orthodontic-orthognathic surgery treatments were reviewed to find out the specialties of this kind of therapy. The asymmetric of mandible presents anterior and posterior teeth tipped both sagitally and horizontally, as well as upper and lower jaws incompatibility. The pre-surgical orthodontic treatments included decomposition of anterior and posterior teeth, leveling and aligning the teeth etc. The post-surgical orthodontic treatments were to detail the occlusions. The patients all got functional and aesthetic good results after the combined orthodontic-orthognathic surgery treatments. The asymmetric mandibular excess affects the harmony of the face badly, and the correction of it must be carried out by the combined orthodontic-orthognathic surgery treatments. The pre- and post-surgical orthodontic treatments are the key stages to make the skeletal corrections stable.

Mandibular reconstruction using plates prebent to fit rapid prototyping 3-dimensional printing models ameliorates contour deformity.

PubMed

Azuma, Masaki; Yanagawa, Toru; Ishibashi-Kanno, Naomi; Uchida, Fumihiko; Ito, Takaaki; Yamagata, Kenji; Hasegawa, Shogo; Sasaki, Kaoru; Adachi, Koji; Tabuchi, Katsuhiko; Sekido, Mitsuru; Bukawa, Hiroki

2014-10-23

Recently, medical rapid prototyping (MRP) models, fabricated with computer-aided design and computer-aided manufacture (CAD/CAM) techniques, have been applied to reconstructive surgery in the treatment of head and neck cancers. Here, we tested the use of preoperatively manufactured reconstruction plates, which were produced using MRP models. The clinical efficacy and esthetic outcome of using these products in mandibular reconstruction was evaluated. A series of 28 patients with malignant oral tumors underwent unilateral segmental resection of the mandible and simultaneous mandibular reconstruction. Twelve patients were treated with prebent reconstruction plates that were molded to MRP mandibular models designed with CAD/CAM techniques and fabricated on a combined powder bed and inkjet head three-dimensional printer. The remaining 16 patients were treated using conventional reconstruction methods. The surgical and esthetic outcomes of the two groups were compared by imaging analysis using post-operative panoramic tomography. The mandibular symmetry in patients receiving the MRP-model-based prebent plates was significantly better than that in patients receiving conventional reconstructive surgery. Patients with head and neck cancer undergoing reconstructive surgery using a prebent reconstruction plate fabricated according to an MRP mandibular model showed improved mandibular contour compared to patients undergoing conventional mandibular reconstruction. Thus, use of this new technology for mandibular reconstruction results in an improved esthetic outcome with the potential for improved quality of life for patients.

Short Lingual Osteotomy Using a Piezosurgery Ultrasonic Bone-Cutting Device During Sagittal Split Ramus Osteotomy.

PubMed

Kawase-Koga, Yoko; Mori, Yoshiyuki; Kanno, Yuki; Hoshi, Kazuto; Takato, Tsuyoshi

2015-10-01

Short lingual osteotomy is a useful method for the performance of sagittal split ramus osteotomy involving interference between the proximal and distal bone fragments when lateral differences exist in the setback distance. However, this procedure occasionally results in abnormal fracture and nerve injury; expert surgical skill is thus required. We herein describe a novel technique involving the use of an ultrasonic bone-cutting device (Piezosurgery; Mectron Medical Technology, Carasco, Italy) for vertical osteotomy posterior to the mandibular foramen. Successful short lingual osteotomy was performed using this technique with avoidance of abnormal fracture and neurovascular bundle damage.

[Study on accuracy of virtual surgical planning in free fibula mandibular reconstruction by using SurgiCase software].

PubMed

Yan, Guangqi; Wang, Xue; Tan, Xuexin; Wang, Xukai; Yang, Mingliang; Lu, Li

2013-08-01

To evaluate the directional significance of SurgiCase software in free fibula mandibular reconstruction. Between September 2010 and March 2012, 10 patients with mandibular defect underwent free fibula mandibular reconstruction. There were 7 males and 3 females, with an age range of 19-43 years (mean, 27 years). The extent of lesions was 7 cm x 5 cm to 16 cm x 8 cm. In each case, three-dimensional spiral CT scan of the maxilla, mandible, and fibula was obtained before surgery. The CT data were imported into the SurgiCase software and the virtual surgery planning was performed. After that, the mandibular rapid prototyping was made according to customized design. The reconstruction surgery was then carried out using these preoperative data. During actual surgery, the extent of mandibular defect was from 6 cm x 3 cm to 16 cm x 5 cm; the length of fibula which was used to reconstruct mandible was 6-17 cm; and the area of flap was from 6 cm x 5 cm to 16 cm x 6 cm. Preoperative data could not be applied because the intraoperative size of tumor was larger than preoperative design in 1 case of mandibular ameloblastoma, and the fibula was shaped according to the actual osteotomy location; operations were performed successfully according to preoperative design in the other 9 patients. The operation time was 5-7 hours (mean, 6 hours). Primary healing of incision was obtained, without early complications. Ten patients were followed up 1 year. At last follow-up, 8 patients were satisfactory with the appearance and 2 patients complained with unsatisfied wide facial pattern. The panoramic radiograghs showed good bone healing. The range of mouth opening was 2.5-3.5 cm. SurgiCase software can provide precise data for free fibula mandibular reconstruction during surgery. It can be applied widely in clinic.

Comparative Evaluation of Immediate Post-Operative Sequelae after Surgical Removal of Impacted Mandibular Third Molar with or without Tube Drain - Split-Mouth Study.

PubMed

Kumar, Barun; Bhate, Kalyani; Dolas, R S; Kumar, Sn Santhosh; Waknis, Pushkar

2016-12-01

Third molar surgery is one of the most common surgical procedures performed in general dentistry. Post-operative variables such as pain, swelling and trismus are major concerns after impacted mandibular third molar surgery. Use of passive tube drain is supposed to help reduce these immediate post-operative sequelae. The current study was designed to compare the effect of tube drain on immediate post-operative sequelae following impacted mandibular third molar surgery. To compare the post-operative sequelae after surgical removal of impacted mandibular third molar surgery with or without tube drain. Thirty patients with bilateral impacted mandibular third molars were divided into two groups: Test (with tube drain) and control (without tube drain) group. In the test group, a tube drain was inserted through the releasing incision, and kept in place for three days. The control group was left without a tube drain. The post-operative variables like, pain, swelling, and trismus were calculated after 24 hours, 72 hours, 7 days, and 15 days in both the groups and analyzed statistically using chi-square and t-test analysis. The test group showed lesser swelling as compared to control group, with the swelling variable showing statistically significant difference at post-operative day 3 and 7 (p≤ 0.05) in both groups. There were no statistically significant differences in pain and trismus variables in both the groups. The use of tube drain helps to control swelling following impacted mandibular third molar surgery. However, it does not have much effect on pain or trismus.

[Temporo-mandibular joints and orthognathic surgery].

PubMed

Bouletreau, P

2016-09-01

Temporo-Mandibular Joints (TMJ) and orthognathic surgery are closely linked. In the past, some authors have even described (with mixed results) the correction of some dysmorphosis through direct procedures on the TMJs. Nowadays, performing orthognathic surgery involves the TMJ in three different occasions: (1) TMJ disorders potentially responsible for dento-maxillary dysmorphosis, (2) effects of orthognathic surgery on TMJs, and (3) condylar positioning methods in orthognathic surgery. These three chapters are developed in order to focus on the close relationships between TMJ and orthognathic surgery. Some perspectives close this article. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Mandibular marginal contouring in oriental aesthetic surgery: refined surgical concept and operative procedure.

PubMed

Satoh, Kaneshige; Mitsukawa, Nobuyuki

2014-05-01

In aesthetic mandibular contouring surgery, which is often conducted in Asians, the operative procedure is thought to deliver a more aesthetic mandibular shape by means of contouring conducted as a whole from the ramus to the symphysis. The authors describe the refined concept and operative procedures of mandibular marginal contouring. For the 7-year period from 2004 to 2011, mandibular marginal contouring has been used in 57 consecutive series of Japanese subjects. Patient ages ranged from 18 to 33 years, and the subjects included 15 men and 42 women. The surgery was carried out by cutting off the protruding deformed mandibular margin from the ramus to the symphysis. In 53 of 57 cases, the focus was on angle contouring. Concomitant genioplasty by horizontal osteotomy of the chin was conducted in 42 of 57 cases (recession, advancement, shortening, elongation, and correction of the shift variously). In 22 materials exhibiting bulk around the mandibular, the ramus to the body was excised sagittally and thinned. In all the patients, mandibular marginal contouring from the ramus to the symphysis was completed. Partial masseter muscle resection was conducted in 11 of 57 cases. Mandibular contouring effectively achieved a highly satisfactory result in all cases. The upper portion of the peripheral branch of the trunk of the mental nerve was dissected by an electric scalpel in 1 case but sutured immediately using an 8-0 nylon stitch. Transient palsy of the mental nerve was noticed in a few cases but subsided in 1 to 2 months. No particular complications were encountered. No secondary revision was required in this series. In mandibular angle plasty, mandibular marginal contouring from the ramus to the symphysis should be carried out by cutting off the angle keeping in mind the entire mandibular shape. This concept and the procedure can deliver greater patient satisfaction.

Protraction of mandibular second and third molars assisted by partial corticision and miniscrew anchorage.

PubMed

Mimura, Hiroshi

2013-08-01

A woman, aged 47 years 6 months, with an anterior open bite and a left-shifted mandible was treated with a mandibular right first molar extraction and without orthognathic surgery. However, her mandibular second molar did not move mesially during treatment because of the dense lamina dura; therefore, corticision was applied only on the mesial aspect of the mandibular second molar, and a miniscrew was inserted simultaneously. Corticision was introduced as a supplemental dentoalveolar surgery in orthodontic therapy to achieve accelerated tooth movement with minimal surgical intervention. In this technique, a reinforced scalpel was used as a thin chisel to separate the interproximal cortices transmucosally without a flap. This technique was applied not to accelerate tooth movement, but to protract the mandibular molars. One miniscrew was inserted on the mesiobuccal side of the mandibular right molar for protraction and intrusion. In addition, 2 miniscrews were inserted in the buccal sides of the maxillary first and second molars and the palatal side of the maxillary first molar to intrude them for correction of the mandibular shift and the cant of the occlusal plane. Excellent occlusion and correction of the anterior open bite were achieved without surgery. At the 2-year follow-up examination, the patient had a good occlusion and showed good stability with no opening of the extraction space. A partial corticision is an effective option for facilitating movement of mandibular molars. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

[Comparison of piezosurgery and chisel osteotomy in the extraction of mandibular impacted third molars].

PubMed

Gao, Yongbo; Jiang, Ai; Li, Boyou; Yang, Liming

2011-08-01

To study the effect of piezosurgery in the extraction of mandibular impacted third molars. 228 mandibular impacted third molars with relative difficulty for extraction according to the scheme of degree of difficulty for extraction were included in the study, and were divided into two groups (114 teeth each group): Test group (treated by piezosurgery), control group (treated by traditional chisel osteotomy). The surgery time and pain, restriction of mouth opening and facial swelling after surgery, were evaluated in both groups. The average surgery time was (16 +/- 5.2) min in test group and (30 +/- 8.7) min in control group. The surgery time, pain, facial swelling rate, and restriction of mouth opening were lower than control group (P<0.05). Compared with traditional chisel osteotomy, the average surgery time with piezosurgery was significantly shorter and the complications are obviously reduced.

Lingual nerve damage after mandibular third molar surgery: a randomized clinical trial.

PubMed

Gomes, Ana Cláudia Amorim; Vasconcelos, Belmiro Cavalcanti do Egito; de Oliveira e Silva, Emanuel Dias; da Silva, Luiz Carlos Ferreira

2005-10-01

The objective of this study was to clinically evaluate the frequency, type, and risk factors for lingual nerve damage after mandibular third molar surgery with reference to lingual flap retraction. A total of fifty-five patients referred for bilateral mandibular third molar removal were included in this study. Each patient was randomly allotted to have the procedure performed on 1 side (experimental group) with lingual flap retraction. On the opposite side (control group), the same procedure was performed without lingual flap retraction. Lingual nerve damage occurred in 9.1% in the experimental group in which lingual flap retraction was performed. In the control group, damage to the lingual nerve was not observed. The difference was statistically significant (P <.001) as measured by the Cochran test. Lingual nerve retraction represented a risk factor to temporary lingual nerve damage during mandibular third molar surgery.

Is The Late Mandibular Fracture From Third Molar Extraction a Risk Towards Malpractice? Case Report with the Analysis of Ethical and Legal Aspects.

PubMed

Dos Santos Silva, Weuler; Silveira, Rubens Jorge; de Araujo Andrade, Michelle Gouveia Benicio; Franco, Ademir; Silva, Rhonan Ferreira

2017-01-01

The present study reports a case of late mandibular fracture due to third molar extraction and highlights the inherent clinical, ethical and legal aspects related to this surgical complication. A female patient underwent surgical procedure for the extraction of the mandibular right third molar. Two days after the surgery the patient reported pain and altered occlusion in the right side of the mandible. After clinical and radiographic re-examination, the diagnosis of late mandibular fracture was established. A second surgery, under general anaesthesia, was performed for the fixation of the mandibular bone. The fractured parts were reduced and fixed with locking plate systems and 2 mm screws following load-sharing principles. The masticatory function showed optimal performance within 7 and 21 days after the surgery. Complete bone healing was observed within 1 year of follow-up. For satisfactory surgical outcomes, adequate surgical planning and techniques must be performed. Signed informed consents explaining the risks and benefits of the treatment must be used to avoid ethical and legal disputes in dentistry.

Prosthetic Rehabilitation After Fibular Free Flap Surgery of Mandibular Defects in a Patient With Oral Squamous Cell Carcinoma.

PubMed

Yoon, Hyung-In

2016-10-01

This report is to present the treatment procedure and clinical considerations of prosthodontic management of a patient who had undergone a partial mandibulectomy and fibular free flap surgery. A 59-year-old man with a squamous cell carcinoma received a partial mandibular resection. Microsurgical reconstruction with a fibular free flap surgery and implant-supported zirconia-fixed prosthesis produced by computer-aided manufacturing led to successful results for the oral rehabilitation of mandibular defects. The implant-supported zirconia-fixed prosthesis can be recommended for use in patients with mandibulectomy and fibular free flaps. Close cooperation between the surgeon and the prosthodontist is mandatory for the satisfaction of the patient.

Application of a real-time three-dimensional navigation system to various oral and maxillofacial surgical procedures.

PubMed

Ohba, Seigo; Yoshimura, Hitoshi; Ishimaru, Kyoko; Awara, Kousuke; Sano, Kazuo

2015-09-01

The aim of this study was to confirm the effectiveness of a real-time three-dimensional navigation system for use during various oral and maxillofacial surgeries. Five surgeries were performed with this real-time three-dimensional navigation system. For mandibular surgery, patients wore acrylic surgical splints when they underwent computed tomography examinations and the operation to maintain the mandibular position. The incidence of complications during and after surgery was assessed. No connection with the nasal cavity or maxillary sinus was observed at the maxilla during the operation. The inferior alveolar nerve was not injured directly, and any paresthesia around the lower lip and mental region had disappeared within several days after the surgery. In both maxillary and mandibular cases, there was no abnormal hemorrhage during or after the operation. Real-time three-dimensional computer-navigated surgery allows minimally invasive, safe procedures to be performed with precision. It results in minimal complications and early recovery.

Comparative Evaluation of Immediate Post-Operative Sequelae after Surgical Removal of Impacted Mandibular Third Molar with or without Tube Drain - Split-Mouth Study

PubMed Central

Bhate, Kalyani; Dolas, RS; Kumar, SN Santhosh; Waknis, Pushkar

2016-01-01

Introduction Third molar surgery is one of the most common surgical procedures performed in general dentistry. Post-operative variables such as pain, swelling and trismus are major concerns after impacted mandibular third molar surgery. Use of passive tube drain is supposed to help reduce these immediate post-operative sequelae. The current study was designed to compare the effect of tube drain on immediate post-operative sequelae following impacted mandibular third molar surgery. Aim To compare the post-operative sequelae after surgical removal of impacted mandibular third molar surgery with or without tube drain. Materials and Methods Thirty patients with bilateral impacted mandibular third molars were divided into two groups: Test (with tube drain) and control (without tube drain) group. In the test group, a tube drain was inserted through the releasing incision, and kept in place for three days. The control group was left without a tube drain. The post-operative variables like, pain, swelling, and trismus were calculated after 24 hours, 72 hours, 7 days, and 15 days in both the groups and analyzed statistically using chi-square and t-test analysis. Results The test group showed lesser swelling as compared to control group, with the swelling variable showing statistically significant difference at post-operative day 3 and 7 (p≤ 0.05) in both groups. There were no statistically significant differences in pain and trismus variables in both the groups. Conclusion The use of tube drain helps to control swelling following impacted mandibular third molar surgery. However, it does not have much effect on pain or trismus. PMID:28209003

Bilateral mandibular angle fractures: clinical considerations.

PubMed

Boffano, Paolo; Roccia, Fabio

2010-03-01

The mandibular angle is a frequent site of fracture. It is a weak zone that is more exposed to fractures than other areas of the mandibular bone. The presence of incompletely erupted third molars is associated with a further increased risk of angle fractures. Our objective was to evaluate and discuss the surgical outcomes of a group of patients with bilateral mandibular angle fractures.In our study, patients with bilateral mandibular angle fractures surgically treated from January 1, 2001, to June 30, 2009, at the Division of Maxillofacial Surgery of the University of Turin were retrospectively analyzed. A combined transbuccal and intraoral approach or an intraoral approach only was adopted.Eight patients (7 men and 1 woman) underwent surgery for bilateral mandibular angle fractures. Good to satisfactory reduction of the fractures was obtained with both surgical techniques. Good to fair restored occlusion was observed postoperatively in all patients.Successful treatment of bilateral mandibular angle fractures may be achieved via different techniques. Superficially impacted third molars seem to be associated with an increased risk of angle fractures. Bilateral angle fractures are an ideal model to study the biomechanical pathogenesis of angle fractures.

Effectiveness of cold therapy in reducing pain, trismus, and oedema after impacted mandibular third molar surgery: a randomized, self-controlled, observer-blind, split-mouth clinical trial.

PubMed

Zandi, M; Amini, P; Keshavarz, A

2016-01-01

Cold therapy is a conventional and widely used modality for reducing pain, trismus, and oedema after dentoalveolar surgeries. However, information reported in the literature on its effectiveness is insufficient and controversial. This study was performed to evaluate the effect of local cold application in reducing pain, trismus, and swelling after impacted mandibular third molar surgery. Thirty patients (seven males and 23 females) with bilateral symmetrical mandibular impacted third molars were enrolled in this randomized, self-controlled, observer-blind clinical trial. The patients were aged between 18 and 30 years. After surgical removal of the tooth on one side (intervention), ice pack therapy was given for 24h after surgery; for the other side (control), no cold therapy was given. The time interval between the two surgeries was at least 4 weeks. The amount of pain, trismus, and facial swelling was measured on days 2 and 7 postoperative, and patient satisfaction with the cold therapy vs. no cold therapy was assessed. The amount of pain, trismus, and facial swelling, and the extent of patient satisfaction were not significantly different between the intervention and control sides. Cold therapy had no beneficial effects on postoperative sequelae after impacted mandibular third molar surgery. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Impact of mandibular third molar extraction in the second molar periodontal status: A prospective study.

PubMed

Stella, Paulo Eduardo Melo; Falci, Saulo Gabriel Moreira; Oliveira de Medeiros, Lorrayne Estéfane; Douglas-de-Oliveira, Dhelfeson Willya; Gonçalves, Patricia Furtado; Flecha, Olga Dumont; Dos Santos, Cássio Roberto Rocha

2017-01-01

The aim of the present study was to assess the periodontal condition and sensitivity of second mandibular molars after the extraction of the adjacent third molar, while also assessing the quality of life of the patients. Twenty-three healthy patients were assessed in terms of probing depth, gingival height, gingival thickness, dental sensitivity, plaque index and bleeding on probing (adjacent second mandibular molar), before the surgical procedure, as well as 60 and 180 days after the surgery. The following data were also recorded and measured: the position and size of the impacted teeth; the size of the alveoli after surgery and the quality of life of the patient. Significant differences were found for probing depth and gingival height before and after 180 days. The plaque index increased significantly after surgery ( P = 0.004), as did bleeding on probing. No significant difference was found for the quality of life. The size of the third molar extracted was correlated with bleeding on probing 180 days after the surgery. An improvement was noted in the periodontal condition of the second mandibular molars after the extraction, based on the assessments of probing depth and gingival height. The position of the third molar affected the periodontal condition of the second mandibular molar. No alterations were recorded for dental sensitivity or the quality of life after the extraction.

Impact of mandibular third molar extraction in the second molar periodontal status: A prospective study

PubMed Central

Stella, Paulo Eduardo Melo; Falci, Saulo Gabriel Moreira; Oliveira de Medeiros, Lorrayne Estéfane; Douglas-de-Oliveira, Dhelfeson Willya; Gonçalves, Patricia Furtado; Flecha, Olga Dumont; Dos Santos, Cássio Roberto Rocha

2017-01-01

Aim: The aim of the present study was to assess the periodontal condition and sensitivity of second mandibular molars after the extraction of the adjacent third molar, while also assessing the quality of life of the patients. Materials and Methods: Twenty-three healthy patients were assessed in terms of probing depth, gingival height, gingival thickness, dental sensitivity, plaque index and bleeding on probing (adjacent second mandibular molar), before the surgical procedure, as well as 60 and 180 days after the surgery. The following data were also recorded and measured: the position and size of the impacted teeth; the size of the alveoli after surgery and the quality of life of the patient. Results: Significant differences were found for probing depth and gingival height before and after 180 days. The plaque index increased significantly after surgery (P = 0.004), as did bleeding on probing. No significant difference was found for the quality of life. The size of the third molar extracted was correlated with bleeding on probing 180 days after the surgery. Conclusion: An improvement was noted in the periodontal condition of the second mandibular molars after the extraction, based on the assessments of probing depth and gingival height. The position of the third molar affected the periodontal condition of the second mandibular molar. No alterations were recorded for dental sensitivity or the quality of life after the extraction. PMID:29456302

Early versus delayed loading of mandibular implant-supported overdentures: 5-year results.

PubMed

Turkyilmaz, Ilser; Tözüm, Tolga F; Tumer, Celal

2010-05-01

Because of poor retention of complete removable dentures for edentulous patients, implant-supported mandibular overdentures have lately become a popular alternative for them. The aims of this prospective study were to evaluate treatment outcomes of mandibular overdentures supported by two unsplinted early-loaded implants and compare these results with those for delayed-loaded implants. A total of 26 edentulous patients were treated with two unsplinted implants supporting a mandibular overdenture. All implants were placed in the canine regions of each mandible according to the one-stage surgical protocol. There were two groups: test group, in which the overdenture was connected 1 week after surgery, and control group, in which the overdenture was connected 3 months after surgery. Standardized clinical and radiographic parameters were recorded at surgery, and after 3, 6, 12, and 18 months, and 2, 3, 4, and 5 years. No implants were lost, and 0.93 +/- 0.3 mm marginal bone resorption was noted for all implants after 5 years. Clinical implant stability measurements, clinical peri-implant parameters, and marginal bone resorptions showed no statistically significant differences between the two groups over 5 years. The results of this prospective clinical study suggest that there is no significant difference in the clinical and radiographic state of patients treated with implant supported mandibular overdentures loaded either 1 week or 3 months after surgery.

Endodontic Microsurgical Treatment of a Three-rooted Mandibular First Molar with Separate Distolingual Root: Report of One Case.

PubMed

Wang, Han Guo; Xu, Ning; Yu, Qing

The separate distolingual (DL) roots of three-rooted mandibular first molars are thought to be too difficult for performing apical surgery. This article represents microsurgical treatment of a three-rooted mandibular first molar with a separate DL root. The procedure includes incision and flap retraction, osteotomy, apicoectomy, retropreparation and retrofilling of the root canal, using micro instruments, ultrasonic retrotips and mineral trioxide aggregate (MTA) under a dental operating microscope. Two mm in length of apical root resection, 2 mm in depth of root canal retropreparation with a personalised ultrasonic retrotip, and 2 mm in length of retrofilling with MTA are the key points for accomplishment of apical surgery on separate DL roots. The case was followed up for 15 months after surgery. Clinical and radiographic examinations revealed complete healing of periapical tissue. Separate DL roots of three-rooted mandibular first molars can be treated by endodontic microsurgery with modifications from standard protocol.

Bilateral bifid mandibular canal

PubMed Central

Sheikhi, Mahnaz; Badrian, Hamid; Ghorbanizadeh, Sajad

2012-01-01

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

Use of rectangular grid miniplates for fracture fixation at the mandibular angle.

PubMed

Hochuli-Vieira, Eduardo; Ha, Thi Khanh Linh; Pereira-Filho, Valfrido Antonio; Landes, Constantin Alexander

2011-05-01

The aim of this study was to evaluate the clinical outcome of patients with mandibular angle fractures treated by intraoral access and a rectangular grid miniplate with 4 holes and stabilized with monocortical screws. This study included 45 patients with mandibular angle fractures from the Department of Oral and Maxillofacial Surgery São Paulo State University, Araraquara, Brazil, and from the Clinic of Oral and Maxillofacial Surgery at the University of Frankfurt, Germany. The 45 fractures of the mandibular angle were treated with a rectangular grid miniplate of a 2.0-mm system by an intraoral approach with monocortical screws. Clinical evaluations were postoperatively performed at 15 and 30 days and 3 and 6 months, and the complications encountered were recorded and treated. The infection rate was 4.44% (2 patients), and in 1 patient it was necessary to replace hardware. This patient also had a fracture of the left mandibular body; 3 patients (6.66%) had minor occlusal changes that have been resolved with small occlusal adjustments. Before surgery, 15 patients (33.33%) presented with hypoesthesia of the inferior alveolar nerve; 4 (8.88%) had this change until the last clinical control, at 6 months. The rectangular grid miniplate used in this study was stable for the treatment of simple mandibular angle fractures through intraoral access, with low complication rates, easy handling, and easy adjustment, with a low cost. Concomitant mandibular fracture may increase the rate of complications. This plate should be indicated in fractures with sufficient interfragmentary contact. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

How much incisor decompensation is achieved prior to orthognathic surgery?

PubMed

McNeil, Calum; McIntyre, Grant T; Laverick, Sean

2014-07-01

To quantify incisor decompensation in preparation for orthognathic surgery. Pre-treatment and pre-surgery lateral cephalograms for 86 patients who had combined orthodontic and orthognathic treatment were digitised using OPAL 2.1 [http://www.opalimage.co.uk]. To assess intra-observer reproducibility, 25 images were re-digitised one month later. Random and systematic error were assessed using the Dahlberg formula and a two-sample t-test, respectively. Differences in the proportions of cases where the maxillary (1100 +/- 60) or mandibular (900 +/- 60) incisors were fully decomensated were assessed using a Chi-square test (p<0.05). Mann-Whitney U tests were used to identify if there were any differences in the amount of net decompensation for maxillary and mandibular incisors between the Class II combined and Class III groups (p<0.05). Random and systematic error were less than 0.5 degrees and p<0.05, respectively. A greater proportion of cases had decompensated mandibular incisors (80%) than maxillary incisors (62%) and this difference was statistically significant (p=0.029). The amount of maxillary incisor decompensation in the Class II and Class III groups did not statistically differ (p=0.45) whereas the mandibular incisors in the Class III group underwent statistically significantly greater decompensation (p=0.02). Mandibular incisors were decompensated for a greater proportion of cases than maxillary incisors in preparation for orthognathic surgery. There was no difference in the amount of maxillary incisor decompensation between Class II and Class III cases. There was a greater net decompensation for mandibular incisors in Class III cases when compared to Class II cases. Key words:Decompensation, orthognathic, pre-surgical orthodontics, surgical-orthodontic.

Treatment of Class III malocclusion in a young adult patient: a case report.

PubMed

Kiran, B H Jyothi; Kumar, Prashanth; Ravi, S; Shivalinga, B M; Bhagyalaxmi; Pradeep; Kudagi, Vishal

2012-01-01

This article describes the treatment of a young adult male with a concave profile, skeletal class III malocclusion because of a prognathic mandible and proclined upper incisors. The therapy included stages: 1. Pre-surgical orthodontics involving leveling and aligning of upper and lower arches, protraction of lower molars and retraction of upper incisors; 2. Surgical phase involving BSSO with mandibular setback and 3. Post-surgical orthodontics for finishing and detailing. The treatment lasted 23 months and improved facial esthetics significantly The treatment resulted in a functional occlusion with a lack of lateral cuspid guidance that could be accepted considering the difficulty of the case. Over jet and overbite are within norms.

Mandibular reconstruction with the vascularized fibula flap: comparison of virtual planning surgery and conventional surgery.

PubMed

Wang, Y Y; Zhang, H Q; Fan, S; Zhang, D M; Huang, Z Q; Chen, W L; Ye, J T; Li, J S

2016-11-01

This study evaluated the accuracy of mandibular reconstruction and assessed clinical outcomes in both virtual planning and conventional surgery patients. ProPlan CMF surgical planning software was used preoperatively in the virtual planning group. In the virtual planning group, fibula flaps were harvested and osteotomized, and the mandibles were resected and reconstructed assisted by the prefabricated cutting guides and templates. The main outcome measures included the operative time, postoperative computed tomography (CT) scans, facial appearance, and occlusal function. The ischemia time and total operation time were shorter in the virtual planning group than in the conventional surgery group. High precision with the use of the cutting guides and templates was found for both the fibula and mandible, and a good fit was noted among the pre-bent plate, mandible, and fibula segments in the virtual planning group. Postoperative CT scans also showed excellent mandibular contours of the fibula flaps in accordance with virtual plans in the virtual planning group. This study demonstrated that virtual surgical planning was able to achieve more accurate mandibular reconstruction than conventional surgery. The use of prefabricated cutting guides and plates makes fibula flap moulding and placement easier, minimizes the operating time, and improves clinical outcomes. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Immediate autotransplantation of mandibular third molar in China.

PubMed

Yan, Quanmei; Li, Bo; Long, Xing

2010-10-01

Tooth autotransplantation is a useful surgical method to replace a nonrestorable tooth. We reported our experiences in the replacement of mandibular nonrestorable molars by immediate autotransplantation in a Chinese population. Thirty-five mandibular third molars with open or closed apices from 34 patients were autotransplanted into the same or contralateral fresh recipient sites immediately after the extraction of the nonrestorable mandibular molars. Root canal treatment was routinely performed in the closed-apical molars within 1 month after surgery. Clinical and radiographic examination of the transplanted donor molars was done after surgery. Two teeth were been extracted for progressive root resorption. The remaining 33 autotransplanted teeth were asymptomatic and functioning after a mean follow-up period of 5.2 years. No infection, ankylosis, loss of the transplants, or root resorption was noted in the remaining autotransplanted teeth. Immediate autotransplantation of the mandibular third molar is a reasonable and alternative treatment to replace a nonrestorable tooth in China. Copyright © 2010 Mosby, Inc. All rights reserved.

[Congenital malformations of the temporo-mandibular joint and the mandibular ramus: Grafting vs distraction osteogenesis].

PubMed

Gallucci, A; Graillon, N; Foletti, J M; Chossegros, C; Cheynet, F

2016-09-01

Congenital deformities of the mandibular ramus and of the temporo-mandibular joint are treated by surgery since the early 20th century. However, morphological and functional results are often disappointing, accounting for iterative operations. Today, a clear consensus concerning the type of intervention to be proposed, and at what age it should be carried out does not yet exist. For mild cases, "conventional" orthognathic or osteogenic distraction procedures seem to work well, especially if they are carried out at the end of growth. In severe cases, it is often necessary to proceed in several surgical steps, usually starting with a chondrocostal graft, especially when interceptive surgery, performed before the end of growth, is preferred in order to improve the patient's quality of life. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study

PubMed Central

Li, B.; Shen, S.; Jiang, W.; Li, J.; Jiang, T.; Xia, J. J.; Shen, S. G.; Wang, X.

2017-01-01

The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Ten patients with dentofacial deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation method. The POSG system was designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints. Finally, the outcome evaluation was completed by comparing planned outcomes with postoperative outcomes. All operations were successfully completed using the POSG system. The largest root-mean-square deviations were 0.74 mm and 1.93° for the maxillary dental arch, 1.10 mm and 2.82° for the mandibular arch, 0.83 mm and 2.59° for the mandibular body, and 0.98 mm and 2.45° for the proximal segments. The results of the study indicated that our POSG system is capable of accurately and effectively transferring the surgical plan without the use of surgical splint. A significant advantage is that the repositioning of the bony segments is independent to the mandibular autorotation, thus eliminates the potential problems associated with the surgical splint. PMID:28552440

[Orthodontic treatment of Class III patients with mandibular asymmetry].

PubMed

Duan, Yin-Zhong; Huo, Na; Chen, Lei; Chen, Xue-Peng; Lin, Yang

2008-12-01

To investigate the treatment outcome of Class III patients with dental, functional and mild skeletal mandibular asymmetry. Thirty-five patients (14 males and 21 females) with dental, functional and mild skeletal mandibular asymmetry were selected. The age range of the patients was 7 - 22 years with a mean age of 16.5 years. Dental mandibular asymmetry was treated with expansion of maxillary arch to help the mandible returning to normal position. Functional mandibular asymmetry was treated with activator or asymmetrical protraction and Class III elastics. Mild skeletal mandibular asymmetry was treated with camouflage treatment. Good occlusal relationships were achieved and facial esthetics was greatly improved after orthodontic treatment in patients with dental and functional mandibular asymmetry. However, patients with skeletal mandibular asymmetry should be treated with both extraction and genioplasty. Orthodontic treatment was suitable for patients with dental and functional mandibular asymmetry, while combined orthodontics and surgery could get good results in patients with skeletal mandibular asymmetry.

Randomized clinical study comparing piezosurgery and conventional rotatory surgery in mandibular cyst enucleation.

PubMed

Pappalardo, Sabrina; Guarnieri, Renzo

2014-07-01

The aim of the present study is to compare piezoelectric surgery to the conventional rotatory surgery in mandibular cyst enucleation, and to determine the 2 method's suitability and the postoperative outcomes. Eighty patients were included in the study. 35 male and 45 female, which showed cystic mandibular lesions, compared with the inferior alveolar nerve or the mental nerve. The patients were randomly divided into two groups. In the test group, cystectomy was performed using conventional rotatory instrumentation (rotatory-group), and in the other one piezoelectric surgery (piezo-group). The swelling was documented 24/48/72 h and 1 week post-surgery and the patients recorded their subjective postoperative pain daily for 7 days using a Visual Analog Scale (VAS). Patients treated with piezoelectric technique have presented a lower VAS, minor swelling and less recovery time compared to the rotatory-group. No lesions of the mandible nerve were detected with piezosurgery whereas surgery with rotary instruments resulted in 8% hypesthesia at least up to one week. The results of this study suggest that piezosurgery may be considered effective in cyst enucleation compared to traditional procedures with burs, since it grants the patients significantly less post-surgical pain and swelling. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Dislocation of the mandibular condyle into the middle cranial fossa causing an epidural haematoma.

PubMed

Struewer, Johannes; Kiriazidis, Ilias; Figiel, Jens; Dukatz, Thomas; Frangen, Thomas; Ziring, Ewgeni

2012-07-01

Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma due to anatomical and biomechanical factors. Owing to the proximity of the temporal glenoid fossa to the middle meningeal artery, there is the risk of serious sequelae in case of trauma. The authors report the case of a 36-year-old male patient, who was beaten up in a family dispute and presented with complex mandibular and maxillofacial fractures, including mandibular condyle intrusion into the middle cranial fossa causing extensive meningeal bleeding. The patient underwent immediate surgery, with evacuation of the epidural haematoma via a temporal approach. In addition open reduction and reconstruction of the temporal glenoid fossa via anatomic reduction of the fragments was performed. A functional occlusion was re-established via miniplate reconstruction of the complex mandibular body and ramus fractures. Prompt diagnosis and a multidisciplinary approach are essential to minimize the complications. Advanced imaging modalities of computed tomography are indicated. Treatment options should be individualized in particular in case of suspected neurological injury. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Surgical Treatment, Oral Rehabilitation, and Orthognathic Surgery After Failure of Pharmacologic Treatment of Central Giant Cell Lesion: A Case Report.

PubMed

Maia Nogueira, Renato Luiz; Osterne, Rafael Lima Verde; Cavalcante, Roberta Barroso; Abreu, Ricardo Teixeira

2016-12-01

Although pharmacologic treatments for central giant cell lesions have gained much emphasis, these treatment modalities do not always have successful outcomes, and surgical treatment may be necessary. The purpose of the present study was to report a case of aggressive central giant cell lesion initially treated by nonsurgical methods without satisfactory results, necessitating segmental mandibular resection for definitive treatment and oral rehabilitation. A 20-year-old woman was diagnosed with an aggressive central giant cell lesion in the mandible. The patient was first treated with intralesional corticosteroid injections. Subsequently, the lesion increased in size. Therefore, a second pharmacologic treatment was proposed with salmon calcitonin nasal spray, but no signs of a treatment response were noted. Because of the lack of response, surgical excision was performed, and a mandibular reconstruction plate was installed. At 12 months after surgical resection, the patient underwent mandibular reconstruction with bone grafts. After 6 months, 7 dental implants were installed, and fixed prostheses were made. After installation of the prostheses, the patient experienced persistent mandibular laterognathism, and a mandibular orthognathic surgery was performed to correct the laterognathia. The follow-up examination 4 years after orthognathic surgery showed no signs of recurrence and good facial symmetry. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Maxillary-driven simultaneous maxillo-mandibular distraction for hemifacial microsomia.

PubMed

Nakajima, Hideo; Sakamoto, Yoshiaki; Tamada, Ikkei; Ogata, Hisao; Kishi, Kazuo; Sakamoto, Teruo

2011-12-01

We treat hemifacial microsomia with a combination of surgery and orthodontic treatment during the growth period, resulting in early improvement in facial asymmetry and the induction of normal growth. We previously used gradual distraction of the mandibular ramus for Pruzansky's type II classification (Pruzansky, 1969). In type II cases, the maxilla should also be treated actively as, using this technique, improvement of the occlusal plane is difficult to achieve, resulting in a cross bite and difficulties in post-operative orthodontic treatment-especially in older patients. Morphologically, the mandibular angle region of the operative side is flat, and the angle of the mouth remains elevated. We performed mandibular-driven simultaneous maxillo-mandibular distraction while the occlusion was maintained using intermaxillary anchorage. However, mandibular-driven distraction tended to elongate the face because the mandible only elongated downwards and the mandibular ramus did not reach the glenoid. Furthermore, external distraction devices produce significant distress for patients until removal of the device and cause scars on the face. We developed a new internal distraction device with a variable angle and performed maxillary-driven simultaneous maxillo-mandibular distraction using this device. The result was morphologically satisfactory and solved the above problems. Because the patient was in the growth period, careful follow-up and induction to normal growth were important while the inferior growth of the affected side was monitored. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Unerupted lower third molar extractions and their risks for mandibular fracture.

PubMed

Corrêa, Ana Paula Simões; Faverani, Leonardo Perez; Ramalho-Ferreira, Gabriel; Ferreira, Sabrina; Ávila Souza, Francisley; de Oliveira Puttini, Igor; Rangel Garcia-Júnior, Idelmo

2014-05-01

As every surgical procedure extraction of third molars can result in several complications, among them the mandibular angle fracture. Predisposing factors for fracture should be analyzed during and after the surgery. This paper aims to discuss the predisposing factors to the occurrence of mandibular angle fractures during and after the procedure for third molars extraction, as well as surgical principles to avoid this complication.

Magnesium-enriched hydroxyapatite as bone filler in an ameloblastoma mandibular defect

PubMed Central

Grigolato, Roberto; Pizzi, Natalia; Brotto, Maria C; Corrocher, Giovanni; Desando, Giovanna; Grigolo, Brunella

2015-01-01

The aim of this study was to evaluate the clinical performance of a magnesium-enriched hydroxyapatite biomaterial used as bone substitute in a case of mandibular ameloblastoma treated with conservative surgery. A 63 year old male patient was treated for an ameloblastoma in the anterior mandibular profile. After tissue excision, the bone defect was filled with a synthetic hydroxyapatite biomaterial enriched with magnesium ions, in order to promote bone tissue regeneration and obtain a good aesthetic result. Twenty-five months after surgery, due to ameloblastoma recurrence in an area adjacent to the previously treated one, the patient underwent to a further surgery. In that occasion the surgeon performed a biopsy in the initially treated area, in order to investigate the nature of the newly-formed tissue and to evaluate the bone regenerative potential of this biomaterial by clinical, radiographic and histological analyses. The clinical, radiographic and histological evaluations showed various characteristics of bone remodeling stage with an ongoing osteogenic formation and a good osteo-integration. In conclusion, magnesium-enriched hydroxyapatite used as bone substitute in a mandibular defect due to ameloblastoma excision showed an effective bone regeneration at 25 months follow-up, demonstrating an excellent biocompatibility and a high osteo-integration property. PMID:25784998

Three-Dimensional Analysis and Surgical Planning in Craniomaxillofacial Surgery.

PubMed

Steinbacher, Derek M

2015-12-01

Three-dimensional (3D) analysis and planning are powerful tools in craniofacial and reconstructive surgery. The elements include 1) analysis, 2) planning, 3) virtual surgery, 4) 3D printouts of guides or implants, and 5) verification of actual to planned results. The purpose of this article is to review different applications of 3D planning in craniomaxillofacial surgery. Case examples involving 3D analysis and planning were reviewed. Common threads pertaining to all types of reconstruction are highlighted and contrasted with unique aspects specific to new applications in craniomaxillofacial surgery. Six examples of 3D planning are described: 1) cranial reconstruction, 2) craniosynostosis, 3) midface advancement, 4) mandibular distraction, 5) mandibular reconstruction, and 6) orthognathic surgery. Planning in craniomaxillofacial surgery is useful and has applicability across different procedures and reconstructions. Three-dimensional planning and virtual surgery enhance efficiency, accuracy, creativity, and reproducibility in craniomaxillofacial surgery. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Alteration of functional loads after tongue volume reduction.

PubMed

Ye, W; Duan, Y Z; Liu, Z J

2013-11-01

An earlier study revealed that the patterns of biomechanical loads on bones around the tongue altered significantly right after tongue volume reduction surgery. The current study was to examine whether these alterations persist or vanish over time post-surgery. Five sibling pairs of 12-week-old Yucatan minipigs were used. For each pair, one had surgery reducing tongue volume by about 15% (reduction) while the other had same incisions without tissue removal (sham). All animals were raised for 4 weeks after surgery. Three rosette strain gauges were placed on the bone surfaces of pre-maxilla (PM), mandibular incisor (MI), and mandibular molar (MM); two single-element gauges were placed across the pre-maxilla-maxillar suture (PMS) and mandibular symphysis (MSP), and two pressure transducers were placed on the bone surfaces of hard palate (PAL) and mandibular body (MAN). These bone strains and pressures were recorded during natural mastication. Overall amount of all loads increased significantly as compared to those in previous study in all animals. Instead of decreased loads in reduction animals as seen in that study, shear strains at PM, MI, and MM, tensile strains at PMS, and pressure at MAN were significantly higher in reduction than sham animals. Compared to the sham, strain dominance shifted at PM, MI, and MM and orientation of tensile strain altered at MI in reduction animals. A healed volume-reduced tongue may change loading regime significantly by elevating loading and altering strain-dominant pattern and orientation on its surrounding structures, and these changes are more remarkable in mandibular than maxillary sites. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Application of biodegradable plates for treating pediatric mandibular fractures.

PubMed

An, Jingang; Jia, Pengcheng; Zhang, Yi; Gong, Xi; Han, Xiaodong; He, Yang

2015-05-01

We assessed the clinical results of a biodegradable plate system for the internal fixation of mandibular fractures in children, and observed the imaging features of fracture healing and bone changes around the biodegradable plates and screws during follow-up. We enrolled 39 patients (22 male, 17 female, average age 4 years 10 months) with different mandibular fractures. We used 2.0-mm resorbable plates to repair the fractures. Postoperative follow-up ranged from 6 months to 5 years; average follow-up was 1 year 2 months. The outcome measures identified and assessed included facial symmetry, mouth opening, occlusal relationship, infection, nonunion, malunion, and plate dehiscence. We fixed 42 fractures with 43 resorbable plates; the fracture site of one patient (aged 11 years 3 months) was fixed with two plates. Two patients developed small fistulas at the intraoral incision 2 months after surgery; the fistulas healed after 1 month without special treatment. In the other patients, the incision healed well, there was facial symmetry, mouth opening was >35 mm, and occlusion was good. Follow-up computed tomography examination data were available for 20 cases, and revealed different degrees of radiolucency indicating that osteolysis had occurred. Radiolucency was observed around the resorbable plates 1 month after the surgery. The extent and depth of the radiolucent region were obvious within 1 year of surgery. In the second year, there were obvious repairs, with the bony defect areas becoming shallower. After 2 years, the bony defect areas had almost disappeared. Biodegradable fixation devices are safe and efficient for treating pediatric mandibular fractures. Osteolysis commonly follows biodegradable fixation of pediatric mandibular fractures, and has no adverse effect on fracture healing. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Impacted mandibular third molars and their influence on mandibular angle and condyle fractures--a retrospective study.

PubMed

Gaddipati, Rajasekhar; Ramisetty, Sudhir; Vura, Nandagopal; Kanduri, Rajeev Reddy; Gunda, Vinay Kumar

2014-10-01

Previous retrospective analyses prove that impacted mandibular third molars (M3s) increase the risk of angle fractures and decrease the risk of concomitant fractures to the condyle. A retrospective cohort was designed for patients reported to the Department of Oral and Maxillofacial Surgery from January 2011 till June 2013. The study variables are presence or absence of third molar, if it is present, their position, classified using the Pell and Gregory system; angulation, classified using Shiller's method. The outcome variables were angle and condyle fractures. Hospital records and panoramic radiographs were used to determine and classify these variables. The study sample comprised of 118 mandibular angle and condyle fractures in 110 patients. Database was constructed and analysed using SPSS version 10.0. This present retrospective study concluded that the presence of impacted third molar predisposes the angle to fracture and reduces the risk of a concomitant condylar fracture. However absence of impacted third molar increases the risk of condylar fracture. The highest incidence of angle fracture was observed in position A impacted mandibular third molars. And there is no significant relationship, concerning ramus position and angulation of impacted mandibular third molars with the angle fracture. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Titanium Mesh Shaping and Fixation for the Treatment of Comminuted Mandibular Fractures.

PubMed

Dai, Jiewen; Shen, Guofang; Yuan, Hao; Zhang, Wenbin; Shen, Shunyao; Shi, Jun

2016-02-01

Treating comminuted mandibular fractures remains a challenge. In this study, we used titanium mesh to treat comminuted mandibular fractures. Nine patients with traumatically comminuted mandibular fractures who received open reduction and internal stable fixation with titanium mesh were retrospectively reviewed. Open reduction-internal stable fixation was performed 7 to 10 days after primary debridement of the facial trauma. After the fractured mandible and the displaced fragments were reduced, the titanium mesh was reshaped according to the morphology of the mandible, and the reduced bone fragments were fixed with the reshaped titanium mesh and screws. Then, the surgical effects were evaluated during routine follow-up. Most of the displaced fragments were preserved and exhibited a favorable shaping ability in restoring the morphology of the mandible during surgery. No intraoperative complications were encountered. In addition, all patients were infection free, with no obvious resorption in the fixed fragments after surgery. The mandible also exhibited favorable morphology and offered sufficient bone mass for dental implantation or a denture prosthesis. We conclude that titanium mesh shaping and fixation can effectively treat comminuted mandibular fractures with little bone fragment loss, little soft tissue exposure, a low infection rate, and favorable mandibular morphology. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Reconstruction of a mandibular segmental defect with a customized 3-dimensional-printed titanium prosthesis in a cat with a mandibular osteosarcoma.

PubMed

Liptak, Julius M; Thatcher, Graham P; Bray, Jonathan P

2017-04-15

CASE DESCRIPTION A 12-year-old neutered male domestic shorthair cat had been treated for a mass arising from the lingual aspect of the caudal right mandibular body. Cytoreductive surgery of the mass had been performed twice over a 2-year period, but the mass recurred following both surgeries. The mass was diagnosed as an osteosarcoma, and the cat was referred for further evaluation and treatment. CLINICAL FINDINGS Clinical findings were unremarkable, except for a 2-cm-diameter mass arising from the lingual aspect of the right mandible and mild anemia and lymphopenia. Pre- and postcontrast CT scans of the head, neck, and thorax were performed, revealing that the osteosarcoma was confined to the caudal right mandibular body, with no evidence of lymph node or pulmonary metastasis. TREATMENT AND OUTCOME The stereolithographic files of the CT scan of the head were sent for computer-aided design and manufacture of a customized 3-D-printed titanium prosthesis. Segmental mandibulectomy was performed, and the mandibular defect was reconstructed in a single stage with the 3-D-printed titanium prosthesis. The cat had 1 minor postoperative complication but had no signs of eating difficulties at any point after surgery. The cat was alive and disease free 14 months postoperatively. CLINICAL RELEVANCE Reconstruction of the mandible of a cat following mandibulectomy was possible with computer-aided design and manufacture of a customized 3-D-printed titanium prosthesis. Cats have a high rate of complications following mandibulectomy, and these initial findings suggested that mandibular reconstruction may reduce the risk of these complications and result in a better functional outcome.

Prevention of neurological injuries during mandibular third molar surgery: technical notes

PubMed Central

La Monaca, Gerardo; Vozza, Iole; Giardino, Rita; Annibali, Susanna; Pranno, Nicola; Cristalli, Maria Paola

2017-01-01

Summary Surgery to the mandibular third molar is common, and injuries to the inferior alveolar nerve and the lingual nerve are well-recognized complications of this procedure. The aim of these technical notes is to describe operative measures for reducing neurological complications during mandibular third molar surgery. The following procedure should be used to prevent damage to the inferior alveolar nerve: a well-designed mucoperiosteal flap, to obtain appropriate access to the surgical area; a conservative ostectomy on the distal and distal-lingual side; tooth sectioning, to facilitate its removal by decreasing the retention zones; tooth dislocation in the path of withdrawal imposed by the curvature of the root apex; and careful socket debridement, when the roots of the extracted tooth are in intimate contact with the mandibular canal. To prevent injury to the lingual nerve, it is important (I) to assess the integrity of the mandibular inner cortex and exclude the presence of fenestration, which could cause the dislocation of the tooth or its fragment into the sublingual or submandibular space; (II) to avoid inappropriate or excessive dislocation proceedings, in order to prevent lingual cortex fracture; (III) to perform horizontal mesial-distal crown sectioning of the lingually inclined tooth; (IV) to protect the lingual flap with a retractor showing the cortical ridge; and (V) to pass the suture not too apically and from the inner side in a buccal-lingual direction in the retromolar area. PMID:29299188

A novel technique for preventing skin pressure sores using a rubber tube during surgical treatment of mandibular condyle fractures.

PubMed

Kawase-Koga, Yoko; Mori, Yoshiyuki; Hoshi, Kazuhito; Takato, Tsuyoshi

2013-11-01

Craniofacial surgery occasionally results in sores and necrosis of the facial skin because of pressure from surgical instruments. During surgical treatment of mandibular condylar process fractures, the main mandibular fragment is routinely retracted downward using a wire to achieve a satisfactory anatomic reduction. This procedure may injure the facial skin. This potential complication is easily overlooked by medical staff, but it is easily preventable. We herein describe a method of using a rubber tube to avoid causing pressure sores of the facial skin during surgical treatment of mandibular condylar process fractures.

Airway and Feeding Outcomes of Mandibular Distraction, Tongue-Lip Adhesion, and Conservative Management in Pierre Robin Sequence: A Prospective Study.

PubMed

Khansa, Ibrahim; Hall, Courtney; Madhoun, Lauren L; Splaingard, Mark; Baylis, Adriane; Kirschner, Richard E; Pearson, Gregory D

2017-04-01

Pierre Robin sequence is characterized by mandibular retrognathia and glossoptosis resulting in airway obstruction and feeding difficulties. When conservative management fails, mandibular distraction osteogenesis or tongue-lip adhesion may be required to avoid tracheostomy. The authors' goal was to prospectively evaluate the airway and feeding outcomes of their comprehensive approach to Pierre Robin sequence, which includes conservative management, mandibular distraction osteogenesis, and tongue-lip adhesion. A longitudinal study of newborns with Pierre Robin sequence treated at a pediatric academic medical center between 2010 and 2015 was performed. Baseline feeding and respiratory data were collected. Patients underwent conservative management if they demonstrated sustainable weight gain without tube feeds, and if their airway was stable with positioning alone. Patients who required surgery underwent tongue-lip adhesion or mandibular distraction osteogenesis based on family and surgeon preference. Postoperative airway and feeding data were collected. Twenty-eight patients with Pierre Robin sequence were followed prospectively. Thirty-two percent had a syndrome. Ten underwent mandibular distraction osteogenesis, eight underwent tongue-lip adhesion, and 10 were treated conservatively. There were no differences in days to extubation or discharge, change in weight percentile, requirement for gastrostomy tube, or residual obstructive sleep apnea between the three groups. No patients required tracheostomy. The greatest reduction in apnea-hypopnea index occurred with mandibular distraction osteogenesis, followed by tongue-lip adhesion and conservative management. Careful selection of which patients with Pierre Robin sequence need surgery, and of the most appropriate surgical procedure for each patient, can minimize the need for postprocedure tracheostomy. A comprehensive approach to Pierre Robin sequence that includes conservative management, mandibular distraction osteogenesis, and tongue-lip adhesion can result in excellent airway and feeding outcomes. Therapeutic, II.

Penetration of flomoxef into human maxillary and mandibular bones.

PubMed

Igawa, H H; Sugihara, T; Yoshida, T; Kawashima, K; Ohura, T

1995-09-01

Penetration of flomoxef into the maxillary and mandibular bones was assayed clinically to provide data about its usefulness for the prevention of postoperative infection after maxillofacial surgery. Twenty-one patients undergoing maxillofacial surgery at our department were given flomoxef 2 g dissolved in 20 ml of physiological saline intravenously over 3 minutes during operation, and the serum, maxillary and mandibular concentrations were measured 1, 3, and 6 hours after injection by the band culture method using Escherichia coli 7437 as the indicator strain. The mean concentrations were 53.4, 16.1, and 2.6 micrograms/ml, respectively, in the serum, 17.6, 7.8, and 1.0 micrograms/g in maxillary bone, and 16.4, 4.2, and 0.9 micrograms/g in mandibular bone. The mean bone:serum ratios at 1, 3, and 6 hours were 33.0%, 48.2%, and 36.8%, respectively, for maxillary bone, and 30.7%, 26.2%, and 35.7% for mandibular bone. When compared with previously reported data on the bone:serum ratios in jaw of various other intravenous antibiotics, our results show that penetration of flomoxef into maxillary and mandibular bone is extremely high. As all the intramaxillary and intramandibular concentrations exceed its MIC80 values against clinical isolates of bacteria frequently isolated in cases of infection in the oral and maxillofacial region, it is apparent that one intravenous shot of flomoxef 2 g allows penetration of the drug into the maxillary and mandibular bones at effective concentrations. Flomoxef is therefore potentially useful for the prevention and treatment of infections in the oral and maxillofacial region, as it has excellent penetration into the maxillary and mandibular bones.

Feasibility of preoperative planning using anatomical facsimile models for mandibular reconstruction.

PubMed

Toro, Corrado; Robiony, Massimo; Costa, Fabio; Zerman, Nicoletta; Politi, Massimo

2007-01-15

Functional and aesthetic mandibular reconstruction after ablative tumor surgery continues to be a challenge even after the introduction of microvascular bone transfer. Complex microvascular reconstruction of the resection site requires accurate preoperative planning. In the recent past, bone graft and fixation plates had to be reshaped during the operation by trial and error, often a time-consuming procedure. This paper outlines the possibilities and advantages of the clinical application of anatomical facsimile models in the preoperative planning of complex mandibular reconstructions after tumor resections. From 2003 to 2005, in the Department of Maxillofacial Surgery of the University of Udine, a protocol was applied with the preoperative realization of stereolithographic models for all the patients who underwent mandibular reconstruction with microvascular flaps. 24 stereolithographic models were realized prior to surgery before emimandibulectomy or segmental mandibulectomy. The titanium plates to be used for fixation were chosen and bent on the model preoperatively. The geometrical information of the virtual mandibular resections and of the stereolithographic models were used to choose the ideal flap and to contour the flap into an ideal neomandible when it was still pedicled before harvesting. Good functional and aesthetic results were achieved. The surgical time was decreased on average by about 1.5 hours compared to the same surgical kind of procedures performed, in the same institution by the same surgical team, without the aforesaid protocol of planning. Producing virtual and stereolithographic models, and using them for preoperative planning substantially reduces operative time and difficulty of the operation during microvascular reconstruction of the mandible.

The Double Mandibular Osteotomy for Vascular and Tumor Surgery of the Parapharyngeal Space.

PubMed

Schlieve, Thomas; Carlson, Eric R; Freeman, Michael; Buckley, Ryan; Arnold, Josh

2017-05-01

The purposes of this study are to describe our experience using a double mandibular osteotomy for access to the parapharyngeal space in vascular and tumor surgery and to report on the outcomes and complications of this procedure. We designed and implemented a case series to review the medical records of all patients treated with a double mandibular osteotomy for parapharyngeal space access from 1994 to 2016. Patient demographic characteristics, indications for the procedure, outcomes, and complications were recorded. A total of 17 patients underwent a double mandibular osteotomy procedure for access to the parapharyngeal space during the study period. There were 7 men (41%) and 10 women (59%) comprising the cohort. The average age was 57 years (range, 29 to 75 years). The follow-up period ranged from 6 to 98 months (mean, 40 months), and 7 patients (41%) were tobacco users at the time of surgery. The most common indication was high internal carotid artery stenosis (n = 6) followed by carotid body paraganglioma (n = 3). Average blood loss was 186 mL, and there were no deaths during the study period. Eight postoperative complications were noted in 7 patients (41%). No procedures were aborted or compromised because of inadequate parapharyngeal space access. All patients showed clinical and radiographic signs of healing of the osteotomy sites. The double mandibular osteotomy provides adequate access to the parapharyngeal space for effective tumor removal and high carotid surgical intervention with acceptable patient morbidity and complications. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Treatment of Mandibular Condyle Fractures Using a Modified Transparotid Approach via the Parotid Mini-Incision: Experience with 31 Cases

PubMed Central

Shi, Jun; Yuan, Hao; Xu, Bing

2013-01-01

Surgery for mandibular condyle fractures must allow direct vision of the fracture, reduce surgical trauma and achieve reduction and fixation while avoiding facial nerve injury. This prospective study was conducted to introduce a new surgical approach for open reduction and internal fixation of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision, and surgical outcomes were evaluated. The modified transparotid approach via the parotid mini-incision was applied and rigid internal fixation using a small titanium plate was carried out for 36 mandibular condyle fractures in 31 cases. Postoperative follow-up of patients ranged from 3 to 26 months; in the first 3 months after surgery, outcomes for all patients were analyzed by evaluating the degree of mouth opening, occlusal relationship, facial nerve function and results of imaging studies. The occlusal relationships were excellent in all patients and none had symptoms of intraoperative ipsilateral facial nerve injury. The mean degree of mouth opening was 4.0 (maximum 4.8 cm, minimum 3.0 cm). No mandibular deviations were noted in any patient during mouth opening. CT showed complete anatomical reduction of the mandibular condyle fracture in all patients. The modified transparotid approach via the smaller, easily concealed parotid mini-incision is minimally invasive and achieves anatomical reduction and rigid internal fixation with a simplified procedure that directly exposes the fracture site. Study results showed that this procedure is safe and feasible for treating mandibular condyle fracture, and offers a short operative path, protection of the facial nerve and satisfactory aesthetic outcomes. PMID:24386221

Clinical efficacy of open reduction and semirigid internal fixation in management of displaced pediatric mandibular fractures: a series of 10 cases and surgical guidelines.

PubMed

Joshi, Samir; Kshirsagar, Rajesh; Mishra, Akshay; Shah, Rahul

2015-01-01

To evaluate the efficacy of open reduction and semirigid internal fixation in the management of displaced pediatric mandibular fractures. Ten patients with displaced mandibular fractures treated with 1.5 mm four holed titanium mini-plate and 4 mm screws which were removed within four month after surgery. All cases showed satisfactory bone healing without any growth disturbance. Open reduction and rigid internal fixation (ORIF) with 1.5 mm titanium mini- plates and 4 mm screws is a reliable and safe method in treatment of displaced paediatric mandibular fractures.

Comparative effect of tube drain on post operative inflammatory complications of impacted mandibular third molar surgery College Hospital, Ibadan, Nigeria.

PubMed

Obimakinde, O S; Fasola, A O; Arotiba, J T; Okoje, V N; Obiechina, A E

2010-09-01

Swelling, pain and trismus are acute reversible inflammatory complications of impacted mandibular third molar (M3) surgery. They contribute to the deterioration of quality of life and loss of several useful working hours. This study aimed to investigate whether the use of a surgical drain following M3 surgery can minimise these inflammatory complications. Eighty consecutive patients who gave consent were enrolled into the study. Patients were assigned into two groups (drain and no drain) by systematic sampling method which was modified to ensure matching of patients by age, sex and spatial relationship of the impacted mandibular third molar. The patients in the drain group (n=40) had a Foley's catheter drain inserted into the wound after the surgical procedure while the patients in the no drain group (n=40) had their wound closed without the use of drain. All patients had primary wound closure with 3.0 black silk sutures after the procedure. Demographic data, cheek dimension and maximal mouth opening were recorded before the procedure. Pain, swelling and trismus were evaluated in the two groups at 24 hours, 48 hours and 7th day after surgery. Post operative swelling and visual analogue scale score for pain were comparatively lesser in the drain group patients. The maximal interincisal distance was also more in the drain group patients. The findings from this study indicated that there is a significant benefit of using a surgical drain in minimising postoperative oedema, pain and trismus following surgical removal of impacted mandibular third molar.

Virtual Surgical Planning for Inferior Alveolar Nerve Reconstruction.

PubMed

Miloro, Michael; Markiewicz, Michael R

2017-11-01

The purpose of this study was to assess the outcomes after preoperative virtual surgical planning (VSP) for inferior alveolar nerve (IAN) reconstruction in ablative mandibular surgery. We performed a retrospective evaluation of consecutive surgical cases using standard VSP for hard tissue resection and reconstructive surgery in addition to IAN VSP performed simultaneously during surgery. Cases were assessed regarding the planning time, additional costs involved, surgeon's subjective impression of the process, accuracy of the prediction during surgery, and operative time during surgery compared with cases performed without VSP. The study sample was composed of 5 cases of mandibular resection for benign disease, with bony, soft tissue, and neural reconstruction with the use of VSP. The addition of IAN reconstruction to the VSP session added no additional expense to the planning session but resulted in an additional 22.5 minutes (±7.5 minutes) for the webinar session. From a subjective standpoint, IAN VSP provided the surgeon with a discreet plan for surgery. From an objective standpoint, IAN VSP provided the exact length and diameter of nerve graft required for surgery, facilitated the surgeon's ability to visualize the actual nerve graft procedure, and limited the additional time required for simultaneous nerve reconstruction. Despite perceived prejudice against simultaneous IAN reconstruction with complex mandibular resection and reconstruction, the use of IAN VSP may facilitate the actual surgical procedure and result in considerably improved patient outcomes without considerable additional time or cost associated with this protocol. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Third-molar extraction with ultrasound bone surgery: a case-control study.

PubMed

Mozzati, Marco; Gallesio, Giorgia; Russo, Andrea; Staiti, Giorgio; Mortellaro, Carmen

2014-05-01

The aim of this case-control study was to evaluate the postoperative period and healing between 2 surgical methods (traditional and ultrasound bone surgery) that are used for mandibular third-molar extraction. Fifteen patients with impaction of both of the lower third molars and indications for their extractions were used in this study. Bilateral-mandibular third-molar extractions were performed at the same surgical time: traditional surgery with burrs was used on 1 side (control site), and ultrasound surgery was used on the other side (test [T] site). After surgery, the patients were examined at 7 and 14 days and at 1 and 3 months to evaluate tissue healing. The following was assessed at every follow-up: pain, trismus, swelling, and alveolar bone level. The study included 15 patients, and 30 mandibular third-molar extractions were performed. We found only 1 postoperative complication: 1 patient had alveolitis in the control site. Complete recoveries without any complications were reported in all of the patients at the T sites. Complete recoveries without any complication were reported in all patients at the T sites. The only disadvantage of the piezoelectric technique was the length of operation time, which was increased by approximately 8 minutes; however, this effect was offset by reducing the morbidity. Our preliminary study showed that Piezosurgery is an excellent tool for reducing the risk of complications and improving the postoperative period.

Treatment of chronic mandibular dislocations by eminectomy: follow-up of 10 cases and literature review.

PubMed

Vasconcelos, Belmiro-Cavalcanti do Egito; Porto, Gabriela-Granja; Neto, José-Pacheco-Martins-Ribeiro; Vasconcelos, César-Freire de Melo

2009-11-01

Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence, with complete separation of the articular surfaces and fixation in that position. To report ten cases treated by eminectomy for chronic mandibular dislocations, to evaluate the results of these surgeries and make a critical review of the literature. The sample was obtained from the records of the Department of Oral and Maxillofacial Surgery, University of Pernambuco and comprises cases submitted to chronic mandibular dislocation treatment by eminectomy between 2002 and 2007. Pre- and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxations, recurrence rate and presence of facial nerve paralysis. The mean maximal mouth opening in the preoperative period was 48.4 +/- 8.5 mm and in the postoperative period it was 41.3 +/- 5.0 mm. No facial nerve paralysis or recurrence was observed. The treatment of chronic mandibular dislocations by eminectomy was shown to be efficient in relationship to the postoperative maximal mouth opening, recurrence and articular function.

Clinical study on mandibular fracture after marginal resection of the mandible.

PubMed

Okuyama, Kohei; Michi, Yasuyuki; Mizutani, Miho; Yamashiro, Masashi; Kaida, Atsushi; Harada, Kiyoshi

2016-05-01

Postoperative mandibular fracture (PMF) after marginal resection (MR) of the mandible remains an unresolved issue, and it has been reported that at least 10 mm of postoperative mandibular body height (PMBH) is required to prevent PMF. This study evaluated the clinical, physical, and structural risk factors for PMF in MR patients and determined appropriate preventive measures for PMF. This retrospective study included 44 patients with lower gingival carcinoma who underwent MR. PMF occurred in four of these patients. Thirteen associated factors identified from medical records and radiographs were statistically analyzed. Mandibular body height (MBH) preservation ratio originally evaluated as less than 0.3, more than 20 remaining teeth after surgery, and inferior alveolar canal (IAC) exposure were significant risk factors for PMF. Prostheses and number of remaining teeth were also correlated with PMF. The preserved mandibular bone should be reinforced in patients with an MBH preservation ratio of less than 0.3, more than 20 remaining teeth after surgery, and intraoperative IAC exposure. Patients with prostheses are at an increased risk of PMF compared with those without because of stable occlusion and a strong occlusal force. Our novel findings provide useful reference standards for PMF prevention in MR patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical and radiological outcomes of transoral endoscope-assisted treatment of mandibular condylar fractures.

PubMed

You, H-J; Moon, K-C; Yoon, E-S; Lee, B-I; Park, S-H

2016-03-01

Fractures of the mandibular condyle are one of the most common craniofacial fractures. However, the diagnosis and treatment of these fractures is controversial because of the multiple surgical approaches available. The purposes of this study were to identify surgery-related technical tips for better outcomes and to evaluate the results as well as complications encountered during 7 years of endoscope use to supplement the limited intraoral approach in the treatment of mandibular condylar fractures. Between 2005 and 2012, 50 patients with condylar fractures underwent endoscope-assisted reduction surgery. Postoperative facial bone computed tomography and panoramic radiography demonstrated adequate reduction of the condylar fractures in all patients. No condylar resorption was detected, and most patients displayed a satisfactory functional and structural recovery. There was no facial nerve damage or transitory hypoesthesia, and there were no visible scars after the surgery. Transoral endoscope-assisted treatment is a challenging but reliable method with lower morbidity and a rapid recovery. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Surgical prediction of skeletal and soft tissue changes in treatment of Class II.

PubMed

de Lira, Ana de Lourdes Sá; de Moura, Walter Leal; Artese, Flávia; Bittencourt, Marcos Alan Vieira; Nojima, Lincoln Issamu

2013-04-01

The purpose of this study was to study the treatment outcomes and the accuracy of digital prediction and the actual postoperative outcome with Dolphin program on subjects presenting Class II malocclusions. Forty patients underwent surgical mandibular advancement (Group 1) and 40 underwent combined surgery of mandibular advancement and maxillary impaction (Group 2). The available pre surgical (t₁) and a minimum of 12 months post surgical (t₂) cephalometric radiographs were digitized. Predictive cephalograms (t₃) for both groups were traced. At all times evaluated, Group 1 displayed a shorter mandibular length and Group 2 had a longer lower face. In both groups the surgical interventions (t₂) were greater than initially predicted. There was no significant difference between groups with regards to overjet, overbite and soft tissue measurements. In both groups surgeries were more extensive than planned. Facial convexity and the distance of the lips to cranial base presented similar values between t₂ (post surgical) and t₃ (predicted). Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Inferior alveolar nerve cutting; legal liability versus desired patient outcomes.

PubMed

Kim, Soung Min; Lee, Jong Ho

2017-10-01

Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be. We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University. Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation. This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.

Factors predictive of the onset and duration of action of local anesthesia in mandibular third-molar surgery: a prospective study.

PubMed

Al-Shayyab, Mohammad H; Baqain, Zaid H

2018-04-01

The aim of this study was to assess the influence of patients' and surgical variables on the onset and duration of action of local anesthesia (LA) in mandibular third-molar (M3) surgery. Patients scheduled for mandibular M3 surgery were considered for inclusion in this prospective cohort study. Patients' and surgical variables were recorded. Two per cent (2%) lidocaine with 1:100,000 epinephrine was used to block the nerves for extraction of mandibular M3. Then, the onset of action and duration of LA were monitored. Univariate analysis and multivariate regression analysis were used to analyze the data. The final cohort included 88 subjects (32 men and 56 women; mean age ± SD = 29.3 ± 12.3 yr). With univariate analysis, age, gender, body mass index (BMI), smoking quantity and duration, operation time, and 'volume of local anesthetic needed' significantly influenced the onset of action and duration of LA. Multivariate regression revealed that age and smoking quantity were the only statistically significant predictors of the onset of action of LA, whereas age, smoking quantity, and 'volume of local anesthetic needed' were the only statistically significant predictors of duration of LA. Further studies are recommended to uncover other predictors of the onset of action and duration of LA. © 2018 Eur J Oral Sci.

Three-dimensional airways reconstruction in syndromic pedriatric patients following mandibular distraction osteogenesis.

PubMed

Spinelli, Giuseppe; Agostini, Tommaso; Arcuri, Francesco; Conti, Marco; Raffaini, Mirco

2015-05-01

Airway obstruction, associated with mandibular hypoplasia, is a frequent complication in syndromic pediatric patients. The clinical signs of airway obstruction change from mild positional obstruction to severe respiratory distress with cyanosis. The young age of the patients makes medical management extremely complex. The purpose was to evaluate the success of surgery, evaluating the expansion of the respiratory volumes measured by computer tomography analyzed through a software (SimPlant Pro 15). Twelve patients with mandibular hypoplasia and respiratory distress were treated between December 2010 and December 2013. Eleven of them had tracheostomy in the preoperative period. The goal of surgery was to prevent permanent tracheostomy or to remove it, if present. Volume and surface area increased by an average of 279.2% and 89.4%, respectively. Tracheostomy was avoided in 1 patient who underwent surgery precociously, and it was removed in 10 patients. Only 1 case failed in volume airway augmentation, and tracheostomy was not removed. Computer tomography can calculate the cross-sectional areas of the airway in 3 planes of space: coronal, sagittal, and axial. In most patients, changes in airways have been accompanied by improvements in sleep and breathing, allowing for the removal of tracheostomy with an improved quality of life. Three-dimensional reconstruction of airways revealed a useful tool to better understand the success of surgery. IV.

Microsurgical Decompression of Inferior Alveolar Nerve After Endodontic Treatment Complications.

PubMed

Bianchi, Bernardo; Ferri, Andrea; Varazzani, Andrea; Bergonzani, Michela; Sesenna, Enrico

2017-07-01

Iatrogenic injury in oral surgery is the most frequent cause of sensory disturbance in the distribution of the inferior alveolar nerve (IAN) and mental nerve.Inferior alveolar nerve damage can occur during third molar extraction, implant location, orthognathic surgery, preprosthetic surgery, salivary gland surgery, local anesthetic injections or during the resection of benign or malignant tumors.Injuries to the IAN can be caused also by endodontic treatment of mandibular molars and premolars when filling material is forced into the tooth and mandibular canal.The sensory disturbances that could follow a damage of the IAN could be hypoesthesia, dysesthesia, hyperesthesia, anesthesia, and sometimes a painful anesthesia that strike ipsilateral lower lip, chin, and teeth. These can undermine life quality by affecting speech, chewing, and social interaction.Treatment of these complications is sometimes difficult and could consist in observation or in surgical decompression of the involved nerve to relieve the patient's symptoms and improve sensory recovery. The most debated points are the timing of intervention and the effective role of decompression in clinical outcome-improvement.The purpose of this article is to show authors' experience with 2 patients treated with microsurgical nerve decompression to remove endodontic material from the mandibular canal and providing also a comprehensive review of the literature.

Comprehensive Analysis of Mandibular Residual Asymmetry after Bilateral Sagittal Split Ramus Osteotomy Correction of Menton Point Deviation

PubMed Central

Lin, Qiuping; Huang, Xiaoqiong; Xu, Yue; Yang, Xiaoping

2016-01-01

Purpose Facial asymmetry often persists even after mandibular deviation corrected by the bilateral sagittal split ramus osteotomy (BSSRO) operation, since the reference facial sagittal plane for the asymmetry analysis is usually set up before the mandibular menton (Me) point correction. Our aim is to develop a predictive and quantitative method to assess the true asymmetry of the mandible after a midline correction performed by a virtual BSSRO, and to verify its availability by evaluation of the post-surgical improvement. Patients and Methods A retrospective cohort study was conducted at the Hospital of Stomatology, Sun Yat-sen University (China) of patients with pure hemi-mandibular elongation (HE) from September 2010 through May 2014. Mandibular models were reconstructed from CBCT images of patients with pre-surgical orthodontic treatment. After mandibular de-rotation and midline alignment with virtual BSSRO, the elongation hemi-mandible was virtually mirrored along the facial sagittal plane. The residual asymmetry, defined as the superimposition and boolean operation of the mirrored elongation side on the normal side, was calculated, including the volumetric differences and the length of transversal and vertical asymmetry discrepancy. For more specific evaluation, both sides of the hemi-mandible were divided into the symphysis and parasymphysis (SP), mandibular body (MB), and mandibular angle (MA) regions. Other clinical variables include deviation of Me point, dental midline and molar relationship. The measurement of volumetric discrepancy between the two sides of post-surgical hemi-mandible were also calculated to verify the availability of virtual surgery. Paired t-tests were computed and the P value was set at .05. Results This study included 45 patients. The volume differences were 407.8±64.8 mm3, 2139.1±72.5 mm3, and 422.5±36.9 mm3; residual average transversal discrepancy, 1.9 mm, 1.0 mm, and 2.2 mm; average vertical discrepancy, 1.1 mm, 2.2 mm, and 2.2 mm (before virtual surgery). The post-surgical volumetric measurement showed no statistical differences between bilateral mandibular regions. Conclusions Mandibular asymmetry persists after Me point correction. A 3D quantification of mandibular residual asymmetry after Me point correction and mandible de-rotation with virtual BSSRO sets up a true reference mirror plane for comprehensive asymmetry assessment of bilateral mandibular structure, thereby providing an accurate guidance for orthognathic surgical planning. PMID:27571364

Comprehensive Analysis of Mandibular Residual Asymmetry after Bilateral Sagittal Split Ramus Osteotomy Correction of Menton Point Deviation.

PubMed

Lin, Han; Zhu, Ping; Lin, Qiuping; Huang, Xiaoqiong; Xu, Yue; Yang, Xiaoping

2016-01-01

Facial asymmetry often persists even after mandibular deviation corrected by the bilateral sagittal split ramus osteotomy (BSSRO) operation, since the reference facial sagittal plane for the asymmetry analysis is usually set up before the mandibular menton (Me) point correction. Our aim is to develop a predictive and quantitative method to assess the true asymmetry of the mandible after a midline correction performed by a virtual BSSRO, and to verify its availability by evaluation of the post-surgical improvement. A retrospective cohort study was conducted at the Hospital of Stomatology, Sun Yat-sen University (China) of patients with pure hemi-mandibular elongation (HE) from September 2010 through May 2014. Mandibular models were reconstructed from CBCT images of patients with pre-surgical orthodontic treatment. After mandibular de-rotation and midline alignment with virtual BSSRO, the elongation hemi-mandible was virtually mirrored along the facial sagittal plane. The residual asymmetry, defined as the superimposition and boolean operation of the mirrored elongation side on the normal side, was calculated, including the volumetric differences and the length of transversal and vertical asymmetry discrepancy. For more specific evaluation, both sides of the hemi-mandible were divided into the symphysis and parasymphysis (SP), mandibular body (MB), and mandibular angle (MA) regions. Other clinical variables include deviation of Me point, dental midline and molar relationship. The measurement of volumetric discrepancy between the two sides of post-surgical hemi-mandible were also calculated to verify the availability of virtual surgery. Paired t-tests were computed and the P value was set at .05. This study included 45 patients. The volume differences were 407.8±64.8 mm3, 2139.1±72.5 mm3, and 422.5±36.9 mm3; residual average transversal discrepancy, 1.9 mm, 1.0 mm, and 2.2 mm; average vertical discrepancy, 1.1 mm, 2.2 mm, and 2.2 mm (before virtual surgery). The post-surgical volumetric measurement showed no statistical differences between bilateral mandibular regions. Mandibular asymmetry persists after Me point correction. A 3D quantification of mandibular residual asymmetry after Me point correction and mandible de-rotation with virtual BSSRO sets up a true reference mirror plane for comprehensive asymmetry assessment of bilateral mandibular structure, thereby providing an accurate guidance for orthognathic surgical planning.

An institutional experience in the management of pediatric mandibular fractures: A study of 74 cases.

PubMed

Andrade, Neelam N; Choradia, Smriti; Sriram S, Ganapathy

2015-09-01

In maxillofacial surgery, children represent a special group of patients, as they have significant differences from adults as far as the facial skeleton is concerned. The etiology and epidemiology of pediatric trauma involving the facial skeleton has been reported in a large series of patients. Nevertheless, few of these reports review large numbers of pediatric patients, and little is known about treatment protocols for fractures in children. The aims of this study were to retrospectively analyze the treatment methods and outcomes of pediatric mandibular fractures in children and young adolescents up to the age of 15 years, to discuss the findings, and to propose treatment protocols for maxillofacial fractures in childhood. The present study retrospectively analyzed the treatment methods and outcome of the pediatric mandibular fractures in children and young adolescents' up to the age of 15 years over a period of 5 years. All patients were followed up for an average period of 18 months, with a maximum follow-up of 2 years. A total of 74 patients were treated for mandibular and dentoalveolar fractures in children upto the age of 15 years at the Department of Oral and Maxillofacial Surgery at Nair Hospital Dental College, Mumbai from 2007 to 2012. AND CONCLUSIONS: The treatment methods used at our centre had satisfactory outcomes at the end of a follow-up period of 2 years. Reported complications were minimal. Our results confirm the usefulness of open reduction and plate fixation in older children (>12 years of age) and a conservative approach in younger children (≤12 years of age) in treating mandibular fractures. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Pathological (late) fractures of the mandibular angle after lower third molar removal: a case series.

PubMed

Cutilli, Tommaso; Bourelaki, Theodora; Scarsella, Secondo; Fabio, Desiderio Di; Pontecorvi, Emanuele; Cargini, Pasqualino; Junquera, Luis

2013-04-30

Pathological (late) fracture of the mandibular angle after third molar surgery is very rare (0.005% of third molar removals). There are 94 cases reported in the literature; cases associated with osseous pathologies such as osteomyelitis or any local and systemic diseases that may compromise mandibular bone strength have not been included. We describe three new cases of pathological (late) fracture of the mandibular angle after third molar surgery. The first patient was a 27-year-old Caucasian man who had undergone surgical removal of a 3.8, mesioangular variety, class II-C third molar 20 days before admission to our clinic. The fracture of his left mandibular angle, complete and composed, occurred during chewing. The second patient was a 32-year-old Caucasian man. He had undergone surgical removal of a 3.8, mesioangular variety, class II-B third molar 22 days before his admission. The fracture, which occurred during mastication, was studied by computed tomography that showed reparative tissue in the fracture site. The third patient was a 36-year-old Caucasian man who had undergone surgical removal of a 3.8, vertical variety, class II-C third molar 25 days before the observation. In this case the fracture of his mandibular angle was oblique (unfavorable), complete and composed. The fracture had occurred during chewing. We studied the fracture by optical projection tomography and computed tomography.All of the surgical removals of the 3.8 third molars, performed by the patients' dentists who had more than 10 years of experience, were difficult. We treated the fractures with open surgical reduction, internal fixation by titanium miniplates and intermaxillary elastic fixation removed after 6 weeks. The literature indicates that the risk of pathological (late) fracture of the mandibular angle after third molar surgery for total inclusions (class II-III, type C) is twice that of partial inclusions due to the necessity of ostectomies more generous than those for partial inclusions. Other important factors are the anatomy of the teeth and the features of the teeth roots. These fractures predominantly occur in patients who are older than 25 years. The highest incidence (67.8% of cases) is found in the second and third week postsurgery. We emphasize that before the third molar surgery it is extremely important to always provide adequate instructions to the patient in order to avoid early masticatory loads and prevent this rare event.

Management of mandibular fractures in a developing country: a review of 314 cases from two urban centers in Nigeria.

PubMed

Adeyemo, Wasiu L; Iwegbu, Innocent O; Bello, Seidu A; Okoturo, Eyituoyo; Olaitan, Ademola A; Ladeinde, Akinola L; Ogunlewe, Mobolanle O; Adepoju, Adegbenga A; Taiwo, Olanrewaju A

2008-12-01

This study was designed to establish the current demographic and treatment patterns of mandibular fractures in two urban centers (Lagos University Teaching Hospital, Lagos, and National Hospital, Abuja) in Nigeria. All cases of mandibular fractures diagnosed and treated at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos (1998-2007) and Department of Oral and Maxillofacial Surgery, National Hospital, Abuja, Nigeria (2001-2007) were reviewed. Data collected included age, sex, etiology of fracture, anatomic site of fracture, associated maxillofacial fracture, types of treatment, and postoperative complications. The highest incidence of mandibular fractures (49.3%) occurred in the age group 21-30 years and the lowest in the age group 0-10 years, with male preponderance in nearly all age groups. Road traffic crashes (RTC) were the leading cause (67.5%), followed by assault (18.8%), and gunshot. Of the RTC cases, 85 (40%) were sustained from motorcycle-related crashes. The commonest site of fracture was the body of the mandible (n = 137), followed by the angle (n = 114). The majority (83.1%) were treated by closed reduction using intermaxillary fixation, 13.1% by open reduction and internal fixation, and 3.8% had conservative treatment. Mandibular fractures are commonest during the third decade of life and in men, with almost half of the cases due to of road traffic crashes. RTC was the leading cause of mandibular fractures in all age groups. Motorcycle-related mandibular fractures seem to be increasing in Nigeria. There is a need to enforce legislation designed to prevent RTC to reduce maxillofacial fractures in Nigeria.

A selective laser sintering guide for transferring a virtual plan to real time surgery in composite mandibular reconstruction with free fibula osseous flaps.

PubMed

Leiggener, C; Messo, E; Thor, A; Zeilhofer, H-F; Hirsch, J-M

2009-02-01

The free fibular flap is the standard procedure for reconstructing mandibular defects. The graft has to be contoured to fit the defect so preoperative planning is required. The systems used previously do not allow transfer of the surgical plan to the operation room in an optimal way. The authors present a method to bring the virtual plan to real time surgery using a rapid prototyping guide. Planning was conducted using the Surgicase CMF software simulating surgery on a workstation. The osteotomies were translated into a rapid prototyping guide, sterilised and applied during surgery on the fibula allowing for the osteotomies and osteosynthesis to be performed with intact circulation. During reconstruction the authors were able to choose the best site for the osteotomies regarding circulation and as a result increased the precision and speed of treatment.

Open reduction and internal fixation of mandibular fracture in an 11-month-old infant: a case report

PubMed Central

Kim, Tae-Wan; Seo, Eun-Woo

2013-01-01

Mandibular fractures in infants are rare. This case report describes management of a mandibular fracture in an 11-month-old infant using a microplate and screws with open reduction. The surgical treatment was successful. Because the bone fragments were displaced and only the primary incisors had erupted, conservative treatment, such as an acrylic splint and circummandibular wiring, was not recommended. Nine weeks after surgery, the microplate was removed. The results showed complete clinical and radiological bone healing with normal eruption of deciduous teeth. PMID:24471024

Mandibular angle augmentation with the use of distraction and homologous lyophilized cartilage in a case of morphing to Michael Jackson surgery.

PubMed

Mommaerts, M Y; Abeloos, J S; Gropp, H

2001-08-01

Correction of an ill-defined mandibular angle is not an easy task, whether it is requested by the "congenital, orthognathic or cosmetic" patient. Deliberate over-correction has not been reported to our knowledge. This article presents a combination of distraction osteogenesis and lyophilized cartilage used to three-dimensionally over-augment the mandibular angle of a long-face prognathic patient who had the wish to be morphed to Michael Jackson or at least as far as current technique and his endogenic features allowed.

Prosthetically guided maxillofacial surgery: evaluation of the accuracy of a surgical guide and custom-made bone plate in oncology patients after mandibular reconstruction.

PubMed

Mazzoni, Simona; Marchetti, Claudio; Sgarzani, Rossella; Cipriani, Riccardo; Scotti, Roberto; Ciocca, Leonardo

2013-06-01

The aim of the present study was to evaluate the accuracy of prosthetically guided maxillofacial surgery in reconstructing the mandible with a free vascularized flap using custom-made bone plates and a surgical guide to cut the mandible and fibula. The surgical protocol was applied in a study group of seven consecutive mandibular-reconstructed patients who were compared with a control group treated using the standard preplating technique on stereolithographic models (indirect computer-aided design/computer-aided manufacturing method). The precision of both surgical techniques (prosthetically guided maxillofacial surgery and indirect computer-aided design/computer-aided manufacturing procedure) was evaluated by comparing preoperative and postoperative computed tomographic data and assessment of specific landmarks. With regard to midline deviation, no significant difference was documented between the test and control groups. With regard to mandibular angle shift, only one left angle shift on the lateral plane showed a statistically significant difference between the groups. With regard to angular deviation of the body axis, the data showed a significant difference in the arch deviation. All patients in the control group registered greater than 8 degrees of deviation, determining a facial contracture of the external profile at the lower margin of the mandible. With regard to condylar position, the postoperative condylar position was better in the test group than in the control group, although no significant difference was detected. The new protocol for mandibular reconstruction using computer-aided design/computer-aided manufacturing prosthetically guided maxillofacial surgery to construct custom-made guides and plates may represent a viable method of reproducing the patient's anatomical contour, giving the surgeon better procedural control and reducing procedure time. Therapeutic, III.

Maxillary Three-Implant Overdentures Opposing Mandibular Two-Implant Overdentures: 10-Year Surgical Outcomes of a Randomized Controlled Trial.

PubMed

Ma, Sunyoung; Tawse-Smith, Andrew; De Silva, Rohana K; Atieh, Momen A; Alsabeeha, Nabeel H M; Payne, Alan G T

2016-06-01

The surgical placement of four maxillary implants for overdentures may not be obligatory when opposing mandibular two-implant overdentures. To determine 10-year surgical outcomes and implant success of three narrow diameter implants in edentulous maxillae with conventional loading. Forty participants with mandibular two-implant overdentures were randomly allocated for surgery for maxillary overdentures. Using osteotomes, three implants of similar systems were placed with a one-stage procedure and 12-week loading with splinted and unsplinted prosthodontic designs. Marginal bone and stability measurements were done at surgery, 12 weeks, 1-, 2-, 5-, 7-, 10 years. One hundred seventeen implants were placed in 39 participants, with 35 being seen at 1 year; 29 at 2 years; 28 at 5 years; 26 at 7 years; and 23 (59%) at 10 years. Marginal bone loss was 1.35 mm between surgery and 12 weeks; 0.36 mm between 12 weeks and 1 year; 0.48 mm between 1 and 5 years; and 0.22 mm between 5 and 10 years. Implant stability quotients were 56.05, 57.54, 60.88, 58.80, 61.17 at surgery, 12 weeks, 1 year, 5 years, and 10 years. Four-field tables by implant showed success rates of 82% at 1 year; 69.2% at 2 years; 66.7% at 5 years; 61.5% at 7 years; 51.3% at 10 years. Data showed no differences between surgical technique, systems, or prosthodontic designs. Surgical placement with osteotomes of three narrow diameter implants for maxillary overdentures, opposing mandibular two-implant overdentures, is an acceptable approach, subject to strict patient selection. Implant success is independent of prosthodontic design. © 2015 Wiley Periodicals, Inc.

Comparison of soft-tissue changes in simultaneous maxillomandibular distraction with mandibular distraction with second-stage maxillary osteotomy.

PubMed

Balaji, S M; Balaji, Preetha

2016-01-01

The purpose of this study was to compare the frontal lip cant changes in common facial asymmetry (FA) cases after simultaneous maxillomandibular distraction osteogenesis (DO) and mandibular DO with maxillary orthognathic surgery. Retrospective analysis of FA cases at tertiary craniofacial referral was performed. Patients of either gender with all medical imaging records and pre- and post-operative (1 year) facial photographs in natural head position were included in the study. The lip cant change was assessed by the ratio of the linear dimension between affected and unaffected side labial commissures and the bi-pupillary reference line. Difference between the pre- and post-operative ratio was analyzed. Statistical analysis was performed for the outcome. P ≤0.05 was taken as significant. The mean preoperative measured value of the affected side was 0.845 ± 0.036 while the postoperative value was 0.95 ± 0.032. The effective change was 0.11 ± 0.044. The postoperative ratio compared with simultaneous DO case was 0.98 ± 0.06 while that of mandibular distraction with orthognathic surgery was 0.92 ± 0.08 (P = 0.048). The mean change of the simultaneous DO case was measured as 0.114 ± 0.041 while the same for the mandibular distraction with orthognathic surgery was 0.069 ± 0.035 (P = 0.013). The results indicate that the simultaneous DO yields more better frontal lip cant change between both halves than the mono-DO with orthognathic surgery. The mean change is much higher in the simultaneous DO cases indicating a more effective correction and desired result. The biological reason and lip musculature mechanism behind the response in both conditions are discussed.

Indications of Free Grafts in Mandibular Reconstruction, after Removing Benign Tumors: Treatment Algorithm

PubMed Central

Alister, Juan Pablo; Uribe, Francisca; Olate, Sergio; Arriagada, Alvaro

2016-01-01

Background: Mandibular reconstruction has been the subject of much debate and research in the fields of maxillofacial surgery and head and neck surgery. Materials and Methods: A retrospective observational study was undertaken with 14 patients diagnosed with benign tumorous pathologies and who underwent immediate mandibular resection and reconstruction at the Hospital del Salvador Maxillofacial Surgery Unit and Dr. Rodrigo Fariña’s private clinic between the years 2002 and 2012. We propose a treatment algorithm, which is previous teeth extractions in area that will be removed. Results: Fourteen patients underwent surgery, and a total of 40 dental implants were installed in 6 men and 8 women, the mean age of 33.5 (age range, 14–58 y). Reconstruction with iliac crest bone graft, and rehabilitation following this protocol (average of reconstruction was 8.7 cm), was successful with no complications at all in 12 patients. One patient had a minor complication, and the graft was partially reabsorbed because of communication of the graft with the oral cavity. This complication did not impede rehabilitation with dental implants. Another patient suffered the total loss of the graft due to infection because of dehiscence of oral mucosa and great communication with the mouth. Another iliac crest free graft reconstruction was undertaken 6 months later. Conclusions: The scientific evidence suggests that mandibular reconstruction using free grafts following the removal of benign tumors is a biologically sustainable alternative. The critical factor to improve the prognosis of free grafts reconstruction in benign tumors is to have good quality soft tissue and avoid communication with the oral cavity. For this, it is vital to do dental extractions before removing the tumor. PMID:27622113

Measure Of Frequency Of Alveolar Osteitis Using Two Different Methods Of Osteotomy In Mandibular Third Molar Impactions: A Double-Blind Randomized Clinical Trial.

PubMed

Rashid, Hina; Hussain, Azmina; Sheikh, Abdul Hafeez; Azam, Kehkishan; Malik, Sofia; Amin, Muhammad

2018-01-01

Dento-alveolar surgical procedures involving third molar teeth are the most common surgical procedure in the field of surgery. The objective of this research was to analyse the impact of surgery on the incidence of alveolar osteitis after surgical removal of mandibular third molar and to compare two different bone cutting methods following impacted mandibular third molar surgery.. This double blinded randomized clinical trial was executed at the OPD of Department of Oral and Maxillofacial Surgery, Dow University of Health Sciences, Karachi. The study duration was four months. It was conducted on 60 patients needing unilateral mandibular third molar impaction removal. Patients were randomized to two groups (i.e., physio dispenser group and slow speed handpiece group) before surgery. The surgical procedure was performed under local anaesthesia by using standardized cross infection protocol. The frequency of alveolar osteitis was evaluated on thirdday postoperatively. Alveolar osteitis was diagnosed and confirmed by patient's history and clinical evaluation. Post-operative sequelae were observed and recorded objectively. Out of 60 patients', five patients experienced alveolar osteitis, and the incidence rate was 8.3%. A significant pvalue of 0.000 was calculated using binomial test for comparison of alveolar osteitis among both groups. Inter-examiner reliability was assessed by kappa and good (62%) agreement, which was found among the examiners, who diagnosed alveolar osteitis clinically. Post-operative sequelae were insignificant in slow speed hand piece group. It was observed that alveolar osteitis was reported in physio-dispenser group; similarly, post-operative complications were also more in this group as compared with slow speed-hand piece group. No surgical complications were observed in slow speed-hand piece group suggesting slow speed hand piece mode of osteotomy to be safer for third molar extraction as compared with physio-dispenser.

Does the titanium plate fixation of symphyseal fracture affect mandibular growth?

PubMed

Bayram, Burak; Yilmaz, Alev Cetinsahin; Ersoz, Esra; Uckan, Sina

2012-11-01

The effect of metallic fixation on growth is a major concern in children and is not yet clear. The aim of this study was to evaluate the effect of metallic fixation of mandibular symphyseal fracture on mandibular growth.Eighteen 90-day-old growing white New Zealand rabbits weighing 1.6 to 2.5 kg were included in this study and divided into 2 groups of 9 subjects. In the experimental group, animals underwent mandibular osteotomy, simulating a symphyseal fracture on the midline of mandibular symphysis. The bone segments were fixed with microplates and microscrews (1.6 mm).In the control group, the same surgical incision without performing symphyseal osteotomy was conducted, and 2 screws were inserted on each side of the symphyseal midline.Digital cephalometric and submentovertex radiographs were taken before the operation and at postoperative 6 months for each animal in 2 groups, and cephalometric measurements were performed. The distance between the centers of the head of 2 screws measured at the end of surgery in the control group was compared with measurements at 6 months after surgery. Obtained data were statistically analyzed.There is no statistically significant difference between the 2 groups for growth amount of both sides of the mandible. Difference of ANS-Id (the most anterior points of nasal bone, the most anterior point on the alveolar bone between the lower incisors) and Cd-Id (the uppermost and most distal point of the mandibular condyle, the most anterior point on the alveolar bone between the lower incisors) values of the 2 groups is not statistically significant (P > 0.05).The distance between the 2 screws at the first application significantly increased at the postoperative sixth month (P < 0.05). Metallic fixation of mandibular symphyseal fracture does not affect the vertical and sagittal mandibular growth in growing rabbits.

Relevance of anterior mandibular body ostectomy in mandibular prognathism.

PubMed

Bansal, Pankaj; Singh, Virender; Anand, S C; Bansal, Sumidha

2013-01-01

We tried to find out the relevance of anterior mandibular body ostectomy in deformities of the mandible specially prognathism, which is primarily limited to anterior part only. Ten patients with skeletal deformity along with malocclusion, which was limited to anterior body of mandible were selected. Selected patients had proper molar interdigitation (even if class 3) and in general had anterior crossbite (except one). All patients had crossed their growth spurts and had no hormonal influence on facial deformity. Specific protocol, including cephelometric analysis cephalometry for orthognathic surgery, prediction tracing and model surgeries were devised. Pre and post-surgical orthodontics and body ostectomy were performed in all patients along with 18-month post-op follow-up. There was significant reduction in prognathism and horizontal dysplasia in all ten patients. Anterior crossbite as well as axis of incisiors over mandibular plane was corrected in all patients due to decrease in length of mandibular body. All patients showed decreased facial height and better lip competence with intact posterior occlusion and no (negligible or transient) sensory loss. Our study could confirm that people whose deformity is limited to the anterior part of mandible with reasonable occlusion posteriorly can get satisfactory cosmetic and functional results through body ostectomy alone rather than going for surgical procedure in the ramal area, which is liable to cause sensory and occlusal disturbances.

Achievability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery.

PubMed

Liebregts, Jeroen; Baan, Frank; de Koning, Martien; Ongkosuwito, Edwin; Bergé, Stefaan; Maal, Thomas; Xi, Tong

2017-08-24

The present study was aimed to investigate the effects of sequencing a two-component surgical procedure for correcting malpositioned jaws (bimaxillary osteotomies); specifically, surgical repositioning of the upper jaw-maxilla, and the lower jaw-mandible. Within a population of 116 patients requiring bimaxillary osteotomies, the investigators analyzed whether there were statistically significant differences in postoperative outcome as measured by concordance with a preoperative digital 3D virtual treatment plan. In one group of subjects (n = 58), the maxillary surgical procedure preceded the mandibular surgery. In the second group (n = 58), the mandibular procedure preceded the maxillary surgical procedure. A semi-automated analysis tool (OrthoGnathicAnalyser) was applied to assess the concordance of the postoperative maxillary and mandibular position with the cone beam CT-based 3D virtual treatment planning in an effort to minimize observer variability. The results demonstrated that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. In selected circumstances, such as a planned counterclockwise rotation of both jaws, the mandible-first sequence resulted in more predictable displacements of the jaws.

Evaluation of adjunctive effect of low-level laser Therapy on pain, swelling and trismus after surgical removal of impacted lower third molar: A double blind randomized clinical trial.

PubMed

Farhadi, Farrokh; Eslami, Hosein; Majidi, Alireza; Fakhrzadeh, Vahid; Ghanizadeh, Milad; KhademNeghad, Sahar

2017-09-30

Wisdom teeth remains impacted in the jaw due to several reasons and surgery of impacted wisdom teeth is one of the most common surgeries in dental clinics. Pain, swelling and trismus are the common complications after this surgery which affect quality of life. In articles, various methods are introduced to control immediate inflammatory-response associated with third-molar surgery. The aim of this study is to evaluate the adjunctive effect of low-level laser Therapy on pain, swelling and trismus after surgical removal of impacted lower third molar. This double-blind randomized controlled trial (RCT) was conducted on two groups of 24 patients (age range of 18-35) that had referred to surgical ward of Faculty of Dentistry, Tabriz University of Medical Sciences for surgery of their mandibular third molar(2015-16). All the subjects were systemically healthy and had at least one impacted mandibular third molar. After surgery, in experimental group, the laser was applied intraorally (inside the tooth socket) and extraorally (at the insertion point of the masseter muscle) immediately after surgery in contact with the target area for 25 seconds each. The laser energy was 2.5 J per area with an energy density of 5 J/ cm 2 at the surface of the probe (spot size= 0.5 cm 2 ). In the other group, as the control group, it was pretended to radiate. Trismus, pain, and swelling were evaluated on the first and seventh days after surgery. The obtained data were evaluated using SPSS 16 software and independent samples T-test. In the group where LLLT had been used, P> 0.05 was calculated for pain, swelling, and trismus on days 1 and 7 after surgery that was not statistically significant. Under limitations of this study, using low-power laser with mentioned parameters, clinically reduces pain, swelling and trismus after surgical removal of impacted mandibular wisdom, but not statistically significant.

Therapist activities preceding setbacks in the assimilation process.

PubMed

Gabalda, Isabel Caro; Stiles, William B; Pérez Ruiz, Sergio

2016-11-01

This study examined the therapist activities immediately preceding assimilation setbacks in the treatment of a good-outcome client treated with linguistic therapy of evaluation (LTE). Setbacks (N = 105) were defined as decreases of one or more assimilation stages from one passage to the next dealing with the same theme. The therapist activities immediately preceding those setbacks were classified using two kinds of codes: (a) therapist interventions and (b) positions the therapist took toward the client's internal voices. Preceding setbacks to early assimilation stages, where the problem was unformulated, the therapist was more often actively listening, and the setbacks were more often attributable to pushing a theme beyond the client's working zone. Preceding setbacks to later assimilation stages, where the problem was at least formulated, the therapist was more likely to be directing clients to consider alternatives, following the LTE agenda, and setbacks were more often attributable to the client following these directives shifting attention to less assimilated (but nevertheless formulated) aspects of the problem. At least in this case, setbacks followed systematically different therapist activities depending on the problem's stage of assimilation. Possible implications for the assimilation model's account of setbacks and for practice are discussed.

Morphological assessment of the mandibular canal trajectory in edentate subjects.

PubMed

Nimigean, Victor; Sîrbu, Valentin Daniel; Nimigean, Vanda Roxana; Bădiţă, Daniela Gabriela; Poll, Alexandru; Moraru, Simona Andreea; Păun, Diana Loreta

2018-01-01

The mandibular canal and its content represent the vital structure, which can complicate dentoalveolar surgical procedures in the posterior region of the mandible. The purpose of the present study was to determine the path the mandibular canal takes in relation to the horizontal and the vertical anatomical reference planes in edentate subjects, in order to minimize the risk of affecting its neurovascular content during various oral surgery procedures. Morphometric evaluations were performed on 12 dried fully edentulous human mandibles and on cone-beam computed tomography (CBCT) cross-sectional images of the mandible, from 20 patients with either partial or complete edentulism. Both methods were utilized, in three target areas (corresponding to the second premolar, to the first molar and to the second molar regions), in order to measure the distance between the mandibular canal and the following reference points: (i) the lateral (buccal) surface of the mandible (MC-BS distance); (ii) the medial (lingual) surface of the mandible (MC-LS distance); (iii) the alveolar surface of the mandible (MC-AS distance). The results were statistically processed in Stata MP/13 software package using analysis of variance (ANOVA) test. The mandibular canal crossed the trabecular bone from the posterior towards the anterior, and from the lingual towards the buccal, reaching the premolar region, distal to the mental foramen, where it was located in the centre of the trabecular bone, main topographic pattern encountered in 27 (84.37%) of the cases. In five (15.63%) of the cases, in the premolar region, the mandibular canal was located near the buccal cortical plate. The mandibular canal descended from the second molar region towards the premolar region, main topographic pattern found in 28 (87.5%) of the cases. In four (12.5%) cases, the mandibular canal had a descending trajectory in the molar regions and it took a slightly ascending course in the premolar region. According to the results, the second molar region represents the highest risk area in the accidental injury to the content of the mandibular canal, during various oral surgery procedures.

Evaluation of levee setbacks for flood-loss reduction, Middle Mississippi River, USA

NASA Astrophysics Data System (ADS)

Dierauer, Jennifer; Pinter, Nicholas; Remo, Jonathan W. F.

2012-07-01

SummaryOne-dimensional hydraulic modeling and flood-loss modeling were used to test the effectiveness of levee setbacks for flood-loss reduction along the Middle Mississippi River (MMR). Four levee scenarios were assessed: (1) the present-day levee configuration, (2) a 1000 m levee setback, (3) a 1500 m levee setback, and (4) an optimized setback configuration. Flood losses were estimated using FEMA's Hazus-MH (Hazards US Multi-Hazard) loss-estimation software on a structure-by-structure basis for a range of floods from the 2- to the 500-year events. These flood-loss estimates were combined with a levee-reliability model to calculate probability-weighted damage estimates. In the simplest case, the levee setback scenarios tested here reduced flood losses compared to current conditions for large, infrequent flooding events but increased flood losses for smaller, more frequent flood events. These increases occurred because levee protection was removed for some of the existing structures. When combined with buyouts of unprotected structures, levee setbacks reduced flood losses for all recurrence intervals. The "optimized" levee setback scenario, involving a levee configuration manually planned to protect existing high-value infrastructure, reduced damages with or without buyouts. This research shows that levee setbacks in combination with buyouts are an economically viable approach for flood-risk reduction along the study reach and likely elsewhere where levees are widely employed for flood control. Designing a levee setback around existing high-value infrastructure can maximize the benefit of the setback while simultaneously minimizing the costs. The optimized levee setback scenario analyzed here produced payback periods (costs divided by benefits) of less than 12 years. With many aging levees failing current inspections across the US, and flood losses spiraling up over time, levee setbacks are a viable solution for reducing flood exposure and flood levels.

Effect of platelet-rich fibrin on frequency of alveolar osteitis following mandibular third molar surgery: a double-blinded randomized clinical trial.

PubMed

Eshghpour, Majid; Dastmalchi, Parisa; Nekooei, Amir Hossein; Nejat, AmirHossein

2014-08-01

To evaluate the effectiveness of platelet-rich fibrin (PRF) in preventing the development of alveolar osteitis (AO). In a double-blinded study, patients with bilateral impacted mandibular third molars underwent surgical extractions, with one socket receiving PRF and the other one serving as a control. The surgeon and patient were unaware of the study or control side. The predictor variable was the PRF application and was categorized as PRF and non-PRF. The outcome variable was the development of AO during the first postoperative week. Other study variables included age, gender, smoking status, irrigation volume, extraction difficulty, surgeon experience, and number of anesthetic cartridges. Data were analyzed using χ(2) and t tests, with the significance level set at a P value less than .05. Seventy-eight patients (mean age, 25 yr) underwent 156 impacted third molar surgeries. The overall frequency of AO was 14.74% for all surgeries. The frequency of AO in the PRF group was significantly lower than in the non-PRF group (odds ratio = 0.44; P < .05). Based on the results of the present study, PRF application may decrease the risk of AO development after mandibular third molar surgery. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Mandibular reconstruction using fibula free flap harvested using a customised cutting guide: how we do it.

PubMed

Tarsitano, A; Ciocca, L; Cipriani, R; Scotti, R; Marchetti, C

2015-06-01

Free fibula flap is routinely used for mandibular reconstructions. For contouring the flap, multiple osteotomies should be shaped to reproduce the native mandibular contour. The bone segments should be fixed using a reconstructive plate. This plate is usually manually bent by the surgeon during surgery. This method is efficient, but during reconstruction it is complicated to reproduce the complex 3D conformation of the mandible and recreate a normal morphology with a mandibular profile as similar as possible to the original; any aberration in its structural alignment may lead to aesthetic and function alterations due to malocclusion or temporomandibular disorders. In order to achieve better morphological and functional outcomes, we have performed a customised flap harvest using cutting guides. This study demonstrates how we have performed customised mandibular reconstruction using CAD-CAM fibular cutting guides in 20 patients undergoing oncological segmental resection.

Variations in the branching pattern of posterior division of mandibular nerve: a case report.

PubMed

Muraleedharan, Aparna; Veeramani, Raveendranath; Chand, Parkash

2014-11-01

Abnormal communications among the branches of mandibular nerve especially the posterior division are significant due to various procedures undertaken in this region. These variations are worth reporting as they pose serious implications in several interventions in this region, and may even lead to false diagnosis. During routine dissection, the mandibular nerve and its branches were dissected in the infratemporal fossa. The branches from the posterior division of the mandibular nerve namely the inferior alveolar and auriculotemporal nerves were carefully dissected, and their abnormal branching pattern was noted. There was a communicating branch between left inferior alveolar and auriculotemporal nerve. There was also a variant recurrent branch from the left inferior alveolar nerve that supplied the lateral pterygoid muscle. Such variant branches and communications between the branches of mandibular nerve as seen in this case have an embryological basis and are clinically important in this region especially for dental surgeries and anesthesia.

Surgical management of pediatric mandibular trauma.

PubMed

Aldelaimi, Tahrir N; Khalil, Afrah A

2013-05-01

Surgical treatment of pediatric maxillofacial region is a complex and challenging task to maxillofacial surgeons. Incorrect and inappropriate treatment of trauma will end with a secondary deformity that is very difficult to correct. Twenty-eight children with mandibular trauma were seen at the maxillofacial surgery department of Ramadi Teaching Hospital during the period from July 2009 to June 2012. Age, sex, etiology, associated injuries, pattern of fractures, and treatments were reviewed. Road traffic accident was the most common cause for pediatric mandibular trauma. Significant advances have been made in the management of these injuries, decreasing the incidence of secondary deformities.

Reconstruction of acquired oromandibular defects.

PubMed

Fernandes, Rui P; Yetzer, Jacob G

2013-05-01

Acquired defects of the mandible resulting from trauma, infection, osteoradionecrosis, and ablative surgery of the oral cavity and lower face are particularly debilitating. Familiarity with mandibular and cervical anatomy is crucial in achieving mandibular reconstruction. The surgeon must evaluate which components of the hard and soft tissue are missing in selecting a method of reconstruction. Complexity of mandibular reconstruction ranges from simple rigid internal fixation to microvascular free tissue transfer, depending on defect- and patient-related factors. Modern techniques for microvascular tissue transfer provide a wide array of reconstructive options that can be tailored to patients' specific needs. Copyright © 2013 Elsevier Inc. All rights reserved.

Maxillary Advancement for Unilateral Crossbite in a Patient with Sleep Apnea Syndrome.

PubMed

Hoshijima, Mitsuhiro; Honjo, Tadashi; Moritani, Norifumi; Iida, Seiji; Yamashiro, Takashi; Kamioka, Hiroshi

2015-01-01

This article reports the case of a 44-year-old male with skeletal Class III, Angle Class III malocclusion and unilateral crossbite with concerns about obstructive sleep apnea syndrome (OSAS), esthetics and functional problems. To correct the skeletal deformities, the maxilla was anteriorly repositioned by employing LeFort I osteotomy following pre-surgical orthodontic treatment, because a mandibular setback might induce disordered breathing and cause OSAS. After active treatment for 13 months, satisfactory occlusion was achieved and an acceptable facial and oral profile was obtained. In addition, the apnea hypopnea index (AHI) decreased from 18.8 preoperatively to 10.6 postoperatively. Furthermore, after a follow-up period of 7 months, the AHI again significantly decreased from 10.6 to 6.2. In conclusion, surgical advancement of the maxilla using LeFort I osteotomy has proven to be useful in patients with this kind of skeletal malocclusion, while preventing a worsening of the OSAS.

Student perception of two different simulation techniques in oral and maxillofacial surgery undergraduate training.

PubMed

Lund, Bodil; Fors, Uno; Sejersen, Ronny; Sallnäs, Eva-Lotta; Rosén, Annika

2011-10-12

Yearly surveys among the undergraduate students in oral and maxillofacial surgery at Karolinska Institutet have conveyed a wish for increased clinical training, and in particular, in surgical removal of mandibular third molars. Due to lack of resources, this kind of clinical supervision has so far not been possible to implement. One possible solution to this problem might be to introduce simulation into the curriculum. The purpose of this study was to investigate undergraduate students' perception of two different simulation methods for practicing clinical reasoning skills and technical skills in oral and maxillofacial surgery. Forty-seven students participating in the oral and maxillofacial surgery course at Karolinska Institutet during their final year were included. Three different oral surgery patient cases were created in a Virtual Patient (VP) Simulation system (Web-SP) and used for training clinical reasoning. A mandibular third molar surgery simulator with tactile feedback, providing hands on training in the bone removal and tooth sectioning in third molar surgery, was also tested. A seminar was performed using the combination of these two simulators where students' perception of the two different simulation methods was assessed by means of a questionnaire. The response rate was 91.5% (43/47). The students were positive to the VP cases, although they rated their possible improvement of clinical reasoning skills as moderate. The students' perception of improved technical skills after training in the mandibular third molar surgery simulator was rated high. The majority of the students agreed that both simulation techniques should be included in the curriculum and strongly agreed that it was a good idea to use the two simulators in concert. The importance of feedback from the senior experts during simulator training was emphasised. The two tested simulation methods were well accepted and most students agreed that the future curriculum would benefit from permanent inclusion of these exercises, especially when used in combination. The results also stress the importance of teaching technical skills and clinical reasoning in concert.

Endoscopic-assisted resection of peripheral osteoma using piezosurgery.

PubMed

Ochiai, Shigeki; Kuroyanagi, Norio; Sakuma, Hidenori; Sakuma, Hidenobu; Miyachi, Hitoshi; Shimozato, Kazuo

2013-01-01

Endoscopic-assisted surgery has gained widespread popularity as a minimally invasive procedure, particularly in the field of maxillofacial surgery. Because the surgical field around the mandibular angle is extremely narrow, the surrounding tissues may get caught in sharp rotary cutting instruments. In piezosurgery, bone tissues are selectively cut. This technique has various applications because minimal damage is caused by the rotary cutting instruments when they briefly come in contact with soft tissues. We report the case of a 33-year-old man who underwent resection of an osteoma in the region of the mandibular angle region via an intraoral approach. During surgery, the complete surgical field was within the view of the endoscope, thereby enabling the surgeon to easily resection the osteoma with the piezosurgery device. Considering that piezosurgery limits the extent of surgical invasion, this is an excellent low-risk technique that can be used in the field of maxillofacial surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

[Three-dimensional evaluation of condylar morphology remodeling after orthognathic surgery in mandibular retrognathism by cone-beam computed tomography].

PubMed

Chen, Shuo; Liu, Xiao-jing; Li, Zi-li; Liang, Cheng; Wang, Xiao-xia; Fu, Kai-yuan; Yi, Biao

2015-08-18

To evaluate the effect of orthognathic surgery on condylar morphology changes by comparing three-dimension surface reconstructions of condyles using cone-beam computed tomography (CBCT) data. In the study, 18 patients with mandible retrognathism deformities were included and CBCT data of 36 temporomandibular joints were collected before surgery and 12 months after surgery. Condyles were reconstructed and superimposed pre- and post-operatively to compare the changes of condylar surfaces. One-sample t test and χ2 test were performed for the analysis of three-dimension metric measurement and condylar head remodeling signs. P<0.05 was considered significant. The root-mean-square (RMS) of condylar surface changes before and after the surgery was (0.37±0.11) mm, which was significant statistically (P<0.05). The distribution of condylar remodeling signs showed significant difference (P<0.05). Bone resorption occurred predominantly in the posterior area of condylar head and bone formation occurred mainly in the anterior area. Three-dimension superimposition method based on CBCT data showed that condylar morphology had undergone remodeling after mandibular advancement.

Clinical comparison between the retromandibular approach for reduction and fixation and endoscope-assisted open reduction and internal fixation for mandibular condyle fractures.

PubMed

Nogami, Shinnosuke; Takahashi, Tetsu; Yamauchi, Kensuke; Miyamoto, Ikuya; Kaneuji, Takeshi; Yamamoto, Noriaki; Yoshiga, Daigo; Yamashita, Yoshihiro

2012-11-01

Endoscope-assisted transoral open reduction and internal fixation (EAORIF) for mandibular condyle fractures has recently become popular because it is minimally invasive, provides excellent visibility without a large incision, and reduces surgical scarring and the risk of facial nerve injury. This report describes a retrospective clinical study that compared certain clinical parameters, including postoperative function, between the retromandibular (RM) approach and EAORIF. Fifteen patients were treated by the RM approach, whereas 15 underwent EAORIF between July 2006 and September 2011 at Kyushu Dental College, Japan. Clinical indices comprised fracture line, fracture type, number of plates used, surgical duration, bleeding amount, and functional items, including maximum interincisal opening, mandibular deviation on the opening pathway, malocclusion, facial paresthesia, and temporomandibular joint pain and clicking. The areas subjected to either approach included lower neck and subcondyle. The RM approach was used for mandibular condyle fractures with dislocation of a small bone segment. Both groups used 2 plates in all cases. Surgical duration, maximum interincisal opening, mandibular deviation, occlusion, and temporomandibular joint function at 6 months after surgery were comparable between groups. The average bleeding amount in the EAORIF group was greater than in the RM group. One patient from the RM group developed facial paresthesia that persisted for 6 months after surgery. It was concluded that surgical treatment was suitable for fractures of the lower neck and subcondylar. Both procedures showed good results in the functional items of this study.

Incidence of lingual nerve paraesthesia following mandibular third molar surgery

PubMed Central

Lata, Jeevan; Tiwari, Arunesh K.

2011-01-01

Context: The surgical removal of impacted mandibular third molar is associated with minor but expected complications like pain, swelling, bruising and trismus. The lingual nerve damage sometimes occurs after the removal of mandibular third molar producing impaired sensation or permanent sensory loss. This complication is usually unexpected and unacceptable for the patients particularly if no prior warning has been given. Aims: The aim of the present clinical prospective study was to determine the clinical incidence of lingual nerve injury following mandibular third molar removal and to analyze possible factors for the lingual nerve injury. Settings and Design: Clinical prospective study in the Department of Oral Surgery, Punjab Government Dental College and Hospital, Amritsar. Materials and Methods: Ninety patients were selected randomly, amongst the patients, who reported to our department from January 2009 to December 2009 for the surgical removal of impacted mandibular third molar. To minimize the risk of lingual nerve injury, the standard terence wards incision was made in all cases and only buccal flap was raised. Statistical Analysis: The small number of paraesthesia precluded statistical analysis. Results: Out of 90 patients, six patients were diagnosed with lingual nerve paraesthesia. The overall incidence rate of lingual nerve injury was 6.6%. Conclusions: It can be concluded that lingual nerve paraesthesia can occur with or without reflection of lingual flap in spite of all the measures taken to protect it. It may be contributed to the fact of anatomical variations of lingual nerve. PMID:22639500

The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures

PubMed Central

Ma, Junli; Ma, Limin; Wang, Zhifa; Zhu, Xiongjie; Wang, Weijian

2017-01-01

Abstract Rationale: Precise bony reduction and reconstruction of optimal contour in treating comminuted mandibular fractures is very difficult using traditional techniques and devices. The aim of this report is to introduce our experiences in using virtual surgery and three-dimensional (3D) printing technique in treating this clinical challenge. Patient concerns: A 26-year-old man presented with severe trauma in the maxillofacial area due to fall from height. Diagnosis: Computed tomography images revealed middle face fractures and comminuted mandibular fracture including bilateral condyles. Interventions and outcomes: The computed tomography data was used to construct the 3D cranio-maxillofacial models; then the displaced bone fragments were virtually reduced. On the basis of the finalized model, a customized titanium mesh tray was designed and fabricated using selective laser melting technology. During the surgery, a submandibular approach was adopted to repair the mandibular fracture. The reduction and fixation were performed according to preoperative plan, the bone defects in the mental area were reconstructed with iliac bone graft. The 3D-printed mesh tray served as an intraoperative template and carrier of bone graft. The healing process was uneventful, and the patient was satisfied with the mandible contour. Lessons: Virtual surgical planning combined with 3D printing technology enables surgeon to visualize the reduction process preoperatively and guide intraoperative reduction, making the reduction less time consuming and more precise. 3D-printed titanium mesh tray can provide more satisfactory esthetic outcomes in treating complex comminuted mandibular fractures. PMID:28682875

Development of a Drilling Simulator for Dental Implant Surgery.

PubMed

Kinoshita, Hideaki; Nagahata, Masahiro; Takano, Naoki; Takemoto, Shinji; Matsunaga, Satoru; Abe, Shinichi; Yoshinari, Masao; Kawada, Eiji

2016-01-01

The aim of this study was to develop and evaluate a dental implant surgery simulator that allows learners to experience the drilling forces necessary to perform an osteotomy in the posterior mandibular bone. The simulator contains a force-sensing device that receives input and counteracts this force, which is felt as resistance by the user. The device consists of an actuator, a load cell, and a control unit. A mandibular bone model was fabricated in which the predicted forces necessary to drill the cortical and trabecular bone were determined via micro CT image-based 3D finite element analysis. The simulator was evaluated by five dentists from the Department of Implantology at Tokyo Dental College. The ability of the evaluators to distinguish the drilling resistance through different regions of the mandibular bone was investigated. Of the five dentists, four sensed the change in resistance when the drill perforated the upper cortical bone. All five dentists were able to detect when the drill made contact with lingual cortical bone and when the lingual bone was perforated. This project successfully developed a dental implant surgery simulator that allows users to experience the forces necessary to drill through types of bone encountered during osteotomy. Furthermore, the researchers were able to build a device by which excessive drilling simulates a situation in which the lingual cortical bone is perforated--a situation that could lead to negative repercussions in a clinical setting. The simulator was found to be useful to train users to recognize the differences in resistance when drilling through the mandibular bone.

Is a computer-assisted design and computer-assisted manufacturing method for mandibular reconstruction economically viable?

PubMed

Tarsitano, Achille; Battaglia, Salvatore; Crimi, Salvatore; Ciocca, Leonardo; Scotti, Roberto; Marchetti, Claudio

2016-07-01

The design and manufacture of patient-specific mandibular reconstruction plates, particularly in combination with cutting guides, has created many new opportunities for the planning and implementation of mandibular reconstruction. Although this surgical method is being used more widely and the outcomes appear to be improved, the question of the additional cost has to be discussed. To evaluate the cost generated by the management of this technology, we studied a cohort of patients treated for mandibular neoplasms. The population was divided into two groups of 20 patients each who were undergoing a 'traditional' freehand mandibular reconstruction or a computer-aided design/computer-aided manufacturing (CAD-CAM) mandibular reconstruction. Data concerning operation time, complications, and days of hospitalisation were used to evaluate costs related to the management of these patients. The mean operating time for the CAD-CAM group was 435 min, whereas that for the freehand group was 550.5 min. The total difference in terms of average time gain was 115.5 min. No microvascular complication occurred in the CAD-CAM group; two complications (10%) were observed in patients undergoing freehand reconstructions. The mean overall lengths of hospital stay were 13.8 days for the CAD-CAM group and 17 days for the freehand group. Finally, considering that the institutional cost per minute of theatre time is €30, the money saved as a result of the time gained was €3,450. This cost corresponds approximately to the total price of the CAD-CAM surgery. In conclusion, we believe that CAD-CAM technology for mandibular reconstruction will become a widely used reconstructive method and that its cost will be covered by gains in terms of surgical time, quality of reconstruction, and reduced complications. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Experimental Validation of the Efficiency of Gamalant-paste-FORTE Plus, a Russian Osteoinductive Material, in Oral Surgery.

PubMed

Olesova, V N; Amkhadova, M A; Simakova, T G; Mirgazizov, M Z; Pozharitskaya, M M

2017-03-01

For evaluation of the efficiency of bone substitute, nanostructurized Gamalant-paste-FORTEPlus was placed into a mandibular defect in rats. Bone tissue reparation was evaluated after 30 days by histological methods under a microscope. Use of bone substitute in experimental mandibular defect ensured more complete and rapid restructuring of the bone tissue in comparison with the control (natural healing).

Consensus or controversy? The classification and treatment decision-making by 491 maxillofacial surgeons from around the world in three cases of a unilateral mandibular condyle fracture.

PubMed

Kommers, Sofie C; Boffano, Paolo; Forouzanfar, Tymour

2015-12-01

Many studies are available in the literature on both classification and treatment of unilateral mandibular condyle fractures. To date however, controversy regarding the best treatment for unilateral mandibular condyle fractures remains. In this study, an attempt was made to quantify the level of agreement between a sample of maxillofacial surgeons worldwide, on the classification and treatment decisions in three different unilateral mandibular condyle fracture cases. In total, 491 of 3044 participants responded. In all three mandibular condyle fracture cases, a fairly high level of disagreement was found. Only in the case of a subcondylar fracture, assuming dysocclusion was present, more than 81% of surgeons agreed that the best treatment would be open reduction and internal fixation. Based on the study results, there is considerable variation among surgeons worldwide with regard to treatment of unilateral mandibular condyle fracture. 3D imaging in higher fractures tends to lead to more invasive treatment decisions. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Pathological mandibular fracture: A severe complication of periimplantitis

PubMed Central

Rodriguez-Campo, Francisco; Naval-Parra, Beatriz; Sastre-Pérez, Jesús

2015-01-01

Nowadays, dental implant treatment is a very common option for patients even in medical compromised conditons. Some complications related to them have been described. Periimplantitis (PI) is one of the biggest concerns complications of these kind of treatments, probably has a multifactorial aethiology. Usually the consequences of PI are the loss of the implants and prostheses, expenses of money and time for dentists and patients. Very often PI implies the necesity of repeating the treatment . Pathological mandibular fracture due to PI is a severe but infrequent complication after dental implant treatment, especially after PI. In this study we present three cases of mandibular pathologic fractures among patients with different medical and dental records but similar management: two of them had been treated years ago of oral squamous cell carcinoma with surgery and radiotherapy, the other patient received oral bisphosphonates for osteoporosis some years after implantation. We analized the causes, consequences and posible prevention of these fractures as well as the special features of this kind of mandibular fractures and the different existing treatments. Key words:Periimplantitis, pathological mandibular fracture, mandibular atrophy, bicortical implants. PMID:26155355

Pathological mandibular fracture: A severe complication of periimplantitis.

PubMed

Naval-Gías, Luis; Rodriguez-Campo, Francisco; Naval-Parra, Beatriz; Sastre-Pérez, Jesús

2015-04-01

Nowadays, dental implant treatment is a very common option for patients even in medical compromised conditons. Some complications related to them have been described. Periimplantitis (PI) is one of the biggest concerns complications of these kind of treatments, probably has a multifactorial aethiology. Usually the consequences of PI are the loss of the implants and prostheses, expenses of money and time for dentists and patients. Very often PI implies the necesity of repeating the treatment . Pathological mandibular fracture due to PI is a severe but infrequent complication after dental implant treatment, especially after PI. In this study we present three cases of mandibular pathologic fractures among patients with different medical and dental records but similar management: two of them had been treated years ago of oral squamous cell carcinoma with surgery and radiotherapy, the other patient received oral bisphosphonates for osteoporosis some years after implantation. We analized the causes, consequences and posible prevention of these fractures as well as the special features of this kind of mandibular fractures and the different existing treatments. Key words:Periimplantitis, pathological mandibular fracture, mandibular atrophy, bicortical implants.

Orthodontic camouflage of skeletal Class III malocclusion with miniplate: a case report

PubMed Central

Farret, Marcel Marchiori; Farret, Milton M. Benitez; Farret, Alessandro Marchiori

2016-01-01

ABSTRACT Introduction: Skeletal Class III malocclusion is often referred for orthodontic treatment combined with orthognathic surgery. However, with the aid of miniplates, some moderate discrepancies become feasible to be treated without surgery. Objective: To report the case of a 24-year-old man with severe skeletal Angle Class III malocclusion with anterior crossbite and a consequent concave facial profile. Methods: The patient refused to undergo orthognathic surgery; therefore, orthodontic camouflage treatment with the aid of miniplates placed on the mandibular arch was proposed. Results: After 18 months of treatment, a Class I molar and canine relationship was achieved, while anterior crossbite was corrected by retraction of mandibular teeth. The consequent decrease in lower lip fullness and increased exposure of maxillary incisors at smiling resulted in a remarkable improvement of patient's facial profile, in addition to an esthetically pleasing smile, respectively. One year later, follow-up revealed good stability of results. PMID:27653269

Orthodontic camouflage of skeletal Class III malocclusion with miniplate: a case report.

PubMed

Farret, Marcel Marchiori; Farret, Milton M Benitez; Farret, Alessandro Marchiori

2016-01-01

Skeletal Class III malocclusion is often referred for orthodontic treatment combined with orthognathic surgery. However, with the aid of miniplates, some moderate discrepancies become feasible to be treated without surgery. To report the case of a 24-year-old man with severe skeletal Angle Class III malocclusion with anterior crossbite and a consequent concave facial profile. The patient refused to undergo orthognathic surgery; therefore, orthodontic camouflage treatment with the aid of miniplates placed on the mandibular arch was proposed. After 18 months of treatment, a Class I molar and canine relationship was achieved, while anterior crossbite was corrected by retraction of mandibular teeth. The consequent decrease in lower lip fullness and increased exposure of maxillary incisors at smiling resulted in a remarkable improvement of patient's facial profile, in addition to an esthetically pleasing smile, respectively. One year later, follow-up revealed good stability of results.

Study of Damped Set-Back Pins for S and A Mechanisms.

DTIC Science & Technology

1976-11-01

arm device for artillery munitions. This damped set-back pin assembly is one of two safety features on a S and A device used in the M739 PD/XM587 ET...The damped set-back pin study program was for the design, testing, fabrication, and delivery and damped set-back pin assemblies for use in a safe and...fuzes for a rotating projectile. A pin, porous disc, return spring, floating O-ring, and sleeve comprise the selected damped set-back pin assembly

[Facial femalization in transgenders].

PubMed

Yahalom, R; Blinder, D; Nadel, S

2015-07-01

Transsexualism is a gender identity disorder in which there is a strong desire to live and be accepted as a member of the opposite sex. In male-to-female transsexuals with strong masculine facial features, facial feminization surgery is performed as part of the gender reassignment. A strong association between femininity and attractiveness has been attributed to the upper third of the face and the interplay of the glabellar prominence of the forehead. Studies have shown that a certain lower jaw shape is characteristic of males with special attention to the strong square mandibular angle and chin and also suggest that the attractive female jaw is smaller with a more round shape mandibular angles and a pointy chin. Other studies have shown that feminization of the forehead through cranioplasty have the most significant impact in determining the gender of a patient. Facial feminization surgeries are procedures aimed to change the features of the male face to that of a female face. These include contouring of the forehead, brow lift, mandible angle reduction, genioplasty, rhinoplasty and a variety of soft tissue adjustments. In our maxillofacial surgery department at the Sheba Medical Center we perform forehead reshaping combining with brow lift and at the same surgery, mandibular and chin reshaping to match the remodeled upper third of the face. The forehead reshaping is done by cranioplasty with additional reduction of the glabella area by burring of the frontal bone. After reducing the frontal bossing around the superior orbital rims we manage the soft tissue to achieve the brow lift. The mandibular reshaping, is performed by intraoral approach and include contouring of the angles by osteotomy for a more round shape (rather than the manly square shape angles), as well as reshaping of the bone in the chin area in order to make it more pointy, by removing the lateral parts of the chin and in some cases performing also genioplasty reduction by AP osteotomy.

Clinical significance of computed tomography assessment for third molar surgery

PubMed Central

Nakamori, Kenji; Tomihara, Kei; Noguchi, Makoto

2014-01-01

Surgical extraction of the third molar is the most commonly performed surgical procedure in the clinical practice of oral surgery. Third molar surgery is warranted when there is inadequate space for eruption, malpositioning, or risk for cyst or odontogenic tumor formation. Preoperative assessment should include a detailed morphologic analysis of the third molar and its relationship to adjacent structures and surrounding tissues. Due to developments in medical engineering technology, computed tomography (CT) now plays a critical role in providing the clear images required for adequate assessment prior to third molar surgery. Removal of the maxillary third molar is associated with a risk for maxillary sinus perforation, whereas removal of the mandibular third molar can put patients at risk for a neurosensory deficit from damage to the lingual nerve or inferior alveolar nerve. Multiple factors, including demographic, anatomic, and treatment-related factors, influence the incidence of nerve injury during or following removal of the third molar. CT assessment of the third molar prior to surgery can identify some of these risk factors, such as the absence of cortication between the mandibular third molar and the inferior alveolar canal, prior to surgery to reduce the risk for nerve damage. This topic highlight presents an overview of the clinical significance of CT assessment in third molar surgery. PMID:25071882

Technical procedures for template-guided surgery for mandibular reconstruction based on digital design and manufacturing.

PubMed

Liu, Yun-feng; Xu, Liang-wei; Zhu, Hui-yong; Liu, Sean Shih-Yao

2014-05-23

The occurrence of mandibular defects caused by tumors has been continuously increasing in China in recent years. Conversely, results of the repair of mandibular defects affect the recovery of oral function and patient appearance, and the requirements for accuracy and high surgical quality must be more stringent. Digital techniques--including model reconstruction based on medical images, computer-aided design, and additive manufacturing--have been widely used in modern medicine to improve the accuracy and quality of diagnosis and surgery. However, some special software platforms and services from international companies are not always available for most of researchers and surgeons because they are expensive and time-consuming. Here, a new technical solution for guided surgery for the repair of mandibular defects is proposed, based on general popular tools in medical image processing, 3D (3 dimension) model reconstruction, digital design, and fabrication via 3D printing. First, CT (computerized tomography) images are processed to reconstruct the 3D model of the mandible and fibular bone. The defect area is then replaced by healthy contralateral bone to create the repair model. With the repair model as reference, the graft shape and cutline are designed on fibular bone, as is the guide for cutting and shaping. The physical model, fabricated via 3D printing, including surgical guide, the original model, and the repair model, can be used to preform a titanium locking plate, as well as to design and verify the surgical plan and guide. In clinics, surgeons can operate with the help of the surgical guide and preformed plate to realize the predesigned surgical plan. With sufficient communication between engineers and surgeons, an optimal surgical plan can be designed via some common software platforms but needs to be translated to the clinic. Based on customized models and tools, including three surgical guides, preformed titanium plate for fixation, and physical models of the mandible, grafts for defect repair can be cut from fibular bone, shaped with high accuracy during surgery, and fixed with a well-fitting preformed locking plate, so that the predesigned plan can be performed in the clinic and the oral function and appearance of the patient are recovered. This method requires 20% less operating time compared with conventional surgery, and the advantages in cost and convenience are significant compared with those of existing commercial services in China. This comparison between two groups of cases illustrates that, with the proposed method, the accuracy of mandibular defect repair surgery is increased significantly and is less time-consuming, and patients are satisfied with both the recovery of oral function and their appearance. Until now, more than 15 cases have been treated with the proposed methods, so their feasibility and validity have been verified.

Orthodontic treatment for oral rehabilitation after multiple maxillofacial bone fractures.

PubMed

Nakamura, Yoshiki; Ogino, Tomoko Kuroiwa; Hirashita, Ayao

2008-09-01

We present the orthodontic treatment of a patient with occlusal dysfunction after plastic surgery for multiple maxillofacial bone fractures caused by a traffic accident. The patient had mandibular deviation to the right because of inappropriate repositioning and fixation of the fractured bone and complete avulsion of both mandibular central incisors. The bilateral mandibular incisors, canines, and premolars were also suspected of partial avulsion or alveolar bone fracture. Several tests, including percussion and dental computed tomography, were performed on these teeth to rule out ankylosis and confirm tooth movement. Camouflage orthodontic treatment was carried out with expansion of the maxillary arch, alignment of both arches, and space closure between the mandibular lateral incisors to improve the occlusion. Good occlusion and interdigitation were obtained. Orthodontic treatment is useful for the rehabilitation of occlusal dysfunction caused by multiple maxillofacial bone fractures.

Repair of a mandibular defect with a free vascularized coccygeal vertebra transfer in a dog.

PubMed

Yeh, L S; Hou, S M

1994-01-01

Bilateral mandibular defects in a male mongrel dog were repaired. On the left side, a free vascularized coccygeal bone graft that included the median caudal artery and caudal vein was used to correct the defect. On the right side, the defect was bridged with a bone plate and screws. For further immobilization, the muzzle was temporarily taped for 3 weeks and a pharyngostomy tube was used for nutritional support. The dog was able to eat dry commercial food satisfactorily within 2 months of surgery despite mild malocclusion. Radiographs taken 2 months and 18 months postoperatively showed bony union with graft hypertrophy in the left mandible, whereas the right mandibular defect showed protracted nonunion. The results indicate that vascularized coccygeal vertebra transfer provides an alternative for the management of canine mandibular defects.

A case of Sotos syndrome treated with distraction osteogenesis in maxilla and mandible.

PubMed

Takano, Masayuki; Kasahara, Kiyohiro; Ogawa, Chiharu; Katada, Hidenori; Sueishi, Kenji

2012-01-01

Sotos syndrome is inherited in an autosomal-dominant manner and is characterized by increased birth weight, excessive growth, advanced bone age, and distinctive facial features, including dolichocephaly, hypertelorism, and a prominent mandible. We treated a jaw deformity due to Sotos syndrome consisting of malocclusion due to a narrow maxillary dental arch and mandibular retrusion from hypoplasia of the rami. The patient was a 17-year-old man. Malocclusion due to a narrow maxillary dental arch and mandibular retrusion was diagnosed. Rapid maxillary expansion with Lines corticotomy and mandibular advancement with distraction osteogenesis were performed. The maxilla was expanded laterally a total of 3 mm and the mandible prolonged 12 mm in the posterior area of the mandibular body. Subsequently, orthodontic treatment was continued. At present, 5 years after surgery, occlusion remains good and stable.

Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery.

PubMed

da Silva-Junior, Geraldo Prisco; de Almeida Souza, Liane Maciel; Groppo, Francisco Carlos

In order to compare the efficacy of lidocaine and articaine for pain control during third molar surgery, 160 patients presenting bilateral asymptomatic impacted mandibular third molars were selected. They received 1.8 mL of 2% lidocaine with epinephrine 1:100,000 during inferior alveolar nerve block. In group 1 (n = 80), an infiltrative injection of 0.9 mL of 2% lidocaine with epinephrine 1:100,000 was performed in buccal-distal mucosa of the third molar. Group 2 (n = 80) received 0.9 mL of 4% articaine with epinephrine 1:100,000 in the contralateral side. All procedures were performed at the same visit, by a single operator, in a double-blind and parallel design. The duration of each surgery and the moment when the patient expressed pain were noted. Data were analyzed by nonpaired t test and chi-square test (alpha = 5%). Duration of surgery did not differ (p = .83) between Groups 1 (19.8 ± 2.3 minutes) and 2 (19.7 ± 3.0 minutes). Pain was expressed more in group 1 (26.3%) than in group 2 (10%) (odds ratio = 3.2, p = .0138). In both groups, tooth sectioning was the most painful event (p < .0001). No influence of gender (p = .85) or age (p = .96) was observed in pain response. Buccal infiltration of 4% articaine with epinephrine 1:100,000 showed more efficacy than 2% lidocaine with epinephrine 1:100,000 when used in combination with inferior alveolar nerve block in controlling intraoperative pain related to impacted mandibular third molar surgery.

Cephalometric and three-dimensional assessment of the posterior airway space and imaging software reliability analysis before and after orthognathic surgery.

PubMed

Burkhard, John Patrik Matthias; Dietrich, Ariella Denise; Jacobsen, Christine; Roos, Malgorzota; Lübbers, Heinz-Theo; Obwegeser, Joachim Anton

2014-10-01

This study aimed to compare the reliability of three different imaging software programs for measuring the PAS and concurrently to investigate the morphological changes in oropharyngeal structures in mandibular prognathic patients before and after orthognathic surgery by using 2D and 3D analyzing technique. The study consists of 11 randomly chosen patients (8 females and 3 males) who underwent maxillomandibular treatment for correction of Class III anteroposterior mandibular prognathism at the University Hospital in Zurich. A set of standardized LCR and CBCT-scans were obtained from each subject preoperatively (T0), 3 months after surgery (T1) and 3 months to 2 years postoperatively (T2). Morphological changes in the posterior airway space (PAS) were evaluated longitudinally by two different observers with three different imaging software programs (OsiriX(®) 64-bit, Switzerland; Mimics(®), Belgium; BrainLab(®), Germany) and manually by analyzing cephalometric X-rays. A significant increase in the upper airway dimensions before and after surgery occurred in all measured cases. All other cephalometric distances showed no statistically significant alterations. Measuring the volume of the PAS showed no significant changes in all cases. All three software programs showed similar outputs in both cephalometric analysis and 3D measuring technique. A 3D design of the posterior airway seems to be far more reliable and precise phrasing of a statement of postoperative gradients than conventional radiography and is additionally higher compared to the corresponding manual method. In case of Class III mandibular prognathism treatment with bilateral split osteotomy of the mandible and simultaneous maxillary advancement, the negative effects of PAS volume decrease may be reduced and might prevent a developing OSAS. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery

PubMed Central

da Silva-Junior, Geraldo Prisco; de Almeida Souza, Liane Maciel; Groppo, Francisco Carlos

2017-01-01

In order to compare the efficacy of lidocaine and articaine for pain control during third molar surgery, 160 patients presenting bilateral asymptomatic impacted mandibular third molars were selected. They received 1.8 mL of 2% lidocaine with epinephrine 1:100,000 during inferior alveolar nerve block. In group 1 (n = 80), an infiltrative injection of 0.9 mL of 2% lidocaine with epinephrine 1:100,000 was performed in buccal-distal mucosa of the third molar. Group 2 (n = 80) received 0.9 mL of 4% articaine with epinephrine 1:100,000 in the contralateral side. All procedures were performed at the same visit, by a single operator, in a double-blind and parallel design. The duration of each surgery and the moment when the patient expressed pain were noted. Data were analyzed by nonpaired t test and chi-square test (alpha = 5%). Duration of surgery did not differ (p = .83) between Groups 1 (19.8 ± 2.3 minutes) and 2 (19.7 ± 3.0 minutes). Pain was expressed more in group 1 (26.3%) than in group 2 (10%) (odds ratio = 3.2, p = .0138). In both groups, tooth sectioning was the most painful event (p < .0001). No influence of gender (p = .85) or age (p = .96) was observed in pain response. Buccal infiltration of 4% articaine with epinephrine 1:100,000 showed more efficacy than 2% lidocaine with epinephrine 1:100,000 when used in combination with inferior alveolar nerve block in controlling intraoperative pain related to impacted mandibular third molar surgery. PMID:28604089

[The clinical effect of root amputation in the treatment of periodontal/alveolar abscess].

PubMed

Tan, Baochun; Wu, Wenlei; Sun, Weibin; Xiao, Jianping

2012-06-01

To study the clinical effect of root amputation in the treatment of periodontal/alveolar abscess teeth with one severe lesion root. 30 periodontal/alveolar abscess teeth with one severe lesion root were chosen in the study. After root canal treatment, supragingival scaling, subgingival scaling and root planning, occlusal adjustment were done. Then the teeth were treated by root amputation. The clinical effect was evaluated 3 months, 6 months and 1 year after surgery. One year after surgery, 27 of 30 teeth were successful, 1 mandibular molar occurred root fracture, 1 mandibular molar was removed because of tooth loosening secondary to periodontal damage. 1 patient lost. Root amputation is an effective solution of periodontal/alveolar abscess.

Combined Orthodontic and Surgical Approach in the Correction of a Class III Skeletal Malocclusion with Mandibular Prognathism and Vertical Maxillary Excess Using Bimaxillary Osteotomy.

PubMed

Jose Cherackal, George; Thomas, Eapen; Prathap, Akhilesh

2013-01-01

For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment. Surgery is not a substitute for orthodontics in these patients. Instead, it must be properly coordinated with orthodontics and other dental treatments to achieve good overall results. Dramatic progress in recent years has made it possible for combined surgical orthodontic treatment to be carried out successfully for patients with a severe dentofacial problem of any type. This case report provides an overview of the current treatment methodology in managing a combination of asymmetrical mandibular prognathism and vertical maxillary excess.

Quality of Postoperative Pain Management After Maxillofacial Fracture Repair.

PubMed

Peisker, Andre; Meissner, Winfried; Raschke, Gregor F; Fahmy, Mina D; Guentsch, Arndt; Schiller, Juliane; Schultze-Mosgau, Stefan

2018-05-01

Effective pain management is an essential component in the perioperative care of surgical patients. However, postoperative pain after maxillofacial fracture repair and its optimal therapy has not been described in detail. In a prospective cohort study, 95 adults rated their pain on the first postoperative day after maxillofacial fracture repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. Quality Improvement in Postoperative Pain Management allowed for a standardized assessment of patients' characteristics and pain-related parameters. Overall, the mean maximal pain and pain on activity (numeric rating scales) were significantly higher in patients with mandibular fractures than in patients with midface fractures (P = 0.002 and P = 0.045, respectively). In patients with mandibular fractures, a longer duration of surgery was significantly associated with higher satisfaction with pain intensity (P = 0.015), but was more frequently associated with postoperative vomiting (P = 0.023). A shorter duration of surgery and an absence of preoperative pain counseling in these patients were significantly correlated to desire for more pain medication (P = 0.049 and P = 0.004, respectively). Patients with mandibular fractures that received opioids in the recovery room had significantly higher strain-related pain (P = 0.017). In patients with midface fractures, a longer duration of surgery showed significantly higher levels of decreased mobility (P = 0.003). Patients receiving midazolam for premedication had significantly less minimal pain (P = 0.021). Patients with mandibular fractures seem to have more postoperative pain than patients with midface fractures. Monitoring of postsurgical pain and a procedure-specific pain-treatment protocol should be performed in clinical routine.

Anatomy of Mandibular Vital Structures. Part I: Mandibular Canal and Inferior Alveolar Neurovascular Bundle in Relation with Dental Implantology

PubMed Central

Wang, Hom-Lay; Sabalys, Gintautas

2010-01-01

ABSTRACT Objectives It is critical to determine the location and configuration of the mandibular canal and related vital structures during the implant treatment. The purpose of the present study was to review the literature concerning the mandibular canal and inferior alveolar neurovascular bundle anatomical variations related to the implant surgery. Material and Methods Literature was selected through the search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular canal, inferior alveolar nerve, and inferior alveolar neurovascular bundle. The search was restricted to English language articles, published from 1973 to November 2009. Additionally, a manual search in the major anatomy, dental implant, prosthetic and periodontal journals and books were performed. Results In total, 46 literature sources were obtained and morphological aspects and variations of the anatomy related to implant treatment in posterior mandible were presented as two entities: intraosseous mandibular canal and associated inferior alveolar neurovascular bundle. Conclusions A review of morphological aspects and variations of the anatomy related to mandibular canal and mandibular vital structures are very important especially in implant therapy since inferior alveolar neurovascular bundle exists in different locations and possesses many variations. Individual, gender, age, race, assessing technique used and degree of edentulous alveolar bone atrophy largely influence these variations. It suggests that osteotomies in implant dentistry should not be developed in the posterior mandible until the position of the mandibular canal is established. PMID:24421958

Mandibular Third Molar Impaction: Review of Literature and a Proposal of a Classification

PubMed Central

Daugela, Povilas

2013-01-01

ABSTRACT Objectives The purpose of present article was to review impacted mandibular third molar aetiology, clinical anatomy, radiologic examination, surgical treatment and possible complications, as well as to create new mandibular third molar impaction and extraction difficulty degree classification based on anatomical and radiologic findings and literature review results. Material and Methods Literature was selected through a search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular third molar, impacted mandibular third molar, inferior alveolar nerve injury third molar, lingual nerve injury third molar. The search was restricted to English language articles, published from 1976 to April 2013. Additionally, a manual search in the major anatomy and oral surgery journals and books was performed. The publications there selected by including clinical and human anatomy studies. Results In total 75 literature sources were obtained and reviewed. Impacted mandibular third molar aetiology, clinical anatomy, radiographic examination, surgical extraction of and possible complications, classifications and risk factors were discussed. New mandibular third molar impaction and extraction difficulty degree classification based on anatomical and radiologic findings and literature review results was proposed. Conclusions The classification proposed here based on anatomical and radiological impacted mandibular third molar features is promising to be a helpful tool for impacted tooth assessment as well as for planning for surgical operation. Further clinical studies should be conducted for new classification validation and reliability evaluation. PMID:24422029

Association between third molar and mandibular angle fracture: A systematic review and meta-analysis.

PubMed

Giovacchini, Francesco; Paradiso, Daniele; Bensi, Caterina; Belli, Stefano; Lomurno, Giuseppe; Tullio, Antonio

2018-04-01

The aim of this study was to investigate the risk of mandibular angle fracture associated with the presence of a mandibular third molar and its position when the mandibular fracture occurs. A systematic literary search was performed in Pubmed, Scopus, and the Cochrane Library for observational studies with at least 250 patients that included frequency of mandibular angle fracture, presence of third molar, and its position. A total of seven studies were included in the review, from an initial search of 622 titles. The relative risk of mandibular angle fracture with third molar was 1.90 (95% CI = 1.47-2.46). The relative risk of mandibular angle fracture related to third molar position (according to the Pell and Gregory classification) was 1.18 (95% CI = 0.62-2.25), 1.98 (95% CI = 0.95-4.10), 2.72 (95% CI = 1.78-4.16), 1.31 (95% CI = 0.80-2.14), 2.21 (95% CI = 1.69-2.87) and 2.99 (95% CI = 2.12-4.22) for Class A, Class B, Class C, Class I, Class II, and Class III, respectively. Our meta-analysis reported a two-fold increased risk of mandibular angle fracture with the presence of a third molar in patients who presented with mandibular fractures. Even the third molar position seemed to influence mandibular angle fracture, especially Class C, Class II, and Class III. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

A Surgery-first approach in surgical-orthodontic treatment of mandibular prognathism--a case report.

PubMed

Yu, Chung-Chih; Chen, Po-Hsun; Liou, Eric J W; Huang, Chiung-Shing; Chen, Yu-Ray

2010-01-01

The conventional approach in orthodontic surgery treatment of dentofacial anomalies requires a varied period of pre-surgical orthodontic treatment. This presurgical period is considered to be important for adequate surgical treatment and stable results. This period is usually long bothersome for patients because dental decompensation is required and there is consequent deterioration of aesthetics and function, especially in cases of skeletal Class III occlusion. At Chang Gung Craniofacial Center, a surgery-first approach (SFA), i.e. minimal pre-surgical orthodontics, is one of the treatment choices for Class III patients. In this report, we present a 19-year-old man with mandibular prognathism, an anterior open bite and severe dental crowding treated with SFA. The patient received orthognathic surgery a week after bracing of the teeth. The operation and recovery were uneventful as well as the following orthodontic treatment. The total treatment time was only four months, much shorter than with the conventional approach. The patient benefitted from immediate improvement of the facial profile after surgery, and a much shorter total treatment, and the results were not compromised. We believe in selected cases, SFA is a good and effective treatment alternative.

Pre-operative planning for mandibular reconstruction - A full digital planning workflow resulting in a patient specific reconstruction

PubMed Central

2011-01-01

Objectives Reconstruction of large mandiblular defects following ablative oncologic surgery could be done by using vascularized bone transfer or, more often, primarily with simultaneous or delayed bone grafting, using load bearing reconstruction plates. Bending of these reconstruction plates is typically directed along the outer contour of the original mandible. Simultaneously or in a second operation vascularized or non-vascularized bone is fixed to the reconstruction plate. However, the prosthodontic-driven backward planning to ease bony reconstruction of the mandible in terms of dental rehabilitation using implant-retained overdentures might be an eligible solution. The purpose of this work was to develop, establish and clinically evaluate a novel 3D planning procedure for mandibular reconstruction. Materials and methods Three patients with tumors involving the mandible, which included squamous cell carcinoma in the floor of the mouth and keratocystic odontogenic tumor, were treated surgically by hemimandibulectomy. Results In primary alloplastic mandible reconstruction, shape and size of the reconstruction plate could be predefined and prebent prior to surgery. Clinical relevance This study provides modern treatment strategies for mandibular reconstruction. PMID:21968330

Setbacks in the process of assimilation of problematic experiences in two cases of emotion-focused therapy for depression.

PubMed

Mendes, Inês; Rosa, Catarina; Stiles, William B; Caro Gabalda, Isabel; Gomes, Pedro; Basto, Isabel; Salgado, João

2016-11-01

Research on the assimilation model has suggested that psychological change takes place in a sequence of stages punctuated by setbacks, that is, by transient reversals in the developmental course. This study analyzed such setbacks in one good outcome case and one poor outcome case of Emotion-focused therapy (EFT) for depression. Intensive analyses of five transcribed sessions from each case identified 26 setbacks in the good outcome case and 27 in the poor outcome case. The reason for each setback was classified into one of four categories: balance strategy, exceeding the therapeutic zone of proximal development either induced by the therapist (ZPD-T) or induced by the client (ZPD-C), or spontaneous switches. In the good outcome case the most frequent reasons for setbacks were balance strategy and spontaneous switches, whereas in the poor outcome case the most frequent reason for setbacks was ZPD-T. As in previously studied therapies, setbacks in EFT, usually represent productive work on relatively less advanced strands of the client's major problems. Results point to the importance of the therapist attending to the limits of the client's therapeutic ZPD.

An indigenous method for closed reduction of pediatric mandibular parasymphysis fracture.

PubMed

Kumar, Naresh; Singh, Akhilesh Kumar; Pandey, Arun; Verma, Vishal

2015-01-01

Mandibular fractures in children are very rare as compared to adults due to protected anatomic features of child and less exposure to road traffic accidents. Management becomes complicated due to inherent dynamic nature, instability of mixed dentition and fear of surgery. Conservative management can be done with the help of acrylic cap splints along with circum-mandibular wiring, intermaxillary fixation with eyelet wires, arch wires or open reduction and internal fixation with bio-resorbable plates. Different methods have various pros and cons. The choice of anesthesia is also very crucial sometimes. This case report describes a new method of closed reduction with 18 gauge needle simulated as an arch bar performed under local anaesthesia.

An indigenous method for closed reduction of pediatric mandibular parasymphysis fracture

PubMed Central

Kumar, Naresh; Singh, Akhilesh Kumar; Pandey, Arun; Verma, Vishal

2015-01-01

Mandibular fractures in children are very rare as compared to adults due to protected anatomic features of child and less exposure to road traffic accidents. Management becomes complicated due to inherent dynamic nature, instability of mixed dentition and fear of surgery. Conservative management can be done with the help of acrylic cap splints along with circum-mandibular wiring, intermaxillary fixation with eyelet wires, arch wires or open reduction and internal fixation with bio-resorbable plates. Different methods have various pros and cons. The choice of anesthesia is also very crucial sometimes. This case report describes a new method of closed reduction with 18 gauge needle simulated as an arch bar performed under local anaesthesia. PMID:27390498

Perception of oral maxillofacial surgery by health-care professionals.

PubMed

Rocha, N S; Laureano Filho, J R; Silva, E D O; Almeida, R C A

2008-01-01

Oral and Maxillofacial Surgery (OMFS), a dentistry specialty recognized by the Federal Dentistry Board in the mid-1960s, is responsible for the diagnosis, and clinical and surgical treatment of traumatic, congenital, developmental and iatrogenic lesions in the maxillofacial complex. Even today, difficulties are experienced owing to the lack of knowledge of the general public and health professionals concerning the scope of OMFS. To investigate recognition of the scope of OMFS, 400 questionnaires were sent to dentistry students, medical students, dentists and doctors, in 4 equal groups. The questionnaire covered 26 clinical situations in four different specialties (OMFS, Plastic Surgery, Ear Nose and Throat Surgery, Head and Neck Surgery) and an option with no specialty specified. Each interviewee had to correlate the clinical situation with the respective specialist. For facial trauma, dento-facial deformities, mandibular reconstruction and temporomandibular joint surgery, most respondents would consult the OMF surgeon for treatment (mean, 90%). In cases of oral biopsy and treatment of benign mandibular tumours the mean referral rate to OMFS was low (48%). On the basis of the questionnaire responses, a good level of knowledge of the scope of OMFS was found. In order to ensure the correct referral of all patients, the specialty needs to broaden its horizons.

Mandibular fracture caused by periodontal abscess: Radiological, US, CT and MRI findings.

PubMed

Mazza, D; Marini, M; Tesei, J; Primicerio, P

2006-09-01

Mandibular fracture is a rare but possible outcome of a periodontal abscess. A case of complete fracture of the mandible with abscess infiltrating the surrounding soft tissues is described. The patient reported nor trauma, nor locoregional surgery. Ultrasonography and orthopantomography revealed the fracture of the mandible and the abscess at the masseter muscle. Further preoperative diagnostic examinations included CT and MRI. CT revealed the complete fracture line more clearly; MR the extension of the abscess.

[How to make your own custom cutting guides for both mandibular and fibular stair step osteotomies?

PubMed

Rem, K; Bosc, R; De Kermadec, H; Hersant, B; Meningaud, J-P

2017-12-01

Using tailored cutting guides for osteocutaneous free fibula flap in complex mandibular reconstruction after cancer resection surgery constitutes a substantial improvement. Autonomously conceiving and manufacturing the cutting guides within a plastic surgery department with computer-aided design (CAD) and three-dimensional (3D) printing allows planning more complex osteotomies, such as stair-step osteotomies, in order to achieve more stable internal fixations. For the past three years, we have been producing by ourselves patient-tailored cutting guides using CAD and 3D printing. Osteotomies were virtually planned, making the cutting lines more complex in order to optimize the internal fixation stability. We also printed reconstructed mandible templates and shaped the reconstruction plates on them. We recorded data including manufacturing techniques and surgical outcomes. Eleven consecutive patients were operated on for an oral cavity cancer. For each patient, we planned the fibular and mandibular stair-step osteotomies and we produced tailored cutting guides. In all patients, we achieved to get immediately stable internal fixations and in 10 patients, a complete bone consolidation after 6 months. Autonomously manufacturing surgical cutting guides for mandibular reconstruction by free fibula flap is a significant improvement, regarding ergonomics and precision. Planning stair-step osteotomies to perform complementary internal fixation increases contact surface and congruence between the bone segments, thus improving the reconstructed mandible stability. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

[Comparison of minimally invasive extraction and traditional method in the extraction of impacted mandibular third molar].

PubMed

Xu, Fang; Zhang, Hui-Xia

2016-10-01

To compare minimally invasive extraction and traditional method in the extraction of impacted mandibular third molar. One hundred and sixty patients with impacted mandibular third molar were equally divided into two groups. Patients in the experimental group were treated with minimally invasive extraction, using implant machine and luxator, while patients in the control group were treated with traditional methods including use of orthodox chisel. The operation time, intraoperative and postoperative complications including deformation of extraction sockets, dry socket, limitation of mouth opening, pain and swelling, and fear were observed and compared between the two groups. The data were analyzed with SPSS18.0 software package. The operation time was (17.32±1.01) min in the experimental group, significantly shorter than the control group which was (33.46±1.12）min (P<0.05); significant difference was found in the incidence of root fracture, medium or severe tooth sockets deformation and incidence of psychological fear during operation between the control group and experimental group(P<0.05); the degree of mouth opening after surgery, the incidence of moderate or severe pain after surgery was significantly lower in the experimental than in the control group(P<0.05). Minimally invasive extraction of mandibular impacted wisdom tooth is better than traditional method, with shorter operation time and less intraoperative and postoperative complications, which should be widely applied in clinic.

Fibular free flap reconstruction for the management of advanced bilateral mandibular osteoradionecrosis.

PubMed

Shan, Xiao-Feng; Li, Ru-Huang; Lu, Xu-Guang; Cai, Zhi-Gang; Zhang, Jie; Zhang, Jian-Guo

2015-03-01

Fibular osteoseptocutaneous flap has been widely used for unilateral mandibular reconstruction. However, reports about the effects of fibular osteoseptocutaneous flap for the reconstruction of bilateral mandibular defects are limited. In this study, we used free vascularized fibular flaps to successfully manage bilateral mandibular osteoradionecrosis(ORN) in 5 patients. Functional aspects were evaluated during the reconstruction process. All 5 patients had bilateral refractory ORN of the mandible and underwent radical resection between 2003 and 2011. The reconstruction surgery was performed in 2 stages using 2 free fibular flaps in 3 patients. In the other 2 patients, reconstruction was performed in a single stage using 2 separate flaps prepared from a single fibula. All patients had a healthy mandibular symphysis and meniscus of the temporomandibular joint, and these structures were preserved during the reconstruction.Of the 10 defects involving the mandible sides, 9 were successfully reconstructed. One microvascular composite flap failed because of radiation injury to the arterial endothelium at the recipient site. After the treatments, all patients had good esthetic and functional outcomes. Preoperative clinical features such as trismus and dysphagia were also markedly improved. Our surgical method may be an effective alternative for the clinical management of advanced bilateral mandibular ORN.

Surgery-first: a new approach to orthognathic surgery

PubMed Central

DE NUCCIO, F.; DE NUCCIO, F.; D’EMIDIO, M.M.; PELO, S.

2016-01-01

SUMMARY This case study describes the treatment of a 20-year-old white woman with a skeletal Class III and dental Class III malocclusion followed by a retrognathic and contracted maxilla, light mandibular crowding and a median line deviation of 5 mm. The treatment was based on the Surgery-First approach, involving LeFort I maxillary advancement surgery, and it was followed by orthodontic treatment. During the 6-month treatment period, excellent aesthetic results and good functional occlusion were achieved. PMID:28280538

Early Experience with Biodegradable Fixation of Pediatric Mandibular Fractures.

PubMed

Mazeed, Ahmed Salah; Shoeib, Mohammed Abdel-Raheem; Saied, Samia Mohammed Ahmed; Elsherbiny, Ahmed

2015-09-01

This clinical study aims to evaluate the stability and efficiency of biodegradable self-reinforced poly-l/dl-lactide (SR-PLDLA) plates and screws for fixation of pediatric mandibular fractures. The study included 12 patients (3-12 years old) with 14 mandibular fractures. They were treated by open reduction and internal fixation by SR-PLDLA plates and screws. Maxillomandibular fixation was maintained for 1 week postoperatively. Clinical follow-up was performed at 1 week, 6 weeks, 3 months, and 12 months postoperatively. Radiographs were done at 1 week, 3 months, and 12 months postoperatively to observe any displacement and fracture healing. All fractures healed both clinically and radiologically. No serious complications were reported in the patients. Normal occlusion was achieved in all cases. Biodegradable osteofixation of mandibular fractures offers a valuable clinical solution for pediatric patients getting the benefit of avoiding secondary surgery to remove plates, decreasing the hospital stay, further painful procedures, and psychological impact.

Efficacy of hyaluronic acid spray on swelling, pain, and trismus after surgical extraction of impacted mandibular third molars.

PubMed

Koray, M; Ofluoglu, D; Onal, E A; Ozgul, M; Ersev, H; Yaltirik, M; Tanyeri, H

2014-11-01

The aim of this study was compare the efficacies of two oral sprays in reducing swelling, pain, and trismus after the extraction of impacted mandibular third molars. This prospective double-blind, randomized, crossover clinical trial included 34 patients with bilateral symmetrically impacted mandibular third molars of similar surgical difficulty. Hyaluronic acid or benzydamine hydrochloride spray was applied (two pumps) to the extraction area, three times daily for 7 days. Swelling was evaluated using a tape measure method, pain with a visual analogue scale (VAS), and trismus by measuring the maximum inter-incisal opening. Assessments were made on the day of surgery and on days 2 and 7 after surgery. Statistically significant differences were detected for the swelling and trismus values between the two treatment groups on the second postoperative day (P=0.002 and P=0.03, respectively). However, there was no statistically significant difference in VAS scores between the two groups. The administration of hyaluronic acid spray was more effective than benzydamine hydrochloride spray in reducing swelling and trismus. Although no evidence of a reduction in pain levels was detected, hyaluronic acid appears to offer a beneficial effect in the management of swelling and trismus during the immediate postoperative period following impacted third molar surgery. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

The role of intraoperative positioning of the inferior alveolar nerve on postoperative paresthesia after bilateral sagittal split osteotomy of the mandible: prospective clinical study.

PubMed

Hanzelka, T; Foltán, R; Pavlíková, G; Horká, E; Sedý, J

2011-09-01

Bilateral sagittal split osteotomy (BSSO) aims to correct congenital or acquired mandibular abnormities. Temporary or permanent neurosensory disturbance is the most frequent complication of BSSO. To evaluate the influence of IAN handling during osteotomy, the authors undertook a prospective study in 290 patients who underwent BSSO. The occurrence and duration of paresthesia was evaluated 4 weeks, 3 months, 6 months, and 1 year after surgery. Paresthesia developed immediately after surgery in almost half of the patients. Most cases of paresthesia resolved within 1 year after surgery. A significantly higher prevalence of paresthesia was observed on the left side. The authors found a correlation between the type of IAN position between the left and right side. The type of split (and IAN exposure) did not have a significant effect on the occurrence or duration of neurosensory disturbance of the IAN. The authors did not find a correlation between the occurrence and duration of paresthesia and the direction of BSSO. Mandibular hypoplasia or mandibular progenia did not represent a predisposition for the development of paresthesia. In the development of IAN paresthesia, the type of IAN exposure and the split is less important than the side on which the split is carried out. Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Optimizing Functional Outcomes in Mandibular Condyle Reconstruction With the Free Fibula Flap Using Computer-Aided Design and Manufacturing Technology.

PubMed

Lee, Z-Hye; Avraham, Tomer; Monaco, Casian; Patel, Ashish A; Hirsch, David L; Levine, Jamie P

2018-05-01

Mandibular defects involving the condyle represent a complex reconstructive challenge for restoring proper function of the temporomandibular joint (TMJ) because it requires precise bone graft alignment for full restoration of joint function. The use of computer-aided design and manufacturing (CAD/CAM) technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap without the need for additional adjuncts. The purpose of this study was to analyze clinical and functional outcomes after reconstruction of mandibular condyle defects using only a free fibula graft with the help of virtual surgery techniques. A retrospective review was performed to identify all patients who underwent mandibular reconstruction with only a free fibula flap without any TMJ adjuncts after a total condylectomy. Three-dimensional modeling software was used to plan and execute reconstruction for all patients. From 2009 through 2014, 14 patients underwent reconstruction of mandibular defects involving the condyle with the aid of virtual surgery technology. The average age was 38.7 years (range, 11 to 77 yr). The average follow-up period was 2.6 years (range, 0.8 to 4.2 yr). Flap survival was 100% (N = 14). All patients reported improved facial symmetry, adequate jaw opening, and normal dental occlusion. In addition, they achieved good functional outcomes, including normal intelligible speech and the tolerance of a regular diet with solid foods. Maximal interincisal opening range for all patients was 25 to 38 mm with no lateral deviation or subjective joint pain. No patient had progressive joint hypomobility or condylar migration. One patient had ankylosis, which required release. TMJ reconstruction poses considerable challenges in bone graft alignment for full restoration of joint function. The use of CAD/CAM technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap through precise planning and intraoperative manipulation with optimal functional outcomes. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Combined Orthodontic and Surgical Approach in the Correction of a Class III Skeletal Malocclusion with Mandibular Prognathism and Vertical Maxillary Excess Using Bimaxillary Osteotomy

PubMed Central

Jose Cherackal, George; Thomas, Eapen; Prathap, Akhilesh

2013-01-01

For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment. Surgery is not a substitute for orthodontics in these patients. Instead, it must be properly coordinated with orthodontics and other dental treatments to achieve good overall results. Dramatic progress in recent years has made it possible for combined surgical orthodontic treatment to be carried out successfully for patients with a severe dentofacial problem of any type. This case report provides an overview of the current treatment methodology in managing a combination of asymmetrical mandibular prognathism and vertical maxillary excess. PMID:24455321

Initial Experience With rhBMP-2 Delivered in a Compressive Resistant Matrix for Mandibular Reconstruction in 5 Dogs.

PubMed

Boudrieau, Randy J

2015-05-01

To document cumulative initial experience and long-term follow-up of the use of rhBMP-2/CRM for reconstruction of large mandibular defects (≥5 cm) in dogs. Retrospective case series. Dogs (n = 5). Medical records (October 1999-April 2011) of dogs that had mandibular reconstruction for defects/resections of ≥5 cm using rhBMP-2/CRM were reviewed. Signalment, preoperative assessment/rationale for mandibular reconstruction, surgical methods, postoperative assessment of the reconstruction (evaluation of occlusion), and complications were recorded. A definitive histologic diagnosis was obtained in dogs that had mandibular resection for mass removal. Long-term complications were determined. A minimum time frame of 2-year in-hospital follow-up was required for case inclusion. Mandibular reconstruction was successfully performed in all dogs' defects where gaps of 5-9 cm were bridged. Surgical reconstruction rapidly restored cosmetic appearance and function. All dogs healed with new bone formation across the gap. New bone formation was present within the defects as early as 2 weeks after surgery based on palpation, and new bone formation bridging the gap was documented radiographically by 16 weeks. Minor complications occurred in all dogs in the early postoperative period, and included early firm swelling and gingival dehiscence in 1 dog; late plate exposure in 3 dogs; and exuberant/cystic bone formation in 2 dogs (related to concentration/formulation of rhBMP-2/CRM). Two dogs had minor long-term complications of late plate exposure and a non-vital canine tooth; the plates and the affected canine tooth were removed. Long-term in-hospital follow-up was 5.3 years (range, 2-12.5 years); further long-term telephone follow-up was 6.3 years (range, 2-12.5 years). All owners were pleased with the outcome and would repeat the surgery again under similar circumstances. The efficacy and success of this mandibular reconstruction technique, using rhBMP-2/CRM with plate fixation, was demonstrated with bridging of large mandibular defects regardless of the underlying cause, and with excellent cosmetic and functional results. Complications were common, but considered minor and easily treated. The complications encountered revealed the importance of tailoring the use of BMPs and fixation methods to this specific anatomic location and indication. © Copyright 2014 by The American College of Veterinary Surgeons.

Maximum mouth opening and trismus in 143 patients treated for oral cancer: a 1-year prospective study.

PubMed

Wetzels, Jan-Willem G H; Merkx, Matthias A W; de Haan, Anton F J; Koole, Ron; Speksnijder, Caroline M

2014-12-01

Patients with oral cancer can develop restricted mouth opening (trismus) because of the oncologic treatment. Maximum mouth opening (MMO) was measured in 143 patients shortly before treatment and 0, 6, and 12 months posttreatment, and the results were analyzed using a linear mixed-effects model. In every patient, MMO decreased after treatment. The patients who underwent surgery, recovered partially by 6 and 12 months after treatment, whereas the patients who received both surgery and radiotherapy or primary radiotherapy did not recover. Tumor location, tumor size, and alcohol consumption had independent effects on MMO. Having trismus (MMO <35 mm) 1 year after treatment was associated most strongly with pretreatment MMO, receiving both surgery and radiotherapy, and maxillary or mandibular tumor involvement. Postoperative radiotherapy and maxillary or mandibular tumor involvement are the highest contributing risk factors to decreasing MMO and the subsequent development of trismus after oral cancer treatment. © 2014 Wiley Periodicals, Inc.

Surgical treatment of comminuted mandibular fractures using a low-profile locking mandibular reconstruction plate system

PubMed Central

Kanno, Takahiro; Sukegawa, Shintaro; Nariai, Yoshiki; Tatsumi, Hiroto; Ishibashi, Hiroaki; Furuki, Yoshihiko; Sekine, Joji

2014-01-01

Objective: The treatment of comminuted mandibular fractures is challenging due to the severity of associated injuries and the need for a careful diagnosis with adequate treatment planning. Recently, open reduction and stable internal fixation (OR-IF) with a load-bearing reconstruction plate have been advocated for reliable clinical outcomes with minimal complications. This clinical prospective study evaluated OR-IF in the surgical management of comminuted mandibular fractures with a new low-profile, thin, mandibular locking reconstruction plate. Materials and Methods: We prospectively assessed OR-IF of comminuted mandibular fractures with a low-profile locking mandibular reconstruction plate in 12 patients (nine men, three women; mean age 32.2 [range 16-71] years) between April 2010 and December 2011. The clinical characteristics and associated clinical parameters of patients were evaluated over a minimum follow-up period of 12 months. Results: Traffic accidents caused 50% of the fractures, followed by falls (25%). Four patients (33.3%) had associated midfacial maxillofacial fractures, while five patients had other mandibular fractures. Seven patients (58.3%) needed emergency surgery, mostly for airway management. Anatomical reduction of the comminuted segments re-established the mandibular skeleton in stable occlusion with rigid IF via extraoral (33.3%), intraoral (50%), or combined (16.7%) approaches. Immediate functional recovery was achieved. Sound bone healing was confirmed in all patients, with no complications such as malocclusion, surgical site infection, or malunion with a mean follow-up of 16.3 (range 12-24) months. Conclusions: OR-IF using a low-profile reconstruction plate system is a reliable treatment for comminuted mandibular fractures, enabling immediate functional recovery with good clinical results. PMID:25593862

Bone-anchored maxillary expansion and bilateral interoral mandibular distraction osteogenesis in adult with severe obstructive sleep apnea syndrome.

PubMed

Nie, Ping; Zhu, Min; Lu, Xiao-Feng; Fang, Bing

2013-05-01

Severe obstructive sleep apnea syndrome (OSAS) threatens patients' lives. To solve ventilation problem, snoring, and avoid another orthognathic surgery for mandibular advancement, bone-anchored rapid maxillary expansion and bilateral interoral mandibular distraction osteogenesis were tried on a 20-year-old Chinese male patient with severe skeletal class II malocclusion and OSAS.The patient had polysomnography (apnea-hypopnea index 54.2), body mass index measurement (19.7 kg/m), and cephalometry before the treatment. Bone-anchored rapid maxillary expansion was performed for the correction of maxillary transverse and minor sagittal deficiency and the improvement of nasal airflow by decreasing nasal resistance. Bilateral interoral mandibular distraction osteogenesis was operated to lengthen the small, retruded mandible by 15 mm. Orthodontic treatment after the maxillary expansion and mandibular distraction osteogenesis can help obtain stable occlusion.The Epworth Sleepiness Scale, a questionnaire for temporomandibular joint, cephalometric analysis, polysomnography, acoustic rhinometry, and multislice spiral computed tomography were performed to evaluate changes from the treatment. All the results showed that the patient had a significantly alleviated OSAS. In addition, an acceptable occlusion was also obtained.

Levee Setbacks: An Innovative, Cost Effective, and Sustainable Solution for Improved Flood Risk management

DTIC Science & Technology

2017-06-30

ER D C/ EL S R- 17 -3 Levee Setbacks: An Innovative, Cost-Effective, and Sustainable Solution for Improved Flood Risk Management En vi...EL SR-17-3 June 2017 Levee Setbacks: An Innovative, Cost-Effective, and Sustainable Solution for Improved Flood Risk Management David L. Smith...describes levee setbacks as alternatives to traditional levees for flood risk management and environmental benefits. It is organized into five sections

Mandibular third molar surgery in 396 patients at a Norwegian university clinic: Morbidity recorded after 1 week utilizing an e-infrastructure for clinical research.

PubMed

Øyri, Hauk; Bjørnland, Tore; Barkvoll, Pål; Jensen, Janicke Liaaen

2016-01-01

To evaluate morbidity 1 week after mandibular third molar (3M) surgery in the authors' department. A prospective 1-year clinical study of patients followed up for 1 week after 3M surgery was performed. Consecutive patients of 18 years or older having 3M surgery under local anaesthesia were included. Patients not able to attend a follow-up appointment after 1 week were excluded. Demographic data, indication for surgery and clinical findings were recorded. Outcome variables were days requiring analgesic, days absent from work/school and complications. All data recording was performed utilizing an e-infrastructure for clinical research (InReach, University Health Network, www.uhnsl.com). Three hundred and ninety-six patients were examined 1 week after surgery. Mean number of days requiring analgesics was 3.8 and mean number of days absent from work/school after surgery was 0.6. Minor complications were reported by 7% of patients. Female patients reported more days requiring analgesics compared to male patients. Smokers had a higher odds ratio for being absent ≥ 3 days. Prophylactic removal of 3Ms was associated with fewer days requiring analgesics and days absent from work/school as compared to teeth with local disease. Overall morbidity after 3M surgery was low. Compared to patients subjected to therapeutic removal of 3Ms, patients undergoing prophylactic removal seem to have less pain and a faster return to normal activities.

Using Levee Setbacks to Increase Floodplain Connectivity and Reduce Flood Risk

NASA Astrophysics Data System (ADS)

Dahl, T. A.; Echevarria-Doyle, W.

2017-12-01

Levees typically constrain flood flows to within the main channel, isolating the river from its natural floodplain. Levees limit the areal and temporal extents of flooding, but can increase flood peaks, alter ecosystems, and cause scour. In order to mitigate these effects, some groups have begun moving portions of levees further away from the main channel, creating setback levees. Here we describe a series of levee setback scenarios for a hypothetical river that were modeled with the unsteady, 2D-hydraulic model AdH. In our scenarios, the water surface elevations were reduced both at the location of the levee setback and for some distance upstream. The models also show that the floodplain roughness can have a greater effect on the reduction in water surface elevation than the size of the levee setback. Groups planning levee setbacks can use these results to help guide their designs.

Gene Therapy in Cardiac Surgery: Clinical Trials, Challenges, and Perspectives

PubMed Central

Katz, Michael G.; Fargnoli, Anthony S.; Kendle, Andrew P.; Hajjar, Roger J.; Bridges, Charles R.

2016-01-01

The concept of gene therapy was introduced in the 1970s after the development of recombinant DNA technology. Despite the initial great expectations, this field experienced early setbacks. Recent years have seen a revival of clinical programs of gene therapy in different fields of medicine. There are many promising targets for genetic therapy as an adjunct to cardiac surgery. The first positive long-term results were published for adenoviral administration of vascular endothelial growth factor with coronary artery bypass grafting. In this review we analyze the past, present, and future of gene therapy in cardiac surgery. The articles discussed were collected through PubMed and from author experience. The clinical trials referenced were found through the Wiley clinical trial database (http://www.wiley.com/legacy/wileychi/genmed/clinical/) as well as the National Institutes of Health clinical trial database (Clinicaltrials.gov). PMID:26801060

A single-center retrospective review of postoperative infectious complications in the surgical management of mandibular fractures: Postoperative antibiotics add no benefit.

PubMed

Domingo, Fernando; Dale, Elizabeth; Gao, Cuilan; Groves, Cynthia; Stanley, Daniel; Maxwell, Robert A; Waldrop, Jimmy L

2016-12-01

Mandibular fractures are common facial injuries and treatment may be complicated by post-operative infection. Risk of infection from contamination with oral flora is well established but no consensus exists regarding antibiotic prophylaxis. The purpose of this study is to assess risk factors and perioperative antibiotics on surgical site infection (SSI) rates following mandibular fracture surgery. Retrospective medical record review was completed for trauma patients of any age surgically treated for mandibular fractures at a Level I Trauma Center from September 2006 to June 2012. Outcomes analysis was performed to determine SSI rates related to perioperative antibiotic use and other risk factors that may contribute to SSI. 359 patients met inclusion criteria for analysis. 76% were male. Mean age was 30.5 years. Thirty-eight patients developed SSI (10.6%). SSI rate was lower in closed versus open surgery (3.2% vs. 16.3%, p=0.0001), and in closed versus open fractures (1% vs. 14%, p=0.0005). SSI rate increased in patients with tobacco, alcohol, and drug use (14.6%, 13.2%, 53.6%, p<0.0001), traumatic dental injuries (19.6%, p=0.0110), and patients in motor vehicle crashes (12.2%, p=0.0062). SSI rates stratified by Injury Severity Score (ISS) less than or equal to 16 (23/255 [9%]) versus ISS greater than 16 (15/104 [14%]) trended toward more severely injured patients developing SSI, p=0.1347. SSI rate was similar in patients who did and did not receive post-operative antibiotics (14.7% vs. 9.6%, p=0.2556). Type of antibiotic, duration of post-operative antibiotic administration, and duration between injury and surgery did not effect SSI rate. Findings suggest that following surgical treatment of mandible fractures, open surgery, open fractures, and risk factors including substance abuse, traumatic dental injury, and mechanism of injury significantly increase SSI rates, while post-operative antibiotics do not appear to provide additional benefit compared to pre-operative antibiotics alone. Therapeutic study, level IV.

Comparison of the analgesic efficacy of oral ketorolac versus intramuscular tramadol after third molar surgery: A parallel, double-blind, randomized, placebo-controlled clinical trial

PubMed Central

Isiordia-Espinoza, Mario-Alberto; Martinez-Rider, Ricardo; Perez-Urizar, Jose

2016-01-01

Background Preemptive analgesia is considered an alternative for treating the postsurgical pain of third molar removal. The aim of this study was to evaluate the preemptive analgesic efficacy of oral ketorolac versus intramuscular tramadol after a mandibular third molar surgery. Material and Methods A parallel, double-blind, randomized, placebo-controlled clinical trial was carried out. Thirty patients were randomized into two treatment groups using a series of random numbers: Group A, oral ketorolac 10 mg plus intramuscular placebo (1 mL saline solution); or Group B, oral placebo (similar tablet to oral ketorolac) plus intramuscular tramadol 50 mg diluted in 1 mL saline solution. These treatments were given 30 min before the surgery. We evaluated the time of first analgesic rescue medication, pain intensity, total analgesic consumption and adverse effects. Results Patients taking oral ketorolac had longer time of analgesic covering and less postoperative pain when compared with patients receiving intramuscular tramadol. Conclusions According to the VAS and AUC results, this study suggests that 10 mg of oral ketorolac had superior analgesic effect than 50 mg of tramadol when administered before a mandibular third molar surgery. Key words:Ketorolac, tramadol, third molar surgery, pain, preemptive analgesia. PMID:27475688

Which route of antibiotic administration should be used for third molar surgery? A split-mouth study to compare intramuscular and oral intake.

PubMed

Crincoli, V; Di Comite, M; Di Bisceglie, M B; Petruzzi, M; Fatone, L; De Biase, C; Tecco, S; Festa, F

2014-01-01

To compare the effectiveness of two different routes of antibiotic administration in preventing septic complications in patients undergoing third molar extraction. Twenty-four healthy patients requiring bilateral surgical removal of impacted mandibular third molars were successfully enrolled for this study. Depth of impaction, angulation, and relationship of the lower third molars with the mandibular branch had to be overlapping on both sides. A split-mouth design was chosen, so each patient underwent both the first and second surgeries, having for each extraction a different antibiotic route of administration. The second extraction was carried out 1 month later. To compare the effects of the two routes of antibiotic administration, inflammatory parameters, such as edema, trismus, pain, fever, dysphagia and lymphadenopathy were evaluated 2 and 7 days after surgery. Side effects of each therapy were evaluated 48 h after surgery. Oral and intramuscular antibiotic therapies overlap in preventing post-operative complications in dental surgery (p>0.05), even if the oral intake, seems to promote the onset of significant gastrointestinal disorders (p=0.003). This study could help dentists in their ordinary practice to choose the right route of antibiotic administration in the third molar surgery. At the same effectiveness, the higher cost and the minor compliance of the patient seem not to justify a routine antibiotic intramuscular therapy, reserving it for patients with gastrointestinal disorders.

Transformation of a vascularised iliac crest or scapula bone to a pedicled osteomuscular transplant for reconstruction of distant defects in the head and neck region: a new method of transforming two island flaps to one longer island flap.

PubMed

Kärcher, Hans; Feichtinger, Matthias

2014-12-01

Bone defects in the maxillofacial region after ablative surgery require reconstructive surgery, usually using microvascular free flaps. This paper presents a new method of reconstructing extensive defects in patients not suitable for microvascular surgery using prefabrication of a vascularised osteomuscular flap from the scapula or iliac crest bone. Three patients who were treated with this new technique are presented. Two patients (one mandibular defect and one defect in the maxillary region) received prefabricated osteomuscular flaps from the iliac crest bone using the latissimus dorsi muscle as a pedicle. One patient also presenting a mandibular defect after tumour surgery received a scapula transplant for reconstruction of the defect using the pectoralis major muscle as pedicle. In all three cases vital bone could be transplanted. The pedicle was strainless in all three cases. Minor bone loss could be seen initially only in one case. The results are stable now and one patient received dental implants for later prosthetic treatment. The presented two-step surgery provides an excellent method for reconstruction of bony defects in the maxillofacial region in patients where microvascular surgery is not possible due to reduced state of health or lack of recipient vessels. Copyright © 2010. Published by Elsevier Ltd.

Adequacy of Current State Setbacks for Directional High-Volume Hydraulic Fracturing in the Marcellus, Barnett, and Niobrara Shale Plays.

PubMed

Haley, Marsha; McCawley, Michael; Epstein, Anne C; Arrington, Bob; Bjerke, Elizabeth Ferrell

2016-09-01

There is an increasing awareness of the multiple potential pathways leading to human health risks from hydraulic fracturing. Setback distances are a legislative method to mitigate potential risks. We attempted to determine whether legal setback distances between well-pad sites and the public are adequate in three shale plays. We reviewed geography, current statutes and regulations, evacuations, thermal modeling, air pollution studies, and vapor cloud modeling within the Marcellus, Barnett, and Niobrara Shale Plays. The evidence suggests that presently utilized setbacks may leave the public vulnerable to explosions, radiant heat, toxic gas clouds, and air pollution from hydraulic fracturing activities. Our results suggest that setbacks may not be sufficient to reduce potential threats to human health in areas where hydraulic fracturing occurs. It is more likely that a combination of reasonable setbacks with controls for other sources of pollution associated with the process will be required. Haley M, McCawley M, Epstein AC, Arrington B, Bjerke EF. 2016. Adequacy of current state setbacks for directional high-volume hydraulic fracturing in the Marcellus, Barnett, and Niobrara Shale Plays. Environ Health Perspect 124:1323-1333; http://dx.doi.org/10.1289/ehp.1510547.

Comparison of incisor inclination in patients with Class III malocclusion treated with orthognathic surgery or orthodontic camouflage.

PubMed

Troy, Beth A; Shanker, Shiva; Fields, Henry W; Vig, Katherine; Johnston, William

2009-02-01

Reports comparing Class III patients treated by camouflage and those treated by orthognathic surgery are not numerous. The purpose of this study was to compare the dental and skeletal values of Class III patients treated with these methods against normative data and over the course of treatment. Thirty-three surgical and 39 camouflage Class III patients were selected from a graduate orthodontic clinic and regional private practices, and lateral cephalograms were digitized. Skeletal and dental values were obtained, and mean and efficacy evaluations referenced to ethnic norms were calculated. At pretreatment, the surgery patients had more severe skeletal discrepancies and more compensated incisors. During presurgical orthodontic treatment, most of the surgery group's mandibular incisors were significantly decompensated, although half of the maxillary incisors remained compensated. The surgical move improved 90% of these patients but to only 60% to 65% of the norm. The camouflage group was compensated at pretreatment, and they became more compensated in the end. After treatment, there were no differences between the incisor positions of the 2 groups. There was no statistical difference in incisor inclination and position between the Class III surgical and camouflage groups after treatment; there was a significant difference in the pretreatment and posttreatment incisor inclination and position compared with normative values for both the surgical and the camouflage groups; the maxillary and mandibular incisors were not adequately decompensated in the surgical group, but significant improvement in mandibular incisor position and axial inclination was achieved presurgically. The outcome of the surgical correction was limited by the inadequate presurgical orthodontic incisor decompensation, and orthodontic compensation of incisors occurred postsurgically to achieve an optimal occlusal result.

Influence of two different flap designs on the sequelae of mandibular third molar surgery.

PubMed

Erdogan, Ozgür; Tatlı, Ufuk; Ustün, Yakup; Damlar, Ibrahim

2011-09-01

The aim of this study was to compare the influence of triangular and envelope flaps on trismus, pain, and facial swelling after mandibular third molar surgery. Twenty healthy patients with bilateral, symmetrically impacted mandibular third molars were included in this double-blinded, prospective, cross-over, randomized study. The patients were operated with envelope flap on one side and triangular flap on the other side. Trismus was determined by measuring maximum interincisal opening, and facial swelling was evaluated using a tape measuring method. Pain was determined using visual analog scale (VAS) and recording the number of pain pills taken. The facial swelling measurements and VAS scores were lower in the envelope flap group compared to the triangular flap group. There was no significant difference between the two flap designs in operation time, maximum interincisal opening, and the number of analgesics taken. Envelope flap yields to less facial swelling and reduced VAS scores in comparison to triangular flap. There is no clinical difference in trismus between the two flap designs. Despite the higher VAS scores with triangular flap, no additional doses of analgesics were required in triangular flap.

Cephalometric evaluation of surgical mandibular advancement.

PubMed

Boeck, Eloísa Marcantônio; Kuramae, Mayury; Lunardi, Nádia; Santos-Pinto, Ary dos; Mazzonetto, Renato

2010-01-01

The treatment of Class II adult individuals with mandibular deficiency has been the combination of orthodontic treatment and orthognathic surgery. Therefore, a study was conducted in which cephalometric analysis was used to evaluate the influence of dentoalveolar decompensation in Class II patients submitted to orthodontic and surgical treatment for mandibular advancement, by bilateral osteotomy of the mandibular ramus. A sample of 15 leukoderma adult female patients were selected and three cephalometric radiographs of each patient, taken before the orthodontic treatment, before surgery and after at least 6 months postoperatively, were analyzed in a total of 45 roentgenograms. The tracings were made by the manual method and the points were digitalized using software. The results showed that values of SNB increased from 75.6 to 78.6 degrees. The measures BNP and PGNP were reduced from -12.7 to -7.7 mm and -12.7 to -6.6 mm, respectively. For ANB there was a reduction of 3.23 degrees (from 8.1 degrees to 4.9 degrees). Likewise, the values of AOBO were diminished by 6.3 mm (from 7.6 to 1.3 mm), and in the values of OJ there was a reduction of 5.7 mm (from 9 to 3.3 mm). It was concluded that the pre-surgical orthodontic treatment promoted minimal and variable dental and skeletal changes in the final result. The surgical treatment caused significant skeletal changes, especially in the measurements related to the mandible (SNB, BNP, PGNP and SNPM) or indirectly to it (ANB, AOBO and OJ).

Correlations between physical properties of jawbone and dental implant initial stability.

PubMed

Seong, Wook-Jin; Kim, Uk-Kyu; Swift, James Q; Hodges, James S; Ko, Ching-Chang

2009-05-01

There is confusion in the literature about how physical properties of bone vary between maxillary and mandibular regions and which physical properties affect initial implant stability. The purpose of this study was to determine correlations between physical properties of bone and initial implant stability, and to determine how physical properties and initial stability vary among regions of jawbone. Four pairs of edentulous maxillae and mandibles were retrieved from fresh human cadavers. Six implants per pair were placed in different anatomical regions (maxillary anterior, right and left maxillary posterior, mandibular anterior, right and left mandibular posterior). Immediately after surgery, initial implant stability was measured with a resonance frequency device and a tapping device. Implant surgeries and initial stability measurements were performed within 72 hours of death. Elastic modulus (EM) and hardness were measured using nano-indentation. Composite apparent density (cAD) was measured using Archimedes' principle. Bone-implant contact percentage and cortical bone thickness were recorded histomorphometrically. Mixed linear models and univariate-correlation analyses were used (alpha=.05). Generally, mandibular bone had higher initial implant stability and physical properties than maxillary bone. Initial implant stability was higher in the anterior region than in the posterior. EM was higher in the posterior region than in the anterior; the reverse was true for cAD. Of the properties evaluated, cAD had the highest correlation with initial implant stability (r=0.82). Both physical properties of bone and initial implant stability differed between regions of jawbone.

Evaluation of the efficacy of platelet-rich plasma and platelet-rich fibrin in alveolar defects after removal of impacted bilateral mandibular third molars

PubMed Central

Doiphode, Amol M.; Hegde, Prashanth; Mahindra, Uma; Santhosh Kumar, S. M.; Tenglikar, Pavan D.; Tripathi, Vivek

2016-01-01

Aim and Objectives: This study attempted the evaluation of the efficacy of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in alveolar defects after removal of bilateral mandibular third molars. Materials and Methods: A total of 30 patients reporting to Department of Oral and Maxillofacial Surgery and having bilateral mandibular third molar impaction in both male and female aged between 18 and 30 years were included in this study. PRF and PRP were placed in extraction site and recalled at 2nd, 4th, and 6th month postoperatively. Data were statistically analyzed using IBM SPSS software for Windows, version 19.0. IBM Corp., Armonk, NY, USA. Results: This study showed decreased probing depth in PRF group compared to PRP and control one. This signifies a better soft tissue healing of extraction sockets with PRF as compared to the PRP and the control group and increase in the bone density highlights the use of PRP and PRF certainly as a valid method in inducing hard tissue regeneration. Conclusion: This study indicates a definite improvement in the periodontal health distal to second molar after third molar surgery in cases treated with PRF as compared to the PRP group and control group. Hence, PRP and PRF can be incorporated as an adjunct to promote wound healing and osseous regeneration in mandibular third molar extraction sites. PMID:27195227

Patient-specific reconstruction plates are the missing link in computer-assisted mandibular reconstruction: A showcase for technical description.

PubMed

Cornelius, Carl-Peter; Smolka, Wenko; Giessler, Goetz A; Wilde, Frank; Probst, Florian A

2015-06-01

Preoperative planning of mandibular reconstruction has moved from mechanical simulation by dental model casts or stereolithographic models into an almost completely virtual environment. CAD/CAM applications allow a high level of accuracy by providing a custom template-assisted contouring approach for bone flaps. However, the clinical accuracy of CAD reconstruction is limited by the use of prebent reconstruction plates, an analogue step in an otherwise digital workstream. In this paper the integration of computerized, numerically-controlled (CNC) milled, patient-specific mandibular plates (PSMP) within the virtual workflow of computer-assisted mandibular free fibula flap reconstruction is illustrated in a clinical case. Intraoperatively, the bone segments as well as the plate arms showed a very good fit. Postoperative CT imaging demonstrated close approximation of the PSMP and fibular segments, and good alignment of native mandible and fibular segments and intersegmentally. Over a follow-up period of 12 months, there was an uneventful course of healing with good bony consolidation. The virtual design and automated fabrication of patient-specific mandibular reconstruction plates provide the missing link in the virtual workflow of computer-assisted mandibular free fibula flap reconstruction. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Comparison of the analgesic efficacy of oral ketorolac versus intramuscular tramadol after third molar surgery: A parallel, double-blind, randomized, placebo-controlled clinical trial.

PubMed

Isiordia-Espinoza, M-A; Pozos-Guillen, A; Martinez-Rider, R; Perez-Urizar, J

2016-09-01

Preemptive analgesia is considered an alternative for treating the postsurgical pain of third molar removal. The aim of this study was to evaluate the preemptive analgesic efficacy of oral ketorolac versus intramuscular tramadol after a mandibular third molar surgery. A parallel, double-blind, randomized, placebo-controlled clinical trial was carried out. Thirty patients were randomized into two treatment groups using a series of random numbers: Group A, oral ketorolac 10 mg plus intramuscular placebo (1 mL saline solution); or Group B, oral placebo (similar tablet to oral ketorolac) plus intramuscular tramadol 50 mg diluted in 1 mL saline solution. These treatments were given 30 min before the surgery. We evaluated the time of first analgesic rescue medication, pain intensity, total analgesic consumption and adverse effects. Patients taking oral ketorolac had longer time of analgesic covering and less postoperative pain when compared with patients receiving intramuscular tramadol. According to the VAS and UAC results, this study suggests that 10 mg of oral ketorolac had superior analgesic effect than 50 mg of tramadol when administered before a mandibular third molar surgery.

A Method of Strengthening Composite/Metal Joints

NASA Technical Reports Server (NTRS)

Polis, Daniel L.

2011-01-01

The term tape setback method denotes a method of designing and fabricating bonded joints between (1) box beams or other structural members made of laminated composite (matrix/ fiber) materials and (2) metal end fittings used to fasten these structural members to other structural members. The basic idea of the tape setback method is to mask the bonded interface between the metallic end fitting and composite member such that the bond does not extend out to the free edges of the composite member. The purpose served by the tape setback method is to strengthen the joints by decoupling stress concentrations from edge defects, which can cause premature failures. A related prior method that serves a similar purpose, involving the use of tapered adherends at the joints, can be too difficult and costly to be acceptable in some applications. The tape setback method offers an easier, less costly alternative. The structural members to which the method was originally applied were box beams in the form of composite tubes having flat faces with rounded corners. The end fittings were plugs made of a low-thermal- expansion nickel/iron alloy (see figure). In computational-simulation studies of tensile and compressive loading of members without tape setback, stresses were found to be concentrated at the free end edges of the composite tubes, and inspection of members that had been subjected to real tension and compression tests showed that cracks started at the free end edges. As applied to these members, the tape setback method makes them less vulnerable to initiation of failure at edge defects produced during fabrication. In real tension tests of comparable members without and with tape setback, the average mean tensile strength of the members with tape setback was found to be 1.9 times that of the members without tape setback.

Ameloblastoma during pregnancy: a case report.

PubMed

da Silva, Helbert Eustáquio Cardoso; Costa, Erika do Socorro Ramos; Medeiros, Antônio Carlos Quintão; Pereira, Paulo Sérgio Dos Santos

2016-09-06

Ameloblastomas are rarely found in pregnant women, with only two cases reported in the scientific literature. We report the first case of ameloblastoma in a pregnant woman in Brazil. A 27-year-old white woman, 12-weeks pregnant, presented with a large mass in her right posterior mandible. Panoramic radiography revealed a lesion involving her mandibular right first molar with displacement of her mandibular right third molar and impairment of the mandibular bone base. The results of an incisional biopsy led to a diagnosis of acanthomatous ameloblastoma. We fixed Erich arch bars to both dental arches and performed an en-bloc resection surgery under general anesthesia for tumor removal. She was then treated by maxillomandibular rigid fixation with the installation of a 2.7 mm non-locking reconstruction plate. So far, she has presented no motor deficits, chewing difficulties, or relevant asymmetries. The tumor showed no recurrence after the first year (pregnancy period) and post-surgery radiographic follow-up revealed a reduction in the surgical area after osseous growth in the margins of the lesion. Although she displayed no systemic comorbidities that affected pregnancy, the fetus was born with alobar holoprosencephaly. The possible influence of pregnancy hormones on the growth and development of tumors in general and ameloblastoma in particular, is still not explained in the literature. However, evidence reveals that the issue should be further studied. Although en-bloc resection surgery is considered a radical method of treatment, it is an effective alternative in ameloblastoma removal, presenting low rates of recurrence.

Self-Compassion and the Self-Regulation of Exercise: Reactions to Recalled Exercise Setbacks.

PubMed

Semenchuk, Brittany N; Strachan, Shaelyn M; Fortier, Michelle

2018-02-01

Self-compassion facilitates health behavior self-regulation; few studies have examined self-compassion and exercise. This online, cross-sectional study investigated self-compassion's relationship with exercise self-regulation of an exercise setback. Adults (N = 105) who had experienced an exercise setback within the last 6 months completed baseline measures, recalled an exercise setback, and completed questionnaires assessing self-regulation in this context. Self-compassion associated with self-determined motivations and exercise goal reengagement, and negatively related to extrinsic motivations, state rumination, and negative affect. Self-compassion predicted unique variance, beyond self-esteem, in exercise goal reengagement, external regulation, state rumination, and negative affect experienced after an exercise setback. Self-compassion and self-esteem had unique relationships with goal reengagement, state rumination, and situational motivation, while having a complementary relationship with negative affect. This research adds to the few studies that examine the role of self-compassion in exercise self-regulation by examining how self-compassion and self-esteem relate to reactions to a recalled exercise setback.

Morphological impact on patients of maxillomandibular advancement surgery for the treatment of obstructive sleep apnea-hypopnea syndrome.

PubMed

Beranger, Thibaut; Garreau, Emilie; Ferri, Joël; Raoul, Gwenael

2017-03-01

The aim of this study is to evaluate the experience of patients who have benefited from maxillomandibular advancement surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), and also the morphological modifications measured on pre- and postoperative lateral headfilms. Twenty-three patients aged 24 to 64 (M=46.8) who had undergone bimaxillary advancement osteotomy for the treatment of OSAHS filled in a questionnaire concerning their overall satisfaction following surgery, the modification of their facial appearance as perceived by themselves and their family and friends, the change in their smile, and the slimmer and more youthful appearance of their face. Measurements of bone and skin points were also performed on lateral cephalograms before and after surgery so as to assess the advancement of the bony bases (maxillary, mandibular and chin advancement) and the impact on soft tissue by analysis of the skin profile. A total of 91.3% of the patients were satisfied overall following the surgical procedure; 78.3% considered that their faces were improved or unchanged; 39.1% found their faces slimmer and 34.8% thought they looked more youthful. Average maxillary, mandibular and chin advancements with respect to the base of the skull were, respectively, 7.4mm, 11.1mm and 14.1mm. Advancement of the stomion point with respect to the Frankfurt plane was 8.3mm on average, reflecting a significant forward movement of the upper and lower lips. Despite greater maxillary and mandibular advancements than in traditional orthognathic surgery, patients reacted positively to these morphological changes, considering in more than a third of cases that their faces looked slimmer or more youthful. It can thus be concluded that overall satisfaction is high, with a morphological impact that is satisfactory and well-accepted by patients postoperatively. Copyright © 2016 CEO. Published by Elsevier Masson SAS. All rights reserved.

Early Experience with Biodegradable Fixation of Pediatric Mandibular Fractures

PubMed Central

Mazeed, Ahmed Salah; Shoeib, Mohammed Abdel-Raheem; Saied, Samia Mohammed Ahmed; Elsherbiny, Ahmed

2014-01-01

This clinical study aims to evaluate the stability and efficiency of biodegradable self-reinforced poly-l/dl-lactide (SR-PLDLA) plates and screws for fixation of pediatric mandibular fractures. The study included 12 patients (3–12 years old) with 14 mandibular fractures. They were treated by open reduction and internal fixation by SR-PLDLA plates and screws. Maxillomandibular fixation was maintained for 1 week postoperatively. Clinical follow-up was performed at 1 week, 6 weeks, 3 months, and 12 months postoperatively. Radiographs were done at 1 week, 3 months, and 12 months postoperatively to observe any displacement and fracture healing. All fractures healed both clinically and radiologically. No serious complications were reported in the patients. Normal occlusion was achieved in all cases. Biodegradable osteofixation of mandibular fractures offers a valuable clinical solution for pediatric patients getting the benefit of avoiding secondary surgery to remove plates, decreasing the hospital stay, further painful procedures, and psychological impact. PMID:26269728

A safe and accurate method to perform esthetic mandibular contouring surgery for Far Eastern Asians.

PubMed

Hsieh, A M-C; Huon, L-K; Jiang, H-R; Liu, S Y-C

2017-05-01

A tapered mandibular contour is popular with Far Eastern Asians. This study describes a safe and accurate method of using preoperative virtual surgical planning (VSP) and an intraoperative ostectomy guide to maximize the esthetic outcomes of mandibular symmetry and tapering while mitigating injury to the inferior alveolar nerve (IAN). Twelve subjects with chief complaints of a wide and square lower face underwent this protocol from January to June 2015. VSP was used to confirm symmetry and preserve the IAN while maximizing the surgeon's ability to taper the lower face via mandibular inferior border ostectomy. The accuracy of this method was confirmed by superimposition of the perioperative computed tomography scans in all subjects. No subjects complained of prolonged paresthesia after 3 months. A safe and accurate protocol for achieving an esthetic lower face in indicated Far Eastern individuals is described. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Coronectomy of the mandibular third molar: Respect for the inferior alveolar nerve.

PubMed

Kouwenberg, A J; Stroy, L P P; Rijt, E D Vree-V D; Mensink, G; Gooris, P J J

2016-05-01

The aim of this study was to evaluate the outcomes of coronectomy as an alternative surgical procedure to complete removal of the impacted mandibular third molar in patients with a suspected close relationship between the tooth root(s) and the mandibular canal. A total of 151 patients underwent coronectomy and were followed up with clinical examinations and panoramic radiographs for a minimum of 6 months after surgery. None of the patients exhibited inferior alveolar nerve injury. Eruption of the retained root(s) was more frequent in younger patients (18-35 years). Thirty-six patients (23.8%) exhibited insufficient growth of new bone in the alveolar defect, and 11.3% required a second surgical procedure to remove the root remnant(s). Our results indicate that coronectomy can be a reliable alternative to complete removal of the impacted mandibular third molar in patients exhibiting an increased risk of damage to the inferior alveolar nerve on panoramic radiographs. Copyright © 2016. Published by Elsevier Ltd.

Correction of Angle Class II division 1 malocclusion with a mandibular protraction appliances and multiloop edgewise archwire technique

PubMed Central

Freitas, Heloiza; dos Santos, Pedro César F; Janson, Guilherme

2014-01-01

A Brazilian girl aged 14 years and 9 months presented with a chief complaint of protrusive teeth. She had a convex facial profile, extreme overjet, deep bite, lack of passive lip seal, acute nasolabial angle, and retrognathic mandible. Intraorally, she showed maxillary diastemas, slight mandibular incisor crowding, a small maxillary arch, 13-mm overjet, and 4-mm overbite. After the diagnosis of severe Angle Class II division 1 malocclusion, a mandibular protraction appliance was placed to correct the Class II relationships and multiloop edgewise archwires were used for finishing. Follow-up examinations revealed an improved facial profile, normal overjet and overbite, and good intercuspation. The patient was satisfied with her occlusion, smile, and facial appearance. The excellent results suggest that orthodontic camouflage by using a mandibular protraction appliance in combination with the multiloop edgewise archwire technique is an effective option for correcting Class II malocclusions in patients who refuse orthognathic surgery. PMID:25309867

[Diagnosis and treatment of temporo-mandibular disorders in orthodontics].

PubMed

Bocquet, Emmanuelle; Moreau, Alexis; Danguy, Michel; Danguy, Chantal

2010-03-01

Orthodontists are fully prepared to treat the problems of occlusion that they are called upon to deal with every day. On the other hand temporo-mandibular joint disorders present more obscure difficulties from the point of view of detection and diagnosis as well the management of their treatment. That is why a profound understanding of the anatomical and physiological functioning of the temporo-mandibular joint has become indispensable for today's orthodontists who are now asked to detect and diagnose an assortment of TMJ disturbances whose etiology may vary greatly. By performing a rigorous diagnostic procedure, based on a thorough clinical examination supported by careful axiographic and radiological studies, of temporo-mandibular malfunctioning and its underlying etiological causes, which are primarily dento-alveolar and occlusal in nature, orthodontists will be able to adopt an appropriate therapeutic approach that might be purely orthodontic or multi-disciplinary and carried out with the collaboration of specialists in occlusion, oral surgery, and even osteopathy. EDP Sciences, SFODF, 2010.

Effect of Audiovisual Treatment Information on Relieving Anxiety in Patients Undergoing Impacted Mandibular Third Molar Removal.

PubMed

Choi, Sung-Hwan; Won, Ji-Hoon; Cha, Jung-Yul; Hwang, Chung-Ju

2015-11-01

The authors hypothesized that an audiovisual slide presentation that provided treatment information regarding the removal of an impacted mandibular third molar could improve patient knowledge of postoperative complications and decrease anxiety in young adults before and after surgery. A group that received an audiovisual description was compared with a group that received the conventional written description of the procedure. This randomized clinical trial included young adult patients who required surgical removal of an impacted mandibular third molar and fulfilled the predetermined criteria. The predictor variable was the presentation of an audiovisual slideshow. The audiovisual informed group provided informed consent after viewing an audiovisual slideshow. The control group provided informed consent after reading a written description of the procedure. The outcome variables were the State-Trait Anxiety Inventory, the Dental Anxiety Scale, a self-reported anxiety questionnaire, completed immediately before and 1 week after surgery, and a postoperative questionnaire about the level of understanding of potential postoperative complications. The data were analyzed with χ(2) tests, independent t tests, Mann-Whitney U  tests, and Spearman rank correlation coefficients. Fifty-one patients fulfilled the inclusion criteria. The audiovisual informed group was comprised of 20 men and 5 women; the written informed group was comprised of 21 men and 5 women. The audiovisual informed group remembered significantly more information than the control group about a potential allergic reaction to local anesthesia or medication and potential trismus (P < .05). The audiovisual informed group had lower self-reported anxiety scores than the control group 1 week after surgery (P < .05). These results suggested that informing patients of the treatment with an audiovisual slide presentation could improve patient knowledge about postoperative complications and aid in alleviating anxiety after the surgical removal of an impacted mandibular third molar. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Effects of platelet-rich fibrin and piezosurgery on impacted mandibular third molar surgery outcomes.

PubMed

Uyanık, Lokman Onur; Bilginaylar, Kani; Etikan, İlker

2015-07-26

The aim of this study was the comparision of postoperative outcomes in impacted mandibular third molars that were treated using either platelet-rich fibrin (PRF), a combination of PRF and piezosurgery, or conventional rotatory osteotomy. The study included 20 patients; 40 extractions of impacted mandibular third molars were performed. Patients were divided into two main groups. In group A (n = 20), traditional surgery was performed on one side (Group 1, n = 10); traditional surgery was performed, and PRF was administered to the extracted socket on the other side of same patient (Group 2, n = 10). In group B (n = 20), on one side, piezosurgery was used for osteotomy, and PRF was administered (Group 3, n = 10); on the other side of same patient, traditional surgery was performed (Group 4, n = 10). Parameters assessed at baseline for each patient included pain, the number of analgesics taken, trismus, and cheek swelling. These variables were also assessed on postoperative days 1, 2, 3, and 7. Statistical analysis revealed a significant reduction in postoperative pain (sum of 1(st), 2(nd), 3(rd) and 7(th) days) and trismus (on postoperative day 1) in group 2 (traditional surgery + PRF group), and in postoperative pain, the number of analgesics taken (sum of 1(st), 2(nd),3(rd) and 7(th) days) and trismus (on postoperative day 1) in group 3 (piezosurgery + PRF group) compared to groups 1 and 4 (traditional surgery groups), (p ≤ 0.05). However, swelling on postoperative days 1, 3, and 7 did not differ among the groups (p > 0.05). Only difference was on second day between groups 1-4 and 2-4 (p ≤ 0.05). The results of our study have shown that the use of PRF with traditional surgery and PRF combined with piezosurgery significantly reduced pain during the postoperative period. In addition, PRF in combination with piezosurgery significantly decreased the number of analgesics taken. Both operations also significantly decreased trismus 24 h after the surgery. As a result of this study, PRF and combination use of PRF and piezosurgery have positive effects in reducing postoperative outcomes after impacted third molar surgery.

Dental Perspectives in Fibrous Dysplasia and McCune-Albright Syndrome

PubMed Central

Akintoye, Sunday O.; Boyce, Alison M.; Collins, Michael T.

2013-01-01

McCune-Albright syndrome (MAS) is a rare multisystem disorder characterized by the triad of polyostotic fibrous dysplasia (PFD), endocrine disorders and café-au-lait skin pigmentation. Ninety percent of MAS patients have FD lesions in the craniofacial area, resulting in significant orofacial deformity, dental disorders, bone pain and compromised oral health. Maxillo-mandibular FD is also associated with dental developmental disorders, malocclusion, and high caries index. There is limited data on the outcomes of dental treatments in maxillo-mandibular FD/MAS patients, because clinicians and researchers have limited access to patients, and there are concerns that dental surgery may activate quiescent jaw FD lesions to grow aggressively. This report highlights current perspectives on dental management issues associated with maxillo-mandibular FD within the context of MAS. PMID:23953425

Effect of vasoconstriction on pain after mandibular third molar surgery: A single-blind, randomized controlled trial.

PubMed

Martin, Wilhelmus J J M; Skorpil, Nynke E; Ashton-James, Claire E; Tuinzing, D Bram; Forouzanfar, Tymour

2016-01-01

Previous research has demonstrated the efficacy of using local compression to reduce postoperative pain after third molar surgery. It has been theorized that compression reduces pain intensity through vasoconstriction. The current research tests the veracity of this vasoconstriction hypothesis by testing the impact of local epinephrine (a local vasoconstrictor) versus a control on patients' pain ratings over 7 days following surgery. Fifty patients scheduled for mandibular third molar surgery were randomly assigned to receive one cartridge of Ultracaine DS Forte (the treatment group) or one cartridge of Ultracaine DS (the control group) after surgical removal of the third molar. Participants used the visual analog scale (VAS) to provide daily ratings of pain intensity for 7 days following surgery. In addition, on day 7, the perceived effectiveness of the pain treatment was measured with the global perceived effect (GPE) scale. A quality- of-life questionnaire was also completed. A repeated-measures ANOVA indicated that the treatment group perceived significantly less pain than the control group on days 2 to 7 following surgery. In addition, 77.8% of the treatment group perceived their pain treatment to be successful, while only 69.6% of the control group reported that their pain was reduced successfully by day 7. The results of this study provide an initial proof of concept that epinephrine may have an analgesic effect on the period following third molar surgery. Further research with larger sample sizes is needed to strengthen evidence for the clinical utility of offering localized epinephrine to patients following third molar surgery.

Prospective analysis of frequency and contributing factors of nerve injuries following third-molar surgery.

PubMed

Janakiraman, Eswari Natt; Alexander, Mohan; Sanjay, Pasupathy

2010-05-01

The objective of this prospective study was to determine the incidence of injury to the inferior alveolar and lingual nerves following surgical removal of impacted mandibular third molars and to evaluate the various factors contributing to the same. A total of 119 patients underwent mandibular third-molar removal during the period of 11 months. Of 119, 3 inferior alveolar nerve and 5 lingual nerve injuries were encountered. Various factors such as lingual retraction, surgical time, operator experience, radiologic findings contributing to the injury were correlated and analyzed.

Setback distance requirements for removal of swine slurry constituents in runoff

USDA-ARS?s Scientific Manuscript database

The establishment of vegetative filter strips at the bottom of a hillslope has been shown to substantially reduce nutrients and sediment in runoff. The use of setback distances on cropland areas could serve a similar function. However, there is little information available to help identify setback ...

Adequacy of Current State Setbacks for Directional High-Volume Hydraulic Fracturing in the Marcellus, Barnett, and Niobrara Shale Plays

PubMed Central

Haley, Marsha; McCawley, Michael; Epstein, Anne C.; Arrington, Bob; Bjerke, Elizabeth Ferrell

2016-01-01

Background: There is an increasing awareness of the multiple potential pathways leading to human health risks from hydraulic fracturing. Setback distances are a legislative method to mitigate potential risks. Objectives: We attempted to determine whether legal setback distances between well-pad sites and the public are adequate in three shale plays. Methods: We reviewed geography, current statutes and regulations, evacuations, thermal modeling, air pollution studies, and vapor cloud modeling within the Marcellus, Barnett, and Niobrara Shale Plays. Discussion: The evidence suggests that presently utilized setbacks may leave the public vulnerable to explosions, radiant heat, toxic gas clouds, and air pollution from hydraulic fracturing activities. Conclusions: Our results suggest that setbacks may not be sufficient to reduce potential threats to human health in areas where hydraulic fracturing occurs. It is more likely that a combination of reasonable setbacks with controls for other sources of pollution associated with the process will be required. Citation: Haley M, McCawley M, Epstein AC, Arrington B, Bjerke EF. 2016. Adequacy of current state setbacks for directional high-volume hydraulic fracturing in the Marcellus, Barnett, and Niobrara Shale Plays. Environ Health Perspect 124:1323–1333; http://dx.doi.org/10.1289/ehp.1510547 PMID:26895553

Coronectomy of Deeply Impacted Lower Third Molar: Incidence of Outcomes and Complications after One Year Follow-Up

PubMed Central

Heijsters, Guido; Salem, Ahmed Sobhy; Van Slycke, Sarah; Schepers, Serge; Politis, Constantinus; Vrielinck, Luc

2015-01-01

ABSTRACT Objectives The purpose of present study was to assess the surgical management of impacted third molar with proximity to the inferior alveolar nerve and complications associated with coronectomy in a series of patients undergoing third molar surgery. Material and Methods The position of the mandibular canal in relation to the mandibular third molar region and mandibular foramen in the front part of the mandible (i.e., third molar in close proximity to the inferior alveolar nerve [IAN] or not) was identified on panoramic radiographs of patients scheduled for third molar extraction. Results Close proximity to the IAN was observed in 64 patients (35 females, 29 males) with an impacted mandibular third molar. Coronectomy was performed in these patients. The most common complication was tooth migration away from the mandibular canal (n = 14), followed by root exposure (n = 5). Re-operation to remove the root was performed in cases with periapical infection and root exposure. Conclusions The results indicate that coronectomy can be considered a reasonable and safe treatment alternative for patients who demonstrate elevated risk for injury to the inferior alveolar nerve with removal of the third molars. Coronectomy did not increase the incidence of damage to the inferior alveolar nerve and would be safer than complete extraction in situations in which the root of the mandibular third molar overlaps or is in close proximity to the mandibular canal. PMID:26229580

An Epidemiological Study on Pattern and Incidence of Mandibular Fractures

PubMed Central

Natu, Subodh S.; Pradhan, Harsha; Gupta, Hemant; Alam, Sarwar; Gupta, Sumit; Pradhan, R.; Mohammad, Shadab; Kohli, Munish; Sinha, Vijai P.; Shankar, Ravi; Agarwal, Anshita

2012-01-01

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. PMID:23227327

The mandibular symphysis as a starting point for the occlusal-level reconstruction of panfacial fractures with bicondylar fractures and interruption of the maxillary and mandibular arches: report of two cases.

PubMed

Pau, Mauro; Reinbacher, Knut Ernst; Feichtinger, Matthias; Navysany, Kawe; Kärcher, Hans

2014-06-01

Panfacial fractures represent a challenge, even for experienced maxillofacial surgeons, because all references for reconstructing the facial skeleton are missing. Logical reconstructive sequencing based on a clear understanding of the correlation between projection and the widths and lengths of facial subunits should enable the surgeon to achieve correct realignment of the bony framework of the face and to prevent late deformity and functional impairment. Reconstruction is particularly challenging in patients presenting with concomitant fractures at the Le Fort I level and affecting the palate, condyles, and mandibular symphysis. In cases without bony loss and sufficient dentition, we believe that accurate fixation of the mandibular symphysis can represent the starting point of a reconstructive sequence that allows successful reconstruction at the Le Fort I level. Two patients were treated in our department by reconstruction starting in the occlusal area through repair of the mandibular symphysis. Both patients considered the postoperative facial shape and profile to be satisfactory and comparable to the pre-injury situation. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Strategic camouflage treatment of skeletal Class III malocclusion (mandibular prognathism) using bone-borne rapid maxillary expansion and mandibular anterior subapical osteotomy.

PubMed

Seo, Yu-Jin; Lin, Lu; Kim, Seong-Hun; Chung, Kyu-Rhim; Nelson, Gerald

2016-01-01

This case report presents the camouflage treatment that successfully improved the facial profile of a patient with a skeletal Class III malocclusion using bone-borne rapid maxillary expansion and mandibular anterior subapical osteotomy. The patient was an 18-year-old woman with chief complaints of crooked teeth and a protruded jaw. Camouflage treatment was chosen because she rejected orthognathic surgery under general anesthesia. A hybrid type of bone-borne rapid maxillary expander with palatal mini-implants was used to correct the transverse discrepancy, and a mandibular anterior subapical osteotomy was conducted to achieve proper overjet with normal incisal inclination and to improve her lip and chin profile. As a result, a Class I occlusion with a favorable inclination of the anterior teeth and a good esthetic profile was achieved with no adverse effects. Therefore, the hybrid type of bone-borne rapid maxillary expander and a mandibular anterior subapical osteotomy can be considered effective camouflage treatment of a skeletal Class III malocclusion, providing improved inclination of the dentition and lip profile. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Prairie Pothole Region wetlands and subsurface drainage systems: Key factors for determining drainage setback distances

USGS Publications Warehouse

Tangen, Brian; Wiltermuth, Mark T.

2018-01-01

Use of agricultural subsurface drainage systems in the Prairie Pothole Region of North America continues to increase, prompting concerns over potential negative effects to the Region's vital wetlands. The U.S. Fish and Wildlife Service protects a large number of wetlands through conservation easements that often utilize standard lateral setback distances to provide buffers between wetlands and drainage systems. Because of a lack of information pertaining to the efficacy of these setback distances for protecting wetlands, information is required to support the decision making for placement of subsurface drainage systems adjacent to wetlands. We used qualitative graphical analyses and data comparisons to identify characteristics of subsurface drainage systems and wetland catchments that could be considered when assessing setback distances. We also compared setback distances with catchment slope lengths to determine if they typically exclude drainage systems from the catchment. We demonstrated that depth of a subsurface drainage system is a key factor for determining drainage setback distances. Drainage systems located closer to the surface (shallow) typically could be associated with shorter lateral setback distances compared with deeper systems. Subsurface drainage systems would be allowed within a wetland's catchment for 44–59% of catchments associated with wetland conservation easements in North Dakota. More specifically, results suggest that drainage setback distances generally would exclude drainage systems from catchments of the smaller wetlands that typically have shorter slopes in the adjacent upland contributing area. For larger wetlands, however, considerable areas of the catchment would be vulnerable to drainage that may affect wetland hydrology. U.S. Fish and Wildlife Service easements are associated with > 2,000 km2 of wetlands in North Dakota, demonstrating great potential to protect these systems from drainage depending on policies for installing subsurface drainage systems on these lands. The length of slope of individual catchments and depth of subsurface drainage systems could be considered when prescribing drainage setback distances and assessing potential effects to wetland hydrology. Moreover, because of uncertainties associated with the efficacy of standard drainage setback distances, exclusion of subsurface drainage systems from wetland catchments would be ideal when the goal is to protect wetlands.

Clinical and Radiographic Characteristics as Predictive Factors of Swelling and Trismus after Mandibular Third Molar Surgery: A Longitudinal Approach

PubMed Central

Pérez-González, José Manuel; Esparza-Villalpando, Vicente; Martínez-Rider, Ricardo; Noyola-Frías, Miguel Ángel

2018-01-01

Introduction Factors that contribute to swelling and trismus are complex, and they are originated by surgical trauma. The aim of the present study was to determine whether clinical and radiographic factors could predict the level of swelling and trismus after lower third molar surgery, through longitudinal approach. Methodology A prospective longitudinal trial was carried out. Forty-five patients of both genders with clinical and radiographic diagnosis of asymptomatic mandibular impacted third molar and with no intake of analgesic or anti-inflammatory drugs 12 h prior to surgery were recruited and evaluated in a 72 h follow-up period. A mixed repeated measures model and backward and restricted maximal likelihood methods were used to analyze the data. Results Male gender, body mass index (BMI), the relation to the lingual and buccal walls, and age were determinants for predicting postoperative swelling and for exerting a significant influence (P < 0.05). Conclusions This study suggests the association of male gender, the relation to lingual and buccal walls, BMI, and age with measurement of swelling. PMID:29849848

Ketoprofen is more effective than diclofenac after oral surgery when used as a preemptive analgesic: a pilot study.

PubMed

Velásquez, Grace Carolaine Esquivel; Santa Cruz, Luis A German; Espinoza, Mario Alberto Isiordia

2014-01-01

To evaluate the preemptive analgesia of ketoprofen in comparison with diclofenac after mandibular third molar surgery. This study was a double-blind, randomized clinical trial. Forty patients were randomized into two treatment groups (each with 20 patients) by using a series of random numbers: group A received ketoprofen 100 mg and group B received diclofenac 75 mg, all intramuscularly. Surgery was done 30 minutes after analgesic treatments. The durations of analgesia, pain intensity, analgesic consumption, and side effects were evaluated. The statistical analysis was done using the chi-square, Student t, Mann-Whitney U, and Log-Rank tests. The duration of analgesia was longer in the ketoprofen group when compared with the diclofenac group. The number of patients taking the first rescue analgesic at 6 hours was lower in the ketoprofen group in comparison with the diclofenac group. Patients who received ketoprofen had lower pain intensity compared with patients who received diclofenac. Intramuscular ketoprofen 100 mg is more effective than intramuscular diclofenac 75 mg after mandibular third molar extraction when used as a preemptive analgesic.

Patient satisfaction after zygoma and mandible reduction surgery: an outcome assessment.

PubMed

Choi, Bong-Kyoon; Goh, Raymond C W; Moaveni, Zachary; Lo, Lun-Jou

2010-08-01

An ovoid and slender face is considered attractive in Oriental culture, and facial bony contouring is frequently performed in Asian countries to achieve this desired facial profile. Despite their popularity, critical analyses of patients' satisfaction after facial-bone contouring surgery is lacking in the current literature. Questionnaires were sent to 90 patients who had undergone zygoma and/or mandibular contouring by a single surgeon at the Craniofacial Center, Chang Gung Memorial Hospital, Taiwan. The number of patients who had mandibular angle reduction and zygoma reduction were 78 and 36, respectively. The questionnaire contained 20 questions, concerning aesthetic and surgical results, psychosocial benefits and general outcome. Medical records were also reviewed for correlation with the questionnaire findings. The survey response rate was 52.2% (47 patients). A total of 95.7% were satisfied with the symmetry of their face after surgery, and 97.9% felt that there was improvement in their final facial appearance. As many as 61.7% could not feel an objectionable new jaw line or bony step and 66.0% could not detect any visible deformity. A total of 87.2% could not detect bony regrowth after surgery. Complication after surgery was experienced by 17.0% of patients, but all of these recovered without long-term consequences. All patients noted a positive psychosocial influence, and 97.9% of patients said that they would undergo the same surgery again under similar circumstances and would recommend the same surgery to friends. The majority of patients with square face seeking facial bone contouring surgery are satisfied with their final appearance. Of equal importance is the ability for this type of surgery to have a positive influence on the patient's psychosocial environment. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Students' Response to Academic Setback: "Growth Mindset" as a Buffer against Demotivation

ERIC Educational Resources Information Center

Aditomo, Anindito

2015-01-01

It is important to understand why some students are able to bounce back following setbacks, while others become de-motivated and suffer negative consequences. This study tests a model which places students' beliefs about ability (Dweck & Leggett, 1988) as a key factor which may influence students' motivational response to setbacks and…

Setback Test Users Manual (U.S. Army Armament Research, Development and Engineering Center’s Method)

DTIC Science & Technology

2011-09-01

Picatinny Arsenal, New Jersey. This ARDEC setback test method collapses a planer air gap against an explosive sample in a manner to mimic what could...Research, Development and Engineering Center (ARDEC), Picatinny Arsenal, New Jersey setback test collapses a planer air gap against an explosive sample

Therapeutic objectives and surgical treatment of mandibular condyle fractures. Personal experience.

PubMed

Burlini, D

2004-10-01

A review of condylar fractures treated ''non-surgically'' and ''surgically'' over the last 5 years (1996-2001) at the Maxillofacial Surgery Division of the Brescia Civil Hospital (Italy) is presented. The non surgical and surgical treatments carried out, as well as their effectiveness and therapeutic aims, are illustrated. From June 1996 to June 2001, at the Maxillofacial Surgery Division of the Brescia Civil Hospital, 179 fractures of the mandibular condyle were treated. Of the 179 cases treated, a distinction was immediately made between ''non-surgical'' (103 cases) and ''surgical'' cases (76 cases). The 76 ''surgical'' cases were all treated with the same surgical technique. Out-patient follow-up was at days 20, 60, 90, and 1 year, together with a radiographic check-up at 60 days. Of the 76 condylar fractures treated surgically, 15 patients selected at random were re-examined; the medical history was investigated and clinical and radiological examinations performed. For each patient, the type of condylar fracture and whether this was associated with other mandibular fractures were recorded. The following data were also recorded: age of the patient; pain at the surgical site or at the mandible at the time of check-up; presence of normal occlusion and laterodeviation; any surgical sequelae at the facial nerve on the operated side; maximum mouth opening; any radiological defect; time since surgery. Then, the patient was asked to give his/her own evaluation of the surgical outcome, by expressing adequate, good or excellent result. In patients treated surgically the indication is almost absolute in the following cases: condylar fractures types II and IV of the Spiessl/Schroll classification, low or high condylar fractures with medial dislocation of the condyle; non-surgical treatment cannot be applied for reasons of patient's health; condylar fracture associated with other open fractures of the face. The use of rigid fixation also may help in the success of the technique adopted. In all the cases (surgical and non-surgical) it is important to achieve early mobilization of the mandible and carry out a rehabilitation program for masticatory function. The goals of condylar treatment may therefore be summarized as follows: to achieve a good occlusion; to eliminate pain; to achieve a proper mandibular symmetry; to achieve good mandibular movement in the 3 planes of space.

A systematic review on soft-to-hard tissue ratios in orthognathic surgery part II: Chin procedures.

PubMed

San Miguel Moragas, Joan; Oth, Olivier; Büttner, Michael; Mommaerts, Maurice Y

2015-10-01

Precise soft-to-hard tissue ratios in orthofacial chin procedures are not well established. The aim of this study was to determine useful soft-to-hard tissue ratios for planning the magnitude of sliding genioplasty (chin osteotomy), osseous chin recontouring and alloplastic chin augmentation. A systematic review of English and non-English articles using PubMed central, ProQuest Dissertations and Theses, Science Citation Index, Elsevier Science Direct Complete, Highwire Press, Springer Standard Collection, SAGE premier 2011, DOAJ Directory of Open Access Journals, Sweetswise, Free E-Journals, Ovid Lippincott Williams & Wilkins total Access Collection, Wiley Online Library Journals, and Cochrane Plus databases from their onset until July 2014. Additional studies were identified by searching the references. Search terms included soft tissue, ratios, genioplasty, mentoplasty, chin, genial AND advancement, augmentation, setback, retrusion, impaction, reduction, vertical deficit, widening, narrowing, and expansion. Study selection criteria were as follows: only academic publications; human patients; no reviews; systematic reviews or meta-analyses; no cadavers; no syndromic patients; no pathology at the chin or mandible region; only articles of level of evidence from I to IV; number of patients must be cited in the articles; hard-to-soft tissue ratios must be cited in the articles or at least are able to be calculated with the quantitative data available in the article; if all patients of one article have had bilateral sagittal split osteotomy (BSSO) performed along with chin osteotomy, there should be an independent group evaluation of the data concerning to the chin; and no restriction regarding the size of the group. Independent extraction of articles by two authors using predefined data fields, including study quality indicators (level of evidence). The search identified 22 articles. Eleven additional articles were found in their reference sections. Of these, two were evidence level IIIb, three were evidence level IIb, and the rest were evidence level IV. Three studies were prospective in nature. A high variability of soft-to-hard tissue ratios regarding genioplasty seemed to disappear if data were stratified according to confounding factors. With the available data, a soft-to-hard pogonion ratio of 0.9:1 and 0.55:1 could be used for chin advancement and chin setback surgery, respectively. Advancement and extrusion movements of the chin segment show respectively a 0.9:1 of sPg:Pg horizontally and 0.95:1 of sMe:Me vertically. Setback and impaction movements show respectively a -0.52:1 of sPg:Pg horizontally and -0.43:1 of sMe:Me vertically. Prospective studies are needed that stratify by confounding factors such as type of osteotomy technique, magnitude of the movement, age, sex, race/ethnicity, and quantity and quality of the soft tissues. More specifically, studies are needed regarding soft-to-hard tissue changes after chin extrusion ("downgrafting"), intrusion ("impaction"), and widening and narrowing surgery. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Orthodontic Camouflage: A Treatment Option - A Clinical Case Report.

PubMed

Mazzini, William Ubilla; Torres, Fátima Mazzini

2017-01-01

Orthodontic camouflage provides an alternative treatment for angle III malocclusion since patients with limited economic resources cannot opt for orthognathic surgery, it being clear that correction will be achieved at the dental level and not at the bone complex. To determine an alternative treatment for patients who do not have the possibility of having orthognathic surgery. A 13-year-old female patient, dolico facial biotype with slightly concave profile, with Class III Skeletal by mandibular prognathism, anterior crossbite, anterior diastema, and large mandibular body, molar class, and canine III. Alexander technique brackets were placed; premolar extraction was not planned. Once the case was completed, the correction of the anterior crossbite was achieved, thanks to the use of the spaces that existed at the beginning of the treatment and also that a correct distalization of canines and retraction of the lower anterior segment were performed.

Orthodontic Camouflage: A Treatment Option – A Clinical Case Report

PubMed Central

Mazzini, William Ubilla; Torres, Fátima Mazzini

2017-01-01

Orthodontic camouflage provides an alternative treatment for angle III malocclusion since patients with limited economic resources cannot opt for orthognathic surgery, it being clear that correction will be achieved at the dental level and not at the bone complex. Objective: To determine an alternative treatment for patients who do not have the possibility of having orthognathic surgery. Clinical case: A 13-year-old female patient, dolico facial biotype with slightly concave profile, with Class III Skeletal by mandibular prognathism, anterior crossbite, anterior diastema, and large mandibular body, molar class, and canine III. Alexander technique brackets were placed; premolar extraction was not planned. Once the case was completed, the correction of the anterior crossbite was achieved, thanks to the use of the spaces that existed at the beginning of the treatment and also that a correct distalization of canines and retraction of the lower anterior segment were performed. PMID:29326524

Determination of biometric measures to evaluate patient suitability for transoral robotic surgery.

PubMed

Arora, Asit; Kotecha, Jalpa; Acharya, Amish; Garas, George; Darzi, Ara; Davies, D Ceri; Tolley, Neil

2015-09-01

Transoral robotic surgery (TORS) represents a novel treatment for oropharyngeal cancer and obstructive sleep apnea. Appropriate patient selection is crucial. The purpose of this study was to investigate whether anatomic biometric measures are useful to determine the feasibility of performing TORS. Three surgeons independently evaluated feasibility in 51 soft-fix cadavers. Transoral visualization was performed with 2 retractors commonly used in TORS. Seven anthropometric parameters and the degree of mouth opening were recorded. Mandibular body height, hyoid-mental length, and neck circumference demonstrated significant differences between "suboptimal" and "adequate" visualization of base of tongue and epiglottis (p < .05). Limited mouth opening was associated with suboptimal visualization. Neck circumference had the strongest influence on predicting TORS feasibility. Mandibular body height, hyoid-mental length, and neck circumference in conjunction with the degree of mouth opening may determine patient suitability for TORS. Clinical evaluation is essential to validate their collective usefulness. © 2014 Wiley Periodicals, Inc.

The use of resorbable plates in association with dental arch stabilization in the treatment of mandibular fractures in children.

PubMed

Li, Zhi; David, Ongodia; Li, Zu-Bing

2014-07-01

The purpose of this study was to investigate the effect of resorbable plate fixation in association with dental arch stabilization in the treatment of displaced mandibular fractures in children. Thirteen children (5 girls and 8 boys, age range 2 years 5 months to 12 years 2 months) with displaced mandibular fractures were included in this case series. Open reduction by intraoral approach was performed on these patients, and the fractures were fixed using resorbable plates and monocortical screws placed at the lower border of the mandible. At the same time, an arch bar or orthodontic wire splint was anchored using stainless steel wires or resin on the teeth to stabilize the whole mandibular dental arch. Postoperatively, follow-up was undertaken to evaluate the fracture healing, mandible movement, and mandible growth. Postoperatively, all patients achieved uneventful healing; premorbid occlusion restoration and wound healing were achieved, along with unimpaired function and normal growth and development of the mandible. Complications such as damage to tooth buds, infection, malunion, and nonunion were not encountered in these patients. Resorbable plates use in association with dental arch stabilization can provide good stabilization for mandibular fractures and is a promising approach for the treatment of displaced mandibular fractures in children. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Anatomy of Mandibular Vital Structures. Part II: Mandibular Incisive Canal, Mental Foramen and Associated Neurovascular Bundles in Relation with Dental Implantology

PubMed Central

Wang, Hom-Lay; Sabalys, Gintautas

2010-01-01

ABSTRACT Objectives The purpose of the present study was to review the literature of how to identify the mental foramen, mandibular incisive canal and associated neurovascular bundles during implant surgery and how to detect and avoid the damage of these vital structures during implant therapy. Material and Methods Literature was selected through a search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular incisive canal, mental foramen, mental nerve, anterior mental loop. The search was restricted to English language articles, published from 1979 to November 2009. Additionally, a manual search in the major anatomy, dental implant, and periodontal journals and books was performed. Results In total, 47 literature sources were obtained and reviewed. The morphology and variations of the mandibular incisive canal, mental foramen and associated neurovascular bundles were presented as two entities. It suggested that clinicians should carefully assess these vital structures to avoid nerve/artery damage. Conclusions The mandibular incisive canal, mental foramen and associated neurovascular bundles exist in different locations and possess many variations. Individual, gender, age, race, assessing technique used and degree of edentulous alveolar bone atrophy largely influence these variations. It suggests that the clinicians should carefully identify these anatomical landmarks, by analyzing all influencing factors, prior to their implant surgical operation. PMID:24421959

Blood-pool SPECT in addition to bone SPECT in the viability assessment in mandibular reconstruction.

PubMed

Aydogan, F; Akbay, E; Cevik, C; Kalender, E

2014-01-01

The assessment of the postoperative viability of vascularized and non-vascularized grafts used in the reconstruction of mandibular defects due to trauma and surgical reasons is a major problem in maxillofacial surgery. In the present study, we evaluated the feasibility and image quality of blood-pool SPECT, which is used for the first time in the literature here in the assessment of mandibular reconstruction, in addition to non-invasive bone scintigraphy and bone SPECT. We also evaluated whether it would be useful in clinical prediction. Micro-vascularized and non-vascularized bone grafts were used in 12 Syrian men with maxillofacial trauma. Between days 5-7 after surgery, three-phase bone scintigraphy, blood-pool SPECT and delayed bone SPECT scans were performed. After month 6, the patients were assessed by control CT scans. Of the non-vascularized grafts, one graft was reported as non-viable at week one. At month 6, graft resorption was demonstrated on the CT images. The remaining non-vascularized grafts and all of the micro-vascularized grafts were considered to be viable according to delayed bone SPECT and blood-pool SPECT images. However, only the anterior and posterior ends could be clearly assessed on delayed SPECT images, while blood-pool SPECT images allowed the clear assessment of the entire graft. The combined use of blood-pool and delayed SPECT scans could allow for better assessment of graft viability in the early period, and can provide more detailed information to clinicians about prognosis in the follow-up of patients undergoing mandibular graft reconstruction.

Relationship between cervical vertebral maturation and mandibular growth.

PubMed

Ball, Gina; Woodside, Donald; Tompson, Bryan; Hunter, W Stuart; Posluns, James

2011-05-01

The cervical vertebrae have been proposed as a method of determining biologic maturity. The purposes of this study were to establish a pattern of mandibular growth and to relate this pattern to the stages of cervical vertebral maturation. Cephalometric radiographs, taken annually from ages 9 to 18 years, were evaluated for 90 boys from the Burlington Growth Center, Toronto, Ontario, Canada. Mandibular lengths were measured from articulare to gnathion, and incremental growth was determined. Cervical vertebral maturation stages were assessed by using a 6-stage method. Advanced, average, and delayed maturation groups were established. The prepubertal mandibular growth minimum velocity occurred during cervical stages 1 through 4 (P = 0.7327). Peak mandibular growth velocity occurred most frequently during stage 4 in all 3 maturation groups, with a statistical difference in the average and delayed groups (P <0.0001) and the advanced group (P = 0.0143). The average number of years spent in stage 4 was 3.79 (P <0.0001). The average amount of mandibular growth occurring during stage 4 was 9.40 mm (P <0.0001). The average amount of growth in stages 5 and 6 combined was 7.09 mm. Progression from cervical stages 1 through 6 does not occur annually; time spent in each stage varies depending on the stage and the maturation group. Cervical vertebral maturation stages cannot accurately identify the mandibular prepubertal growth minimum and therefore cannot predict the onset of the peak in mandibular growth. The cervical vertebral maturation stages should be used with other methods of biologic maturity assessment when considering both dentofacial orthopedic treatment and orthognathic surgery. Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Ankylosis of temporomandibular joints after mandibular distraction osteogenesis in patients with Nager syndrome: Report of two cases and literature review.

PubMed

Wu, Cheng Chun; Sakahara, Daisuke; Imai, Keisuke

2017-10-01

Nager syndrome, also known as Nager acrofacial dysostosis, was first described by Nager and de Reynier in 1948. The patients commonly present with micrognathia, and a preventive tracheostomy is necessary when there are symptoms of upper airway obstruction. Mandibular distraction osteogenesis is considered as an effective procedure, which not only improves micrognathia but also minimizes the chances of tracheostomy. However, mandibular distraction osteogenesis has some complications such as relapse, teeth injury, infection, and injury of the temporomandibular joints (TMJs). In this study, the author reported two patients with Nager syndrome who suffered from ankylosis of TMJs after mandibular distraction osteogenesis. In addition, a comprehensive literature review of post-distraction ankylosis of TMJs in patients with Nager syndrome was performed. Few studies demonstrated the condition of TMJs after mandibular distraction osteogenesis, and three studies were identified from the review. One study reported ankylosis of bilateral coronoid processes, in which coronoidectomies were necessary. Another study reported the use of prostheses to replace the ankylosed joints in a patient who had undergone many surgeries of the joints, such as gap arthroplasties, reconstructions with costochondral grafts, etc. One other study raised the concept of unloading the condyles during the mandibular distraction to prevent subsequent ankylosis. It seems that multiple factors are related to the ankylosis of TMJs after mandibular distraction osteogenesis in patients with Nager syndrome. Prevention of post-distraction ankylosis of the joints is important because the treatment is difficult and not always effective. We should conduct more studies about protection of the joints during mandibular distraction in the future. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Morphologic evaluation of dentoalveolar structures of mandibular anterior teeth during augmented corticotomy-assisted decompensation.

PubMed

Ahn, Hyo-Won; Seo, Dong-Hwi; Kim, Seong-Hun; Park, Young-Guk; Chung, Kyu-Rhim; Nelson, Gerald

2016-10-01

Our aim in this study was to evaluate the effect of augmented corticotomy on the decompensation pattern of mandibular anterior teeth, alveolar bone, and surrounding periodontal tissues during presurgical orthodontic treatment. Thirty skeletal Class III adult patients were divided into 2 groups according to the application of augmented corticotomy labial to the anterior mandibular roots: experimental group (with augmented corticotomy, n = 15) and control group (without augmented corticotomy, n = 15). Lateral cephalograms and cone-beam computed tomography images were taken before orthodontic treatment and before surgery. The measurements included the inclination and position of the mandibular incisors, labial alveolar bone area, vertical alveolar bone height, root length, and alveolar bone thickness at 3 levels surrounding the mandibular central incisors, lateral incisors, and canines. The mandibular incisors were significantly proclined in both groups (P <0.001); however, the labial movement of the incisor tip was greater in the experimental group (P <0.05). Significant vertical alveolar bone loss was observed only in the control group (P <0.001). The middle and lower alveolar thicknesses and labial alveolar bone area increased in the experimental group. In the control group, the upper and middle alveolar thicknesses and labial alveolar bone area decreased significantly. There were no significant differences in dentoalveolar changes between the 3 kinds of anterior teeth in each group, except for root length in the experimental group (P <0.05). Augmented corticotomy provided a favorable decompensation pattern of the mandibular incisors, preserving the periodontal structures surrounding the mandibular anterior teeth for skeletal Class III patients. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Are virtual planning and guided surgery for head and neck reconstruction economically viable?

PubMed

Zweifel, Daniel Fritz; Simon, Christian; Hoarau, Remy; Pasche, Philippe; Broome, Martin

2015-01-01

Virtual planning and guided surgery with or without prebent or milled plates are becoming more and more common for mandibular reconstruction with fibular free flaps (FFFs). Although this excellent surgical option is being used more widely, the question of the additional cost of planning and cutting-guide production has to be discussed. In capped payment systems such additional costs have to be offset by other savings if there are no special provisions for extra funding. Our study was designed to determine whether using virtual planning and guided surgery resulted in time saved during surgery and whether this time gain resulted in self-funding of such planning through the time saved. All consecutive cases of FFF surgery were evaluated during a 2-year period. Institutional data were used to determine the price of 1 minute of operative time. The time for fibula molding, plate adaptation, and insetting was recorded. During the defined period, we performed 20 mandibular reconstructions using FFFs, 9 with virtual planning and guided surgery and 11 freehand cases. One minute of operative time was calculated to cost US $47.50. Multiplying this number by the time saved, we found that the additional cost of virtual planning was reduced from US $5,098 to US $1,231.50 with a prebent plate and from US $6,980 to US $3,113.50 for a milled plate. Even in capped health care systems, virtual planning and guided surgery including prebent or milled plates are financially viable. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

A numerical simulation of the effect of using porous superelastic Nitinol and stiff Titanium fixation hardware on the bone remodeling

NASA Astrophysics Data System (ADS)

Raad, Bahram; Shayesteh Moghaddam, Narges; Elahinia, Mohammad

2016-04-01

The aim of this article is to investigate the effect of two different fixation hardware materials on bone remodeling after a mandibular reconstruction surgery and to restore the mandible's function, healthy appearance, mastication, swallowing, breathing, and speech. The hypothesis is that using fixation hardware with stiffness close to that of the surrounding bone will result in a more successful healing process in the mandible bone. The finite element model includes the material properties and forces of the cancellous bone, cortical bone, ligaments, muscles, and teeth. The reconstruction surgery is modeled by including the fixation hardware and the grafted bone. In the sectioned mandible, to best mimic the geometry of the mandible, two single barrel grafts are placed at the top of each other to form a double barrel graft set. Two different materials were used as the mandibular fixation parts, stiff Ti-6Al-4V, and porous superelastic Nickel-Titanium (NiTi) alloys. A comparison of these two alloys demonstrates that using porous NiTi alloy as the fixation part results in a faster healing pace. Furthermore, the density distribution in the mandibular bone after the healing process is more similar to the normal mandible density distribution. The simulations results indicate that the porous superelastic NiTi fixation hardware transfers and distributes the existing forces on the mandible bone more favorably. The probability of stress shielding and/or stress concentration decrease. This type of fixation hardware, therefore, is more appropriate for mandible bone reconstruction surgery. These predictions are in agreement with the clinical observations.

Primary radical ablative surgery and fibula free-flap reconstruction for T4 oral cavity squamous cell carcinoma with mandibular invasion: oncologic and functional results and their predictive factors.

PubMed

Camuzard, Olivier; Dassonville, Olivier; Ettaiche, Marc; Chamorey, Emmanuel; Poissonnet, Gilles; Berguiga, Riadh; Leysalle, Axel; Benezery, Karen; Peyrade, Frédéric; Saada, Esma; Hechema, Raphael; Sudaka, Anne; Haudebourg, Juliette; Demard, François; Santini, José; Bozec, Alexandre

2017-01-01

The aims of this study were to evaluate clinical outcomes and to determine their predictive factors in patients with oral cavity squamous cell carcinoma (OCSCC) invading the mandibular bone (T4) who underwent primary radical surgery and fibula free-flap reconstruction. Between 2001 and 2013, all patients who underwent primary surgery and mandibular fibula free-flap reconstruction for OCSCC were enrolled in this retrospective study. Predictive factors of oncologic and functional outcomes were assessed in univariate and multivariate analysis. 77 patients (55 men and 22 women, mean age 62 ± 10.6 years) were enrolled in this study. Free-flap failure and local and general complication rates were 9, 31, and 22 %, respectively. In multivariate analysis, ASA score (p = 0.002), pathologic N-stage (p = 0.01), and close surgical margins (p = 0.03) were independent predictors of overall survival. Six months after therapy, oral diet, speech intelligibility, and mouth opening functions were normal or slightly impaired in, respectively, 79, 88, and 83 % of patients. 6.5 % of patients remaining dependent on enteral nutrition 6 months after therapy. With acceptable postoperative outcomes and satisfactory oncologic and functional results, segmental mandibulectomy with fibula free-flap reconstruction should be considered the gold standard primary treatment for patients with OCSCC invading mandible bone. Oncologic outcomes are dependent on three main factors: ASA score, pathologic N-stage, and surgical margin status.

Six-year follow-up in skeletal Class III patient aged over 40 receiving orthognathic surgery and autotransplantation: a case report.

PubMed

Motegi, Etsuko; Takane, Yumi; Tokunaga, Eri; Sueishi, Kenji; Takano, Nobuo; Shibahara, Takahiko; Saito, Chikara

2009-08-01

This paper describes the post-operative course of care in a patient requiring orthognathic surgery for skeletal mandibular protrusion in whom autotransplantation of a third molar was performed. A lower third molar that had to be removed for sagittal split ramus osteotomy (SSRO) was transplanted to replace the missing right second molar during pre-surgical orthodontic treatment, contributing to post-treatment occlusal stability. A 44-year-old woman presented with mandibular protrusion. The upper left second molar was congenitally missing and the lower right second molar had been extracted. She was diagnosed as having skeletal mandibular protrusion with excess vertical growth of the mandible and anterior open bite. Correction of the skeletal problem required orthognathic surgery by SSRO and Le Fort I osteotomy without orthodontic tooth extraction. At month 5 during 18 months of pre-surgical orthodontic treatment, the lower left third molar was transplanted to the lower right second molar site. Active treatment was completed after 7 months of post-surgical orthodontic treatment. The patient wore upper and lower Begg-type removable retainers for approximately 2 years. She returned for a recall checkup at 6 years post-treatment. Although radiographic examination revealed root resorption and ankylosis of the autotransplanted tooth at 8 years after transplantation, occlusion has remained stable with no clinically significant complications. The autotransplanted tooth helped stabilize her occlusion and acted as a kind of temporary tooth prior to the final decision on treatment to be given such a dental implant.

Piezosurgery versus Rotatory Osteotomy in Mandibular Impacted Third Molar Extraction.

PubMed

Bhati, Bharat; Kukreja, Pankaj; Kumar, Sanjeev; Rathi, Vidhi C; Singh, Kanika; Bansal, Shipra

2017-01-01

The aim of this study is to compare piezoelectric surgery versus rotatory osteotomy technique in removal of mandibular impacted third molar. Sample size of 30 patients 18 males, 12 females with a mean age of 27.43 ± 5.27. Bilateral extractions were required in all patients. All the patients were randomly allocated to two groups in one group, namely control group, surgical extraction of mandibular third molar was done using conventional rotatory osteotomy and in the other group, namely test group, extraction of lower third molar was done using Piezotome. Parameters assessed in this study were - mouth opening (interincisal opening), pain (visual analog scale VAS score), swelling, incidence of dry socket, paresthesia and duration of surgery in both groups at baseline, 1 st , 3 rd , and 7 th postoperative day. Comparing both groups pain scores with ( P < 0.05) a statistically significant difference was found between two groups. Mean surgical time was longer for piezosurgery group (51.40 ± 17.9) minutes compared to the conventional rotatory group with a mean of (37.33 ± 15.5) minutes showing a statistically significant difference ( P = 0.002). The main advantages of piezosurgery include soft tissue protection, optimal visibility in the surgical field, decreased blood loss, less vibration and noise, increased comfort for the patient, and protection of tooth structures. Therefore, the piezoelectric device was efficient in decreasing the short-term outcomes of pain and swelling although taking longer duration than conventional rotatory technique it significantly reduces the associated postoperative sequelae of third molar surgery.

Piezosurgery versus Rotatory Osteotomy in Mandibular Impacted Third Molar Extraction

PubMed Central

Bhati, Bharat; Kukreja, Pankaj; Kumar, Sanjeev; Rathi, Vidhi C.; Singh, Kanika; Bansal, Shipra

2017-01-01

Aim: The aim of this study is to compare piezoelectric surgery versus rotatory osteotomy technique in removal of mandibular impacted third molar. Materials and Methods: Sample size of 30 patients 18 males, 12 females with a mean age of 27.43 ± 5.27. Bilateral extractions were required in all patients. All the patients were randomly allocated to two groups in one group, namely control group, surgical extraction of mandibular third molar was done using conventional rotatory osteotomy and in the other group, namely test group, extraction of lower third molar was done using Piezotome. Results: Parameters assessed in this study were – mouth opening (interincisal opening), pain (visual analog scale VAS score), swelling, incidence of dry socket, paresthesia and duration of surgery in both groups at baseline, 1st, 3rd, and 7th postoperative day. Comparing both groups pain scores with (P < 0.05) a statistically significant difference was found between two groups. Mean surgical time was longer for piezosurgery group (51.40 ± 17.9) minutes compared to the conventional rotatory group with a mean of (37.33 ± 15.5) minutes showing a statistically significant difference (P = 0.002). Conclusion: The main advantages of piezosurgery include soft tissue protection, optimal visibility in the surgical field, decreased blood loss, less vibration and noise, increased comfort for the patient, and protection of tooth structures. Therefore, the piezoelectric device was efficient in decreasing the short-term outcomes of pain and swelling although taking longer duration than conventional rotatory technique it significantly reduces the associated postoperative sequelae of third molar surgery. PMID:28713729

Investigation of a pre-clinical mandibular bone notch defect model in miniature pigs: clinical computed tomography, micro-computed tomography, and histological evaluation.

PubMed

Carlisle, Patricia L; Guda, Teja; Silliman, David T; Lien, Wen; Hale, Robert G; Brown Baer, Pamela R

2016-02-01

To validate a critical-size mandibular bone defect model in miniature pigs. Bilateral notch defects were produced in the mandible of dentally mature miniature pigs. The right mandibular defect remained untreated while the left defect received an autograft. Bone healing was evaluated by computed tomography (CT) at 4 and 16 weeks, and by micro-CT and non-decalcified histology at 16 weeks. In both the untreated and autograft treated groups, mineralized tissue volume was reduced significantly at 4 weeks post-surgery, but was comparable to the pre-surgery levels after 16 weeks. After 16 weeks, CT analysis indicated that significantly greater bone was regenerated in the autograft treated defect than in the untreated defect (P=0.013). Regardless of the treatment, the cortical bone was superior to the defect remodeled over 16 weeks to compensate for the notch defect. The presence of considerable bone healing in both treated and untreated groups suggests that this model is inadequate as a critical-size defect. Despite healing and adaptation, the original bone geometry and quality of the pre-injured mandible was not obtained. On the other hand, this model is justified for evaluating accelerated healing and mitigating the bone remodeling response, which are both important considerations for dental implant restorations.

Successful implant placement in a Case of Florid Cemento-osseous Dysplasia: a case report and literature review.

PubMed

Esfahanizadeh, Nasrin; Yousefi, Hila

2018-02-06

Florid cemento-osseus dysplasia (FCOD) has been described as a reactive process in which normal bone is replaced by fibrous connective tissues and cementum-like materials. Radiographically it appears as dense, lobulated masses, often occurring bilaterally with symmetric involvement. In this case report a successful implant placement has been reported in a 62-year-old Caucasian woman with a chief complaint of mandibular partial edentulous. Radiographic images showed the bilateral radio-opaque lesions in edentulous regions of mandible, and mandibular anterior teeth alike. All mandibular teeth were vital and no root resorption was detected. The findings of X-ray images were attributable to FCOD. A highly conservative step-by-step two-stage implant surgery was performed. After 6 months the implants loaded with fixed prosthesis. 2, 4,6,12 and 18 months after the surgery radiographic images were taken, which revealed an optimal functional rehabilitation and complete integration of implants. This report confirms that treating the edentulous area near the FCOD lesions could be planned, if conservative and step-by-step implant placement been considered. To the best of our knowledge, a case of FCOD with successful implant placement has not been reported previously. More studies in more patients are needed to confirm results of such a therapeutic modality.

Piezosurgery for the lingual split technique in mandibular third molar removal: a suggestion.

PubMed

Pippi, Roberto; Alvaro, Roberto

2013-03-01

The lingual split technique is a surgical procedure for extraction of impacted mandibular third molar throughout a lingual approach. The main disadvantage of this technique is the high rate of temporary lingual nerve injury mainly because of the trauma induced by the lingual flap retraction. The purpose of this paper is to suggest the use of piezosurgery in performing the lingual cortical plate osteotomy of the third molar alveolar process. Surgical procedure was performed under general anesthesia, and it lasted approximately 60 minutes. After the buccal and lingual full-thickness flaps were incised and elevated, a piezosurgical device was used for osteotomy. A well-defined bony window was then removed, and it allowed the entire tooth was extracted in a lingual direction. The patient did not show any neurological postoperative complication. Lingual and inferior alveolar nerve functionality was normal before as well as after surgery. The use of piezoelectric surgery seems to be a good option in removing lower third molars when a lingual access is clearly indicated. The only disadvantage of this technique can be represented by an operating time lengthening possibly because of a lower power cut of the piezoelectric device, to the high mineralization of the mandibular cortical bone and to the use of inserts with a low degree of sharpening.

[Mandibular advancement devices in the treatment of obstructive sleep apnea].

PubMed

Korczyński, Piotr; Górska, Katarzyna; Wilk, Krzysztof; Bielicki, Piotr; Byśkiniewicz, Krzysztof; Baczkowski, Tadeusz

2004-12-01

Obstructive sleep apnea (OSA) affects approximately 450,000 people in Poland. Use of nasal continuous positive airway pressure (nCPAP) devices and laryngeal surgery are widely accepted OSA treatment methods. In 1995 ASDA approved oral devices for treatment of OSA patients. The aim of the study was to determine efficiency of mandibular advancement devices (MAD) in OSA therapy. The study group included 20 patients with OSA, all of whom did not tolerate nCPAP and did not have indications or did not agree for surgical treatment. Control polysomnography was carried out in 11 patients using MAD. In 64% of patients AHI was lower then 10. No correlation between MAD use and AHI values was found. 45% of patients declared improvement of sleep quality and life comfort. Use of mandibular advancement devices is an important alternative therapy of OSA.

Short-term outcomes of mandibular reconstruction in oncological patients using a CAD/CAM prosthesis including a condyle supporting a fibular free flap.

PubMed

Tarsitano, Achille; Battaglia, Salvatore; Ramieri, Valerio; Cascone, Piero; Ciocca, Leonardo; Scotti, Roberto; Marchetti, Claudio

2017-02-01

Condylar reconstruction and replacement using alloplastic materials currently attracts much surgical interest. The major challenge is to functionally reconstruct the anatomical region; this is crucial in terms of correct mandibular function. The goal of the present study was to evaluate the clinical outcomes of and complications experienced by a series of oncological patients who underwent computer-aided design/computer-aided manufacturing (CAD/CAM) condylar reconstruction following resection-disarticulation of the mandible. We included nine patients who underwent disarticulation resection surgery to treat benign and malignant mandibular tumors involving the condylar region. All resections preserved the articular meniscus and featured placement of a CAD/CAM reconstructive plate supporting a fibular, microvascular free flap. The head of the prosthetic condyle reproduced the anatomical morphology of the native condyle. Patients were clinically evaluated in terms of occlusion stability, mandibular functional recovery, static and dynamic pain, and preservation of the normal mandibular contour. Planning and postoperative computed tomography (CT) scans were superimposed to assess the accuracy of reconstruction. No patient experienced plate exposure and, on direct clinical examination, no patient complained of joint pain. No patient developed plate loosening. No resorption of the glenoid fossa was evident when pre- and postoperative bone thicknesses were compared by CT. Preoperative occlusion was preserved in all dentate patients. One patient exhibited condylar displacement. In terms of reconstructive accuracy, the average postoperative deviation of the condyle from the preoperative position was 3.8 mm (range: 1.3-6.7 mm). The clinical outcomes of our series of oncological patients who underwent reconstruction using CAD/CAM plates including condyles were encouraging. The utility of our protocol needs to be confirmed in larger patient series. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Progressive changes in patients with skeletal Class III malocclusion treated by 2-jaw surgery with minimal and conventional presurgical orthodontics: A comparative study.

PubMed

Zhou, Yang; Li, Zili; Wang, Xiaoxia; Zou, Bingshuang; Zhou, Yanheng

2016-02-01

In this study, we aimed to compare treatment efficacy and postsurgical stability between minimal presurgical orthodontics and conventional presurgical orthodontics for patients with skeletal Class III malocclusion. Forty patients received minimal presurgical orthodontics (n = 20) or conventional presurgical orthodontics (n = 20). Lateral cephalograms were obtained before treatment, before orthognathic surgery, and at 1 week, 3 months, 6 months, and 12 months after surgery. Changes of overjet and mandibular incisal angle before surgery were greater in the conventional presurgical orthodontics group than in the minimal presurgical orthodontics group. Postsurgical horizontal changes in Points A and B, overjet, and mandibular incisal angle showed significant differences among the time points. Most of the horizontal and vertical relapses in the maxilla and the mandible occurred within the first 6 months in both groups. Minimal presurgical orthodontics and conventional presurgical orthodontics showed similar extents and directions of skeletal changes in patients with Class III malocclusion. However, orthodontists and surgeons should preoperatively consider the postsurgical counterclockwise rotation of the mandible when using minimal presurgical orthodontics. Close and frequent observations are recommended in the early postsurgical stages. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Factors related to stability following the surgical correction of skeletal open bite.

PubMed

Ito, Goshi; Koh, Myongsun; Fujita, Tadashi; Shirakura, Maya; Ueda, Hiroshi; Tanne, Kazuo

2014-05-01

If a skeletal anterior open bite malocclusion is treated by orthognathic surgery directed only at the mandible, the lower jaw is repositioned upward in a counter-clockwise rotation. However, this procedure has a high risk of relapse. In the present study, the key factors associated with post-surgical stability of corrected skeletal anterior open bite malocclusions were investigated. Eighteen orthognathic patients were subjected to cephalometric analysis to assess the dental and skeletal changes following mandibular surgery for the correction of an anterior open bite. The patients were divided into two groups, determined by an increase or decrease in nasion-menton (N-Me) distance as a consequence of surgery. Changes in overbite, the displacements of molars and positional changes in Menton were evaluated immediately before and after surgery and after a minimum of one year post-operatively. The group with a decreased N-Me distance exhibited a significantly greater backward positioning of the mandible. The group with an increased N-Me distance experienced significantly greater dentoalveolar extrusion of the lower molars. A sufficient mandibular backward repositioning is an effective technique in the prevention of open bite relapse. In addition, it is important not to induce molar extrusion during post-surgical orthodontic treatment to preserve stability of the surgical open bite correction.

Comparison of circummandibular wiring with resorbable bone plates in pediatric mandibular fractures.

PubMed

Saikrishna, D; Gupta, Nimish

2010-06-01

Pediatric patients present a unique challenge to maxillofacial surgeons in terms of their treatment planning as well as in their functional and nutritional needs which are different from that of adult patients. Early literature has advocated conservative closed management of pediatric fractures to prevent complications. However recent advances in maxillofacial surgery has enabled us to use biodegradable plates and screws, which overcomes the limitations of metallic plates. We present a comparison of two cases of parasymphysis fracture treated with circum-mandibular wiring and biodegradable plate fixation their outcome in terms of fracture healing and functional stability.

Are Biodegradable Plates Applicable in Endoscope-Assisted Open Reduction and Internal Fixation of Mandibular Subcondyle Fractures?

PubMed

Son, Jang-Ho; Ha, Jinhee; Cho, Yeong-Cheol; Sung, Iel-Yong

2017-08-01

To investigate whether biodegradable plates are applicable in endoscope-assisted open reduction and internal fixation (EAORIF) of mandibular subcondyle fractures. This retrospective case-series study included patients with mandibular subcondyle fractures treated with EAORIF using an unsintered hydroxyapatite particles/poly-l-lactide biodegradable plate system, with at least 6 months of clinical follow-up data available. The outcome variables were fracture healing with postoperative stability and postoperative complications. Other variables included age, gender, fracture site, cause of injury, accompanying mandibular fracture, total follow-up period, fracture classification, extent of displacement, preoperative status of occlusion, preoperative mandibular movements, fixation materials in accompanying mandibular fracture, location and number of fixation plates, periods of intermaxillary fixation/elastic bands, and postoperative mandibular movements. Fracture healing in these patients was assessed by comparing the immediate postoperative cone-beam computed tomography (CBCT) images with those obtained at least 3 months after surgery. A total of 11 patients, 9 male and 2 female, with a mean ± standard deviation age of 35.3 ± 15.9 years, were included. The mean follow-up period was 18.8 ± 7.8 months. Four patients had an accompanying mandibular fracture. Two 4-hole, 2.0-mm biodegradable plates were fixed with 6-mm screws along the posterior border of the mandibular ramus and near the sigmoid notch. Complete bone formation around the fracture lines or fading of the fracture lines, with no change in the position of the fractured segments, was observed on the postoperative CBCT images at 3 months. With the exception of 2 patients, no patient complained of plate palpability, deviation in occlusion, or discomfort during the postoperative follow-up period. EAORIF using biodegradable plates for mandible subcondylar fractures is a stable and reliable method, with considerable advantages compared with titanium plates. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Treatment of mandibular symphyseal fracture combined with dislocated intracapsular condylar fractures.

PubMed

Xu, Xiaofeng; Shi, Jun; Xu, Bing; Dai, Jiewen; Zhang, Shilei

2015-03-01

To evaluate the treatment methods of mandibular symphyseal fracture combined with dislocated intracapsular condylar fractures (MSF&DICF) and to compare the effect of different treatment methods of condylar fractures. Twenty-eight patients with MSF&DICF were included in this study. Twenty-two sites were treated by open reduction, and all the medial condylar fragments were fixed with titanium screws; whereas the other 22 sites underwent close treatment. The surgical effect between these 2 groups was compared based on clinical examination and radiographic examination results. Seventeen of 22 condyle fractures were repositioned in the surgery group, whereas 4 of 22 condyle fractures were repositioned in the close treatment group. Statistical difference was observed between these 2 groups (P < 0.01). Functional outcomes of the patients treated in the surgical treatment group also were better than those in the close treatment group. The dislocated intracapsular condyle fractures should be treated by surgical reduction with the maintenance of the attachment of lateral pterygoid muscle, which is beneficial to repositioning the dislocated condyle to its original physiological position, to closure of the mandibular lingual gap, to restore the mandibular width.

[Pre- and post-surgical orthodontic treatment of mandibular asymmetry and prognathism].

PubMed

Chen, Song; Chen, Yang-xi; Hu, Jing

2005-01-01

The purpose of this study was to analyze the pre- and post surgical orthodontic treatment of mandibular asymmetry and prognathism in our hospital, and to summarize some helpful experiences for future clinical work. The data were derived from 21 adults aged from 19 - 28 years who had severe mandibular asymmetry and prognathism. The ANB angle of all patients is from -3 degrees to -8 degrees. The value of wits of all patients is from -7 mm to -14 mm. The deviation of chin point of all patients is from 3 mm to 7 mm. The duration of pre- and post-surgical orthodontic treatment was 10-20 months (mean 18 months) and 5-10 months (mean 7.5 months), respectively. The keys in pre-surgical orthodontic treatment include (1) three dimensional dental decompensation; (2) arch form and transverse discrepancy correction; (3) model surgery and the splint making. The main objective of post surgical orthodontic treatment is to detail the occlusion. Pre- and post surgical orthodontic treatment is essential for the orthognathic treatment of patients with mandibular asymmetry and prognathism.

Reconstruction of mandibular defects with autogenous bone grafts: a review of 30 cases.

PubMed

Sajid, Malik Ali Hassan; Warraich, Riaz Ahmed; Abid, Hina; Ehsan-ul-Haq, Muhammad; Shah, Khurram Latif; Khan, Zafar

2011-01-01

Multitudes of options are available for reconstruction of functional and cosmetic defects of the mandible, caused by various ailments. At the present time, autogenous bone grafting is the gold standard by which all other techniques of reconstruction of the mandible can be judged. The purpose of this study was to evaluate the outcome of different osseous reconstruction options using autogenous bone grafts for mandibular reconstruction. This Interventional study was conducted at Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital Lahore, from January 2008 to July 2009 including one year follow-up. The study was carried out on thirty patients having bony mandibular defects. They were reconstructed with the autogenous bone grafts from different graft donor sites. On post-operative visits they were evaluated for outcome variables. Success rate of autogenous bone grafts in this study was 90%. Only 10% of the cases showed poor results regarding infection, resorption and graft failure. Autogenous bone grafts, non-vascularised or vascularised, are a reliable treatment modality for the reconstruction of the bony mandibular defects with predictable functional and aesthetic outcome.

Prefabricated fibula free flap with dental implants for mandibular reconstruction.

PubMed

Pauchet, D; Pigot, J-L; Chabolle, F; Bach, C-A

2018-03-02

Free fibula transplant is routinely used for mandibular reconstruction in head and neck cancer. Dental rehabilitation, the objective of mandibular reconstruction, requires the use of dental implants as supports for fixed or removable dentures. Positioning of fibular bone grafts and implants determines implant osseointegration and the possibilities of dental rehabilitation. Prefabrication of a fibula free flap with dental implants prior to harvesting as a free flap can promote implant osseointegration. The position of the implants must then be precisely planned. Virtual surgery and computer-assisted design and prefabrication techniques are used to plan the reconstruction and then reproduce this planning by means of tailored fibula and mandible cutting guides, thereby ensuring correct positioning of fibular bone fragments and implants. The prefabricated fibula free flap technique requires two surgical procedures (prefabrication and flap transfer) and precise preoperative planning. Prefabricated fibula free flap with dental implants, by improving the quality of osseointegration of the implants before flap transfer, extends the possibilities of prosthetic rehabilitation in complex secondary mandibular reconstructions. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Free Gingival Graft to Increase Keratinized Mucosa after Placing of Mandibular Fixed Implant-Supported Prosthesis

PubMed Central

Marcantonio, Elcio

2017-01-01

Insufficiently keratinized tissue can be increased surgically by free gingival grafting. The presence or reconstruction of keratinized mucosa around the implant can facilitate restorative procedure and allow the maintenance of an oral hygiene routine without irritation or discomfort to the patient. The aim of this clinical case report is to describe an oral rehabilitation procedure of an edentulous patient with absence of keratinized mucosa in the interforaminal area, using a free gingival graft associated with a mandibular fixed implant-supported prosthesis. The treatment included the manufacturing of a maxillary complete denture and a mandibular fixed implant-supported prosthesis followed by a free gingival graft to increase the width of the mandibular keratinized mucosa. Free gingival graft was obtained from the palate and grafted on the buccal side of interforaminal area. The follow-up of 02 and 12 months after mucogingival surgery showed that the free gingival graft promoted peri-implant health, hygiene, and patient comfort. Clinical Significance. The free gingival graft is an effective treatment in increasing the width of mandibular keratinized mucosa on the buccal side of the interforaminal area and provided an improvement in maintaining the health of peri-implant tissues which allows for better oral hygiene. PMID:28293441

Overview of Levee Setback Projects and Benefits

DTIC Science & Technology

2017-07-31

VII-17 July 2017 2 Levee setback projects do not necessarily remove or relocate an entire levee (USACE 2012). Levee alterations that create “ managed ...reduction or environmental improvement. For individual projects , there may also be additional economic and societal benefits. Flood Risk Management ...ERDC/CHL CHETN-VII-17 July 2017 Approved for public release; distribution is unlimited. Overview of Levee Setback Projects and Benefits by

Effectiveness of Maxillomandibular advancement (MMA) surgery in sleep apnea treatment: Case report.

PubMed

Ferraz, Otávio; Guimarães, Thais M; Rossi, Rowdley R; Cunali, Paulo A; Fabbro, Cibele Dal; Chaves, Cauby M; Maluly, Milton; Bittencourt, Lia; Tufik, Sergio

2016-01-01

Obstructive sleep apnea (OSA) is characterized by episodes of pharyngeal collapse during sleep. Craniofacial alterations such as retrognathia are often found in OSA patients. Maxillomandibular advancement (MMA) surgeries increase the pharyngeal space and are a treatment option for OSA. The aim of this study was to present a successful case of MMA surgery in the treatment of OSA. A patient with moderate OSA (apnea-hypopnea index (AHI)=25.2) and mandibular retrognathism and Maxillomandibular asymmetry underwent MMA surgery. The apnea-hypopnea index (AHI) were considerably improved after six months (IAH =6.7) and one year of treatment (IAH=0.2).

Modeling of light propagation in canine gingiva

NASA Astrophysics Data System (ADS)

Mrotek, Marcin

2017-08-01

This study is a preliminary evaluation of the effectivenes of laser-based surgery of maxillary and mandibular bone in dogs. Current methods of gingivial surgery in dogs require the use of general anaesthesia.1, 2 The proposed methods of laser surgery can be performed on conscious dogs, which substantially reduces the associated risks. Two choices of lasers, Nd:YAG and a 930 nm semiconductor lasers were evaluated. The former is already widely used in human laser surgery, while the latter provides an opportunity of decreasing the size of the optical setup. The results obtained from the simulations warrant further experiments with the evaluated wavelengths and animal tissue samples.

Neurovascular structures of the mandibular angle and condyle: a comprehensive anatomical review.

PubMed

Yang, Hun-Mu; Won, Sung-Yoon; Kim, Hee-Jin; Hu, Kyung-Seok

2015-11-01

Various surgical interventions including esthetic surgery, salivary gland excision, and open reduction of fracture have been performed in the area around the mandibular angle and condyle. This study aimed to comprehensively review the anatomy of the neurovascular structures on the angle and condyle with recent anatomic and clinical research. We provide detailed information about the branching and distributing patterns of the neurovascular structures at the mandibular angle and condyle, with reported data of measurements and proportions from previous anatomical and clinical research. Our report should serve to help practitioners gain a better understanding of the area in order or reduce potential complications during local procedures. Reckless manipulation during mandibular angle reduction could mutilate arterial branches, not only from the facial artery, but also from the external carotid artery. The transverse facial artery and superficial temporal artery could be damaged during approach and incision in the condylar area. The marginal mandibular branch of the facial nerve can be easily damaged during submandibular gland excision or facial rejuvenation treatment. The main trunk of the facial nerve and its upper and lower distinct divisions have been damaged during parotidectomy, rhytidectomy, and open reductions of condylar fractures. By revisiting the information in the present study, surgeons will be able to more accurately prevent procedure-related complications, such as iatrogenic vascular accidents on the mandibular angle and condyle, complete and partial facial palsy, gustatory sweating (Frey syndrome), and traumatic neuroma after parotidectomy.

The Accuracy of Computer Image-Guided Template for Mandibular Angle Ostectomy.

PubMed

Ye, Niansong; Long, Hu; Zhu, Songsong; Yang, Yunqiang; Lai, Wenli; Hu, Jing

2015-02-01

Mandibular angle ostectomy (MAO) is commonly used to correct prominent mandibular angles through an intraoral approach. However, limited vision in the operative site may lead to difficulties or complications during surgery. Therefore, it is necessary to develop an effective method for helping surgeons to perform MAO more precisely and safely. In this study, we report a novel method of a computer image-guided surgical template for navigation of MAO, and evaluate its accuracy and clinical outcomes. Nine patients with a prominent mandibular angle were enrolled in this study. A pair of stereolithographic templates was fabricated by computer-aided image design and 3D printing. In all cases, bilateral MAO was performed under the guide of these templates. Post-operative effects were evaluated by 3D curve functions and maximal shell-to-shell deviations. All patients were satisfied with their cosmetic outcomes. The mean and SD of ICC between R-Sim and R-Post were 0.958 ± 0.011; between L-Sim and L-Post, 0.965 ± 0.014; and between R-Post and L-Post, 0.964 ± 0.013. The maximal shell-to-shell deviations between the simulated mandibular contour and post-operative mandibular contour on the right and left sides were 2.02 ± 0.32 and 1.97 ± 0.41 mm, respectively. The results of this study suggest that this new technique could assist surgeons in making better pre-surgical plans and ensure more accurate and safer manipulation for completion of this procedure.

Maxillary advancement for mandibular prognathism: indications and rationale.

PubMed

Rosen, H M

1991-05-01

The surgical correction of mandibular prognathism has traditionally involved posterior repositioning of the mandibular body. This treatment approach corrects the skeletal disproportion at the expense of reducing facial skeletal volume and can unpredictably result in inadequately supported soft tissues with loss of skeletal definition. In an effort to avoid these sequelae of mandibular reduction, 18 patients diagnosed as having mandibular prognathism were treated with maxillary advancement surgery at the Le Fort I level. Mean patient SNB angle was 85.2 degrees, as compared with a normal 79 +/- 3 degrees. Maxillae were documented to be in normal position relative to both cranial base and Frankfort horizontal. The mean maxillary advancement was 6.9 mm, with a range of 4.5 to 8.8 mm. All patients required genioplasty to reduce vertical chin height and/or to laterally shift the chin. At the time of follow-up (mean 16.2 months), all patients retained cephalometric data suggestive of enlarged mandibles and excessive anterior facial divergence. However, maxillomandibular harmony and facial convexity had been restored without sacrificing skeletal volume. Treatment results demonstrated these faces to be skeletally well proportioned despite lower face protrusion that was beyond "normal." Postoperative appearances were characterized by a well-supported soft-tissue envelope and a highlighted skeletal foundation, creating angular, well-defined lower faces. These findings support the credibility of maxillary advancement as the procedure of choice in selected individuals with mandibular prognathism. Indications and an aesthetic rationale for this surgical approach are presented.

Conservative orthodontic treatment of mandibular bilateral condyle fracture.

PubMed

Gašpar, Goran; Brakus, Ivan; Kovačić, Ivan

2014-09-01

Maxillofacial trauma is rare in children younger than the age of 5 years (range 0.6%-1.2%), and they can require different clinical treatment strategies compared with fractures in the adult population because of concerns regarding mandibular growth and development of dentition. A 5-year-old girl with a history of falling from a bicycle 7 hours earlier was referred to the department of oral and maxillofacial surgery. Multislice computed tomographic examination demonstrated a bilateral fracture of the mandibular condyle neck associated with minimal fracture of the alveolar ridge of the maxilla. The multislice computed tomographic scan also demonstrated dislocation on the right condyle neck and, on the left side, a medial inclination of approximately 45 degrees associated with greenstick fracture of the right parasymphysis region. In this particular case, orthodontic rubber elastics in combination with fixed orthodontic brackets provided good results in the treatment of bilateral condyle neck fractures associated with greenstick fracture of parasymphysis.

Prosthetic rehabilitation of a marginally resected mandibular arch with a metal reinforced telescopic overdenture.

PubMed

Rohit, Raghavan; Prathith, Uthappa; Regish, K M; Rupesh, P L; Basavaraj, Salagundi; Padmanabhan, T V

2014-09-01

Success of the prosthesis after mandibular resection is related directly to the amount of the remaining bone and soft tissue present. The prognosis for mandibulectomy patients becomes less favorable as the size of the resection increases. Prosthetic rehabilitation for such patients is a challenge for clinicians. Without preprosthetic reconstructive surgery, denture fabrication for mandibulectomy patients becomes extremely difficult. Telescopic dentures is a modality of treatment consisting of an inner or primary telescopic coping which is permanently cemented to an abutment and an outer or secondary telescopic coping which is attached to the prosthesis. These copings protect the abutment from dental caries and thermal irritations and also provide retention and stabilization of the secondary coping. The secondary coping engages the primary copings to form a telescopic unit and it provides retention and stability to the prosthesis. This clinical report aims at utilizing the remaining natural teeth for a mandibular overdenture with telescopic coping.

Comparative study of intravenous Tramadol versus Ketorolac for preventing postoperative pain after third molar surgery--a prospective randomized study.

PubMed

Gopalraju, Prathibha; Lalitha, Ramanujapuram Manikarnike; Prasad, Kavitha; Ranganath, Krishnappa

2014-07-01

The aim of this comparative, prospective, randomized, controlled study was to evaluate two different regimens of analgesics: a preoperative intravenous dose of either Tramadol or Ketorolac given 10 min prior to surgery to assess their impact on clinical recovery after third molar surgery. Forty patients requiring surgical extraction of unilateral impacted mandibular third molars similar in position were enrolled in the study. Patients were randomly divided into two groups based on permuting the numbers. Patients in Group 1 and Group 2 were administered either Tramadol 50 mg or Ketorolac 30 mg, intravenously, 10 min prior to surgery. The difference in postoperative pain was assessed by four primary points: pain intensity as measured by a 10 mm visual analogue scale hourly for 12 h, median time to rescue analgesics, number of analgesics consumed and patient's overall 5-point global assessment scale. Throughout the 12 h investigation period, patients treated with Ketorolac reported significantly lower pain intensity scores, significantly longer time to rescue analgesics (Acetaminophen 500 mg) and less intake of postoperative analgesics. In Group 2, 40% of the patient had good overall assessment as compared to Group 1 where only 25% of patients had good overall assessment. The current study shows that pre-emptive use of Inj. Ketorolac 30 mg intravenously can reduce the severity of the postoperative sequelae of asymptomatic impacted mandibular third molar surgery. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Pulpal and Periodontal Tissues Changes Associated with Le Fort I and Sagittal Split Ramus Osteotomies: A review

PubMed Central

Lazaridis, Konstantinos; Athanasiou, Athanasios E.

2018-01-01

Introduction: Le Fort I and sagittal split ramus osteotomies are the most commonly performed orthognathic surgery procedures on the maxilla and mandible, respectively. Techniques: Despite progress in the techniques, these procedures may still be associated with morbidity, expressed as inflammation, inadequate bony union, periodontal damages or in extreme cases even total bone loss. Discussion: Through a comprehensive review of the literature, the influences of maxillary and mandibular surgery on Pulpal Blood Flow (PBF), pulp sensitivity and pulp vitality are examined. Moreover, adverse effects of maxillary surgery on tooth color and periodontal tissues are also reported. The effects had a variety of expression. Concerning maxillary surgery, some studies showed an initial increase in PBF followed by a decrease to the baseline or even lower levels after 1-3 months. Other studies found an initial decrease in PBF followed by an increase soon after. There were also studies that showed no significant PBF changes, in contrast. Conclusion: Concerning mandibular surgery, a recent study showed a decrease in PBF immediately after sagittal split ramus osteotomy. Some authors detected tooth discoloration of maxillary teeth after Le Fort I osteotomy. Root resorption and root injury were also detected, but were of minor significance. Usually, these adverse effects derive from injury of the vessels of the palatal pedicle. This pedicle should be maintained intact for the avoidance of blood flow impairments. In addition, the descending palatine artery should be protected during maxillary surgery procedures in order to maintain the highest possible blood flow on the maxillary teeth. PMID:29456771

IMF-screws or arch bars as conservative treatment for mandibular condyle fractures: Quality of life aspects.

PubMed

van den Bergh, B; de Mol van Otterloo, J J; van der Ploeg, T; Tuinzing, D B; Forouzanfar, T

2015-09-01

Arch bars as treatment for a fractured mandibular condyle are inconvenient to patients and lead to lowered quality of life (QOL). To overcome these inconveniences, IMF-screws (IMFS) to facilitate intermaxillary fixation during surgery have been developed. The purpose of the present study is to investigate and compare QOL for patients treated for a fractured mandibular condyle with either IMFS or arch bars. This research trial was conducted from 2010 to 2014 as part of an earlier prospective, multicenter, randomized clinical trial in which the use of IMFS was compared to the use of arch bars in the treatment of mandibular condylar fractures. In total, 50 patients were included: 30 (60%) male patients and 20 (40%) female patients (mean age: 31.8 years, standard deviation [SD] = 13.9 years, range = 18-64 years). A total of 24 (48%) patients were allocated in the IMFS group, and 26 (52%) patients were assigned to the arch-bars control group. Significant results were observed in the subscales social isolation, possibility to eat and vary diet, influence on sleep, and satisfaction with the given treatment, all in favour of IMFS. In conclusion, using IMFS as a method for conservative treatment of condylar fractures led to a higher QOL during the 6-week period of fracture healing. In comparison to arch bars, patients treated with IMFS experienced less social isolation, had fewer problems with eating, and express the feeling they are able to continue their normal diet. Furthermore it seems that the use of IMFS has a lower negative impact on social and financial aspects of the patient. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Preoperative percutaneous cranial nerve mapping in head and neck surgery.

PubMed

Park, Jung I

2003-01-01

To identify and map the course of the peripheral branches of the cranial nerve preoperatively and percutaneously. Prospective study. Preoperative percutaneous nerve mapping performed prior to the operation under deep sedation or general anesthesia without muscle paralysis. Private office surgery suite, freestanding surgery center, and regional medical centers. A total of 142 patients undergoing head and neck surgery and facial plastic surgery between August 1994 and July 1999. Monopolar probe was used for nerve stimulation. Electromyographic reading was done through intramuscular bipolar recording electrodes. The equipment used was a nerve monitor. The mandibular divisions were tested in 142 cases, the frontal division in 60 cases, the accessory nerve in 12 cases, and the hypoglossal nerve in 3 cases. Satisfactory mappings were obtained in 115 cases of the mandibular division, 49 cases of the frontal division, 8 cases of the accessory division, and 1 case of the hypoglossal nerve. Preoperative percutaneous nerve mapping is a new method of identifying the location of the peripheral branches of the cranial nerves. Identifying and mapping the course of peripheral branches of the cranial nerves safely assists the head and neck surgeon in the placement of incisions in a favorable location and in the dissection of the area involving the nerves. Mapping alerts the surgeon to an area containing a nerve and allows the surgeon to avoid just the specific area where a nerve is present, preventing large-scale abandonment of unmapped areas for fear of potential nerve damage.

Soft tissue outcome after mandibular advancement--an anthropometric evaluation of 171 consecutive patients.

PubMed

Raschke, Gregor F; Rieger, Ulrich M; Bader, Rolf-Dieter; Guentsch, Arndt; Schaefer, Oliver; Schultze-Mosgau, Stefan

2013-06-01

There is an ongoing discussion in the literature about preoperative planning and postoperative evaluation of orthognathic surgery and its impact on facial appearance and aesthetics. We present an anthropometric and cephalometric evaluation of orthognathic surgery results based on reference anthropometric data. In 171 Class II patients, mandibular advancement by bilateral sagittal split osteotomy was performed. Preoperative as well as 3 and 9 months postoperative standardized frontal view and profile photographs and lateral cephalograms were evaluated in a standardized manner by use of 21 anthropometric indices. In cephalograms, SNA and SNB angle as well as Wits appraisal were investigated. Results of anthropometric and cephalometric measurements were correlated. Lower vermilion contour, vermilion and cutaneous total lower lip height, nose-lower face height, nose-face height, upper face-face height, upper lip- and chin-mandible height index showed significant pre- to postoperative changes as well as SNB angle and Wits appraisal. Furthermore, medial-lateral cutaneous upper lip height, vermilion and cutaneous total lower lip height and philtrum-mouth width index presented significant correlations to cephalometric measurements. The investigated anthropometric indices and cephalometric measurements presented reproducible results related to surgery. The correlation of cephalometric to anthropometric measurements has been proven useful for preoperative planning and postoperative evaluation of orthognathic surgery patients. The presented anthropometric measurements and their observed correlation to cephalometric measurements could lead to a better prediction and optimized planning of the soft tissue result in orthognathic surgery patients and thereby improve the aesthetic outcome.

Comparison of two preoperative protocols for mandibular symphyseal distraction osteogenesis to reduce the risk of tooth damage.

PubMed

Winsauer, Heinz; Ploder, Oliver; Juengling, Katharina; Walter, Andre; Kolk, Andreas

2017-04-01

Two techniques to separate the lower incisors prior to mandibular symphyseal distraction osteogenesis (MSDO) were evaluated with respect to avoiding tooth damage. Fifty patients (20.2 ± 7.0 years) requiring MSDO were treated with a tooth-borne appliance by utilizing two preoperative protocols to separate the central incisors: i) brackets and a V-bent wire with an open coil spring (two-step; TS; n = 24) and ii) a wire attached from the appliance to the central incisors with subsequent dento-alveolar expansion prior to surgery (one-step; OS; n = 26). The distance between the lower incisors was measured preoperatively on radiographs and measurements at the cast models were performed. Complications and radiographs were analyzed. The mean distance (±SD) between the lower central incisors for OS and TS prior to surgery was 3.44 ± 1.05 and 3.18 ± 1.13 mm, respectively. The mean expansion for OS and TS was 4.3 ± 2.9 and 4.3 ± 2.7 mm at the dental level and 3.8 ± 3.2 and 4.0 ± 2.1 mm at the bone level, respectively. Four patients undergoing the TS and one patient undergoing the OS showed transient dental complications. Pre-surgical dento-alveolar expansion by utilizing a one-step technique to separate the lower central incisors reduces the risk of permanent tooth damage and weakens the mandibular bone in the midline. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Comparison of patient-reported outcomes between immediately and conventionally loaded mandibular two-implant overdentures: A preliminary study.

PubMed

Omura, Yuri; Kanazawa, Manabu; Sato, Daisuke; Kasugai, Shohei; Minakuchi, Shunsuke

2016-07-01

The aim of this preliminary study is to compare patient-reported outcomes between immediately and conventionally loaded mandibular two-implant overdentures retained by magnetic attachments. Nineteen participants with edentulous mandibles were randomly assigned into either an immediate loading group (immediate group) or a conventional loading group (conventional group). Each participant received 2 implants in the inter-foraminal region by means of flapless surgery. Prostheses in the immediate and conventional groups were loaded using magnetic attachments on the same day as implant placement or 3 months after surgery, respectively. All participants completed questionnaires (the Japanese version of the Oral Health Impact Profile for edentulous [OHIP-EDENT-J], the patient's denture assessment [PDA], and general satisfaction) before implant placement (baseline) and 1, 2, 3, 4, 5, 6, and 12 months after surgery. The median differences between baseline and each monthly score were compared using the Mann-Whitney U test. The differences in median and 95% confidence interval between two groups were analyzed. The immediate group showed slightly lower OHIP-EDENT-J summary score at 1 and 3 months than the conventional group (P=0.09). In the lower denture domain of PDA, the immediate group showed a statistically higher score at 3 months (P=0.04). There was no statistically significant difference in general satisfaction between the two groups. Based on this preliminary study, immediate loading of mandibular two-implant overdentures with magnetic attachments tends to improve oral health-related quality of life and patient assessment earlier than observed with a conventional loading protocol. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Antibiotics in third molar extraction; are they really necessary: A non-inferiority randomized controlled trial

PubMed Central

Arora, Ankit; Roychoudhury, Ajoy; Bhutia, Ongkila; Pandey, Sandeep; Singh, Surender; Das, Bimal K.

2014-01-01

Introduction: Antibiotic resistance is now a serious problem, although it was not so only a few years ago. The need of the hour is to give clear evidence of the efficacy of antibiotic use, or lack thereof, to the surgeon for a procedure as common as mandibular third molar surgery. Aim: This study aimed to evaluate whether postoperative combined amoxicillin and clavulanic acid in mandibular third molar extraction is effective in preventing inflammatory complications. Study and Design: The study was structured as a prospective randomized double-blind placebo-controlled clinical trial. Materials and Methods: A study was designed wherein the 96 units (two bilaterally similar impacted mandibular third molars per head in 48 patients) were randomly assigned to two treatment groups (Group I and Group II). Each patient served as his/her own control. Each patient received 625 mg of combined amoxicillin and clavulanic acid 1 h before surgery. In the case of third molars belonging to Group I, 625 mg of combined amoxicillin and clavulanic acid TDS was continued for 3 days; in Group II, placebo in similar-looking packs was continued for 3 days. The patients were evaluated on the third and seventh postoperative days for signs of clinical infection and for microbial load evaluation. Statistical Analysis: The data between the two groups were statistically analyzed by the two-tailed Fisher's exact test, with a 95% confidence interval. Results: The difference was not statistically significant between the test group and the control group with regard to erythema, dehiscence, swelling, pain, trismus, and infection based on microbial load. The data were statistically significant for alveolar osteitis, with the occurrence of alveolar osteitis (14.58%) in the placebo group. Conclusion: Postoperative antibiotics are recommended only for patients undergoing contaminated, long-duration surgery. PMID:25937728

Efficacy of low level laser therapy on neurosensory recovery after injury to the inferior alveolar nerve

PubMed Central

Ozen, Tuncer; Orhan, Kaan; Gorur, Ilker; Ozturk, Adnan

2006-01-01

Background The most severe complication after the removal of mandibular third molars is injury to the inferior alveolar nerve or the lingual nerve. These complications are rather uncommon (0.4% to 8.4%) and most of them are transient. However, some of them persist for longer than 6 months, which can leave various degrees of long-term permanent disability. While several methods such as pharmacologic therapy, microneurosurgery, autogenous and alloplastic grafting can be used for the treatment of long-standing sensory aberrations in the inferior alveolar nerve, there are few reports regarding low level laser treatment. This paper reports the effects of low level laser therapy in 4 patients with longstanding sensory nerve impairment following mandibular third molar surgery. Methods Four female patients had complaints of paresthesia and dysesthesia of the lip, chin and gingiva, and buccal regions. Each patient had undergone mandibular third molar surgery at least 1 year before. All patients were treated with low level laser therapy. Clinical neurosensory tests (the brush stroke directional discrimination test, 2-point discrimination test, and a subjective assessment of neurosensory function using a visual analog scale) were used before and after treatment, and the responses were plotted over time. Results When the neurosensory assessment scores after treatment with LLL therapy were compared with the baseline values prior to treatment, there was a significant acceleration in the time course, as well as in the magnitude, of neurosensory return. The VAS analysis revealed progressive improvement over time. Conclusion Low level laser therapy seemed to be conducive to the reduction of long-standing sensory nerve impairment following third molar surgery. Further studies are worthwhile regarding the clinical application of this treatment modality. PMID:16480503

Prevalence of Surgical Site Infections Following Orthognathic Surgery: A Double-Blind, Randomized Controlled Trial on a 3-Day Versus 1-Day Postoperative Antibiotic Regimen.

PubMed

Davis, Clayton M; Gregoire, Curtis E; Davis, Ian; Steeves, Thomas W

2017-04-01

The purpose of this study was to determine the effect of a 3- versus 1-day antibiotic regimen on the rate of surgical site infection (SSI) in patients undergoing orthognathic surgery at a department of oral and maxillofacial surgery in Halifax, Nova Scotia, Canada. A prospective, randomized controlled trial was conducted. All patients received 1 day of intravenous antibiotics after surgery. Then, patients were randomly distributed into groups that received 2 days of additional antibiotics (group A) or placebo (group B). The primary outcome measured was the presence of SSI. The operating surgeon, concomitant extraction of teeth, surgical procedures performed, duration of intermaxillary fixation, and length of hospital stay were analyzed for an effect on SSI. Patients were followed for 1 year after surgery to identify SSIs that might have been diagnosed outside the hospital. The trial started with 288 patients, and 117 patients were lost to follow-up. Statistical analyses were ultimately performed on those 171 patients who were adherent to the study medication regimen. Group A (n = 86) and B (n = 85) SSI rates were 7.0 and 17.6% (number needed to treat = 10; P = .04), respectively. Mandibular bilateral sagittal split osteotomy (BSSO) was involved in 71% of SSIs. Intra- and postoperative surgical variables did not have a relevant effect on the SSI rate. Patients were followed for 1 year after surgery, and group A (n = 46) and group B (n = 44) had SSI rates of 4 and 25% (P < .05), respectively. Three days of postoperative cefazolin and cephalexin markedly decreases SSI rates compared with 1 day. However, the number needed to treat of 10 suggests that the benefits of the extended regimen might not outweigh the risks. The high prevalence of SSIs at the mandibular BSSO incisions might have been caused by contamination, with more saliva and reception of a lower blood supply, than maxillary Le Fort I incisions. Mandibular osteotomies could benefit from an extended antibiotic regimen to minimize SSIs and associated complications. Other surgical variables might not require special consideration for antibiotic therapy. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

The accuracy of three-dimensional fused deposition modeling (FDM) compared with three-dimensional CT-Scans on the measurement of the mandibular ramus vertical length, gonion-menton length, and gonial angle

NASA Astrophysics Data System (ADS)

Savitri, I. T.; Badri, C.; Sulistyani, L. D.

2017-08-01

Presurgical treatment planning plays an important role in the reconstruction and correction of defects in the craniomaxillofacial region. The advance of solid freeform fabrication techniques has significantly improved the process of preparing a biomodel using computer-aided design and data from medical imaging. Many factors are implicated in the accuracy of the 3D model. To determine the accuracy of three-dimensional fused deposition modeling (FDM) models compared with three-dimensional CT scans in the measurement of the mandibular ramus vertical length, gonion-menton length, and gonial angle. Eight 3D models were produced from the CT scan data (DICOM file) of eight patients at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Indonesia, Cipto Mangunkusumo Hospital. Three measurements were done three times by two examiners. The measurements of the 3D CT scans were made using OsiriX software, while the measurements of the 3D models were made using a digital caliper and goniometry. The measurement results were then compared. There is no significant difference between the measurements of the mandibular ramus vertical length, gonion-menton length, and gonial angle using 3D CT scans and FDM 3D models. FDM 3D models are considered accurate and are acceptable for clinical applications in dental and craniomaxillofacial surgery.

The effect of extracapsular injuries on growth and development of the mandible condyle: an experimental study in growing dogs.

PubMed

Liu, Siying; Tian, Lei; Ding, Mingchao; Liu, Yanpu; Li, Guiyu; Chen, Jinwu; Ding, Yin

2016-11-01

To investigate the effects of condylar extracapsular injuries on the development of the mandibular condyle and try to find a way to treat condylar hyperplasia by electively using such injuries to restrict the overdeveloped mandibular condyle. Sixty 6-month-old beagle puppies were divided randomly into five groups: blank control; unilateral fracture to the condylar neck; unilateral fracture to the condylar neck treated with rigid internal fixation; unilateral periosteum injury; unilateral decortication of the condylar neck. Computed tomography, 99 m Tc single-photon emission computed tomography, and tetracycline-calcein double-labeling were performed after surgery. The puppies were sacrificed 12 and 24 weeks after surgery. Morphologic analyses and examination of growth activity were done. Unilateral fracture of the condylar neck without fixation caused local morphologic changes during the early postoperative period, but compensatory growth of the condyle altered such changes after healing. The other types of injury failed to inhibit the growth of the condyle and the mandible, whereas functional deviation of the chin was found after unilateral fracture of the condylar neck with or without fixation. The four types of extracapsular injury described here failed to inhibit the growth of the mandibular condyle and could not be selected as alternatives to treat condylar hyperplasia. Copyright © 2016 Elsevier Inc. All rights reserved.

Mandibular reconstruction after cancer: an in-house approach to manufacturing cutting guides.

PubMed

Bosc, R; Hersant, B; Carloni, R; Niddam, J; Bouhassira, J; De Kermadec, H; Bequignon, E; Wojcik, T; Julieron, M; Meningaud, J-P

2017-01-01

The restoration of mandibular bone defects after cancer can be facilitated by computer-assisted preoperative planning. The aim of this study was to assess an in-house manufacturing approach to customized cutting guides for use in the reconstruction of the mandible with osteocutaneous free flaps. A retrospective cohort study was performed, involving 18 patients who underwent mandibular reconstruction with a fibula free flap at three institutions during the period July 2012 to March 2015. A single surgeon designed and manufactured fibula and mandible cutting guides using a computer-aided design process and three-dimensional (3D) printing technology. The oncological outcomes, production parameters, and quality of the reconstructions performed for each patient were recorded. Computed tomography scans were acquired after surgery, and these were compared with the preoperative 3D models. Eighteen consecutive patients with squamous cell carcinoma underwent surgery and then reconstruction using this customized in-house surgical approach. The lengths of the fibula bone segments and the angle measurements in the simulations were similar to those of the postoperative volume rendering (P=0.61). The ease of access to 3D printing technology has enabled the computer-aided design and manufacturing of customized cutting guides for oral cancer treatment without the need for input from external laboratories. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

The spectrum of Apert syndrome: phenotype, particularities in orthodontic treatment, and characteristics of orthognathic surgery

PubMed Central

Hohoff, Ariane; Joos, Ulrich; Meyer, Ulrich; Ehmer, Ulrike; Stamm, Thomas

2007-01-01

In the PubMed accessible literature, information on the characteristics of interdisciplinary orthodontic and surgical treatment of patients with Apert syndrome is rare. The aim of the present article is threefold: (1) to show the spectrum of the phenotype, in order (2) to elucidate the scope of hindrances to orthodontic treatment, and (3) to demonstrate the problems of surgery and interdisciplinary approach. Children and adolescents who were born in 1985 or later, who were diagnosed with Apert syndrome, and who sought consultation or treatment at the Departments of Orthodontics or Craniomaxillofacial Surgery at the Dental School of the University Hospital of Münster (n = 22; 9 male, 13 female) were screened. Exemplarily, three of these patients (2 male, 1 female), seeking interdisciplinary (both orthodontic and surgical treatment) are presented. Orthodontic treatment before surgery was performed by one experienced orthodontist (AH), and orthognathic surgery was performed by one experienced surgeon (UJ), who diagnosed the syndrome according to the criteria listed in OMIM™. In the sagittal plane, the patients suffered from a mild to a very severe Angle Class III malocclusion, which was sometimes compensated by the inclination of the lower incisors; in the vertical dimension from an open bite; and transversally from a single tooth in crossbite to a circular crossbite. All patients showed dentitio tarda, some impaction, partial eruption, idopathic root resorption, transposition or other aberrations in the position of the tooth germs, and severe crowding, with sometimes parallel molar tooth buds in each quarter of the upper jaw. Because of the severity of malocclusion, orthodontic treatment needed to be performed with fixed appliances, and mainly with superelastic wires. The therapy was hampered with respect to positioning of bands and brackets because of incomplete tooth eruption, dense gingiva, and mucopolysaccharide ridges. Some teeth did not move, or moved insufficiently (especially with respect to rotations and torque) irrespective of surgical procedures or orthodontic mechanics and materials applied, and without prognostic factors indicating these problems. Establishing occlusal contact of all teeth was difficult. Tooth movement was generally retarded, increasing the duration of orthodontic treatment. Planning of extractions was different from that of patients without this syndrome. In one patient, the sole surgical procedure after orthodontic treatment with fixed appliances in the maxilla and mandible was a genioplasty. Most patients needed two- jaw surgery (bilateral sagittal split osteotomy [BSSO] with mandibular setback and distraction in the maxilla). During the period of distraction, the orthodontist guided the maxilla into final position by means of bite planes and intermaxillary elastics. To our knowledge, this is the first article in the PubMed accessible literature describing the problems with respect to interdisciplinary orthodontic and surgical procedures. Although the treatment results are not perfect, patients undergoing these procedures benefit esthetically to a high degree. Patients need to be informed with respect to the different kinds of extractions that need to be performed, the increased treatment time, and the results, which may be reached using realistic expectations. PMID:17286873

Low-cost Method for Obtaining Medical Rapid Prototyping Using Desktop 3D printing: A Novel Technique for Mandibular Reconstruction Planning.

PubMed

Velasco, Ignacio; Vahdani, Soheil; Ramos, Hector

2017-09-01

Three-dimensional (3D) printing is relatively a new technology with clinical applications, which enable us to create rapid accurate prototype of the selected anatomic region, making it possible to plan complex surgery and pre-bend hardware for individual surgical cases. This study aimed to express our experience with the use of medical rapid prototype (MRP) of the maxillofacial region created by desktop 3D printer and its application in maxillofacial reconstructive surgeries. Three patients with benign mandible tumors were included in this study after obtaining informed consent. All patient's maxillofacial CT scan data was processed by segmentation and isolation software and mandible MRP was printed using our desktop 3D printer. These models were used for preoperative surgical planning and prebending of the reconstruction plate. MRP created by desktop 3D printer is a cost-efficient, quick and easily produced appliance for the planning of reconstructive surgery. It can contribute in patient orientation and helping them in a better understanding of their condition and proposed surgical treatment. It helps surgeons for pre-operative planning in the resection or reconstruction cases and represent an excellent tool in academic setting for residents training. The pre-bended reconstruction plate based on MRP, resulted in decreased surgery time, cost and anesthesia risks on the patients. Key words: 3D printing, medical modeling, rapid prototype, mandibular reconstruction, ameloblastoma.

Environmental Assessment of Installation Development at Fairchild Air Force Base, Washington

DTIC Science & Technology

2007-05-01

attributed to natural topography and AT/FP setback requirements. • Natural Topography. There are a number of basalt rock outcroppings within the JPRA...facility. A setback of 50 feet is required around each basalt rock outcropping. These outcroppings and setbacks limit 38.1 acres from potential...extent of the Miocene-aged Columbia Plateau lava flows. Layers of basalt might be as much as 500 feet thick with interbeds between layers of gravels

The effect of partial rostral hemimandibulectomy on mandibular mobility and temporomandibular joint morphology in the dog.

PubMed

Umphlet, R C; Johnson, A L; Eurell, J C; Losonsky, J

1988-01-01

Partial rostral hemimandibulectomy was performed in 10 adult dogs. The temporomandibular joints (TMJs) were examined radiographically and tomographically before surgery, and mandibular stability was evaluated before and immediately after surgery. Radiographic, tomographic, and hemimandibular mobility assessments were made again at months 3 and 6. The TMJs were examined grossly and histologically in five dogs euthanatized at month 3 and in five dogs euthanatized at month 6. Statistically significant hemimandibular instability (p less than 0.05) persisted in all subjects throughout the study. The radiographic appearance of the joints remained unaltered; however, space asymmetry was identified in postoperative tomograms of three dogs at month 3 and four dogs at month 6. The TMJs were grossly normal at necropsy. Histologically, there were degenerative changes in articular cartilage and subchondral bone in all of the joints. The authors conclude that partial rostral hemimandibulectomy causes TMJ degeneration, as a consequence of hemimandibular instability or abnormal loading, or both.

Taking advantage of an unerupted third molar: a case report.

PubMed

Pereira, Igor Figueiredo; Santiago, Fernando Zander Mucci; Sette-Dias, Augusto Cesar; Noronha, Vladimir Reimar Augusto de Souza

2017-01-01

Treatments with dental surgery seek to displace tooth to the correct position within the dental arch. To report a clinical case that took advantage of an unerupted third molar. A male patient, 18 years of age, was referred by his dentist to evaluate the third molars. The clinical exam revealed no visible lower third molars. The computed tomography (CT) exam showed the presence of a supernumerary tooth in the region of the mandibular ramus, on the left side, and impaction of the third molar, which was causing root resorption on the second molar, thus making it impossible to remain in the buccal cavity. The preferred option, therefore, was to remove both second molar and the supernumerary tooth, in addition to attaching a device to the third molar during surgery for further traction. After 12 months, the third molar reached the proper position. When a mandibular second permanent molar shows an atypical root resorption, an impacted third molar can effectively substitute the tooth by using an appropriate orthodontic-surgical approach.

Accidental displacement of a high-speed handpiece bur during mandibular third molar surgery: a case report.

PubMed

Yalcin, Serhat; Aktas, Irem; Emes, Yusuf; Atalay, Belir

2008-03-01

Removal of third molars is one of the most common surgical procedures performed in oral and maxillofacial surgery. This procedure may result in a number of major and minor complications. Accidental displacement of impacted third molars is a complication that occasionally occurs during these operations, but accidental displacement of a high-speed handpiece bur has never been reported in literature before. The aim of this article is to present a rare and previously unreported case of a foreign body in the submandibular space and to review the possible complications seen after third molar surgery.

Severe Angle Class III skeletal malocclusion associated to mandibular prognathism: orthodontic-surgical treatment

PubMed Central

Souki, Marcelo Quiroga

2016-01-01

ABSTRACT The present case report describes the orthodontic treatment of a young adult patient (18y / 1m), Class III skeletal malocclusion, with mandibular prognathism and significant dental compensation. The canine relation was Class III, incisors with tendency to crossbite and open bite, moderate inferior crowding, and concave profile. Skeletal correction of malocclusion, facial profile harmony with satisfactory labial relationship, correction of tooth compensation and normal occlusal relationship were obtained with orthodontic treatment associated to orthognathic surgery. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO), as part of the requirements to become a BBO diplomate. PMID:28125146

Nonsurgical Management of Pediatric Temporomandibular Joint Dysfunction.

PubMed

Scrivani, Steven John; Khawaja, Shehryar Nasir; Bavia, Paula Furlan

2018-02-01

Temporomandibular disorders (TMD) are a subgroup of craniofacial pain problems involving the temporomandibular joint (TMJ), masticatory muscles, and associated head and neck musculoskeletal structures. These disorders are subclassified into TMJ articular disorders and masticatory muscle disorders. Patients with TMD most commonly present with pain, restricted or asymmetric mandibular motion, and TMJ sounds during mandibular movements. The prevalence tends to increase with age. Management of TMJ articular disorders consists of a combination of patient education, home-care plan, biobehavioral therapy, physical therapy, orthotic jaw appliance therapy, pharmacotherapy, and/or surgery. The goal is to increase function, reduce pain, and improve quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

Impacted lower third molars and distal caries in the mandibular second molar. Is prophylactic removal of lower third molars justified?

PubMed

Marques, José; Montserrat-Bosch, Marta; Figueiredo, Rui; Vilchez-Pérez, Miguel-Angel; Valmaseda-Castellón, Eduard; Gay-Escoda, Cosme

2017-06-01

The objective of this study was to evaluate the association between the presence of mandibular third molars and the occurrence of carious lesions in the distal aspect of the mandibular second molar. A retrospective cohort study comprising 327 lower third molars extracted in the Oral Surgery and Implantology Master's Degree program of the School of Dentistry of the University of Barcelona (Barcelona, Spain) was carried out. A descriptive and bivariate analysis was made. The diagnosis of caries in the second molar and the position of the mandibular third molar were evaluated through panoramic radiographies. The sample included 203 patients, 94 males (46.3%) and 109 females (53.7%), with a mean age of 26,8 years and 327 lower third molars. The prevalence of second molar distal caries was 25.4% (95% CI= 20.6% to 30.2%). This pathology was significantly more frequent when the third molar was in a horizontal position (27.7%), when the contact point was at (45,8%) or below (47.0%) the cementoenamel junction (CEJ), and when the distal CEJ of the mandibular second molar and the mesial CEJ of the third molar was 7 to 12 mm apart. Horizontal lower third molars with contact points at or below the CEJ are more likely to produce distal caries in the mandibular second molars. Due to the high prevalence of this pathology (20.6% to 30.2%), a prophylactic removal of lower third molars with the above-mentioned features might be advisable. Key words: Second molar, caries, third molar, prophylactic removal.

Four osteotomy methods with piezosurgery to remove complicated mandibular third molars: a retrospective study.

PubMed

Ge, Jing; Yang, Chi; Zheng, Jia-Wei; He, Dong-Mei; Zheng, Ling-Yan; Hu, Ying-Kai

2014-11-01

Piezosurgery has been used widely in oral and maxillofacial surgery, but there has been no report systematically describing an osteotomy method with piezosurgery for complicated mandibular third molar removal. The aim of this study was to introduce 4 osteotomy methods using piezosurgery and evaluate their effects. A retrospective study was conducted of patients with a complicated impacted mandibular third molar requiring extraction. The predictor variable was the extraction technique. Four osteotomy methods using piezosurgery were tested according to different impaction types: method 1 involved complete bone removal; method 2 involved segmental bone removal; method 3 involved bone removal combined with tooth splitting; and method 4 involved block bone removal. Outcome variables were success rate, operative time, major complications (including nerve injury, mandible fracture, severe hematoma, or severe edema), and serious pyogenic infection. Data were analyzed using descriptive statistics. The study was composed of 55 patients with 74 complicated impacted mandibular third molars. All impacted mandibular third molars were removed successfully. The average surgical time was 15 minutes (range, 8 to 26 minutes). Thirty-eight molars (51.4%) were extracted by method 1, 18 molars (24.3%) by method 2, 12 molars (16.2%) by method 3, and 6 molars (8.1%) by method 4. Two cases (2.7%) developed postoperative infections and recovered within 1 week using drainage and antibiotic administration. The 4 osteotomy methods with piezosurgery provide effective ways of removing complicated impacted mandibular third molars. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Pilot study on laser propagation in maxillary and mandibular bone: Grey level image analysis for optical measurements.

PubMed

Guiselini, Monalisa Jacob; Deana, Alessandro Melo; de Fátima Teixeira da Silva, Daniela; Koshoji, Nelson Hideyoshi; Mesquita-Ferrari, Raquel Agnelli; do Vale, Katia Llanos; Mascaro, Marcelo Betti; de Moraes, Simone Aleksandra; Bussadori, Sandra Kalil; Fernandes, Kristianne Porta Santos

2017-06-01

Bone tissue anatomy, density and porosity vary among subjects in different phases of life and even within areas of a single specimen. The optical characteristics of changes in bone tissue are analyzed based on these properties. Photobiomodulation has been used to improve bone healing after surgery or fractures. Thus, knowledge on light propagation is of considerable importance to the obtainment of successful clinical outcomes. This study determines light penetration and distribution in human maxillary and mandibular bones in three different regions (anterior, middle, and posterior). A HeNe laser (633nm) irradiated maxillary and mandibular bones in the cervical-apical direction. The light propagation and scattering pattern were acquired and the grey level of the images was analyzed. Three-dimensional plots of the intensity profile and attenuation profiles were created. Differences in optical properties were found between the mandibular and maxillary bones. The maxilla attenuated more light than the mandible at all sites, leading to a shallower penetration depth. Our results provide initial information on the behavior of the propagation of red laser on alveolar bone using an optical method. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison of titanium and biodegradable miniplates for fixation of mandibular fractures.

PubMed

Lee, Hyo-Bin; Oh, Ji-Su; Kim, Su-Gwan; Kim, Hak-Kyun; Moon, Seong-Yong; Kim, Young-Kyun; Yun, Pil-Young; Son, Jun-Sik

2010-09-01

The purpose of the present study was to compare the use of biodegradable miniplates and titanium miniplates for the fixation of mandibular fractures. BioSorb FX biodegradable plates and screws and titanium miniplates were used in 91 patients (65 males and 26 females; age range 11 to 69 years) for the treatment of mandibular fractures. The clinical and radiographic findings were recorded at 1, 3, 6, and 12 months after surgery. The overall complication rate was 4.41%. In the biodegradable plate group, infection occurred in 2 cases (4.26%) and was resolved by incision and drainage and antibiotics. In the titanium plate group, infection occurred in 1 case and plate fracture in 1 case (4.56%). The fractured plate was removed, and a new titanium miniplate was applied using a trocar. The infection was resolved with antibiotics. No adverse tissue reactions, malocclusions, or malunions occurred during the observation period. Our results have shown that the rate of morbidity is very low with the use of biodegradable plates and titanium plates, suggesting that biodegradable and titanium plates have the potential for successful use in the fixation of mandibular fractures. Crown Copyright 2010. Published by Elsevier Inc. All rights reserved.

The effect of informed consent on stress levels associated with extraction of impacted mandibular third molars.

PubMed

Casap, Nardy; Alterman, Michael; Sharon, Guy; Samuni, Yuval

2008-05-01

To evaluate the effect of informed consent on stress levels associated with removal of impacted mandibular third molars. A total of 60 patients scheduled for extraction of impacted mandibular third molars participated in this study. The patients were unaware of the study's objectives. Data from 20 patients established the baseline levels of electrodermal activity (EDA). The remaining 40 patients were randomly assigned into 2 equal groups receiving either a detailed document of informed consent, disclosing the possible risks involved with the surgery, or a simplified version. Pulse, blood pressure, and EDA were monitored before, during, and after completion of the consent document. Changes in EDA, but not in blood pressure, were measured on completion of either version of the consent document. A greater increase in EDA was associated with the detailed version of the consent document (P = .004). A similar concomitant increase (although nonsignificant) in pulse values was monitored on completion of both versions. Completion of overdisclosed document of informed consent is associated with changes in physiological parameters. The results suggest that overdetailed listing and disclosure before extraction of impacted mandibular third molars can increase patient stress.

How to improve retromandibular transmasseteric anteroparotid approach for mandibular condylar fractures: our clinical experience.

PubMed

Salgarelli, A C; Anesi, A; Bellini, P; Pollastri, G; Tanza, D; Barberini, S; Chiarini, L

2013-04-01

Fractures of the mandibular condyle are common and account for 25-35% of all mandibular fractures reported in the literature. Even with the development of a consensus on the preference for open reduction and internal fixation of these fractures, the clinician is still faced with a dilemma concerning the optimal approach to the ramus-condyle unit. Limited access and injury to the facial nerve are the most common problems. The most commonly used extraoral approaches are the submandibular, retromandibular and preauricular methods. In this study, we propose a modified cosmetic preauricular incision with a short end in the neck, to improve the transmasseteric anteroparotid (TMAP) approach previously described by Wilson et al. in 2005. We retrospectively analysed 13 patients treated in our department for mandibular condylar fractures. Post-operative complications, occlusal status, interincisal opening and joint tenderness were evaluated at 3 months after surgery. The wider skin incision described here provides a convenient approach for open reduction and rigid internal fixation, and good results were obtained. The follow-up ranged from 6 to 40 months. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Temporo-mandibular joint condylectomy and its effect over occlusion in cats: cadaveric study.

PubMed

El-Warrak, A O; Ferrer, G A; Lanthier, T; Loureiro Silva, B; El-Warrak, L O

2011-03-01

To determine the effect of unilateral condylectomy on dental occlusion in cats. Twelve feline cadaver heads were randomly submitted to either a right or left unilateral condylectomy of the temporo-mandibular joint. The distance between the mandibular and maxillary canine tooth was measured before (B0) and after the unilateral condylectomy (P0). A right or left latero--lateral standardised force (4 N) was applied to the mandibular mentus area before and after the surgical procedure. These measurements were analysed with a linear model for repeated measures. The comparative analysis between pre- and postsurgical values indicated no significant variation in teeth displacement following condylectomy between B0 and P0 measurements. Statistically significant differences were detected after either left or right condylectomy with respect to all measurements after application of the standardised forces. Occlusion changes are significant when comparing bites before and after surgery. Unilateral condylectomy causes a significant increase in latero-lateral amplitude of jaw movement which might clinically affect feline dental occlusion. Clinical studies are required to determine the effect of unilateral condylectomies on mastication and dental occlusion in feline patients. © 2011 British Small Animal Veterinary Association.

Personality predictors of dimensions of psychosocial adjustment after surgery.

PubMed

Weinryb, R M; Gustavsson, J P; Barber, J P

1997-01-01

Although many studies have examined the relationship between personality factors and adjustment after surgery, most of them have had very short follow-up periods. The present prospective study examines whether preoperative psychodynamic assessment of personality traits enhances prediction of various areas of psychosocial adjustment assessed at least 1 year after surgery. In 53 patients undergoing pelvic pouch surgery for ulcerative colitis, we examined the relationship between personality traits measured before surgery, and postoperative psychosocial adjustment assessed at a median of 17 months postoperatively, controlling for the effect of surgical functional outcome. Personality traits were assessed with the Karolinska Psychodynamic Profile (KAPP). Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale (PAIS) were used. Problems with sexual satisfaction, perfectionistic body ideals, lack of alexithymia, and poor frustration tolerance predicted poor postoperative adjustment in various areas, beyond what was predicted by surgical functional outcome alone. Moreover, moderate preoperative levels of alexithymia were beneficial to postoperative adjustment in the area of psychological distress. The findings suggest that the preoperative assessment of the patient's long-term sexual functioning and satisfaction, the importance attached to his or her appearance, level of alexithymia, and general capacity to tolerate frustration and set-backs in life, might alert both the surgeon and the patient to potential risk factors for poor postsurgical adjustment.

Mandibular Reconstruction with Lateral Tibial Bone Graft: An Excellent Option for Oral and Maxillofacial Surgery.

PubMed

Miceli, Ana Lucia Carpi; Pereira, Livia Costa; Torres, Thiago da Silva; Calasans-Maia, Mônica Diuana; Louro, Rafael Seabra

2017-12-01

Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity, and augmentation of sinus maxillary. Bone graft can be harvested from iliac bone, calvarium, tibial bone, rib, and intraoral bone. Proximal tibia is a common donor site with few reported problems compared with other sites. The aim of this study was to evaluate the use of proximal tibia as a donor area for maxillofacial reconstructions, focusing on quantifying the volume of cancellous graft harvested by a lateral approach and to assess the complications of this technique. In a retrospective study, we collected data from 31 patients, 18 women and 13 men (mean age: 36 years, range: 19-64), who were referred to the Department of Oral and Maxillofacial Surgery at the Servidores do Estado Federal Hospital. Patients were treated for sequelae of orthognathic surgery, jaw fracture, nonunion, malunion, pathology, and augmentation of bone volume to oral implant. The technique of choice was lateral access of proximal tibia metaphysis for graft removal from Gerdy tubercle under general anesthesia. The mean volume of bone harvested was 13.0 ± 3.7 mL (ranged: 8-23 mL). Only five patients (16%) had minor complications, which included superficial infection, pain, suture dehiscence, and unwanted scar. However, none of these complications decreases the result and resolved completely. We conclude that proximal tibia metaphysis for harvesting cancellous bone graft provides sufficient volume for procedures in oral and maxillofacial surgery with minimal postoperative morbidity.

Complex sleep apnea unmasked by the use of a mandibular advancement device.

PubMed

Kuźniar, Tomasz J; Kovačević-Ristanović, Ružica; Freedom, Thomas

2011-05-01

According to most accepted definitions, complex sleep apnea syndrome (CompSAS) is described as an emergence of central apneas in a patient with obstructive sleep apnea (OSA) upon introduction of continuous positive airway pressure therapy (CPAP). We present two patients who developed comparable central apnea activity when treated with either a CPAP device or a mandibular advancement device. As similar findings have been previously documented in patients with OSA treated with maxillofacial surgery or tracheostomy, we propose that the current definition of CompSAS should broaden to include diagnosis of CompSAS in non-PAP-treated patients, who are managed with either a dental appliance or a surgical procedure.

Early implant placement for a patient with ectodermal dysplasia: Thirteen years of clinical care.

PubMed

Knobloch, Lisa A; Larsen, Peter E; Saponaro, Paola C; L'Homme-Langlois, Emilie

2017-11-29

Patients with ectodermal dysplasia have abnormalities of 2 or more structures that originate from the ectoderm. The oral manifestations often include the congenital absence of teeth and malformed teeth. This clinical report describes the interdisciplinary care from childhood through the definitive dental rehabilitation completed at skeletal maturation to replace the missing teeth in a patient with ectodermal dysplasia. Treatment began at 9 years of age with an implant-assisted mandibular overdenture to improve function and replace the missing mandibular teeth. Orthodontic treatment for the consolidation of space, composite resin restorations, and interim removable dental prostheses were provided to improve esthetics and replace the missing maxillary teeth. Skeletal growth was monitored, and orthognathic surgery was performed at the cessation of growth. The definitive rehabilitation consisted of a mandibular fixed dental prosthesis supported by dental implants and a maxillary removable dental prosthesis to restore the patient to esthetics and function. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Reconstruction of Canine Mandibular Bone Defects Using a Bone Transport Reconstruction Plate

PubMed Central

Elsalanty, Mohammed E.; Zakhary, Ibrahim; Akeel, Sara; Benson, Byron; Mulone, Timothy; Triplett, Gilbert R.; Opperman, Lynne A.

2010-01-01

Objectives Reconstruction of mandibular segmental bone defects is a challenging task. This study tests a new device used for reconstructing mandibular defects based on the principle of bone transport distraction osteogenesis. Methods Thirteen beagle dogs were divided into control and experimental groups. In all animals, a 3 cm defect was created on one side of the mandible. In eight control animals, the defect was stabilized with a reconstruction plate without further reconstruction and the animals were sacrificed two to three months after surgery. The remaining five animals were reconstructed with a bone transport reconstruction plate (BTRP), comprising a reconstruction plate with attached intraoral transport unit, and were sacrificed after one month of consolidation. Results Clinical evaluation, cone-beam CT densitometry, three-dimensional histomorphometry, and docking site histology revealed significant new bone formation within the defect in the distracted group. Conclusion The physical dimensions and architectural parameters of the new bone were comparable to the contralateral normal bone. Bone union at the docking site remains a problem. PMID:19770704

Treatment of displaced mandibular condylar fracture with botulinum toxin A.

PubMed

Akbay, Ercan; Cevik, Cengiz; Damlar, Ibrahim; Altan, Ahmet

2014-04-01

The aim of this case report is to discuss the effect on condylar reduction of botulinum toxin A treatment used in a child with displaced fracture at condylar neck of mandible. A 3-years old boy was admitted to our clinic for incomplete fracture of mandibular symphysis and displaced condylar fracture at the left side. An asymmetrical occlusal splint with intermaxillary fixation was used instead of open reduction and internal fixation because of incomplete fracture of symphysis and possible complications of condyle surgery. However, it was observed that condylar angulation persisted despite this procedure. Thus, botulinum toxin A was administered to masseter, temporalis and pterygoideus medialis muscles. At the end of first month, it was seen that mandibular condyle was almost completely recovered and that fusion was achieved. In conclusion, Botulinum A toxin injection aiming the suppression of masticatory muscle strength facilitates the reduction in the conservative management of displaced condyle in pediatric patients. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Angiogenesis in the reparatory mucosa of the mandibular edentulous ridge is driven by endothelial tip cells.

PubMed

Stănescu, Ruxandra; Didilescu, Andreea Cristiana; Jianu, Adelina Maria; Rusu, M C

2012-01-01

Sprouting angiogenesis is led by specialized cell--the endothelial tip cells (ETCs) which can be targeted by pro- or anti-angiogenic therapies. We aimed to perform a qualitative study in order to assess the guidance by tip cells of the endothelial sprouts in the repairing mucosa of the edentulous mandibular crest. Mucosa of the mandibular edentulous ridge was collected from six adult patients, prior to healing abutment placement (second surgery). Slides were prepared and immunostained with antibodies for CD34 and Ki67. The abundant vasculature of the lamina propria was observed on slides and the CD34 antibodies labeled endothelial tip cells in various stages of the endothelial sprouts. Ki67 identified positive endothelial cells, confirming the proliferative status of the microvascular bed. According to the results, the in situ sprouting angiogenesis is driven by tip cells in the oral mucosa of the edentulous ridge and these cells can be targeted by various therapies, as required by the local pathologic or therapeutic conditions.

Radiological changes with magnetic resonance imaging and computed tomography after irradiating minipig mandibles: The role of T2-SPIR mixed signal intensities in the detection of osteoradionecrosis.

PubMed

Poort, Lucas J; Postma, Alida A; Stadler, Annika A R; Böckmann, Roland A; Hoebers, Frank J; Kessler, Peter A W H

2017-05-01

Radiotherapy in the head and neck can induce several radiologically detectable changes in bone, osteoradionecrosis (ORN) among them. The purpose is to investigate radiological changes in mandibular bone after irradiation with various doses with and without surgery and to determine imaging characteristics of radiotherapy and ORN in an animal model. Sixteen Göttingen minipigs were divided into groups and were irradiated with two fractions with equivalent doses of 0, 25, 50 and 70 Gray. Thirteen weeks after irradiation, left mandibular teeth were removed and dental implants were placed. CT-scans and MR-imaging were made before irradiation and twenty-six weeks after. Alterations in the bony structures were recorded on CT-scan and MR-imaging and scored by two head-neck radiologists. Increased signal changes on MR-imaging were associated with higher radiation doses. Two animals developed ORN clinically. Radiologically mixed signal intensities on T2-SPIR were seen. On CT-scans cortical destruction was found in three animals. Based on imaging, three animals were diagnosed with ORN. Irradiation of minipig mandibles with various doses induced damages of the mandibular bone. Imaging with CT-scan and MR-imaging showed signal and structural changes that can be interpreted as prolonged and insufficient repair of radiation induced bone damages. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Low-cost Method for Obtaining Medical Rapid Prototyping Using Desktop 3D printing: A Novel Technique for Mandibular Reconstruction Planning

PubMed Central

Vahdani, Soheil; Ramos, Hector

2017-01-01

Background Three-dimensional (3D) printing is relatively a new technology with clinical applications, which enable us to create rapid accurate prototype of the selected anatomic region, making it possible to plan complex surgery and pre-bend hardware for individual surgical cases. This study aimed to express our experience with the use of medical rapid prototype (MRP) of the maxillofacial region created by desktop 3D printer and its application in maxillofacial reconstructive surgeries. Material and Methods Three patients with benign mandible tumors were included in this study after obtaining informed consent. All patient’s maxillofacial CT scan data was processed by segmentation and isolation software and mandible MRP was printed using our desktop 3D printer. These models were used for preoperative surgical planning and prebending of the reconstruction plate. Conclusions MRP created by desktop 3D printer is a cost-efficient, quick and easily produced appliance for the planning of reconstructive surgery. It can contribute in patient orientation and helping them in a better understanding of their condition and proposed surgical treatment. It helps surgeons for pre-operative planning in the resection or reconstruction cases and represent an excellent tool in academic setting for residents training. The pre-bended reconstruction plate based on MRP, resulted in decreased surgery time, cost and anesthesia risks on the patients. Key words:3D printing, medical modeling, rapid prototype, mandibular reconstruction, ameloblastoma. PMID:29075412

Efficacy of 3-Dimensional plates over Champys miniplates in mandibular anterior fractures

PubMed Central

Barde, Dhananjay H; Mudhol, Anupama; Ali, Fareedi Mukram; Madan, R S; Kar, Sanjay; Ustaad, Farheen

2014-01-01

Background: Mandibular fractures are treated surgically by either rigid or semi-rigid fixation, two techniques that reflect almost opposite concept of craniomaxillofacial osteosynthesis. The shortcomings of these fixations led to the development of 3 dimensional (3D) miniplates. This study was designed with the aim of evaluating the efficiency of 3D miniplate over Champys miniplate in anterior mandibular fractures. Materials & Methods: This study was done in 40 patients with anterior mandibular fractures. Group I consisting of 20 patients in whom 3D plates were used for fixation while in Group II consisting of other 20 patients, 4 holes straight plates were used. The efficacy of 3D miniplate over Champy’s miniplate was evaluated in terms of operating time, average pain, post operative infection, occlusion, wound dehiscence, post operative mobility and neurological deficit. Results: The mean operation time for Group II was more compared to Group I (statistically significant).There was significantly greater pain on day of surgery and at 2nd week for Group II patients but there was no significant difference between the two groups at 4th week. The post operative infection, occlusal disturbance, wound dehiscence, post operative mobility at facture site, neurological deficit was statistically insignificant (chi square test). Conclusion: The results of this study suggest that fixation of anterior mandibular fractures with 3D plates provides three dimensional stability and carries low morbidity and infection rates. The only probable limitation of these 3D plates may be excessive implant material, but they seem to be easy alternative to champys miniplate. How to cite the article: Barde DH, Mudhol A, Ali FM, Madan RS, Kar S, Ustaad F. Efficacy of 3-Dimensional plates over Champys miniplates in mandibular anterior fractures. J Int Oral Health 2014;6(1):20-6. PMID:24653598

Histopathological evaluation of the effect of locally administered strontium on healing time in mandibular fractures: An experimental study.

PubMed

Durmuş, Kasım; Turgut, Nergiz Hacer; Doğan, Mehtap; Tuncer, Ersin; Özer, Hatice; Altuntaş, Emine Elif; Akyol, Melih

2017-10-01

Mandibular fractures are the most common facial fractures. They can be treated by conservative techniques or by surgery. The authors hypothesized that the application of a single local dose of strontium chloride would accelerate the healing of subcondylar mandibular fractures, shorten the recovery time and prevent complications. The aim of the present pilot study was to evaluate the effects of a single local dose of strontium chloride on the healing of subcondylar mandibular fractures in rats. This randomized experimental study was carried out on 24 male Wistar albino rats. The rats were randomly divided into 3 groups: experimental group 1, receiving 3% strontium chloride; experimental group 2, receiving 5% strontium chloride; and the control group. A full thickness surgical osteotomy was created in the subcondylar area. A single dose of strontium solution (0.3 cc/site) was administered locally by injection on the bone surfaces of the fracture line created. Nothing was administered to the control group. The mandibles were dissected on postoperative day 21. The fractured hemimandibles were submitted to histopathological examination. The median bone fracture healing score was 9 (range: 7-9) in experimental group 1; 8 (range: 7-10) in experimental group 2; and 7.50 (range: 7-8) in the control group. When the groups were compared in terms of bone healing scores, there was a statistically significant difference between experimental group 1 and the control group (p < 0.05). This study is the first to show that local strontium may have positive effects on the healing of subcondylar mandibular fractures. In the authors' opinion, 3% strontium was beneficial for accelerating facial skeleton consolidation and bone regeneration in rat subcondylar mandibular fractures. This treatment procedure may be combined with closed fracture treatment or a conservative approach.

Impacted lower third molars and distal caries in the mandibular second molar. Is prophylactic removal of lower third molars justified?

PubMed Central

Marques, José; Montserrat-Bosch, Marta; Vilchez-Pérez, Miguel-Angel; Valmaseda-Castellón, Eduard; Gay-Escoda, Cosme

2017-01-01

Background The objective of this study was to evaluate the association between the presence of mandibular third molars and the occurrence of carious lesions in the distal aspect of the mandibular second molar. Material and Methods A retrospective cohort study comprising 327 lower third molars extracted in the Oral Surgery and Implantology Master’s Degree program of the School of Dentistry of the University of Barcelona (Barcelona, Spain) was carried out. A descriptive and bivariate analysis was made. The diagnosis of caries in the second molar and the position of the mandibular third molar were evaluated through panoramic radiographies. Results The sample included 203 patients, 94 males (46.3%) and 109 females (53.7%), with a mean age of 26,8 years and 327 lower third molars. The prevalence of second molar distal caries was 25.4% (95% CI= 20.6% to 30.2%). This pathology was significantly more frequent when the third molar was in a horizontal position (27.7%), when the contact point was at (45,8%) or below (47.0%) the cementoenamel junction (CEJ), and when the distal CEJ of the mandibular second molar and the mesial CEJ of the third molar was 7 to 12 mm apart. Conclusions Horizontal lower third molars with contact points at or below the CEJ are more likely to produce distal caries in the mandibular second molars. Due to the high prevalence of this pathology (20.6% to 30.2%), a prophylactic removal of lower third molars with the above-mentioned features might be advisable. Key words:Second molar, caries, third molar, prophylactic removal. PMID:28638558

Comparative Evaluation of Cone-beam Computed Tomography versus Direct Surgical Measurements in the Diagnosis of Mandibular Molar Furcation Involvement

PubMed Central

Padmanabhan, Shyam; Dommy, Ahila; Guru, Sanjeela R.; Joseph, Ajesh

2017-01-01

Aim: Periodontists frequently experience inconvenience in accurate assessment and treatment of furcation areas affected by periodontal disease. Furcation involvement (FI) most commonly affects the mandibular molars. Diagnosis of furcation-involved teeth is mainly by the assessment of probing pocket depth, clinical attachment level, furcation entrance probing, and intraoral periapical radiographs. Three-dimensional imaging has provided advantage to the clinician in assessment of bone morphology. Thus, the present study aimed to compare the diagnostic efficacy of cone-beam computed tomography (CBCT) as against direct intrasurgical measurements of furcation defects in mandibular molars. Subjects and Methods: Study population included 14 patients with 25 mandibular molar furcation sites. CBCT was performed to measure height, width, and depth of furcation defects of mandibular molars with Grade II and Grade III FI. Intrasurgical measurements of the FI were assessed during periodontal flap surgery in indicated teeth which were compared with CBCT measurements. Statistical analysis was done using paired t-test and Bland–Altman plot. Results: The CBCT versus intrasurgical furcation measurements were 2.18 ± 0.86 mm and 2.30 ± 0.89 mm for furcation height, 1.87 ± 0.52 mm and 1.84 ± 0.49 mm for furcation width, and 3.81 ± 1.37 mm and 4.05 ± 1.49 mm for furcation depth, respectively. Results showed that there was no statistical significance between the measured parameters, indicating that the two methods were statistically similar. Conclusion: Accuracy of assessment of mandibular molar FI by CBCT was comparable to that of direct surgical measurements. These findings indicate that CBCT is an excellent adjunctive diagnostic tool in periodontal treatment planning. PMID:29042732

A histomorphometric analysis of the nature of the mandibular canal in the anterior molar region.

PubMed

Bertl, Kristina; Heimel, Patrick; Reich, Karoline Maria; Schwarze, Uwe Yacine; Ulm, Christian

2014-01-01

Knowledge of the position and configuration of the mandibular canal is a basic requirement before implant placement in the mandible. Radiological studies suggest a positive correlation between alveolar trabecular bone quality and mandibular canal corticalization. The aim of this study was to test this assumption histomorphometrically in the anterior molar region, which is one of the most frequent places for implantation. Fifty thin ground sections (from 28 male and 22 female cadavers) of the first molar region were investigated for trabecular bone volume and thickness and the presence of a mandibular canal wall. Trabecular bone volume was significantly higher in males (p = 0.009). Further, it correlated significantly with the presence of a canal wall (rho = 0.585, p < 0.001), indicating that a reduced trabecular bone volume is associated with a reduced amount of bone surrounding the alveolar nerve. The cranial aspects of the canal wall were present at a significantly lower frequency (64.64 %) than the buccal, lingual, or caudal sides (p < 0.006). The present study demonstrated that low trabecular bone volume correlates with only a fragmentarily present mandibular canal wall. This suggests that bone surrounding the alveolar nerve is of trabecular, not cortical, origin and possibly affected by reduction of the trabecular bone. These results imply that oral surgeons should pay particular attention to implant placement in patients with low alveolar bone quality. The cranial aspects of the mandibular canal might be only fragmentarily or even completely missing. Consequently, they hardly present resistance during implant site preparation, and the risk for nerve injury, e.g., due to post-surgery hematoma, could be increased.

Mandibular angle resection and masticatory muscle hypertrophy - a technical note and morphological optimization.

PubMed

Andreishchev, A R; Nicot, R; Ferri, J

2014-11-01

Mandibular angle resection is rarely used, but is a highly effective means of correcting facial defects. We report a mandibular angle resection technique associated with the removal of a part of hypertrophic masseter muscles and resection of buccal fat pad. Anatomical reminders: the most important entities are the facial artery and vein, crossing the lower margin of the jaw just in front of the anterior boarder of the masseter muscle and the temporomaxillary vein, passing through the temporomaxillary fossa; preoperative aspects: the preoperative examination included a radiological assessment of the shape and size of the mandibular angle; surgical technique: an intra-oral approach was usually used. The most effective and convenient method for the osteotomy was using a reciprocating saw. This technique allowed achieving a smooth contour of masseter muscles during masticatory movements or at rest. Eleven mandibular angle resections were performed from 2001 to 2009. The surgery was supplemented by remodeling the lower margin of the jaw for 5 other patients. No permanent facial palsy was noted. One patient presented a unilateral long-term loss of sensitivity of the lower lip and chin. This surgical technique if simple even requires using good technical equipment, and observing a set of rules. Using these principles allows simplifying the surgical technique, and decreasing its morbidity. A part of the masseter muscles and the buccal fat pad can sometimes be resected to improve the morphological results. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Fixation of zygomatic and mandibular fractures with biodegradable plates.

PubMed

Degala, Saikrishna; Shetty, Sujeeth; Ramya, S

2013-01-01

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. To assess the fixation of zygomatic-complex and mandibular fractures with biodegradable copolymer osteosynthesis system. 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. Descriptives, Frequencies, and Chi-square test were used. 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. 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.

Evaluation of gas well setback policy in the Marcellus Shale region of Pennsylvania in relation to emissions of fine particulate matter.

PubMed

Banan, Zoya; Gernand, Jeremy M

2018-04-18

Shale gas has become an important strategic energy source with considerable potential economic benefits and the potential to reduce greenhouse gas emissions in so far as it displaces coal use. However, there still exist environmental health risks caused by emissions from exploration and production activities. In the United States, states and localities have set different minimum setback policies to reduce the health risks corresponding to the emissions from these locations, but it is unclear whether these policies are sufficient. This study uses a Gaussian plume model to evaluate the probability of exposure exceedance from EPA concentration limits for PM2.5 at various locations around a generic wellsite in the Marcellus shale region. A set of meteorological data monitored at ten different stations across Marcellus shale gas region in Pennsylvania during 2015 serves as an input to this model. Results indicate that even though the current setback distance policy in Pennsylvania (500 ft. or 152.4 m) might be effective in some cases, exposure limit exceedance occurs frequently at this distance with higher than average emission rates and/or greater number of wells per wellpad. Setback distances should be 736 m to ensure compliance with the daily average concentration of PM2.5, and a function of the number of wells to comply with the annual average PM2.5 exposure standard. The Marcellus Shale gas is known as a significant source of criteria pollutants and studies show that the current setback distance in Pennsylvania is not adequate to protect the residents from exceeding the established limits. Even an effective setback distance to meet the annual exposure limit may not be adequate to meet the daily limit. The probability of exceeding the annual limit increases with number of wells per site. We use a probabilistic dispersion model to introduce a technical basis to select appropriate setback distances.

Performance evaluation of setback buildings with open ground storey on plain and sloping ground under earthquake loadings and mitigation of failure

NASA Astrophysics Data System (ADS)

Ghosh, Rahul; Debbarma, Rama

2017-06-01

Setback structures are highly vulnerable during earthquakes due to its vertical geometrical and mass irregularity, but the vulnerability becomes higher if the structures also have stiffness irregularity in elevation. The risk factor of such structure may increase, if the structure rests on sloping ground. In this paper, an attempt has been made to evaluate the seismic performance of setback structures resting on plain ground as well as in the slope of a hill, with soft storey configuration. The analysis has been performed in three individual methods, equivalent static force method, response spectrum method and time history method and extreme responses have been recorded for open ground storeyed setback building. To mitigate this soft storey effect and the extreme responses, three individual mitigation techniques have been adopted and the best solution among these three techniques is presented.

Oral Rehabilitation With Orthognathic Surgery After Dental Implant Placement for Class III Malocclusion With Skeletal Asymmetry and Posterior Bite Collapse.

PubMed

Ohba, Seigo; Nakatani, Yuya; Kawasaki, Takako; Tajima, Nobutaka; Tobita, Takayoshi; Yoshida, Noriaki; Sawase, Takashi; Asahina, Izumi

2015-08-01

Increasing numbers of older patients are seeking orthognathic surgery to treat jaw deformity. However, orthodontic and orthognathic surgical treatment is difficult in cases without occlusal vertical stop. A 55-year-old man presented with Class III malocclusion and mandibular protrusion including esthetic problems and posterior bite collapse. He underwent dental implant treatment to reconstruct an occlusal vertical stop before orthognathic surgery. His occlusal function and esthetic problems improved after surgery, and his skeletal and occlusal stability has been maintained for 6 years. Dental implant placement at appropriate positions could help to determine the position of the proximal segment at orthognathic surgery and could shorten the time required to restore esthetic and occlusal function. This case demonstrates how skeletal and dental stability can be maintained long after surgery in a patient with jaw deformity and posterior bite collapse.

[Relationship between Work Ⅱ type of congenital first branchial cleft anomaly and facial nerve and surgical strategies].

PubMed

Zhang, B; Chen, L S; Huang, S L; Liang, L; Gong, X X; Wu, P N; Zhang, S Y; Luo, X N; Zhan, J D; Sheng, X L; Lu, Z M

2017-10-07

Objective: To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies. Methods: Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases. Results: Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web. Conclusions: CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.

The relationship between the fistula tract and the facial nerve in type II first branchial cleft anomalies.

PubMed

Ertas, Burak; Gunaydin, Rıza Onder; Unal, Omer Faruk

2015-04-01

To share our experience involving seven patients with type II first branchial cleft anomalies (hereafter, type II anomalies), to determine whether the location of the external fistula openings of the anomalies are associated with the location of the facial nerve tract, and elucidate the relationship between the location of the fistula opening and the facial nerve. The medical records of seven patients who underwent surgery from 2005 to 2013 for type II anomalies were retrospectively examined. The relationship between the fistula opening and the facial nerve was evaluated in each patient with respect to whether the fistula opening was superior or inferior to the mandibular angle. All patients underwent partial parotidectomy, facial nerve exposure, and total excision of the mass together with connection of a small cuff of the external auditory canal skin to the fistula tract. The fistula tracts were located medially to the facial nerve in two patients, and both fistulae had openings inferior to the mandibular angle. The fistula tracts were located laterally to the facial nerve in the remaining five patients: one patient had no external opening, one had an opening inferior to the mandibular angle, and the remaining three had openings superior to the mandibular angle. Because type II anomalies are rare, their diagnosis is difficult. Surgery of such lesions is challenging and associated with a high risk due to their proximity to the facial nerve. We believe that the location of the fistula opening may help to identify the relationship between the anomalous lesion and facial nerve. Studies involving larger series of cases are needed to confirm our hypothesis; however, because of the rarity of this specific anomaly, it will not be easy to compile a large number of cases. We believe that our study will encourage further investigation on this subject. Copyright © 2014. Published by Elsevier Ireland Ltd.

Fixation of mandibular fractures with biodegradable plates and screws.

PubMed

Yerit, Kaan C; Enislidis, Georg; Schopper, Christian; Turhani, Dritan; Wanschitz, Felix; Wagner, Arne; Watzinger, Franz; Ewers, Rolf

2002-09-01

Little data exist regarding the use of biodegradable plates and screws for the internal fixation of human mandibular fractures. The purpose of this study was to evaluate the stability of biodegradable, self-reinforced poly-L-lactide plates and screws for the internal fixation of fractures of the human mandible. Twenty-two individuals (14 male, 8 female; average age, 26.3 years) with a variety of fracture patterns of the mandible underwent management with a biodegradable fixation system. After surgery, maxillomandibular fixation was applied in 3 cases. Images (panoramic radiograph, computed tomographic scan) were taken immediately after surgery and at the 4-week, 8-week, 12-week, and 24-week intervals. The follow-up period averaged 49.1 weeks (range, 22 to 78 weeks). Mucosal dehiscences over the resorbable devices were present in 2 patients. In 1 of these 2 cases, the material had to be replaced with titanium plates. Mucosal healing and consolidation of the fracture were normal in all other patients. Self-reinforced biodegradable osteosynthesis materials provide a reliable and sufficient alternative to conventional titanium plate systems.

A comparative study of surgical drain placement and the use of kinesiologic tape to reduce postoperative morbidity after third molar surgery.

PubMed

Genc, Aysenur; Cakarer, Sirmahan; Yalcin, Basak Keskin; Kilic, Beril Berivan; Isler, Sabri Cemil; Keskin, Cengizhan

2018-04-19

Our aim was to compare the effects of the surgical drain and kinesiotape applications on postoperative morbidity after mandibular third molar surgery in a split-mouth study design. A single-centre, split-mouth study was performed in 23 patients who needed surgical removal of bilateral mandibular third molars. Each patient was treated with a drain tube on one side of the mandible and Kinesio tape (KT) on the contralateral side. Swelling was significantly greater in the KT group than in the drain group throughout the study period. The groups did not differ significantly in the amount of trismus at any time point. The Visual Analogue Scale (VAS)-measured pain intensity was significantly lower in the drainage group. Patients with KT had greater postoperative discomfort than those with a drain tube. All patients were generally satisfied with their treatments. Although both treatments were useful, a surgical drain was significantly more effective at reducing swelling and pain intensity than Kinesio tape. The effects of both on trismus were similar.

The correction of maxillary defciency with internal distraction devices: a multidisciplinary approach.

PubMed

Oz, A Alper; Ozer, Mete; Eroglu, Lütfi; Ozdemir, Oguz Suleyman

2013-09-01

The purpose of this case report is to present the orthodontic, surgical and restorative treatments in the case of an operated cleft lip and palate and severe maxillary defciency in a 14-year-old female patient. Only orthodontic treatment could be ineffcient for cleft lip and palate patients characterized with maxillary hypoplasia. Orthodontic and surgical treatment shows suffcient results, especially with severe skeletal defciency. A cleft lip and palate patient required complex multidisciplinary treatment to preserve health and restore esthetics. Dental leveling and alignment of the maxillary and mandibular teeth were provided before the surgery. Maxillary advancement and clockwise rotation of the maxillary-mandibular complex was applied by a Le Fort 1 osteotomy with two internal distraction devices. After the active treatment including orthodontic treatment and orthognathic surgery, upper full mouth ceramic restoration was applied. This report shows the efficiency of internal distraction devices in cleft lip palate patients and exemplifes the multidisciplinary care required for such diffcult cases. Clinical signifcance: Stable improved occlusion and skeletal relations were observed after a follow-up examination period of 12 months.

ELECTROMYOGRAPHIC EVALUATION OF MASTICATION AND SWALLOWING IN ELDERLY INDIVIDUALS WITH MANDIBULAR FIXED IMPLANTSUPPORTED PROSTHESES

PubMed Central

Berretin-Felix, Giédre; Nary, Hugo; Padovani, Carlos Roberto; Trindade, Alceu Sergio; Machado, Wellington Monteiro

2008-01-01

This study evaluated the effect of implant-supported oral rehabilitation in the mandible on the electromyographic activity during mastication and swallowing in edentulous elderly individuals. Fifteen patients aged more than 60 years were evaluated, being 10 females and 5 males. All patients were edentulous, wore removable complete dentures on both dental arches, and had the mandibular dentures replaced by implant-supported prostheses. All patients were submitted to electromyographic evaluation of the masseter, superior orbicularis oris muscles, and the submental muscles, before surgery and 3, 6 and 18 months postoperatively, using foods of different textures. The results obtained at the different periods were analyzed statistically by Kruskal-Wallis non-parametric test. Statistical analysis showed that only the masseter muscle had a significant loss in electromyographic activity (p<0.001), with a tendency of similar response for the submental muscles. Moreover, there was an increase in the activity of the orbicularis oris muscle during rubber chewing after treatment, yet without statistically significant difference. Mandibular fixed implant-supported prostheses in elderly individuals revealed a decrease in electromyographic amplitude for the masseter muscles during swallowing, which may indicate adaptation to new conditions of stability provided by fixation of the complete denture in the mandibular arch. PMID:19089202

Prototyped grafting plate for reconstruction of mandibular defects.

PubMed

Zhou, Libin; Wang, Peilin; Han, Haolun; Li, Baowei; Wang, Hongnan; Wang, Gang; Zhao, Jinlong; Liu, Yanpu; Wu, Wei

2014-12-01

To esthetically and functionally restore a 40-mm canine mandibular discontinuity defect using a custom-made titanium bone-grafting plate in combination with autologous iliac bone grafts. Individualized titanium bone-grafting plates were manufactured using a series of techniques, including reverse engineering, computer aided design, rapid prototyping and titanium casting. A 40-mm discontinuous defect in the right mandibular body was created in 9 hybrid dogs. The defect was restored immediately using the customized plate in combination with autologous cancellous iliac blocks. Sequential radionuclide bone imaging was performed to evaluate the bone metabolism and reconstitution of the grafts. The specimens were evaluated by biomechanical testing, 3-dimensional microcomputed tomographic scanning, and histological examination. The results revealed that the symmetry of the mandibles was reconstructed using the customized grafting plate, and the bony continuity of the mandibles was restored. By 12 weeks after the operation, the cancellous iliac grafts became a hard bone block, which was of comparable strength to native mandibles. A fibrous tissue intermediate was found between the remodelled bone graft and the titanium plate. The results indicate that the prototyped grafting plate can be used to restore mandibular discontinuous defects, and satisfactory aesthetical and functional reconstruction can be achieved. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Finite-element design and optimization of a three-dimensional tetrahedral porous titanium scaffold for the reconstruction of mandibular defects.

PubMed

Luo, Danmei; Rong, Qiguo; Chen, Quan

2017-09-01

Reconstruction of segmental defects in the mandible remains a challenge for maxillofacial surgery. The use of porous scaffolds is a potential method for repairing these defects. Now, additive manufacturing techniques provide a solution for the fabrication of porous scaffolds with specific geometrical shapes and complex structures. The goal of this study was to design and optimize a three-dimensional tetrahedral titanium scaffold for the reconstruction of mandibular defects. With a fixed strut diameter of 0.45mm and a mean cell size of 2.2mm, a tetrahedral structural porous scaffold was designed for a simulated anatomical defect derived from computed tomography (CT) data of a human mandible. An optimization method based on the concept of uniform stress was performed on the initial scaffold to realize a minimal-weight design. Geometric and mechanical comparisons between the initial and optimized scaffold show that the optimized scaffold exhibits a larger porosity, 81.90%, as well as a more homogeneous stress distribution. These results demonstrate that tetrahedral structural titanium scaffolds are feasible structures for repairing mandibular defects, and that the proposed optimization scheme has the ability to produce superior scaffolds for mandibular reconstruction with better stability, higher porosity, and less weight. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

The Use of Computer-Aided Design and Manufacturing in Acute Mandibular Trauma Reconstruction.

PubMed

Kokosis, George; Davidson, Edward H; Pedreira, Rachel; Macmillan, Alexandra; Dorafshar, Amir H

2018-05-01

Virtual surgical planning (VSP) with subsequent computer-aided design and manufacturing have proved efficacious in improving the efficiency and outcomes of a plethora of surgical modalities, including mandibular reconstruction and orthognathic surgery. Five patients underwent complex mandibular reconstruction after traumatic injury using VSP from July 2016 to August 2017 at our institution. The Johns Hopkins University Hospital institutional review board approved the present study. The patient's occlusion was restored virtually, and a milled 2.0-mm plate was created that would bridge the defect with the patient in occlusion. Appropriate occlusion was confirmed using postoperative computed tomography. No patient developed any adverse outcomes, except for a minor dehiscence of the intraoral incision in 1 patient that was treated with local wound care. The average interval from the injury to custom plate availability was approximately 7 days. The utility of this technology in acute complex mandibular trauma can overcome the challenges of traditional treatment. Custom patient-specific prebent and milled plates permit the use of a lower profile and therefore less palpable hardware, can guide reduction, avoid the need for plate bending, and obviate the need for an extraoral incision. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

16. 4th floor roof, view west, north side of setback ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

16. 4th floor roof, view west, north side of setback to left and delivery stair bulkhead to right - Sheffield Farms Milk Plant, 1075 Webster Avenue (southwest corner of 166th Street), Bronx, Bronx County, NY

Removal of a fractured needle during inferior alveolar nerve block: two case reports.

PubMed

You, Jae-Seek; Kim, Su-Gwan; Oh, Ji-Su; Choi, Hae-In; Jih, Myeong-Kwan

2017-09-01

The inferior alveolar nerve block is the most common method of local anesthesia for intraoral surgery at the posterior mandibular region. However, unexpected complications may occur when administering the local anesthesia. One of these uncommon complications is the fracture of the needle. If the injection needle is broken during the surgery, it should be removed immediately. However, this is one of the most difficult procedures. In this report, we present two cases of needle fracture during the procedure, and its successful removal under general/local anesthesia administration.

Canine and Premolar Root Dimensions in Chinese. A Reference for Osteoodontokeratoprosthesis Surgery.

PubMed

Sun, Stella Yue; Yeo, Woon Chee; Tay, Andrew Ban Guan; Tan, Donald Tiang Hwee; Tan, Danny Ben Poon

2018-01-01

Osteoodontokeratoprosthesis (OOKP) surgery is used to restore vision in end-stage corneal disorders, where an autogenous tooth supporting an optical cylinder is implanted through the cornea under a buccal mucosal graft. The ideal tooth for OOKP is a healthy single-rooted permanent tooth with sufficient buccolingual/palatal root diameter to accommodate an optical cylinder. The aim of this study was to determine the buccolingual/palatal diameters of canine and premolar roots in Chinese, for selection of teeth for OOKP surgery. This was an anatomical study on root dimensions of extracted intact teeth. Extracted canine and premolar teeth (excluding maxillary first premolars) were collected and the buccolingual/palatal and mesiodistal diameters of the root at the cervical line and at 2-mm intervals below the cervical line were measured with Vernier calipers. Other measurements included total tooth length, crown buccolingual/palatal diameter, and root length. Mean and minimum buccolingual/palatal root diameters were compiled for each 2-mm interval. A total of 415 extracted teeth (198 male, 217 female) were collected and measured. Recorded dimensions of keratoprostheses in 55 previous OOKP surgeries were used to establish acceptable lamina dimensions to ascertain root size adequacy. Premolars in Chinese female patients were undersized in a small minority. Minimal dimensions of teeth were insufficient if at 6 mm root level, the buccolingual/palatal width was less than 5 mm, or the mesiodistal width was less than 3 mm. This was noted in female mandibular first premolars (5.6%), maxillary second premolars (4.5%), and mandibular second premolars (1.5%). Canines have adequate dimensions for OOKP surgery. However, premolars in Chinese females may be undersized in a small minority. Copyright 2017 Asia-Pacific Academy of Ophthalmology.

Magnitude of benefit for adjuvant radiotherapy following minimally invasive surgery in intermediate to high risk HPV-positive oropharyngeal squamous cell carcinoma.

PubMed

Pasalic, Dario; Funk, Ryan K; García, Joaquín J; Price, Daniel L; Price, Katharine A; Harmsen, William S; Patel, Samir H; Young, Geoffrey D; Foote, Robert L; Moore, Eric J; Ma, Daniel J

2018-07-01

To determine the outcomes and toxicities of minimally-invasive surgery with adjuvant intensity-modulated radiotherapy +/- chemotherapy (AT) compared to definitive surgical therapy (ST) in a contemporary cohort of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). From 2005 to 2013, a consecutive cohort of 190 HPV-positive OPSCC patients was retrospectively reviewed from multi-institutional databases maintained by the Departments of Otorhinolaryngology and Radiation Oncology. A total of 116 AT patients and 42 ST patients with intermediate or high risk pathologic features were included in the final analysis. All patients received minimally invasive surgery. Time to recurrence and time to death from the onset of surgery were evaluated. Toxicity data collected included dysphagia or xerostomia requiring feeding tube placement >6 months, or mandibular osteonecrosis requiring surgery or hyperbaric oxygen. All AT patients received IMRT to a median dose of 60 Gy. Chemotherapy delivered to 67.2% of AT patients. AT group included more high-risk patients given higher nodal classification (p = 0.005) and extracapsular extension (p = 0.0005). AT improved disease-free survival (HR 2.77, CI 1.22-6.28; p = 0.02) and local-regional control (HR 14.83, CI 3.240-67.839; p = 0.001). Disease-free survival with AT and tumor extracapsular extension was improved when compared to ST (HR of 4.34, CI 1.540-12.213; p = 0.006). Dysphagia or mandibular osteonecrosis toxicity after AT vs. ST of 19.0% vs. 2.4%. AT improved local-regional control and disease-free survival but was associated with greater toxicity. The recurrence benefit was most pronounced in tumors with extracapsular extension. Copyright © 2018 Elsevier Ltd. All rights reserved.

Prevalence and Pattern of Mandibular Third Molar Impaction in Eritrean Population: A Retrospective Study.

PubMed

Kumar, V Raj; Yadav, Priya; Kahsu, Efrem; Girkar, Farhana; Chakraborty, Rajnish

2017-02-01

The most commonly impacted tooth in the oral cavity is the mandibular third molar. Various etiologic factors have been suggested for impacted mandibular third molars. The pattern and prevalence of impacted mandibular third molars vary with different population and region. This study throws light on the prevalence and pattern of impacted mandibular third molars in Eritrea, East Africa. This is the first reported study regarding the same from Eritrea. To assess the prevalence and pattern of impacted mandibu-lar third molars in the population of Eritrea, East Africa by conducting a retrospective study from January 2009 to January 2014. This study was conducted in the Department of Oral and Maxillofacial Surgery, Orotta School of Medicine and Dental Medicine and the Orotta Referral Medical and Surgical Hospital, Asmara, Eritrea. A total of 1,813 clinical and radiographic records [orthopantomograms] were assessed and 276 cases were selected for the study as per the inclusion criteria. They were evaluated for the frequency among the various age groups, gender and region along with the sides affected, angulation and level of impaction. The presence of systemic conditions and associated pathologies was also assessed according to the type of impaction. The average age of these patients in the study was found to be 30 years, with the 20 to 30 years age group being the most affected (67.4%). Females (53.3%) were affected more than the males (46.7%). People from the Asmara region showed significantly more prevalence (79.7%) than the adjoining areas (20.3%). Mesioangular impaction was the most common angulation with a definite relationship to the age groups (p = 0.032). The level of impaction had no significant relationship to the age groups, gender, or region, although class I position A was found to be the most common type. Mesioangular class I position A impac-tion showed an apparent relationship with underlying systemic conditions, but it was statistically insignificant. Mesioangular impaction was found to be associated with the most number of pathologies (p = 0.001). The prevalence of mandibular impaction was less in Eritrea (15.2%) compared with other populations. This study provides useful baseline data for the prevalence and pattern of mandibular impaction in the Eritrean population. This study throws light on the pattern, type, and frequency of mandibular impacted teeth as per age, sex, and region among the population of Eritrea.

Hydraulic Performance of Set-Back Curb Inlets

DOT National Transportation Integrated Search

1998-06-01

The objective of this study was to develop hydraulic design charts for the location and sizing of set-back curb inlets. An extensive program of hydraulic model testing was conducted to evaluate the performance of various inlet opening sizes. The grad...

Incidence of Port-Site Incisional Hernia After Single-Incision Laparoscopic Surgery

PubMed Central

Rainville, Harvey; Ikedilo, Ojinika; Vemulapali, Pratibha

2014-01-01

Background and Objectives: Single-incision laparoscopic surgery is gaining popularity among minimally invasive surgeons and is now being applied to a broad number of surgical procedures. Although this technique uses only 1 port, the diameter of the incision is larger than in standard laparoscopic surgery. The long-term incidence of port-site hernias after single-incision laparoscopic surgery has yet to be determined. Methods: All patients who underwent a single-incision laparoscopic surgical procedure from May 2008 through May 2009 were included in the study. Single-incision laparoscopic surgical operations were performed either by a multiport technique or with a 3-trocar single-incision laparoscopic surgery port. The patients were seen at 30 to 36 months' follow-up, at which time they were examined for any evidence of port-site incisional hernia. Patients found to have hernias on clinical examination underwent repairs with mesh. Results: A total of 211 patients met the criteria for inclusion in the study. The types of operations included were cholecystectomy, appendectomy, sleeve gastrectomy, gastric banding, Nissen fundoplication, colectomy, and gastrojejunostomy. We found a port-site hernia rate of 2.9% at 30 to 36 months' follow-up. Conclusion: Port-site incisional hernia after single-incision laparoscopic surgical procedures remains a major setback for patients. The true incidence remains largely unknown because most patients are asymptomatic and therefore do not seek surgical aid. PMID:24960483

A Method for Direct Fabrication of a Lingual Splint for Management of Pediatric Mandibular Fractures

PubMed Central

Davies, Sarah; Costello, Bernard J.

2013-01-01

Summary: Pediatric mandibular fractures have successfully been managed in various ways. The use of a lingual splint is one such option. The typical indirect method for acrylic lingual splint fabrication involves obtaining dental impressions. Dental models are produced from those impressions so that model surgery may be performed. The splint is then made on those models using resin powder and liquid monomer in a wet laboratory and transferred to the patient. Obvious limitations to this technique exist for both patient and operator. We present a technique for direct, intraoperative, fabrication of a splint using commercially available light-cured material that avoids some of the shortcomings of the indirect method. Recommendations are made based on available material safety information. PMID:25289246

Prosthetic Rehabilitation of Mandibular Defects with Fixed-removable Partial Denture Prosthesis Using Precision Attachment: A Twin Case Report.

PubMed

Munot, Vimal Kantilal; Nayakar, Ramesh P; Patil, Raghunath

2017-01-01

The restoration of normal function and esthetic appearance with a dental prosthesis is a major challenge in the rehabilitation of patients who have lost their teeth and surrounding bone because of surgery for oral cyst or tumor. Rehabilitation with fixed or removable prosthesis is even more challenging when the edentulous span is long and the ridge is defective. Anatomic deformities and unfavorable biomechanics encountered in the region of resection add to the misery. In such situation, a fixed-removable prosthesis allows favorable biomechanical stress distribution along with restoration of esthetics, phonetics, comfort, hygiene, and better postoperative care and maintenance. This article describes rehabilitation of two cases with mandibular defects with an attachment-retained fixed-removable hybrid prosthesis.

Piezosurgery for Excision of Large Osteoid Osteoma.

PubMed

Gadre, Pushkar; Singh, Divya; Gadre, Kiran; Khan, Imran

2016-10-01

Osteoid osteoma, a rare benign osteoblastic tumor first described by Jaffe in 1935, is characterized as a small but painful lesion that mostly affects younger people. Usually benign and harmless, osteomas are removed for pain or esthetic reasons.Piezoelectric surgery is also increasingly being used effectively in major and minor osseous oral and maxillofacial surgeries, in delicate areas. It is used regularly for various procedures, including sinus lift procedures, bone graft harvesting, osteogenic distraction, ridge expansion, inferior alveolar nerve decompression and lateralization, cyst removal, dental extraction, and impacted tooth removal.The following report presents a patient of intraoral excision of a large osteoid osteoma from lingual aspect of mandibular lower border in the body region using piezoelectric surgery.

Orthognathic Surgery in Craniofacial Microsomia: Treatment Algorithm

PubMed Central

Valladares, Salvador; Torrealba, Ramón; Nuñez, Marcelo; Uribe, Francisca

2015-01-01

Summary: Craniofacial microsomia is a broad term that covers a variety of craniofacial malformation conditions that are caused by alterations in the derivatives of the first and second pharyngeal arches. In general terms, diverse therapeutic alternatives are proposed according to the growth stage and the severity of the alteration. When craniofacial growth has concluded, conventional orthognathic surgery (Le Fort I osteotomy, bilateral sagittal split osteotomy, and genioplasty) provides good alternatives for MI and MIIA type cases. Reconstruction of the mandibular ramus and temporomandibular joint before orthognathic surgery is the indicated treatment for cases MIIB and MIII. The goal of this article is to establish a surgical treatment algorithm for orthognathic surgery on patients with craniofacial microsomia, analyzing the points that allow the ideal treatment for each patient to be chosen. PMID:25674375

Rostral mandibular fracture repair in a pet bearded dragon (Pogona vitticeps).

PubMed

Nau, Melissa R; Eshar, David

2018-04-15

CASE DESCRIPTION A 2-year-old male bearded dragon (Pogona vitticeps) was evaluated because of a traumatic mandibular fracture. CLINICAL FINDINGS An open comminuted fracture of the rostral aspect of the right mandible was evident, with a fragment of bone exposed and dorsally displaced. Whole-body radiography revealed no evidence of additional injury. Other findings were unremarkable, except for moderate anemia (PCV, 19%). TREATMENT AND OUTCOME The fracture fragments were stabilized with 2 crossed 36-gauge interfragmentary wire loops. An external fixator device was fashioned from four 25-gauge needles inserted at alternating angles through the fracture fragments; plastic IV fluid line tubing filled with dental acrylic was used as a connecting bar. One day after surgery, the lizard had regained its typical activity level and appetite. Body weight was measured and the external fixator was inspected 1 week after surgery and monthly thereafter. Three months after initial injury, the fracture was stable, radiography revealed bony callus formation at the fracture site, and the external fixator was removed. Recheck radiography performed 5.5 months after initial injury revealed complete osseous union of the fracture fragments, and the interfragmentary wires were removed. CLINICAL RELEVANCE Surgical management of the traumatic comminuted mandibular fracture in this bearded dragon by means of a combination of internal and external fixation resulted in complete healing of the mandible and restoration of function. Management of this complicated fracture was achieved with the aid of readily available and inexpensive supplies in a clinical setting, which may be useful to other clinicians in the management of similar cases.

Does intraoperative navigation improve the accuracy of mandibular angle osteotomy: Comparison between augmented reality navigation, individualised templates and free-hand techniques.

PubMed

Zhu, Ming; Liu, Fei; Zhou, Chaozheng; Lin, Li; Zhang, Yan; Chai, Gang; Xie, Le; Qi, Fazhi; Li, Qingfeng

2018-04-11

Augmented reality (AR)-based navigation surgery has evolved to be an advanced assisted technology. The aim of this study is to manifest the accuracy of AR navigation for the intraoperative mandibular angle osteotomy by comparing the navigation with other interventional techniques. A retrospective study was conducted with 93 post-surgical patients with mandibular angle hypertrophy admitted at our plastic and reconstructive surgery department between September 2011 and June 2016. Thirty-one patients received osteotomy conducted using a navigation system based on augmented reality (AR group), 28 patients received osteotomy conducted using individualised templates (IT group) and the remaining 34 patients received osteotomy performed by free hand (free-hand group). The post-operative computed tomography (CT) images were reviewed and analysed by comparing with pre-surgical planning generated by three-dimensional (3D) software. The preparation time, cutting time, whole operating time and discrepancy in osteotomy lines were measured. The preparation time was much shorter for the free-hand group than that for the AR group and the IT group (P < 0.01). However, no significant difference in the whole operating time was observed among the three groups (P > 0.05). In addition, the discrepancy in osteotomy lines was lower for the AR group and in the IT group than for the free-hand group (P < 0.01). The navigation system based on AR has a higher accuracy, more reliability and better user friendliness for some particular clinical procedures than for other techniques, which has a promising clinical prospect. Copyright © 2018. Published by Elsevier Ltd.

An in vivo evaluation of PLLA/PLLA-gHA nano-composite for internal fixation of mandibular bone fractures.

PubMed

Peng, Weihai; Zheng, Wei; Shi, Kai; Wang, Wangshu; Shao, Ying; Zhang, Duo

2015-11-09

Internal fixation of bone fractures using biodegradable poly(L-lactic-acid) (PLLA)-based materials has attracted the attention of many researchers. In the present study, 36 male beagle dogs were randomly assigned to two groups: PLLA/PLLA-gHA (PLLA-grafted hydroxyapatite) group and PLLA group. PLLA/PLLA-gHA and PLLA plates were embedded in the muscular bags of the erector spinae and also implanted to fix mandibular bone fractures in respective groups. At 1, 2, 3, 6, 9, and 12 months postoperatively, the PLLA/PLLA-gHA and PLLA plates were evaluated by adsorption and degradation tests, and the mandibles were examined through radiographic analysis, biomechanical testing, and histological analysis. The PLLA/PLLA-gHA plates were non-transparent and showed a creamy white color, and the PLLA plates were transparent and faint yellow in color. At all time points following surgery, adsorption and degradation of the PLLA/PLLA-gHA plates were significantly less than those of the PLLA plates, and the lateral and longitudinal bending strengths of the surgically treated mandibles of the beagle dogs in the PLLA/PLLA-gHA group were significantly greater than those of the PLLA group and reached almost the value of intact mandibles at 12 months postoperatively. Additionally, relatively rapid bone healing was observed in the PLLA/PLLA-gHA group with the formation of new lamellar bone tissues at 12 months after the surgery. The PLLA/PLLA-gHA nano-composite can be employed as a biodegradable material for internal fixation of mandibular bone fractures.

Accurate 3D kinematic measurement of temporomandibular joint using X-ray fluoroscopic images

NASA Astrophysics Data System (ADS)

Yamazaki, Takaharu; Matsumoto, Akiko; Sugamoto, Kazuomi; Matsumoto, Ken; Kakimoto, Naoya; Yura, Yoshiaki

2014-04-01

Accurate measurement and analysis of 3D kinematics of temporomandibular joint (TMJ) is very important for assisting clinical diagnosis and treatment of prosthodontics and orthodontics, and oral surgery. This study presents a new 3D kinematic measurement technique of the TMJ using X-ray fluoroscopic images, which can easily obtain the TMJ kinematic data in natural motion. In vivo kinematics of the TMJ (maxilla and mandibular bone) is determined using a feature-based 2D/3D registration, which uses beads silhouette on fluoroscopic images and 3D surface bone models with beads. The 3D surface models of maxilla and mandibular bone with beads were created from CT scans data of the subject using the mouthpiece with the seven strategically placed beads. In order to validate the accuracy of pose estimation for the maxilla and mandibular bone, computer simulation test was performed using five patterns of synthetic tantalum beads silhouette images. In the clinical applications, dynamic movement during jaw opening and closing was conducted, and the relative pose of the mandibular bone with respect to the maxilla bone was determined. The results of computer simulation test showed that the root mean square errors were sufficiently smaller than 1.0 mm and 1.0 degree. In the results of clinical application, during jaw opening from 0.0 to 36.8 degree of rotation, mandibular condyle exhibited 19.8 mm of anterior sliding relative to maxillary articular fossa, and these measurement values were clinically similar to the previous reports. Consequently, present technique was thought to be suitable for the 3D TMJ kinematic analysis.

Fixation of zygomatic and mandibular fractures with biodegradable plates

PubMed Central

Degala, Saikrishna; Shetty, Sujeeth; Ramya, S

2013-01-01

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. PMID:23662255

Anatomical analysis of the resected roots of mandibular first molars after failed non-surgical retreatment

PubMed Central

2018-01-01

Objectives Understanding the reason for an unsuccessful non-surgical endodontic treatment outcome, as well as the complex anatomy of the root canal system, is very important. This study examined the cross-sectional root canal structure of mandibular first molars confirmed to have failed non-surgical root canal treatment using digital images obtained during intentional replantation surgery, as well as the causative factors of the failed conventional endodontic treatments. Materials and Methods This study evaluated 115 mandibular first molars. Digital photographic images of the resected surface were taken at the apical 3 mm level and examined. The discolored dentin area around the root canal was investigated by measuring the total surface area, the treated areas as determined by the endodontic filling material, and the discolored dentin area. Results Forty 2-rooted teeth showed discolored root dentin in both the mesial and distal roots. Compared to the original filled area, significant expansion of root dentin discoloration was observed. Moreover, the mesial roots were significantly more discolored than the distal roots. Of the 115 molars, 92 had 2 roots. Among the mesial roots of the 2-rooted teeth, 95.7% of the roots had 2 canals and 79.4% had partial/complete isthmuses and/or accessory canals. Conclusions Dentin discoloration that was not visible on periapical radiographs and cone-beam computed tomography was frequently found in mandibular first molars that failed endodontic treatment. The complex anatomy of the mesial roots of the mandibular first molars is another reason for the failure of conventional endodontic treatment. PMID:29765897

Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal: A Retrospective Study.

PubMed

Ge, Jing; Yang, Chi; Zheng, Jiawei; Qian, Wentao

2016-03-01

The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery.Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed.All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ± 0.63, 3.88 ± 0.66(cm), 2.4 ± 0.2(cm), and 23.7 ± 5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment.Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar.

Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal

PubMed Central

Ge, Jing; Yang, Chi; Zheng, Jiawei; Qian, Wentao

2016-01-01

Abstract The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery. Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed. All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ± 0.63, 3.88 ± 0.66(cm), 2.4 ± 0.2(cm), and 23.7 ± 5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment. Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar. PMID:27015214

Interdisciplinary treatment for a compensated Class II partially edentulous malocclusion: Orthodontic creation of a posterior implant site.

PubMed

Chiu, Grace; Chang, Chris; Roberts, W Eugene

2018-03-01

A 36-year-old woman with good periodontal health sought treatment for a compensated Class II partially edentulous malocclusion associated with a steep mandibular plane (SN-MP, 45°), 9 missing teeth, a 3-mm midline discrepancy, and compromised posterior occlusal function. She had multiple carious lesions, a failing fixed prostheses in the mandibular right quadrant replacing the right first molar, and a severely atrophic edentulous ridge in the area around the mandibular left first and second molars. After restoration of the caries, the mandibular left third molar served as anchorage to correct the mandibular arch crowding. The mandibular left second premolar was retracted with a light force of 2 oz (about 28.3 cN) on the buccal and lingual surfaces to create an implant site between the premolars. Modest lateral root resorption was noted on the distal surface of the mandibular left second premolar after about 7 mm of distal translation in 7 months. Six months later, implants were placed in the mandibular left and right quadrants; the spaces were retained with the fixed appliance for 5 months and a removable retainer for 1 month. Poor cooperation resulted in relapse of the mandibular left second premolar back into the implant site, and it was necessary to reopen the space. When the mandibular left fixture was uncovered, a 3-mm deep osseous defect on the distobuccal surface was found; it was an area of relatively immature bundle bone, because the distal aspect of the space was reopened after the relapse. Subsequent bone grafting resulted in good osseous support of the implant-supported prosthesis. The relatively thin band of attached gingiva on the implant at the mandibular right first molar healed with a recessed contour that was susceptible to food impaction. A free gingival graft restored soft tissue form and function. This severe malocclusion with a discrepancy index value of 28 was treated to an excellent outcome in 38 months of interdisciplinary treatment. The Cast-Radiograph Evaluation score was 13. However, the treatment was complicated by routine relapse and implant osseous support problems. Retreatment of space opening and 2 additional surgeries were required to correct an osseous defect and an inadequate soft tissue contour. Orthodontic treatment is a viable option for creating implant sites, but fixed retention is required until the prosthesis is delivered. Bone augmentation is indicated at the time of implant placement to offset expected bone loss. Complex restorative treatment may result in routine complications that are effectively managed with interdisciplinary care. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

36 CFR 910.66 - Sidewalk setback.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false Sidewalk setback. 910.66 Section 910.66 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION GENERAL GUIDELINES AND UNIFORM STANDARDS FOR URBAN PLANNING AND DESIGN OF DEVELOPMENT WITHIN THE PENNSYLVANIA AVENUE...

36 CFR 910.66 - Sidewalk setback.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Sidewalk setback. 910.66 Section 910.66 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION GENERAL GUIDELINES AND UNIFORM STANDARDS FOR URBAN PLANNING AND DESIGN OF DEVELOPMENT WITHIN THE PENNSYLVANIA AVENUE...

Implicit theories of body weight: entity beliefs can weigh you down.

PubMed

Burnette, Jeni L

2010-03-01

The current research extended the implicit theory approach to a weight management context and merged it with value expectancy theory. Three studies investigated the hypothesis that individuals are especially unlikely to self-regulate effectively after dieting setbacks when they believe body weight to be fixed (entity theory) rather than malleable (incremental theory). Study 1 examined avoidant coping after a hypothetical dieting setback. Study 2 examined the implicit theory-avoidant coping relation after naturally occurring challenges to participants' weight-loss goals. Across both studies, entity theorists, relative to incremental theorists, reported more avoidant coping after setbacks. In Study 2, avoidant coping, in turn, predicted difficulty achieving weight-loss success. Study 3 manipulated implicit theories of weight to test the causal effects of implicit theories on effortful regulation. Entity theorists, relative to incremental theorists, reported less persistence following setbacks. Across the three studies, expectations about the potential for future dieting success mediated the link between implicit theory and self-regulation.

Condylar repositioning using centric relation bite in bimaxillary surgery

PubMed Central

Lee, Chang-Youn; Jang, Chang-Su; Kim, Ju-Won; Kim, Jwa-Young

2013-01-01

Objective The purpose of this study was to evaluate displacement of the mandibular condyle after orthognathic surgery using a condylar-repositioning device. Methods The patient group comprised 20 adults who underwent bimaxillary surgery between August 2008 and July 2011. The degree of condylar displacement was measured by pre- and postoperative tomographic analysis using centric relation bite and a wire during surgery. A survey assessing temporomandibular joint (TMJ) sound, pain, and locking was performed. The 20 tomographs and surveys were analyzed using the Wilcoxon signed-rank test and McNemar's test, respectively. Results No significant changes were observed in the anterior, superior, or posterior joint space of the TMJ (p > 0.05). In addition, no significant change was observed in TMJ sound (p > 0.05). However, TMJ pain and locking both decreased significantly after surgery (p < 0.05). Conclusions Due to its simplicity, this method may be feasible and useful for repositioning condyles. PMID:23671832

Virtual skeletal complex model- and landmark-guided orthognathic surgery system.

PubMed

Lee, Sang-Jeong; Woo, Sang-Yoon; Huh, Kyung-Hoe; Lee, Sam-Sun; Heo, Min-Suk; Choi, Soon-Chul; Han, Jeong Joon; Yang, Hoon Joo; Hwang, Soon Jung; Yi, Won-Jin

2016-05-01

In this study, correction of the maxillofacial deformities was performed by repositioning bone segments to an appropriate location according to the preoperative planning in orthognathic surgery. The surgery was planned using the patient's virtual skeletal models fused with optically scanned three-dimensional dentition. The virtual maxillomandibular complex (MMC) model of the patient's final occlusal relationship was generated by fusion of the maxillary and mandibular models with scanned occlusion. The final position of the MMC was simulated preoperatively by planning and was used as a goal model for guidance. During surgery, the intraoperative registration was finished immediately using only software processing. For accurate repositioning, the intraoperative MMC model was visualized on the monitor with respect to the simulated MMC model, and the intraoperative positions of multiple landmarks were also visualized on the MMC surface model. The deviation errors between the intraoperative and the final positions of each landmark were visualized quantitatively. As a result, the surgeon could easily recognize the three-dimensional deviation of the intraoperative MMC state from the final goal model without manually applying a pointing tool, and could also quickly determine the amount and direction of further MMC movements needed to reach the goal position. The surgeon could also perform various osteotomies and remove bone interference conveniently, as the maxillary tracking tool could be separated from the MMC. The root mean square (RMS) difference between the preoperative planning and the intraoperative guidance was 1.16 ± 0.34 mm immediately after repositioning. After surgery, the RMS differences between the planning and the postoperative computed tomographic model were 1.31 ± 0.28 mm and 1.74 ± 0.73 mm for the maxillary and mandibular landmarks, respectively. Our method provides accurate and flexible guidance for bimaxillary orthognathic surgery based on intraoperative visualization and quantification of deviations for simulated postoperative MMC and landmarks. The guidance using simulated skeletal models and landmarks can complement and improve conventional navigational surgery for bone repositioning in the craniomaxillofacial area. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Class II malocclusion with accentuated occlusal plane inclination corrected with miniplate: a case report

PubMed Central

Farret, Marcel Marchiori; Farret, Milton M. Benitez

2016-01-01

ABSTRACT Introduction: A canted occlusal plane presents an unesthetic element of the smile. The correction of this asymmetry has been typically considered difficult by orthodontists, as it requires complex mechanics and may sometimes even require orthognathic surgery. Objective: This paper outlines the case of a 29-year-old woman with Class II malocclusion, pronounced midline deviation and accentuated occlusal plane inclination caused by mandibular deciduous molar ankylosis. Methods: The patient was treated with a miniplate used to provide anchorage in order to intrude maxillary teeth and extrude mandibular teeth on one side, thus eliminating asymmetry. Class II was corrected on the left side by means of distalization, anchored in the miniplate as well. On the right side, maxillary first premolar was extracted and molar relationship was kept in Class II, while canines were moved to Class I relationship. The patient received implant-prosthetic rehabilitation for maxillary left lateral incisor and mandibular left second premolar. Results: At the end of treatment, Class II was corrected, midlines were matched and the canted occlusal plane was totally corrected, thereby improving smile function and esthetics. PMID:27409658

Experience with the Use of Prebent Plates for the Reconstruction of Mandibular Defects

PubMed Central

Salgueiro, Martin I.; Stevens, Mark R.

2010-01-01

Bending of large titanium plates for mandibular reconstruction is a tedious task. This is usually done by trial and error over an intraoperatively bent template. By means of rapid prototype technology, accurate three-dimensional models can be obtained. Using these models, it is possible to design, obtain, and adapt custom hardware for individual surgical cases. Reductions of operating room time when using this technology have been reported from 17% to 60%, with an average of 20%. This translates to reduction of cost and risks, improving the overall surgical outcome. The purpose of this article is to establish the indications and contraindication for the use three-dimensional models and prebent plates. We present our experience with five cases in which prebent reconstruction plates were used for mandibular reconstruction. No significant complications occurred, and satisfactory results were achieved in all cases. We found that the models required to obtain the hardware are extremely accurate, have multiple reported applications, and represent a valuable surgical tool in the planning and execution of reconstructive surgery. PMID:22132258

Prosthodontic rehabilitation in patient with ectodermal dysplasia combining preprosthetic techniques: a case report.

PubMed

Pombo Castro, María; Luaces Rey, Ramón; Arenaz Búa, Jorge; Santana-Mora, Urbano; López-Cedrún Cembranos, José Luís

2013-10-01

Oral manifestations in ectodermal dysplasia include oligodontia, alveolar ridges hypoplasia, and others. Due to the special conditions in terms of unhealthy teeth and lack of bone, implant-supported rehabilitation seems to offer the most satisfactory outcome. A 27-year-old male diagnosed with ectodermal dysplasia was referred to our department for oral rehabilitation. Oral manifestations included oligodontia, maxillary and mandibular atrophy, mandibular alveolar ridge with knife-edge morphology, and conical teeth. Treatment planning consisted of a Le Fort I osteotomy with interpositional grafts, bilateral sinus lift, and placement of maxillary and mandibular inlay and onlay corticocancellous grafts, using autologous iliac crest bone. In the second surgery, all remaining teeth were removed and 11 endosteal implants were placed. Six months after implant placement, a bimaxillary fixed implant-supported prosthesis was delivered, maintaining a satisfactory esthetic and functional result after a 2-year follow-up. The use of combined preprosthetic techniques allows the placement of endosteal implants and a fixed implant-supported prosthesis in patients with oligodontia and ectodermal dysplasia, providing an esthetic and functional oral rehabilitation.

Treatment of linear mandibular fractures using a single 2.0-mm AO locking reconstruction plate: is a second plate necessary?

PubMed

Scolozzi, Paolo; Martinez, Alvaro; Jaques, Bertrand

2009-12-01

To prospectively evaluate the use of a single Arbeitsgemeinschaft für Osteosynthesefragen (AO) 2.0-mm locking reconstruction plate for linear noncomminuted mandibular fractures without the use of a second plate. We analyzed the clinical and radiologic data of 45 patients with 74 fractures (21 single fractures, 22 double fractures, and 2 triple fractures). Fracture locations were the symphysis (n = 35, 47.3%), body (n = 15, 20.3%), and angle (n = 24, 32.4%). We recorded the mechanism of injury, time between admission to the hospital and surgery, gender and age, temporary maxillomandibular fixation and its duration, and the surgical approach. Postsurgical complications that were recorded as minor did not require surgical intervention, whereas major complications required further surgical intervention. All patients had satisfactory fracture reduction and a successful treatment outcome without major complications. Ten patients (22.2%) developed minor complications. The present study has demonstrated that treating linear noncomminuted mandibular fractures with a single AO 2.0-mm locking reconstruction plates is associated with no major complications and sound bone healing in all patients.

FAMI Screws for Mandibulo-Maxillary fixation in mandibular fracture treatment - Clinico-radiological evaluation.

PubMed

Kauke, Martin; Safi, Ali-Farid; Timmer, Marco; Nickenig, Hans-Joachim; Zöller, Joachim; Kreppel, Matthias

2018-04-01

Mandibulo-maxillary fixation (MMF) is indispensable for mandibular fracture treatment. Various means for MMF have been proposed, of which arch bars are widely considered to be the mainstay. However, disadvantages to this method have initiated a quest for an alternative, leading to the introduction of MMF screws. MMF screws have frequently been criticized for poor stability of fracture sites, root damage, hardware failure, and nerve damage. We retrospectively evaluate the FAMI (Fixation and Adaptation in Mandibular Injuries) screw in mandibular fracture treatment by scanning for clinically and radiologically visible complications. In total, 534 FAMI screws were used in the successful treatment of 96 males and 34 females. Condylar fractures were most commonly encountered, representing 120 of 241 fracture sites. 15 general fracture-related complications occurred, with the most common being nerve function impairment (3.8%) and postoperative malocclusion (4.6%). In nine cases (7%), clinically visible FAMI-screw-related complications occurred, with the most prevalent being screw loosening (2.3%) and mucosal signs of inflammation (3.1%). Duration of FAMI screws was associated with the occurrence of clinically visible complications (p = 0.042). Radiologically, clinically invisible dental hard tissue damage was noted in 21 individuals (16%). Therefore, FAMI screws seem to be a reliable and safe method for mandibulo-maxillary fixation. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Local administration of calcitriol positively influences bone remodeling and maturation during restoration of mandibular bone defects in rats.

PubMed

Liu, Hongrui; Cui, Jian; Feng, Wei; Lv, Shengyu; Du, Juan; Sun, Jing; Han, Xiuchun; Wang, Zhenming; Lu, Xiong; Yimin; Oda, Kimimitsu; Amizuka, Norio; Li, Minqi

2015-04-01

The aim of this study was to investigate the influence of calcitriol on osteoinduction following local administration into mandibular bone defects. Calcitriol-loaded absorbable collagen membrane scaffolds were prepared using the polydopamine coating method and characterized by scanning electron microscopy. Composite scaffolds were implanted into rat mandibular bone defects in the following groups: no graft material (control), bare collagen membrane (CM group), collagen membrane bearing polydopamine coating (DOP/CM group), and collagen membrane bearing polydopamine coating absorbed with calcitriol (CAL/DOP/CM group). At 1, 2, 4 and 8weeks post-surgery, the osteogenic potential of calcitriol was examined by histological and immunohistochemical methods. Following in vivo implantation, calcitriol-loaded composite scaffolds underwent rapid degradation with pronounced replacement by new bone and induced reunion of the bone marrow cavity. Calcitriol showed strong potential in inhibiting osteoclastogenesis and promotion of osteogenic differentiation at weeks 1, and 2. Furthermore, statistical analysis revealed that the newly formed bone volume in the CAL/DOP/CM group was significantly higher than other groups at weeks 1, and 2. At weeks 4, and 8, the CAL/DOP/CM group showed more mineralized bone and uniform collagen structure. These data suggest that local administration of calcitriol is promising in promoting osteogenesis and mineralization for restoration of mandibular bone defects. Copyright © 2014 Elsevier B.V. All rights reserved.

Response of ramus following vertical lengthening with distraction osteogenesis.

PubMed

Tuzuner-Oncul, Aysegul Mine; Kisnisci, Reha S

2011-09-01

Vertical lengthening of the mandibular ramus is considered to be one of the least stable surgical procedures in the management of musculoskeletal maxillofacial deformities. The aim of this study was to evaluate the response of the mandibular ramus following vertical lengthening by means of distraction osteogenesis. This study included eight non-syndromic adult patients with temporomandibular joint ankylosis. The vertical height deficiency of the mandibular ramus and the ramus/condyle unit on the affected side were simultaneously reconstructed by transportation of a bone segment using distraction osteogenesis following gap arthroplasty. Lateral and posteroanterior (PA) cephalograms taken postoperatively before active distraction, at the completion of distraction and 6, 12, 24 months after distraction, were compared to evaluate the changes of the ramus height. In all cases the vertical ramus and ramus/condyle unit height loss were successfully reconstructed by distraction osteogenesis. There was no relapse in the amount of height gained by distraction osteogenesis at the 24 months follow-up review (p>0.05). Acute one stage vertical lengthening of the mandibular ramus is considered to be one of the least stable musculoskeletal procedures with relapse being a significant adverse outcome. In this clinical study gradual vertical lengthening of the ramus through ramus/condyle unit distraction osteogenesis has maintained the initial vertical ramus height gained for 24 months. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Cohort study of pain symptoms and management following impacted mandibular third molar extraction.

PubMed

Motonobu, A; Hidemichi, Y; Eri, U; Takashi, T; Kenichi, K

2017-01-01

The aim of this study was to investigate the possibility of intravenous sedation as a useful pain-relieving option for impacted third molar extractions. A prospective cohort study was conducted among patients who underwent bilateral mandibular third molar extractions under local anaesthesia and intravenous sedation (sedation group) and patients who underwent unilateral mandibular third molar extraction under local anaesthesia alone (local anaesthesia group). The frequency of use of postoperative oral analgesia and the intensity of pain assessed using the full cup test were compared between the two groups. The maximum pain intensity (0-100) on postoperative day 1 in the sedation and local anaesthesia groups was 72.8 ± 16.98 and 84.8 ± 15.84, respectively, and the mean pain intensity was 42.2 ± 16.00 and 49.6 ± 18.94. The maximum and mean pain intensities in the sedation group were significantly milder than those in the local anaesthesia group. The number of oral analgesic doses in the sedation group was significantly smaller on the day of surgery and on postoperative day 1 than in the local anaesthesia group. The results of this study suggest that bilateral impacted mandibular third molar extractions under intravenous sedation could be a recommended treatment option. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Treatment of Class II malocclusion with mandibular skeletal anchorage.

PubMed

Cakir, Ezgi; Malkoç, Siddik; Kirtay, Mustafa

2017-06-01

The aim of this case report was to present the dentofacial changes obtained with bone anchorage in a Class II patient with moderate to severe crowding. A boy, aged 14.5 years, with a dolichofacial type, convex profile, and skeletal and dental Class II relationships was examined. After evaluation, functional treatment with bone anchorage and 4 first premolar extractions was decided as the treatment approach. Miniplates were placed on the buccal shelves of the mandibular third molars. The hook of the anchor was revealed from the first molar level. After surgery, the 4 first premolars were extracted to retract the protrusive mandibular incisors. The maxillary and mandibular first molars were banded, and a lip bumper was inserted to apply elastics and to help distalize the maxillary first molars. Orthodontic forces of 300 to 500 g were applied immediately after placement, originating from the miniscrews to the hooks of the appliance to advance the mandible. After 20 months of treatment, the patient had a dental and skeletal Class I relationship, the mandible was advanced, the maxilla was restrained, and overjet was decreased. The combination of a bone anchor, Class II elastics, and an inner bow is a promising alternative to functional treatment, along with extractions, in Class II patients. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

A computer-guided bone block harvesting procedure: a proof-of-principle case report and technical notes.

PubMed

De Stavola, Luca; Fincato, Andrea; Albiero, Alberto Maria

2015-01-01

During autogenous mandibular bone harvesting, there is a risk of damage to anatomical structures, as the surgeon has no three-dimensional control of the osteotomy planes. The aim of this proof-of-principle case report is to describe a procedure for harvesting a mandibular bone block that applies a computer-guided surgery concept. A partially dentate patient who presented with two vertical defects (one in the maxilla and one in the mandible) was selected for an autogenous mandibular bone block graft. The bone block was planned using a computer-aided design process, with ideal bone osteotomy planes defined beforehand to prevent damage to anatomical structures (nerves, dental roots, etc) and to generate a surgical guide, which defined the working directions in three dimensions for the bone-cutting instrument. Bone block dimensions were planned so that both defects could be repaired. The projected bone block was 37.5 mm in length, 10 mm in height, and 5.7 mm in thickness, and it was grafted in two vertical bone augmentations: an 8 × 21-mm mandibular defect and a 6.5 × 18-mm defect in the maxilla. Supraimposition of the preoperative and postoperative computed tomographic images revealed a procedure accuracy of 0.25 mm. This computer-guided bone harvesting technique enables clinicians to obtain sufficient autogenous bone to manage multiple defects safely.

Prevention of meatal stenosis in conchal setback otoplasty.

PubMed

Small, A

1975-10-01

The conchal setback is a useful technique for correcting many prominent ear deformities. A disadvantage of the technique in some cases is meatal stenosis of the external auditory canal. By excising a portion of meatal cartilage, this problem is prevented. The technique is illustrated and post-operative result is shown.

44 CFR 63.12 - Setback and community flood plain management requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.12... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Setback and community flood...

44 CFR 63.12 - Setback and community flood plain management requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.12... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Setback and community flood...

44 CFR 63.12 - Setback and community flood plain management requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.12... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Setback and community flood...

44 CFR 63.12 - Setback and community flood plain management requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.12... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Setback and community flood...

44 CFR 63.12 - Setback and community flood plain management requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.12... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Setback and community flood...

Prosthetic Rehabilitation of Mandibular Defects with Fixed-removable Partial Denture Prosthesis Using Precision Attachment: A Twin Case Report

PubMed Central

Munot, Vimal Kantilal; Nayakar, Ramesh P.; Patil, Raghunath

2017-01-01

The restoration of normal function and esthetic appearance with a dental prosthesis is a major challenge in the rehabilitation of patients who have lost their teeth and surrounding bone because of surgery for oral cyst or tumor. Rehabilitation with fixed or removable prosthesis is even more challenging when the edentulous span is long and the ridge is defective. Anatomic deformities and unfavorable biomechanics encountered in the region of resection add to the misery. In such situation, a fixed-removable prosthesis allows favorable biomechanical stress distribution along with restoration of esthetics, phonetics, comfort, hygiene, and better postoperative care and maintenance. This article describes rehabilitation of two cases with mandibular defects with an attachment-retained fixed-removable hybrid prosthesis. PMID:29042738

Anterior open-bite orthodontic treatment in an adult patient: A clinical case report.

PubMed

Gracco, Antonio; Siviero, Laura; de Stefani, Alberto; Bruno, Giovanni; Stellini, Edoardo

2016-06-01

A 45-year-old woman presented with an anterior open-bite complaining chiefly of her unpleasant smile esthetics and masticatory and speech problems. Treatment included speech therapy initiated immediately after bonding. Lingual spurs were positioned on the mandibular incisors in order to help tongue rehabilitation. During the working phase, temporary anchorage devices (TADs) were used at the mandibular anterior segment to intrude the lower left premolars. A splint was used to ensure retention in the upper and lower arches; an enveloppe linguale nocturne (ELN) was provided. Non-surgical open-bite treatment could offer a valid alternative to orthognanthic surgery when cephalometric evaluation shows no vertical growth pattern; patient compliance is essential to prevent relapse. Copyright © 2016 CEO. Published by Elsevier Masson SAS. All rights reserved.

Three-dimensional virtual operations can facilitate complicated surgical planning for the treatment of patients with jaw deformities associated with facial asymmetry: a case report.

PubMed

Hara, Shingo; Mitsugi, Masaharu; Kanno, Takahiro; Nomachi, Akihiko; Wajima, Takehiko; Tatemoto, Yukihiro

2013-09-01

This article describes a case we experienced in which good postsurgical facial profiles were obtained for a patient with jaw deformities associated with facial asymmetry, by implementing surgical planning with SimPlant OMS. Using this method, we conducted LF1 osteotomy, intraoral vertical ramus osteotomy (IVRO), sagittal split ramus osteotomy (SSRO), mandibular constriction and mandibular border genioplasty. Not only did we obtain a class I occlusal relationship, but the complicated surgery also improved the asymmetry of the frontal view, as well as of the profile view, of the patient. The virtual operation using three-dimensional computed tomography (3D-CT) could be especially useful for the treatment of patients with jaw deformities associated with facial asymmetry.

Three-dimensional virtual operations can facilitate complicated surgical planning for the treatment of patients with jaw deformities associated with facial asymmetry: a case report

PubMed Central

Hara, Shingo; Mitsugi, Masaharu; Kanno, Takahiro; Nomachi, Akihiko; Wajima, Takehiko; Tatemoto, Yukihiro

2013-01-01

This article describes a case we experienced in which good postsurgical facial profiles were obtained for a patient with jaw deformities associated with facial asymmetry, by implementing surgical planning with SimPlant OMS. Using this method, we conducted LF1 osteotomy, intraoral vertical ramus osteotomy (IVRO), sagittal split ramus osteotomy (SSRO), mandibular constriction and mandibular border genioplasty. Not only did we obtain a class I occlusal relationship, but the complicated surgery also improved the asymmetry of the frontal view, as well as of the profile view, of the patient. The virtual operation using three-dimensional computed tomography (3D-CT) could be especially useful for the treatment of patients with jaw deformities associated with facial asymmetry. PMID:23907678

Use of Orthodontic Mini-Implants for Maxillomandibular Fixation in Mandibular Fracture

PubMed Central

Pires, Mario Sergio Medeiros; Reinhardt, Leandro Calcagno; Antonello, Guilherme de Marco; Torres do Couto, Ricardo

2011-01-01

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. PMID:23205173

Impact of 3D virtual planning on reconstruction of mandibular and maxillary surgical defects in head and neck oncology.

PubMed

Witjes, Max J H; Schepers, Rutger H; Kraeima, Joep

2018-04-01

This review describes the advances in 3D virtual planning for mandibular and maxillary reconstruction surgical defects with full prosthetic rehabilitation. The primary purpose is to provide an overview of various techniques that apply 3D technology safely in primary and secondary reconstructive cases of patients suffering from head and neck cancer. Methods have been developed to overcome the problem of control over the margin during surgery while the crucial decision with regard to resection margin and planning of osteotomies were predetermined by virtual planning. The unlimited possibilities of designing patient-specific implants can result in creative uniquely applied solutions for single cases but should be applied wisely with knowledge of biomechanical engineering principles. The high surgical accuracy of an executed 3D virtual plan provides tumor margin control during ablative surgery and the possibility of planned combined use of osseus free flaps and dental implants in the reconstruction in one surgical procedure. A thorough understanding of the effects of radiotherapy on the reconstruction, soft tissue management, and prosthetic rehabilitation is imperative in individual cases when deciding to use dental implants in patients who received radiotherapy.

Influence of immediate post-extraction socket irrigation on development of alveolar osteitis after mandibular third molar removal: a prospective split-mouth study, preliminary report.

PubMed

Tolstunov, L

2012-12-01

The aim of this prospective comparative split-mouth study was to evaluate the role of socket irrigation with a normal saline solution routinely used at the end of extraction on the development of alveolar osteitis (AO) after removal of impacted mandibular third molars (MTMs). Thirty-five patients who satisfied the inclusion criteria were involved in the study and underwent extraction of four third-molars. To be included in the study, the mandibular third molars had to be impacted (partial or full bone) and require an osteotomy for extraction with use of a motorised drill. All surgeries were done under local anaesthesia or IV sedation. This was a prospective split-mouth study. The patient's left (assistant) side was a control side; it had a standard extraction technique of an impacted mandibular third molar that required a buccal full-thickness flap, buccal trough (osteotomy) and extraction of the tooth (with or without splitting the tooth into segments), followed by a traditional end-of-surgery debridement protocol consisting of a gentle curettage, bone filing of the socket walls, socket irrigation with approximately 5 ml of sterile normal saline solution and socket suctioning. The patient's right (operator) side was an experimental side; it also had a standard extraction technique of an impacted mandibular third molar at the beginning with a flap and osteotomy, but it was followed by a modified end-of-surgery protocol. It consisted of gentle curettage but the socket was not irrigated and not suctioned. It was simply left to bleed. The gauze was placed on top of the socket for haemostasis on both sides and the patient was asked to bite. On both sides, the buccal flap was positioned back without the suture. All patients were seen for a follow-up appointment four to seven days after the surgery to assess healing and check for symptoms and signs of alveolar osteitis, if present, on both irrigated and non-irrigated sides. This study followed the ethical guidelines of human subjects based on the Helsinki Declaration. Thirty-five patients or 70 sockets were evaluated. Eleven out of 35 patients in the study were subjected to a dry socket syndrome (31.4%). The higher number of AO was likely related to specifics of MTM selection in this study - only impacted (partial and full bone) MTMs were chosen. Among eleven patients with AO, two patients had a bilateral condition. By excluding two patients with bilateral dry sockets from the study, there were nine patients (18 extraction sites) with unilateral AO in the study. Seven out of nine patients (14 extraction sites) developed unilateral dry socket on the control (irrigated) side (77.8%) and only two (four extraction sites) on the experimental (non-irrigated) side (22.2%). Therefore, in this study there were 3.5 times more patients (extraction sites) with dry socket syndrome on the irrigated (control) side than patients (extraction sites) in the non-irrigated (experimental) side. A noticeable difference of dry socket syndromes (77.8% on the irrigated versus 22.2% on non-irrigated side) was demonstrated between the traditional extraction protocol versus modified approach without the end-of-surgery irrigation. The study demonstrated that the post-extraction socket bleeding is very important for the proper uncomplicated socket healing. If it's not washed away with irrigation solution at the end of extraction, the normal blood clot has a higher likelihood to form, and therefore, can potentially lead to an uncomplicated socket healing without development of alveolar osteitis. Socket bleeding at the extraction site creates a favourable environment for the formation of a blood clot - a protective dressing - necessary for a favourable osseous healing of the socket.

Alternative Fuels Data Center: Animation of a Hydrogen Fueling Station

Science.gov Websites

containers (only pertains to dispersing equipment) - 3-foot setback Setbacks are applicable to a 7,000 psi , Safe Handling of Compressed Gases in Containers (Compressed Gas Association, 2006) 4.1 Transportation Storage Containers for Compressed Gases (Compressed Gas Association, 2005) 5.3.2 Nonliquid Compressed

Evaluation of a Summer Reading Program to Reduce Summer Setback

ERIC Educational Resources Information Center

Johnston, Jessica; Riley, Jessica; Ryan, Carey; Kelly-Vance, Lisa

2015-01-01

Summer setback, which is defined as a decline in academic achievement over the summer months, occurs in many academic areas but seems especially problematic in reading. We assessed students from a midwestern parochial school serving predominantly students from a low--socioeconomic status background for their reading achievement before they left…

Tooth movements in foxhounds after one or two alveolar corticotomies.

PubMed

Sanjideh, Payam A; Rossouw, P Emile; Campbell, Phillip M; Opperman, Lynne A; Buschang, Peter H

2010-02-01

The aim of this split-mouth experimental study was to determine (1) whether corticotomy procedures increase tooth movement and (2) the effects of a second corticotomy procedure after 4 weeks on the rate of tooth movement. The mandibular third and maxillary second premolars of five skeletally mature male foxhounds, approximately 2 years of age, were extracted. One randomly selected mandibular quadrant had buccal and lingual flaps and corticotomies performed around the second premolar; the other quadrant served as the control. Both maxillary quadrants had initial buccal flaps and corticotomies; one randomly selected quadrant had a second buccal flap surgery and corticotomy after 28 days. Coil springs (200 g force), along with a 0.045 mm diameter tube on a 0.040 mm diameter guiding wire, were used to move the mandibular second and maxillary third premolars. Records, including digital calliper measurements and radiographs, were taken on days 0, 10, 14, 28, 42, and 56. Multilevel statistical procedures were used to model longitudinal tooth movements. The radiographic measurements initially showed increasing mandibular tooth movement rates, peaking between 22 and 25 days, and then decelerating. Total mandibular tooth movements were significantly (P < 0.05) greater on the experimental (2.4 mm) than on the control (1.3 mm) side. The rates of maxillary tooth movement slowed over time, with significantly (P < 0.05) more overall tooth movement on the side that had two (2.3 mm) than one (2.0 mm) corticotomy procedure. Alveolar corticotomy significantly increases orthodontic tooth movement. Performing a second corticotomy procedure after 4 weeks maintained higher rates of tooth movement over a longer duration and produced greater overall tooth movement than performing just one initial corticotomy, but the difference was small.

Surgical Template to Minimize the Damage of Tooth Buds in Young Children With Mandibular Distraction Osteogenesis.

PubMed

Wang, Chenglong; Chen, Ying; You, Yuanrong; Wang, Meng; Lv, Changsheng; Gui, Lai

2016-10-01

Mandibular distraction osteogenesis has become one of the most powerful reconstructive techniques for the treatment of mandibular deformities in young children. Damage to the tooth buds is often cited as a complication of it. The purpose of this study was to precisely design the osteotomy line and avoid the damage of tooth buds at the mandibular angle area with the help of surgical template. Six patients aged from 6 to 10 years were selected in this study. Three-dimensional computed tomography data was put into Mimics software for preoperative planning the osteotomy line and the accurate placement of the distractor based on the exact position of tooth follicle. And then the surgical template was manufactured by a three-dimensional printer with rapid prototyping technique. The surgeons were guided to perform the osteotomy aided with the prefabricated template through an intraoral approach. Distraction began 7 days postoperation with a rate of 1 mm/d and the distractor was removed after a 6 to 8 months consolidation period. The tooth buds were observed through radiographs that were performed at 5 time intervals: before distraction, at the end of latency, at the end of distraction, at the end of consolidation and 2 years of the postoperation to remove the distractor. The average follow-up time is 24 months. Facial appearance and occlusal plane of all the young patients were greatly improved without complications. From the radiological observation, the tooth buds was intact after the surgery and the second molar normally erupted after removing the distractor. The surgical template was considered to be helpful in improving the surgical accuracy and avoiding the tooth buds damage during mandibular distraction osteogenesis.

Primary Premaxillary Ostectomy and Setback: Dealing With the "Fly-away" Premaxilla.

PubMed

Farhadi, Rana; Wallace, Robert D

2018-05-14

This study aimed to analyze our outcomes of primary premaxillary ostectomy and setback combined with lip adhesion as the first stage in repair of the bilateral cleft lip with fly-away premaxilla. This retrospective study included all patients who required primary premaxillary setback by a single surgeon to achieve successful lip repair between 2011 and 2017 at a tertiary children's hospital. All patients had bilateral cleft lip and complete cleft palate with significant premaxillary protrusion. All patients either had failed presurgical orthodontic manipulation or were thought to be poor candidates because of the rigidity of the premaxilla on clinical examination. Patient data were obtained from review of medical records and photographs. Surgical technique is described. Eleven patients with bilateral cleft lip, all of whom also had complete cleft palate, underwent primary premaxillary setback and lip adhesion at an average age of 8.2 months. The mean follow-up was 1.9 years (range, 139 days to 4.5 years). All patients subsequently completed formal lip repair, of which 10 have undergone palatoplasty. Serial photography documented stable premaxillary position and successful lip repair within the follow-up time frame. No patient had postoperative premaxillary instability or vascular compromise. One patient had dehiscence of the lip adhesion requiring reoperation. Primary premaxillary ostectomy and setback allows for successful staged formal lip repair in patients with bilateral cleft lip and palate who have failed presurgical infant orthopedics. Further research is required regarding long-term follow-up with respect to midfacial growth.

Toward a multi-objective decision support framework to support regulations of unconventional oil and gas development

NASA Astrophysics Data System (ADS)

Alongi, M.; Howard, C.; Kasprzyk, J. R.; Ryan, J. N.

2015-12-01

Unconventional oil and gas development (UOGD) using hydraulic fracturing and horizontal drilling has recently fostered an unprecedented acceleration in energy development. Regulations seek to protect environmental quality of areas surrounding UOGD, while maintaining economic benefits. One such regulation is a setback distance, which dictates the minimum proximity between an oil and gas well and an object such as a residential or commercial building, property line, or water source. In general, most setback regulations have been strongly politically motivated without a clear scientific basis for understanding the relationship between the setback distance and various performance outcomes. This presentation discusses a new decision support framework for setback regulations, as part of a large NSF-funded sustainability research network (SRN) on UOGD. The goal of the decision support framework is to integrate a wide array of scientific information from the SRN into a coherent framework that can help inform policy regarding UOGD. The decision support framework employs multiobjective evolutionary algorithm (MOEA) optimization coupled with simulation models of air quality and other performance-based outcomes on UOGD. The result of the MOEA optimization runs are quantitative tradeoff curves among different objectives. For example, one such curve could demonstrate air pollution concentrations versus estimates of energy development profits, for different levels of setback distance. Our results will also inform policy-relevant discussions surrounding UOGD such as comparing single- and multi-well pads, as well as regulations on the density of well development over a spatial area.

Correlations between the clinical, histological and neurophysiological examinations in patients before and after parotid gland tumor surgery: verification of facial nerve transmission.

PubMed

Wiertel-Krawczuk, Agnieszka; Huber, Juliusz; Wojtysiak, Magdalena; Golusiński, Wojciech; Pieńkowski, Piotr; Golusiński, Paweł

2015-05-01

Parotid gland tumor surgery sometimes leads to facial nerve paralysis. Malignant more than benign tumors determine nerve function preoperatively, while postoperative observations based on clinical, histological and neurophysiological studies have not been reported in detail. The aims of this pilot study were evaluation and correlations of histological properties of tumor (its size and location) and clinical and neurophysiological assessment of facial nerve function pre- and post-operatively (1 and 6 months). Comparative studies included 17 patients with benign (n = 13) and malignant (n = 4) tumors. Clinical assessment was based on House-Brackmann scale (H-B), neurophysiological diagnostics included facial electroneurography [ENG, compound muscle action potential (CMAP)], mimetic muscle electromyography (EMG) and blink-reflex examinations (BR). Mainly grade I of H-B was recorded both pre- (n = 13) and post-operatively (n = 12) in patients with small (1.5-2.4 cm) benign tumors located in superficial lobes. Patients with medium size (2.5-3.4 cm) malignant tumors in both lobes were scored at grade I (n = 2) and III (n = 2) pre- and mainly VI (n = 4) post-operatively. CMAP amplitudes after stimulation of mandibular marginal branch were reduced at about 25 % in patients with benign tumors after surgery. In the cases of malignant tumors CMAPs were not recorded following stimulation of any branch. A similar trend was found for BR results. H-B and ENG results revealed positive correlations between the type of tumor and surgery with facial nerve function. Neurophysiological studies detected clinically silent facial nerve neuropathy of mandibular marginal branch in postoperative period. Needle EMG, ENG and BR examinations allow for the evaluation of face muscles reinnervation and facial nerve regeneration.

Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite.

PubMed

von Arx, Thomas; Hänni, Stefan; Jensen, Simon Storgård

2010-07-01

The aim of apical surgery is to hermetically seal the root canal system after root-end resection, thereby enabling periradicular healing. The objective of this nonrandomized prospective clinical study was to report results of 2 different root-end preparation and filling methods, ie, mineral trioxide aggregate (MTA) and an adhesive resin composite (Retroplast). The study included 353 consecutive cases with endodontic lesions limited to the periapical area. Root-end cavities were prepared with sonic microtips and filled with MTA (n = 178), or alternatively, a shallow concavity was prepared in the cut root face, with subsequent placement of an adhesive resin composite (Retroplast) (n = 175). Patients were recalled after 1 year. Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete (scar tissue) healing of previous radiolucencies. The overall rate of healed cases was 85.5%. MTA-treated teeth demonstrated a significantly (P = .003) higher rate of healed cases (91.3%) compared with Retroplast-treated teeth (79.5%). Within the MTA group, 89.5%-100% of cases were classified as healed, depending on the type of treated tooth. In contrast, more variable rates ranging from 66.7%-100% were found in the Retroplast group. In particular, mandibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast. MTA can be recommended for root-end filling in apical surgery, irrespective of the type of treated tooth. Retroplast should be used with caution for root-end sealing in apical surgery of mandibular premolars and molars. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

3.0 Tesla MRI in the early evaluation of inferior alveolar nerve neurological complications after mandibular third molar extraction: a prospective study

PubMed Central

Pranno, N; Barchetti, F; Sorrentino, V; Lo Mele, L

2014-01-01

Objectives: To evaluate the use of 3.0 T MRI in the prognosis of inferior alveolar nerve (IAN) sensory disorders after mandibular third molar extraction, in the early post-operative period. Methods: 343 IANs were examined before and 3 days after surgery. Two radiologists evaluated the course of the nerve and the relative signal intensity (RSI). Cohen's kappa coefficient (κ) and intraclass correlation coefficient (ICC) were used to evaluate the interobserver (k = 0.891) and intra-observer variability (ICC = 0.927; 0.914, respectively). The IANs were divided into four groups on the basis of neurosensory disorders recovery time. ANOVA was used to evaluate the differences among the RSIs of the four groups, and multiple comparisons were performed with Tukey's range test. Results: No differences in the course of IANs were found before and after surgery. In 280 IANs, no iatrogenic paraesthesia was found (Group A). 63 IANs showed a neurosensory impairment. 38 IANs showed recovery of post-operative paraesthesia at 3-month follow-up (Group B). 16 IANs showed a full recovery of iatrogenic paraesthesia at 6-month follow-up (Group C). Seven IANs displayed a full recovery at 12-month follow-up and two IANs showed persistence of neurosensory disorders at 18-month follow-up (Group D). The one-way ANOVA results indicated statistically significant difference among all groups (p < 0.05), except between Groups C and D (p = 0.504). Conclusions: The early evaluation of RSI values represents a valid tool to determine the prognosis of IAN sensory disorders after mandibular third molar extraction. PMID:24947977

Assessment of digital panoramic radiography's diagnostic value in angular bony lesions with 5 mm or deeper pocket depth in mandibular molars.

PubMed

Saberi, Bardia Vadiati; Nemati, Somayeh; Malekzadeh, Meisam; Javanmard, Afrooz

2017-01-01

Assessment of alveolar bone level in periodontitis is very important in determining prognosis and treatment plan. Panoramic radiography is a diagnostic tool used to screen patients. The aim of the present study was to assess the diagnostic value of digital panoramic radiography in angular bony defects with 5 mm or deeper pocket depth in mandibular molars. In this cross-sectional study, ninety angular bony defects in mandibular molars teeth with 5 mm or deeper pocket depth were selected in sixty patients with the diagnosis of chronic periodontitis. Before surgery, bone probing was performed. During the surgery, the vertical distance from cementoenamel junction to the most apical part of bony defect was measured using a Williams probe and this measurements were employed as gold standard. This distance was measured on the panoramic radiographs by a Digital Calliper and Digital Ruler. All data were compare dusing independent samples t -test and Pearson's correlation coefficient. No significant difference was found between the results of bone probing and intra-surgical measurements ( P = 0.377). The mean defect depth determined by Digital Caliper and Digital Ruler on panoramic radiographs was significantly less than surgical measurements ( P < 0.001). The correlation between bone probing and surgical measurements in determining the defect depth was strong ( r = 0.98, P < 0.001). Radiographic measurements made by Digital Ruler ( r = 0.86), comparing to Digital Caliper ( r = 0.79), showed a higher degree of correlation with surgical measurements. Based on this study, bone probing is a reliable method in vertical alveolar bone defect measurements. While the information obtained from digital panoramic radiographs should be used with caution and the ability of digital panoramic radiography in the determination of defect depth is limited.

Mandibular second molar periodontal healing after impacted third molar extraction in young adults.

PubMed

Faria, Ana Inocêncio; Gallas-Torreira, Mercedes; López-Ratón, Mónica

2012-12-01

To estimate the prevalence of preoperative periodontal defects and analyze 12-month spontaneous healing on the distal aspect of the mandibular second molar (M2) after impacted mandibular third molar (M3) extraction. This prospective clinical study was conducted in 25 healthy young patients (21.03 ± 4.38 yr old) with 40 extractions of higher-risk periodontal impacted M3s. Plaque and gingival indexes, recession, bleeding on probing, probing depth (PD), and attachment level were recorded before surgery and at 3, 6, and 12 months after surgery at 5 sites on the distal aspect of the M2. The initial mean PD was 5.70 ± 3.80 mm, with the deepest mean PD at the lingual side. At 12 months, a mean PD average of 3.77 ± 2.86 mm was recorded, with a total average recovery of 1.93 ± 2.46 mm (P < .001), that was higher at 3 months (-1.62 mm, P < .001). The PD and attachment level improvements were statistically significant (P < .001) and nearly clinically significant from baseline to 12-month follow-up and from the buccal to the lingual side of the distal aspect of the M2. Impacted M3s adjacent to M2s lead to periodontal defects that are deepest at the lingual side and almost recover at 12 months after extraction. The first 3 months is considered the cutoff for periodontal healing. Young adults with high-risk periodontal M3 impactions may benefit from early extraction, which increases spontaneous periodontal healing. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Surgical Management of Laterognathia in Orthofacial Surgery.

PubMed

García Y Sánchez, J M; Gómez Rodríguez, C L; Romero Flores, J

2017-09-01

Each year around the world, various surgical procedures are carried out with the goal of correcting laterognathia; both the intraoral vertical ramus osteotomy (IVRO) and bilateral sagittal split ramus osteotomy (OSB) have been the most used techniques in mandibular surgery. These techniques have advantages and disadvantages; for example the advantages of the OSB include: increased coefficient of friction between bony segments, for both the forward and the retroposition, as well as decrease in the time of intermaxillary fixation (IMF). Disadvantages include injury to the inferior alveolar nerve (IAN), hemorrhage, bad split, among others. The advantages of IVRO include decrease of possibility of injury to the IAN, ease of implementation of the technique, a lower incidence of hemorrhage and the short duration of the surgical procedure. Their disadvantages include: lower coefficient of friction between bony segments, requires a relatively long period of IMF. The combination between the techniques of mandibular osteotomy for the correction of minor 10 mm laterognathia is the ideal treatment, since it avoids potential recurrence. We describe two cases of patients with laterognathia greater than 6 mm associated with maxilla deformity, which were treated with combined osteotomies. At Maxillofacial Surgery Service, Specialty Hospital, National Medical Center XXI Century, we describe the advantages and disadvantages, pre and postoperative nosocomial, by comparing them with the reports of the literature. The combination of techniques in the correction of laterognathias greater than 4 mm (smaller than 10 mm) is the ideal treatment, eliminating problems of articular compression, recurrence and damage to the alveolar nerve.

A Retrospective Radiographic Survey of Pathology Associated with Impacted Third Molars among Patients Seen in Oral & Maxillofacial Surgery Clinic of College of Dentistry, Riyadh.

PubMed

Khawaja, Naveed Ahmad; Khalil, Hesham; Parveen, Kauser; Al-Mutiri, Abdulmajeed; Al-Mutiri, Saif; Al-Saawi, Abdullah

2015-04-01

The purpose of this study is to determine the type and frequency of pathological conditions around third molar teeth among randomly selected patient's records in Oral and Maxillofacial Surgery, College of Dentistry, King Saud University, Riyadh. Totally, 281 patient panoramic radiographs were selected with detectable pathology among 570 files of patients seen in oral and maxillofacial surgery clinics 2 years retrospectively. Almost 17-55 years age (mean age 25.43) was selected. The following radiographs were analyzed for all pathology associated impacted teeth; dental caries, bone resorption, periodontitis, and apical pathology. The study found caries, external bone resorption and periodontitis are highly frequent to mesioangular and horizontal in mandibular impacted third molar compared to maxillary impacted third molar. Overall result evaluated that tooth #28 related periodontitis is significant (P = 0.021), and tooth #38 related bone resorption, tooth #48 related root caries, bone resorption and apical pathology are highly significant (P = 0.000) comparing to others. This study also concluded the high frequency of root caries, bone resorption and apical pathology reported in relation to mandibular impacted third teeth. Significant results were also achieved with periodontitis in relation to mesiangular and vertical angulation of left impacted maxillary third molars. Prophylactic removal of impacted third molars is recommended in many studies to avoid future risk of associated pathology. Retained asymptomatic impacted third molars imply pathology that could be difficult in later ages as less morbidity in younger ages.

Changes in the pattern of patients receiving surgical-orthodontic treatment

PubMed Central

Proffit, William R.; Jackson, Tate H.; Turvey, Timothy A.

2014-01-01

Introduction The characteristics of patients who seek and accept orthognathic surgery appear to be changing over time but have not been well documented in the 21st century. Methods Records for patients who had orthognathic surgery at the University of North Carolina from 1996 to 2000 and from 2006 to 2010 were reviewed to collect data for changes in the prevalence of patients with mandibular deficiency (Class II), maxillary deficiency or mandibular prognathism (Class III), long face, and asymmetry problems. The changes were compared with those in previous time periods and at other locations. Results Between 1996 and 2000 and between 2006 and 2010, the percentage of Class III patients increased from 35% to 54%, and the percentage of Class II patients decreased from 59% to 41%, while the percentages for long face and asymmetry showed little change. The decrease in Class II patients was accentuation of a long-term trend; the increase in Class III patients occurred only after the turn of the century. Conclusions A similar but less-marked change has been noted at some but not all other locations in the United States. It appears to be related primarily to an increase in the numbers of African Americans, Native Americans, Hispanics, and Asians who now are seeking surgical treatment, but it also has been affected by changes in where orthognathic surgery is performed, decisions by third-party payers (insurance and Medicaid) about coverage for treatment, and the availability of nonsurgical orthodontic treatment options for Class II patients. PMID:23726329

Alar setback technique: a controlled method of nasal tip deprojection.

PubMed

Foda, H M

2001-11-01

To describe an alar cartilage-modifying technique aimed at decreasing nasal tip projection in cases with overdeveloped alar cartilages and to compare it with other deprojection techniques used to correct such deformity. Selected case series. University and private practice settings in Alexandria, Egypt. Twenty patients presenting for rhinoplasty who had overprojected nasal tips primarily due to overdeveloped alar cartilages. All cases were primary cases except for one patient, who had undergone 2 previous rhinoplasties. An external rhinoplasty approach was used to set back the alar cartilages by shortening their medial and lateral crura. The choice of performing a high or low setback depended on the preexisting lobule-to-columella ratio. Following the setback, the alar cartilages were reconstructed in a fashion that increased the strength and stability of the tip complex. Subjective evaluation included clinical examination, analysis of preoperative and postoperative photographs, and patient satisfaction. Objective evaluation of nasal tip projection, using the Goode ratio and the nasofacial angle, was performed preoperatively and repeated at least 6 months postoperatively. A low setback was performed in 16 cases (80%) and a high setback in 4 (20%). The mean follow-up period was 18 months (range, 6-36 months). The technique effectively deprojected the nasal tip as evidenced by the considerable postoperative decrease in values of the Goode ratio and the nasofacial angle. No complications were encountered and no revision surgical procedures were required. The alar setback technique has many advantages; it results in precise predictable amounts of deprojection, controls the degree of tip rotation, preserves the natural contour of the nasal tip, respects the tip support mechanisms, increases the strength and stability of nasal tip complex, preserves or restores the normal lobule-to-columella proportion, and does not lead to alar flaring. However, the technique requires an external rhinoplasty approach and fine technical precision.

Automatic repositioning of jaw segments for three-dimensional virtual treatment planning of orthognathic surgery.

PubMed

Santos, Rodrigo Mologni Gonçalves Dos; De Martino, José Mario; Passeri, Luis Augusto; Attux, Romis Ribeiro de Faissol; Haiter Neto, Francisco

2017-09-01

To develop a computer-based method for automating the repositioning of jaw segments in the skull during three-dimensional virtual treatment planning of orthognathic surgery. The method speeds up the planning phase of the orthognathic procedure, releasing surgeons from laborious and time-consuming tasks. The method finds the optimal positions for the maxilla, mandibular body, and bony chin in the skull. Minimization of cephalometric differences between measured and standard values is considered. Cone-beam computed tomographic images acquired from four preoperative patients with skeletal malocclusion were used for evaluating the method. Dentofacial problems of the four patients were rectified, including skeletal malocclusion, facial asymmetry, and jaw discrepancies. The results show that the method is potentially able to be used in routine clinical practice as support for treatment-planning decisions in orthognathic surgery. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

The Ultrasonographic Determination of the Position of the Mental Foramen and its Relation to the Mandibular Premolar Teeth.

PubMed

Laher, Abdullah Ebrahim; Motara, Feroza; Moolla, Muhammed

2016-06-01

The position of the mental foramen has been well researched in cadaver specimens, radiographically as well as intraoperatively. To our knowledge, this landmark study is the first to make use of ultrasonography in a study population to determine the position of the mental foramen in relation to the mandibular premolar teeth. Ultrasonography has great potential to further revolutionize the practice of medicine and dento-maxillofacial surgery. To make use of ultrasound to determine the position of the mental foramen and its relation to the mandibular premolar teeth. One hundred Black and Caucasian subjects were enrolled. A high frequency (8MHz) transducer (PLF.805ST) of a diagnostic ultrasound system (model SSA-510A) was applied above the inferior border of the mandible, just lateral to the mentum. With the marker of the transducer pointing cranially, the position of the mental foramen in relation to the closest mandibular premolar tooth was determined. The position was compared across race, sex and age groups. All mental foramina (100%) were visualised. Overall the most frequent position of the mental foramen was in line with the long axis of the second premolar on the right (44%) and between the first and second premolars on the left (44%). There were no statistical differences (p >0.05) between race groups, sex and age groups with regard to the position of the mental foramen in relation to the mandibular premolars. However, in Blacks, the most frequent position of the mental foramen was in line with the long axis of the second premolar and in Caucasians the most common position was between the first and second premolars. The most frequent position of the mental foramen in females was in line with the long axis of the second premolar on the right and between the first and second premolars on the left. In males, the most frequent position of the mental foramen was in line with the long axis of the second premolar bilaterally. The most common position of the mental foramen in the age group category 18-30 years was between the first and second premolars. In patients aged 31-60 years the most frequent position was in line with the long axis of the second premolar. Ultrasound is a sensitive modality to locate the mental foramen. There are differences in the most common position of the mental foramen with regard to the long axis of the premolar teeth. Ultrasonography has the potential to revolutionize the practice of dento-maxillofacial surgery.

Speech-language therapy program for mouth opening in patients with oral and oropharyngeal cancer undergoing adjuvant radiotherapy: a pilot study.

PubMed

Marrafon, Caroline Somera; Matos, Leandro Luongo; Simões-Zenari, Marcia; Cernea, Claudio Roberto; Nemr, Katia

2018-01-01

Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.

Condyle and mandibular bone change after unilateral condylar neck fracture in growing rats.

PubMed

Hu, Y; Yang, H-f; Li, S; Chen, J-z; Luo, Y-w; Yang, C

2012-08-01

Unilateral fracture of the condylar neck in immature subjects might lead to mandible asymmetry and condyle remodelling. A rat model was used to investigate mandibular deviation and condylar remodelling associated with condyle fracture. 72 4-week-old male rats were randomly divided into three groups: an experimental group (unilateral transverse condylar fracture induced surgically), a sham operation group (surgical exposure but no fracture), and a non-operative control group (no operation). The rats were killed at intervals up to 9weeks after surgery, and outcomes were assessed using various measures of mandible deviation, histological and X-ray observation, and immunohistochemical measures of expression levels of connective tissue growth factor (CTGF) and type II collagen (Col II). The fracture led to the degeneration of mandibular size, associated with atrophy of fractured condylar process. Progressive remodelling of cartilage and increasing expression levels of CTGF and Col II were found. The authors conclude that condylar fracture can lead to asymmetries in mandible and condyle remodelling and expression of CTGF and Col II in condylar cartilage on both the ipsilateral and the contralateral sides. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study.

PubMed

Zrounba, Hugues; Lutz, Jean-Christophe; Zink, Simone; Wilk, Astrid

2014-09-01

Surgical management of mandibular condyle fractures is still controversial. Although it provides better outcome than closed treatment questions still remain about the surgical approach and the osteosynthesis devices to be used. Between 2005 and 2010, we managed 168 mandibular condyle fractures with open treatment. Two surgical approaches were used in this study, a pre-auricular and a high submandibular approach (one or the other or as a combined approach). Internal fixation was performed using TCP(®) plates (Medartis, Basel, Switzerland) or with two lag screws (15 and 17 mm). Delta plates were used in 15 cases (8.9%). We report the epidemiology of these fractures and the outcomes of the surgical treatment. We assessed the complications related to the surgical procedure and those related to the osteosynthesis material. The facial nerve related complication rate was very low and the osteosynthesis materials used proved to be strong enough to realize a stable fixation. The two approaches used in this study appeared to be safe with good aesthetic results. Most of the surgical procedure failures occurred in high subcondylar fractures especially when bilateral. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Clinical, retrospective case-control study on the mechanics of obstacle in mouth opening and malocclusion in patients with maxillofacial fractures.

PubMed

Zhou, Hai-Hua; Lv, Kun; Yang, Rong-Tao; Li, Zhi; Yang, Xue-Wen; Li, Zu-Bing

2018-05-16

This study aims to identify and distinguish various factors that may influence the clinical symptoms (limited mouth opening and malocclusion) in patients with maxillofacial fractures. From January 2000 to December 2009, 963 patients with maxillofacial fractures were enrolled in this statistical study to aid in evaluating the association between various risk factors and clinical symptoms. Patients with fractured posterior mandibles tended to experience serious limitation in mouth opening. Patients who sustained coronoid fractures have the highest risk of serious limitation in mouth opening (OR = 9.849), followed by arch fractures, maxilla fractures, condylar fractures, zygomatic complex fractures and symphysis fractures. Meanwhile, the combined fracture of zygomatic arch and condylar process results in normal or mild mouth opening. High risks of sustaining malocclusion are preceded by the fracture of nasal bone (OR = 3.067), mandible, condylar neck/base, combined fracture of zygomatic arch and condylar process, mandibular body, bilateral condylar, dental trauma, mandibular ramus, symphysis, mandibular angle and mid-facial. Patients who experienced serious limitation in mouth opening are treated with surgery more frequently (OR = 2.118). No relationship exists between the treatment options and the patients with malocclusion.

Photogrammetry Impression Technique: A Case History Report.

PubMed

Sánchez-Monescillo, Andrés; Sánchez-Turrión, Andrés; Vellon-Domarco, Elena; Salinas-Goodier, Carmen; Prados-Frutos, Juan Carlos

2016-01-01

The aim of this report is to present photogrammetry as a reliable step in the fabrication of a full-arch immediate rehabilitation. A 59-year-old man attended the department seeking dental rehabilitation for the sequelae of severe oral health neglect. The mandibular teeth suffered from advanced periodontal disease and the patient wore a maxillary complete denture. An irreversible hydrocolloid impression of the mandibular arch was made, poured in stone, and digitally scanned to create the first stereolithography (STL) file. All teeth with the exception of two retained as landmarks were extracted, and seven implants were placed under local anesthesia and their positions recorded using photogrammetry. Maxillary and mandibular dental arch alginate impressions were made, poured in laboratory stone, and scanned. A provisional restoration was placed 7 hours after surgery using the STL files to determine the best-fit line. Radiographic and clinical follow-up after 1 year showed a favorable evolution of the implants. No screw loosening or other mechanical or biologic complications were observed. The case history using the described system suggests certain advantages over conventional techniques. More research is needed to assess the possible benefits associated with photogrammetry when making implant-supported restorations.

Orthodontic decompensation in skeletal Class III malocclusion: redefining the amount of movement assessed by Cone-Beam Computed Tomography

PubMed Central

Cappellozza, José Antonio Zuega; Guedes, Fabio Pinto; Nary, Hugo; Capelozza, Leopoldino; Cardoso, Mauricio de Almeida

2015-01-01

Introduction: Cone-Beam Computed Tomography (CBCT) is essential for tridimensional planning of orthognathic surgery, as it allows visualization and evaluation of bone structures and mineralized tissues. Tomographic slices allow evaluation of tooth inclination and individualization of movement performed during preoperative decompensation. The aim of this paper was to assess maxillary and mandibular incisors inclination pre and post orthodontic decompensation in skeletal Class III malocclusion. Methods: The study was conducted on six individuals with skeletal Class III malocclusion, surgically treated, who had Cone-Beam Computed Tomographic scans obtained before and after orthodontic decompensation. On multiplanar reconstruction view, tomographic slices (axial, coronal and sagittal) were obtained on the long axis of each incisor. The sagittal slice was used for measurement taking, whereas the references used to assess tooth inclination were the long axis of maxillary teeth in relation to the palatal plane and the long axis of mandibular teeth in relation to the mandibular plane. Results: There was significant variation in the inclination of incisors before and after orthodontic decompensation. This change was of greater magnitude in the mandibular arch, evidencing that natural compensation is more effective in this arch, thereby requiring more intensive decompensation. Conclusion: When routinely performed, the protocols of decompensation treatment in surgical individuals often result in intensive movements, which should be reevaluated, since the extent of movement predisposes to reduction in bone attachment levels and root length. PMID:26560818

Continuity resection of the mandible after ameloblastoma - feasibility of oral rehabilitation with rhBMP-2 associated to bovine xenograft followed by implant installation.

PubMed

Lustosa, Romulo Maciel; Macedo, Diogo de Vasconcelos; Iwaki, Lilian Cristina Vessoni; Tolentino, Elen de Souza; Hasse, Paulo Norberto; Marson, Giordano Bruno de Oliveira; Iwaki Filho, Liogi

2015-10-01

Recombinant human morphogenetic protein (rhBMP) is a graft alternative for extensive mandibular reconstruction after tumor resections. However, the feasibility of rhBMP-2 to receive osseointegrated implants and prosthetic rehabilitation has been rarely reported. This study reports on a case of an extensive solid ameloblastoma along the mandibular body. The treatment consisted of resection followed by off-label use of rhBMP type 2 associated with bovine bone xenograft. Eleven months postoperatively, the patient was prosthetically rehabilitated with dental implants, without evidence of resorption or complications. The literature on mandibular reconstructions using rhBMP and their feasibility for future osseointegrated implant placement was also reviewed. Based on the presented case, the association between rhBMP-2 and a bovine bone xenograft could be considered a feasible option for the reconstruction and rehabilitation of large mandibular defects after tumor resection. According to the literature, the use of rhBMP as a graft material is encouraging, with good clinical outcome. However, there are no long-term studies demonstrating success and survival rates of implants placed in these grafts. Future investigations will be required to ascertain the long-term survival of implants in areas grafted with rhBMP. Also, there is a lack of information regarding the prosthetic rehabilitation of these patients. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Unconditional regard buffers children's negative self-feelings.

PubMed

Brummelman, Eddie; Thomaes, Sander; Walton, Gregory M; Poorthuis, Astrid M G; Overbeek, Geertjan; Orobio de Castro, Bram; Bushman, Brad J

2014-12-01

Unconditional regard refers to the feeling that one is accepted and valued by others without conditions. Psychological theory suggests that experiences of unconditional regard lead children to feel that they are valuable despite setbacks. We hypothesized that reflecting on experiences of unconditional regard would buffer children's negative self-feelings (eg, shame, insecurity, powerlessness) in the face of setbacks. To test this hypothesis, we randomized children to reflect on experiences of unconditional regard or other experiences, and examined their response to an academic setback 3 weeks later. Participants (11-15 years old) were randomly assigned to reflect for 15 minutes on experiences of unconditional regard (n = 91), conditional regard (n = 80), or other social experiences (n = 76). Research personnel, teachers, and classmates remained blind to condition assignment. Three weeks later, after receiving their course grades, children reported their self-feelings. Course grades were obtained from school records. Receiving low course grades represents a salient and painful real-world setback for children. Replicating previous research, children who received lower grades experienced more negative self-feelings (P < .001). As predicted, this well-established relationship was significantly attenuated among children who had reflected, 3 weeks previously, on experiences of unconditional regard (Ps < .03). Reflecting on unconditional regard specifically reduced negative self-feelings after low grades (P = .01), not after average or high grades (Ps > .17). Reflecting on unconditional regard buffered children's selves against the adverse impact of an academic setback over an extended period of time. Unconditional regard may thus be an important psychological lever to reduce negative self-feelings in youth. Copyright © 2014 by the American Academy of Pediatrics.

Treatment in Borderline Class III Malocclusion: Orthodontic Camouflage (Extraction) Versus Orthognathic Surgery.

PubMed

Rabie, A-Bakr M; Wong, Ricky W K; Min, G U

2008-01-01

To investigate the differences in morphological characteristics of borderline class III patients who had undergone camouflage orthodontic treatment or orthognathic surgery, and to compare the treatment effects between these two modalities. Cephalograms of 25 patients (13 orthodontic, 12 surgical) with class III malocclusion were analyzed. All had a pretreatment ANB angle greater than -5 masculine. Using discriminant analysis, only Holdaway angle was selected to differentiate patients in the pretreatment stage. Seventy-two per cent patients were correctly classified. In the orthodontic group, reverse overjet was corrected by retraction of the lower incisors and downward and backward rotation of the mandible. The surgical group was corrected by setback of the lower anterior dentoalveolus and uprighting of the lower incisors. No difference was found in posttreatment soft tissue measurements between the two groups. Twelve degree for the Holdaway angle can be a guideline in determining the treatment modalities for borderline class III patients, but the preferences of operators and patients are also important. (2) Both therapeutic options should highlight changes in the lower dentoalveolus and lower incisors. (3) Both treatment modalities can achieve satisfactory improvements to the people.

Novel Positional Devices for the Treatment of Positional Obstructive Sleep Apnea, and How This Relates to Sleep Surgery.

PubMed

Ravesloot, Madeline J L; Benoist, Linda; van Maanen, Peter; de Vries, Nico

2017-01-01

If untreated, obstructive sleep apnea (OSA) develops as a gradual progressive disease. In the early stage of the disease most patients with OSA are positional. The archetypical patient might progress from simple positional snoring via positional early-stage mild disease to less positional moderate and finally nonpositional severe OSA. At first, the apnea-hypopnea index (AHI) is high only in the supine position, and later is high in all sleeping positions. The phenomenon is reversible. After partial effective treatment, patients with severe OSA can reverse to less severe positional OSA or, in other words, the AHI drops more in the lateral position than in supine position. This has been shown for palatal surgery, multilevel surgery, bimaxillary osteotomies, and bariatric surgery. The absence or presence of positional dependency has a great influence on sleep surgery. First, the results of sleep surgery might be worse in positional patients. Second, the addition of positional therapy to sleep surgery might improve the overall outcome and, as such, enhance the indication of sleep surgery as an alternative to continuous positive airway pressure and mandibular advancement device treatment. © 2017 S. Karger AG, Basel.

Arthroscopy for treating temporomandibular joint disorders.

PubMed

Currie, Roger

2011-01-01

The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline Embase, Lilacs, Allied and Complementary Medicine Database (AMED) and CINAHL databases were searched. In addition the reference lists of the included articles were checked and 14 journals hand searched. Randomised controlled clinical trials (RCT) of arthroscopy for treating TMDs were included. There were no restrictions regarding the language or date of publication. Two review authors independently extracted data, and three review authors independently assessed the risk of bias of included trials. The authors of the selected articles were contacted for additional information. Pooling of trials was only attempted if at least two trials of comparable protocols, with the same conditions and similar outcome measurements were available. Statistical analysis was performed in accordance with the Cochrane Collaboration guidelines. Seven RCTs (n = 349) met the inclusion criteria. All the studies were either at high or unclear risk of bias. Pain was evaluated after six months in two studies. No statistically significant differences were found between the arthroscopy versus nonsurgical groups (standardised mean difference (SMD) = 0.004; 95% confidence interval (CI) - 0.46 to 0.55, P = 0.81). Two studies analysed pain 12 months after surgery (arthroscopy and arthrocentesis) in 81 patients. No statistically significant differences were found (mean difference (MD) = 0.10; 95% CI -1.46 to 1.66, P = 0.90). Three studies analysed the same outcome in patients who had been submitted to arthroscopic surgery or to open surgery and a statistically significant difference was found after 12 months (SMD = 0.45; 95% CI 0.01 to 0.89, P = 0.05) in favour of open surgery.The two studies compared the maximum interincisal opening in six different clinical outcomes (interincisal opening over 35 mm; maximum protrusion over 5 mm; click; crepitation; tenderness on palpation in the TMJ and the jaw muscles 12 months after arthroscopy and open surgery). The outcome measures did not present statistically significant differences (odds ratio (OR) = 1.00; 95% CI 0.45 to 2.21, P = 1.00). Two studies compared the maximum interincisal opening after 12 months of postsurgical follow-up. A statistically significant difference in favour of the arthroscopy group was observed (MD = 5.28; 95% CI 3.46 to 7.10, P < 0.0001).The two studies compared the mandibular function after 12 months of follow-up with 40 patients evaluated. The outcome measure was mandibular functionality (MFIQ). This difference was not statistically significant (MD = 1.58; 95% CI -0.78 to 3.94, P = 0.19). Both arthroscopy and nonsurgical treatments reduced pain after six months. When compared with arthroscopy, open surgery was more effective at reducing pain after 12 months. Nevertheless, there were no differences in mandibular functionality or in other outcomes in clinical evaluations. Arthroscopy led to greater improvement in maximum interincisal opening after 12 months than arthrocentesis; however, there was no difference in pain.

[Comparative effectiveness of surgical and non-surgical treatment for pediatric mandibular condylar fractures].

PubMed

Hu, Min; Wang, Yanyi; Zhang, Lihai; Yao, Jun

2010-12-01

To compare the effectiveness of open reduction and conservative treatment for pediatric mandibular condylar fractures and to provide the evidence for the selection of clinical therapy. The clinical data were retrospectively analyzed from 25 patients with the mandibular condylar fractures between January 1988 and December 2006. Of them, 8 patients (11 fractures) were treated with surgical treatment (surgical group) and 17 patients (22 fractures) with non-surgical treatment (non-surgical group). In surgical group, there were 6 males (9 fractures) and 2 females (2 fractures) with an age range of 8-13 years; fracture was caused by tumbling in 7 cases and by traffic accident in 1 with an interval of 1-6 days between injury and hospitalization; and 5 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 3 cases as bilateral condylar fractures complicated by mental fractures. In non-surgical group, there were 12 males (15 fractures) and 5 females (7 fractures) with an age range of 3-12 years; fracture was caused by falling from height in 4 cases, by tumbling in 10, and by traffic accident in 3 with an interval of 1-25 days between injury and hospitalization; and 12 cases were identified as unilateral condylar fractures (3 complicated by mental fractures) and 5 cases as bilateral condylar fractures (1 complicated by mental fracture). Incision healed by first intention in surgical group, and 25 cases were followed up 1-6 years with an average of 3.5 years. At 12 months after treatment, no temporomandibular joint pain, eating disorder, or limited mandibular movement occurred in 2 groups. No significant difference was observed in opening mouth extent, protrusive and lateral movements between 2 groups at 6 and 12 months (P > 0.05). During centric occlusion, mental point located at the midline with symmetric face figure. Two patients in surgical group and 3 in non-surgical group had slight snap when opening their mouths. Mandible deviation was observed in 3 patients of 2 groups, respectively when gaping. The X-ray films showed healing of fracture and condylar remodeling at 3-6 months. Mandibular ramus were symmetric in cephalometry. Good effectiveness can be obtained by surgical or non-surgical treatment in pediatric mandibular condylar fractures. Considering the pediatric mandibular condyle having powerful healing and reconstructing potency and avoiding secondary injury on the temporomandibular joint from surgery, non-surgical treatment should be first selected for the pediatric mandibular condylar fractures in patients under 7 years.

Class II treatment in adults: comparing camouflage orthodontics, dentofacial orthopedics and orthognathic surgery--a cephalometric study to evaluate various therapeutic effects.

PubMed

Kinzinger, Gero; Frye, Linda; Diedrich, Peter

2009-01-01

It was the aim of this clinical study to compare the skeletal and dentoalveolar effects as well as those on the profile of three different treatment approaches in Class II patients (camouflage orthodontics, dentofacial orthopedics, and combined orthodontic and surgical treatment). Our study cohort consisted of 60 young adults presenting a skeletal Class II, Division 1 malocclusion: 20 patients whose overjet was reduced by camouflage following premolar extraction, 20 patients whose occlusions were corrected by placement of a fixed functional orthopedic appliance, and 20 who underwent orthognathic surgery (bilateral sagittal split osteotomy of the mandible without genioplasty). We documented the therapeutic progress using cephalometry. Each patient group achieved a reduction in overjet via their respective treatment. While no treatment-related changes in the maxillary area were assessable, the effects on the mandible differed. We observed advancement of the bony chin and an increase in mandibular length in the sagittal-diagonal dimension in the surgical and functional orthopedic groups. However, the extent of the treatment-related changes was significant only in the group of patients that had undergone orthognathic surgery. Only the surgical group presented changes in vertical relationships. Incisor repositioning as an outcome of the respective treatments differed fundamentally, with those in the surgical group revealing significant protrusion of the upper incisors. The maxillary incisors were retruded and mandibular incisors proclined in the functional orthopedic group, whereas the upper and lower incisors both retruded significantly in the extraction group. Soft-tissue remodeling bore no linear relationship to treatment-induced skeletal and dental effects. Still, orthognathic surgery led to the most marked profile changes. Treatment using fixed functional orthopedic appliances reduced the convexity of the soft-tissue profile at least moderately. Camouflage orthodontics, on the other hand, resulted in an increase in the nasolabial angle. In young adults fixed functional appliances are a treatment alternative to extraction therapy but to a lesser extent to orthognathic surgery. Because of their limited skeletal effects and minor changes in the profile they are indicated only in patients with a moderately severe Class II malocclusion. Pre-treatment proclined mandibular incisors limit the scope of indications for fixed functional appliances, as they can cause an increase in lower incisor proclination. Significant reductions in profile convexity are achievable only by combined orthodontic and surgical treatment of the malocclusion. When performing camouflage orthodontics in conjunction with maxillary premolar extractions in adults, an increase in the nasolabial angle, which is often esthetically undesirable, has to be discussed as a potential side effect and has to be taken into account when considering the different therapeutic approaches.

Efficacy of Codeine When Added to Paracetamol (Acetaminophen) and Ibuprofen for Relief of Postoperative Pain After Surgical Removal of Impacted Third Molars: A Double-Blinded Randomized Control Trial.

PubMed

Best, Adrian D; De Silva, R K; Thomson, W M; Tong, Darryl C; Cameron, Claire M; De Silva, Harsha L

2017-10-01

The use of opioids in combination with nonopioids is common practice for acute pain management after third molar surgery. One such combination is paracetamol, ibuprofen, and codeine. The authors assessed the efficacy of codeine when added to a regimen of paracetamol and ibuprofen for pain relief after third molar surgery. This study was a randomized, double-blinded, placebo-controlled trial conducted in patients undergoing the surgical removal of at least 1 impacted mandibular third molar requiring bone removal. Participants were randomly allocated to a control group (paracetamol 1,000 mg and ibuprofen 400 mg) or an intervention group (paracetamol 1,000 mg, ibuprofen 400 mg, and codeine 60 mg). All participants were treated under intravenous sedation and using identical surgical conditions and technique. Postoperative pain was assessed using the visual analog scale (VAS) every 3 hours (while awake) for the first 48 hours after surgery. Pain was globally assessed using a questionnaire on day 3 after surgery. There were 131 participants (36% men; control group, n = 67; intervention group, n = 64). Baseline characteristics were similar for the 2 groups. Data were analyzed using a modified intention-to-treat analysis and, for this, a linear mixed model was used. The model showed that the baseline VAS score was associated with subsequent VAS scores and that, with each 3-hour period, the VAS score increased by an average of 0.08. The treatment effect was not statistically meaningful, indicating there was no difference in recorded pain levels between the 2 groups during the first 48 hours after mandibular third molar surgery. Similarly, the 2 groups did not differ in their global ratings of postoperative pain. Codeine 60 mg added to a regimen of paracetamol 1,000 mg and ibuprofen 400 mg does not improve analgesia after third molar surgery. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

A case study examining the efficacy of drainage setbacks for limiting effects to wetlands in the Prairie Pothole Region, USA

USGS Publications Warehouse

Tangen, Brian; Finocchiaro, Raymond

2017-01-01

The enhancement of agricultural lands through the use of artificial drainage systems is a common practice throughout the United States, and recently the use of this practice has expanded in the Prairie Pothole Region. Many wetlands are afforded protection from the direct effects of drainage through regulation or legal agreements, and drainage setback distances typically are used to provide a buffer between wetlands and drainage systems. A field study was initiated to assess the potential for subsurface drainage to affect wetland surface-water characteristics through a reduction in precipitation runoff, and to examine the efficacy of current U.S. Department of Agriculture drainage setback distances for limiting these effects. Surface-water levels, along with primary components of the catchment water balance, were monitored over 3 y at four seasonal wetland catchments situated in a high-relief terrain (7–11% slopes). During the second year of the study, subsurface drainage systems were installed in two of the catchments using drainage setbacks, and the drainage discharge volumes were monitored. A catchment water-balance model was used to assess the potential effect of subsurface drainage on wetland hydrology and to assess the efficacy of drainage setbacks for mitigating these effects. Results suggest that overland precipitation runoff can be an important component of the seasonal water balance of Prairie Pothole Region wetlands, accounting on average for 34% (19–49%) or 45% (39–49%) of the annual (includes snowmelt runoff) or seasonal (does not include snowmelt) input volumes, respectively. Seasonal (2014–2015) discharge volumes from the localized drainage systems averaged 81 m3 (31–199 m3), and were small when compared with average combined inputs of 3,745 m3 (1,214–6,993 m3) from snowmelt runoff, direct precipitation, and precipitation runoff. Model simulations of reduced precipitation runoff volumes as a result of subsurface drainage systems showed that ponded wetland surface areas were reduced by an average of 590 m2 (141–1,787 m2), or 24% (3–46%), when no setbacks were used (drainage systems located directly adjacent to wetland). Likewise, wetland surface areas were reduced by an average of 141 m2 (23–464 m2), or 7% (1–28%), when drainage setbacks (buffer) were used. In totality, the field data and model simulations suggest that the drainage setbacks should reduce, but not eliminate, impacts to the water balance of the four wetlands monitored in this study that were located in a high-relief terrain. However, further study is required to assess the validity of these conclusions outside of the limited parameters (e.g., terrain, weather, soils) of this study and to examine potential ecological effects of altered wetland hydrology.

Reliability of implant placement after virtual planning of implant positions using cone beam CT data and surgical (guide) templates.

PubMed

Nickenig, Hans-Joachim; Eitner, Stephan

2007-01-01

We assessed the reliability of implant placement after virtual planning of implant positions using cone-beam CT data and surgical guide templates. A total of 102 patients (250 implants, 55.4% mandibular; mean patient age, 40.4 years) who had undergone implant treatment therapy in an armed forces dental clinic (Cologne, Germany) between July 1, 2005 and December 1, 2005. They were treated with a system that allows transfer of virtual planning to surgical guide templates. Only in eight cases the surgical guides were not used because a delayed implant placement was necessary. In four posterior mandibular cases, handling was limited because of reduced interocclusal distance, requiring 50% shortening of the drill guides. The predictability of implant size was high: only one implant was changed to a smaller diameter (because of insufficient bone). In all cases, critical anatomical structures were protected and no complications were detected in postoperative panoramic radiographs. In 58.1% (147) of the 250 implants, a flapless surgery plan was realized. Implant placement after virtual planning of implant positions using cone beam CT data and surgical templates can be reliable for preoperative assessment of implant size, position, and anatomical complications. It is also indicative of cases amenable to flapless surgery.

Evaluation of selected speech parameters after prosthesis supply in patients with maxillary or mandibular defects.

PubMed

Müller, Rainer; Höhlein, Andreas; Wolf, Annette; Markwardt, Jutta; Schulz, Matthias C; Range, Ursula; Reitemeier, Bernd

2013-01-01

Ablative surgery of oropharyngeal tumors frequently leads to defects in the speech organs, resulting in impairment of speech up to the point of unintelligibility. The aim of the present study was the assessment of selected parameters of speech with and without resection prostheses. The speech sounds of 22 patients suffering from maxillary and mandibular defects were recorded using a digital audio tape (DAT) recorder with and without resection prostheses. Evaluation of the resonance and the production of the sounds /s/, /sch/, and /ch/ was performed by 2 experienced speech therapists. Additionally, the patients completed a non-standardized questionnaire containing a linguistic self-assessment. After prosthesis supply, the number of patients with rhinophonia aperta decreased from 7 to 2 while the number of patients with intelligible speech increased from 2 to 20. Correct production of the sounds /s/, /sch/, and /ch/ increased from 2 to 13 patients. A significant improvement of the evaluated parameters could be observed only in patients with maxillary defects. The linguistic self-assessment showed a higher satisfaction in patients with maxillary defects. In patients with maxillary defects due to ablative tumor surgery, an increase in speech performance and intelligibility is possible by supplying resection prostheses. © 2013 S. Karger GmbH, Freiburg.

Use of the 3D surgical modelling technique with open-source software for mandibular fibula free flap reconstruction and its surgical guides.

PubMed

Ganry, L; Hersant, B; Quilichini, J; Leyder, P; Meningaud, J P

2017-06-01

Tridimensional (3D) surgical modelling is a necessary step to create 3D-printed surgical tools, and expensive professional software is generally needed. Open-source software are functional, reliable, updated, may be downloaded for free and used to produce 3D models. Few surgical teams have used free solutions for mastering 3D surgical modelling for reconstructive surgery with osseous free flaps. We described an Open-source software 3D surgical modelling protocol to perform a fast and nearly free mandibular reconstruction with microvascular fibula free flap and its surgical guides, with no need for engineering support. Four successive specialised Open-source software were used to perform our 3D modelling: OsiriX ® , Meshlab ® , Netfabb ® and Blender ® . Digital Imaging and Communications in Medicine (DICOM) data on patient skull and fibula, obtained with a computerised tomography (CT) scan, were needed. The 3D modelling of the reconstructed mandible and its surgical guides were created. This new strategy may improve surgical management in Oral and Craniomaxillofacial surgery. Further clinical studies are needed to demonstrate the feasibility, reproducibility, transfer of know how and benefits of this technique. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Clinical and radiological investigations of mandibular overdentures supported by conventional or mini-dental implants: A 2-year prospective follow-up study.

PubMed

Temizel, Sonay; Heinemann, Friedhelm; Dirk, Cornelius; Bourauel, Christoph; Hasan, Istabrak

2017-02-01

Conventional dental implants are not applicable in the mandibular interforaminal region if bone volume is limited. Mini-dental implants offer an alternative means of supporting mandibular overdentures in a narrow residual ridge, without additional surgery. The purpose of this nonrandomized clinical trial was to compare the ability of mini-dental implants with that of conventional dental implants in supporting mandibular overdentures during a 2-year clinical follow-up. Bone quality, bone resorption, implant stability, and oral health were assessed radiographically. A total of 32 participants with edentulism were included. Twenty-two participants (99 implants) received 4 to 5 mini-dental implants (diameter: 1.8-2.4 mm; length: 13-15 mm, study group), and 10 participants (35 implants) received 2 to 4 conventional dental implants (diameter: 3.3-3.7 mm; length: 11-13 mm, control group). The selection of the participants in the study or control group was based on the available bone volume in the mandible. The selection was not randomized. The density of cortical bone thickness was measured in Hounsfield units (HU) from computed tomography data, and patients were followed for 2 years. The participants were examined 3, 6, 12, and 24 months after surgery. Primary stability immediately after the insertion of dental implants (Periotest), secondary stability 6 months after implantation, modified plaque, bleeding on probing indices, and probing depth were measured and analyzed statistically (α=.05). The mean HU value 6 months after implantation in the participants who received mini-dental implants was significantly (P=.035) higher (1250 HU) than that in the participants who received conventional dental implants (1100 HU). The probing depths around the conventional dental implants (1.6 and 1.8 mm, respectively) were significantly higher than those around the mini-dental implants (1.3 and 1.2 mm, respectively) 12 and 24 months after surgery, respectively (P<.001). The mean primary and secondary stability values for conventional dental implants were -4.0 and -4.9, respectively. The primary and secondary stability values for the mini-dental implants were -0.3 and -1.4, respectively. The Periotest values of the primary (measured immediately after implant insertion) and secondary implant stabilities (measured 6 months after implant insertion) were significantly higher for the conventional dental implants than for the mini-dental implants (P<.001). Based on this 2-year clinical trial, patients receiving mini-dental implants had clinical outcomes similar to those of patients receiving conventional dental implants to support overdenture prostheses. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Numerical Hydrodynamic Study of Hypothetical Levee Setback Scenarios

DTIC Science & Technology

2018-01-01

ER D C /C HL T R- 18 -1 Flood and Coastal Systems Research and Development Program Numerical Hydrodynamic Study of Hypothetical Levee...default. Flood and Coastal Systems Research and Development Program ERDC/CHL TR-18-1 January 2018 Numerical Hydrodynamic Study of Hypothetical...Reduction” ERDC/CHL TR-18-1 ii Abstract A numerical hydrodynamic study was conducted to compare multiple levee setback alternatives to the base

An Analysis of Electrical Consumption at Representative Army Installations.

DTIC Science & Technology

1980-05-01

can be done by analyzing and optimizing HVAC system and building operation. For example, if the minimum hourly usage (demand) of a typical bachelor...equipment. (Major candidates for scheduling are air-handler motors, chillers , air compressors, exhaust fans, exterior lights, hot water heaters, and hot...location: Thermostats Setpoint Measured Limiters Setback Area Temperature Temperature Yes No Yes No Are night setback thermostats recommended? Yes _ No

JPRS Report, West Europe.

DTIC Science & Technology

1987-07-31

Sees Earlier Elections 24 Setback for Privitization Movement, by Egon Balsby 25 Many Economic Problems Unsolved, by Lasse Ellegaard 28 First...Geisler, Inuit Ataqatigiit. Setback For Privitization Movement Copenhagen BERLINGSKE AFTEN in Danish 29 May - 4 Jun 87 pp lr 2 [Article by Egon Balsby...34Yes to Socialism — No to Privitization "! [Text] The two large parties in Greenland politics, Ätassut and Siumut, both suffered defeats in an

Postoperative outcomes of two- and three-dimensional planning in orthognathic surgery: A comparative study.

PubMed

Wu, Ting-Yu; Lin, Hsiu-Hsia; Lo, Lun-Jou; Ho, Cheng-Ting

2017-08-01

Compared with conventional two-dimensional (2D) planning, three-dimensional (3D) planning in orthognathic surgery yields more accurate anatomical information and enables the precise positioning of maxillary and mandibular segments, particularly for patients with facial asymmetry. Accordingly, surgical outcomes achieved using 3D planning should be superior. This study determined the differences between the 2D and 3D planning techniques by comparing their surgical outcomes. In this retrospective study, patients who underwent surgery following the traditional 2D planning technique were classified into the 2D planning group. Patients in whom the 2D plan was transferred to a 3D system after surgical simulation were classified into the 3D planning group. Surgical outcomes were compared using cephalometric measurements and patient perception of the results. In the 3D planning group, more favorable results were observed in frontal symmetry, change in the angle between the orbital and occlusal lines, frontal ramus inclination, and the distances from the mandibular central incisor and menton to the midsagittal line. No significant differences were observed in the lateral profiles (SNA, SNB, ANB, and angle convexity) of the two groups. Patient satisfaction was favorable in the two groups, but more patients in the 3D planning group reported being very satisfied. The 3D planning technique provided superior overall outcomes. The study findings can be used to augment clinical planning and surgical execution when using a conventional approach. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Evaluation of the muscle relaxant cyclobenzaprine after third-molar extraction.

PubMed

de Santana Santos, Thiago; Calazans, Anna Carla Maranhão; Martins-Filho, Paulo Ricardo Saquete; Silva, Luiz Carlos Ferreira da; de Oliveira E Silva, Emanuel Dias; Gomes, Ana Claudia Amorim

2011-10-01

Pain, swelling and trismus are undesirable effects of extraction of impacted mandibular third molars. The authors conducted a study to evaluate the effectiveness of the muscle relaxant cyclobenzaprine when used as a supplement to cryotherapeutic, antibiotic and steroidal anti-inflammatory treatment with the aim of reducing undesirable consequences after third-molar extraction. The authors conducted a prospective, randomized, double-masked, placebo-controlled clinical trial involving 50 participants aged 18 to 29 years randomly assigned to receive cyclobenzaprine or the placebo. The authors used a split-mouth design, so each participant acted as his or her own control. For each participant, the authors extracted one impacted mandibular third molar on each side of the mouth at different times. Participants received 10 milligrams of cyclobenzaprine or a placebo once per day the day before surgery, the day of surgery and the first day after surgery. The authors assessed the participants' postoperative pain by means of a visual analog scale at four, six, eight, 12, 24 and 48 hours. They measured the participants' swelling and maximal interincisor distance at 48 hours and seven days. The authors assessed both sides of each participant's mouth for differences in pain, swelling and trismus. They found no statistically significant differences between sides of the mouth regarding these three variables. The results of this trial indicate that the influence of cyclobenzaprine over pain, swelling and trismus does not justify prescribing additional medication for patients undergoing third-molar extraction. The muscle relaxant cyclobenzaprine was ineffective in reducing pain, swelling and trismus after third-molar extraction.

A worldwide comparison of the management of surgical treatment of advanced oral cancer.

PubMed

Kansy, Katinka; Mueller, Andreas Albert; Mücke, Thomas; Koersgen, Friederike; Wolff, Klaus Dietrich; Zeilhofer, Hans-Florian; Hölzle, Frank; Pradel, Winnie; Schneider, Matthias; Kolk, Andreas; Smeets, Ralf; Acero, Julio; Haers, Piet; Ghali, G E; Hoffmann, Jürgen

2018-03-01

Microvascular surgery following tumor resection has become an important field of oral and maxillofacial surgery (OMFS). Following the results from management of T1/T2 floor-of-mouth and tongue squamous cell carcinoma (SCC) in German-speaking countries, Europe, and worldwide, this paper presents specific concepts for the management of resection and reconstruction of T3/T4 SCC of the maxillary and mandibular alveolar process and tongue. The DÖSAK questionnaire was distributed in three different phases to a growing number of maxillofacial units worldwide. Within this survey, clinical patient settings were presented to participants and center-specific treatment strategies were evaluated. A total of 188 OMFS units from 36 different countries documented their treatment strategies for T3/T4 maxillary and mandibular alveolar process and tongue SCC. The extent of surgical resections and subsequent reconstructions is more consistent than with T1/T2 tumors, although the controversy surrounding continuity resections and mandible-sparing procedures remains. For continuity resection of the mandible the fibula free flap is the most frequently used bone replacement, whereas maxilla reconstruction concepts are less consistent, ranging from locoregional coverage concepts and different microvascular reconstruction options to treatment via obturator prosthesis. Results from treatment strategies for T3/T4 tumors underline the limited evidence for the appropriate amount of resection and subsequent reconstruction process, especially in cases involving the mandible. Prospective randomized trials will be necessary in the long term to establish valid treatment guidelines. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Effect of age, impaction types and operative time on inflammatory tissue reactions following lower third molar surgery

PubMed Central

2011-01-01

Background Postoperative mobidity following third molar surgery is affected by a number of factors. The study of these factors is essential for effective planning and limitation of morbidity. The aim of this study was to determine the effect of age, type of impaction and operative time on immediate postoperative tissue reactions following mandibular third molar surgery. Methods Consecutive patients with impacted mandibular third molar teeth were studied. All the third molars were classified according to Winter's classification. Surgical extraction was performed on all the patients by a single surgeon under local anaesthesia. The operation time was determined by the time lapse between incision and completion of suturing. Postoperative pain, swelling and trismus were evaluated. Results There were 120 patients with an age range of 19-42 years. Patients in the age range of 35-42 years recorded a lower pain score (p = 0.5) on day 1. The mouth opening was much better in the lower age group on day 2 and 5 (p = 0.007 and p = 0.01 respectively). Pain, swelling and trismus increased with increasing operative time. Distoangular impaction was significantly associated with higher VAS score on day 1 and 2 (p = 0.01, 0.0, 04). Distoangular and horizontal impaction are associated with a higher degree of swelling and reduced mouth opening on postoperative review days. Vertical impaction was associated with the least degree of facial swelling and best mouth opening. Conclusions Increasing operating time and advancing age are associated with more postoperative morbidity, likewise distoangular and horizontal impaction types. PMID:21527036

Non Surgical Correction of Mandibular Deviation and Neuromuscular Coordination after Two years of Mandibular Guidance Therapy: A Case Report.

PubMed

Singh, Bijay; Sinha, Nidhi; Sharma, Rohit; Parekh, Narzi

2015-11-01

Carcinomas of the mandible may require resection of a segment of bone (continuity defect), partial removal of bone (discontinuity defect), tongue, and floor of the mouth and muscle attachments. Patients undergoing such treatment suffer from facial disfigurement, loss of muscle function, loss of neuromuscular coordination resulting in inability to masticate and swallow acceptably. Surgical reconstruction may not always be possible because of high reoccurrence rate, inability of the patient to cope with another surgery etc. The treatment of choice in non surgical cases is prosthetic rehabilitation using guiding flange prosthesis. This article describes the management of a patient who had undergone hemimandibulectomy and was not willing for a surgical reconstruction. Interim maxillary ramp prosthesis was given to the patient 15 days postoperatively followed by definitive guiding flange prosthesis for two years after which the patient was able to occlude in centric occlusal position without any aid.

Orthodontic retreatment using anchorage with miniplate to camouflage a Class III skeletal pattern.

PubMed

Farret, Marcel Marchiori

2016-06-01

This manuscript describes the treatment of a 27-year-old patient who was previously treated with two maxillary first premolar extractions. The patient had skeletal Class III malocclusion, Class III canine relationship, anterior crossbite, and a concave profile. As the patient refused orthognathic surgery, a miniplate was used on the right side of the lower arch as an anchorage unit after the extraction of mandibular first premolars, aiding the retraction of anterior teeth. At the end of treatment, anterior crossbite was corrected, in which first molars and canines were in a Class I relationship, and an excellent intercuspation was reached. Furthermore, patient's profile remarkably improved as a result of mandibular incisor retraction. A 30-month follow-up showed good stability of the results obtained. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as one of the requirements to become diplomate by the BBO.

Orthodontic retreatment using anchorage with miniplate to camouflage a Class III skeletal pattern

PubMed Central

Farret, Marcel Marchiori

2016-01-01

ABSTRACT This manuscript describes the treatment of a 27-year-old patient who was previously treated with two maxillary first premolar extractions. The patient had skeletal Class III malocclusion, Class III canine relationship, anterior crossbite, and a concave profile. As the patient refused orthognathic surgery, a miniplate was used on the right side of the lower arch as an anchorage unit after the extraction of mandibular first premolars, aiding the retraction of anterior teeth. At the end of treatment, anterior crossbite was corrected, in which first molars and canines were in a Class I relationship, and an excellent intercuspation was reached. Furthermore, patient's profile remarkably improved as a result of mandibular incisor retraction. A 30-month follow-up showed good stability of the results obtained. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as one of the requirements to become diplomate by the BBO. PMID:27409659

Surgery of the head and neck in patient with Kniest dysplasia: Is wound healing an issue?

PubMed

Husain, Qasim; Cho, Jungsuk; Neugarten, Jay; Modi, Vikash K

2017-02-01

Kniest dysplasia is a type II collagen disorder that arises from a genetic mutation of the COL2A1 gene that results in short stature, midface anomalies, tracheomalacia, and hearing loss. Disruption of the normal collagen pathway can lead to many changes given its critical role in the body, and can cause complications with respect to wound healing. We present a case in which a patient with Kniest dysplasia successfully underwent multiple procedures in the head and neck region including cochlear implantation, mandibular distraction, palatoplasty, and laryngotracheal reconstruction. All procedures did not have any associated complications with respect to wound healing, indicating that surgery in this population can take place as indicated and surgery should not be contraindicated or delayed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Chemical application strategies to protect water quality.

PubMed

Rice, Pamela J; Horgan, Brian P; Barber, Brian L; Koskinen, William C

2018-07-30

Management of turfgrass on golf courses and athletic fields often involves application of plant protection products to maintain or enhance turfgrass health and performance. However, the transport of fertilizer and pesticides with runoff to adjacent surface waters can enhance algal blooms, promote eutrophication and may have negative impacts on sensitive aquatic organisms and ecosystems. Thus, we evaluated the effectiveness of chemical application setbacks to reduce the off-site transport of chemicals with storm runoff. Experiments with water soluble tracer compounds confirmed an increase in application setback distance resulted in a significant increase in the volume of runoff measured before first off-site chemical detection, as well as a significant reduction in the total percentage of applied chemical transported with the storm runoff. For example, implementation of a 6.1 m application setback reduced the total percentage of an applied water soluble tracer by 43%, from 18.5% of applied to 10.5% of applied. Evaluation of chemographs revealed the efficacy of application setbacks could be observed with storms resulting in lesser (e.g. 100 L) and greater (e.g. > 300 L) quantities of runoff. Application setbacks offer turfgrass managers a mitigation approach that requires no additional resources or time inputs and may serve as an alternative practice when buffers are less appropriate for land management objectives or site conditions. Characterizing potential contamination of surface waters and developing strategies to safeguard water quality will help protect the environment and improve water resource security. This information is useful to grounds superintendents for designing chemical application strategies to maximize environmental stewardship. The data will also be useful to scientists and regulators working with chemical transport and risk models. Copyright © 2018. Published by Elsevier Inc.

Comparison of general anaesthesia versus regional anaesthesia with sedation in selected maxillofacial surgery: a randomized controlled trial.

PubMed

Rastogi, Amit; Gyanesh, Prakhar; Nisha, Surbhi; Agarwal, Appurva; Mishra, Priya; Tiwari, Akhilesh Kumar

2014-04-01

The airway is the foremost challenge in maxillofacial surgery. The major concerns are difficulty in managing the patient's airway and sharing it between the anaesthetist and surgeons. General anaesthesia, with endotracheal intubation, is the commonly used technique for maxillofacial procedures. We assessed the efficacy and safety of a regional block with sedation technique in certain maxillofacial operations, specifically temporomandibular joint (TMJ) ankylosis and mandibular fracture cases, and compared it with conventional general anaesthesia. We compared the time to discharge from the post anaesthesia care unit (PACU) and the occurrence of side effects, as well as surgeon and patient satisfaction with the anaesthetic technique, between the two groups. We enrolled 50 patients of ASA grade 1 or 2, aged 15-50 years, scheduled for maxillofacial surgery (mandibular fracture or TMJ ankylosis). The patients were divided into two groups of 25 each, to receive sedation with a regional block with the use of a peripheral nerve stimulator in group I and general anaesthesia in group II. We observed haemodynamic parameters, intraoperative and postoperative complications and the amount of surgical bleeding in the two groups. Total anaesthesia time, patient and surgeon satisfaction, time to rescue analgesia, the number of rescue doses required, and the time to discharge from the PACU were compared. The groups were comparable with respect to demographic profile, intraoperative haemodynamic parameters, surgical time, and amount of blood loss. Postoperative pain was assessed using the visual analogue score (VAS). Patients in group I had lower VAS scores after surgery and remained pain-free for longer than those in group II. The mean pain-free interval in group I was 159.12 ± 43.95 min and in group II was 60.36 ± 19.77 min (p < 0.005). Patients in group I required lower doses of rescue analgesia than those undergoing the surgery under general anaesthesia (p < 0.005). Patients receiving regional blocks also had fewer episodes of postoperative nausea and vomiting (p = 0.005). These results led to earlier discharge of patients in group I from the PACU. Regional block with sedation is a safe alternative technique for patients undergoing surgery for mandible fracture or TMJ ankylosis, with clear advantages over general anaesthesia. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Upper airway surgery of obstructive sleep apnea in pycnodysostosis: case report and literature review.

PubMed

Testani, Elisa; Scarano, Emanuele; Leoni, Chiara; Dittoni, Serena; Losurdo, Anna; Colicchio, Salvatore; Gnoni, Valentina; Vollono, Catello; Zampino, Giuseppe; Paludetti, Gaetano; Della Marca, Giacomo

2014-08-01

Pycnodysostosis is an autosomal recessive disorder due to a mutation in the cathepsin K gene, which causes a decrease of the bone turnover; a review of the literature suggests that pycnodysostosis is frequently associated with severe respiratory obstruction, which needs surgical treatment. The aim of this paper is to describe the surgical treatment of a 3½-year-old girl affected by Pycnodysostosis complicated by a severe sleep-related respiratory disorder. The surgical treatment, consisting of adenotonsillectomy and palatoplasty, resulted in a striking amelioration of respiratory parameters and increased posterior airway space, and allowed the patient to avoid tracheotomy while awaiting for maxillo-mandibular surgery. © 2014 Wiley Periodicals, Inc.

Efficacy of Platelet-Rich Fibrin After Mandibular Third Molar Extraction: A Systematic Review and Meta-Analysis.

PubMed

Al-Hamed, Faez Saleh; Tawfik, Mohamed Abdel-Monem; Abdelfadil, Ehab; Al-Saleh, Mohammed A Q

2017-06-01

To assess the effect of platelet-rich fibrin (PRF) on the healing process of the alveolar socket after surgical extraction of the mandibular third molars. PubMed, the Cochrane Central Register of Controlled Trials, Scopus, and relevant journals were searched using a combination of specific keywords ("platelet-rich fibrin," "oral surgery," and "third molar"). The final search was conducted on November 2, 2015. Randomized controlled clinical trials, as well as controlled clinical trials, aimed at comparing the effect of PRF versus natural healing after extraction of mandibular third molars were included. Five randomized controlled trials and one controlled clinical trial were included. There were 335 extractions (168 with PRF and 167 controls) in 183 participants. Considerable heterogeneity in study characteristics, outcome variables, and estimated scales was observed. Positive results were generally recorded for pain, trismus, swelling, periodontal pocket depth, soft tissue healing, and incidence of localized osteitis, but not in all studies. However, no meta-analysis could be conducted for such variables because of the different measurement scales used. The qualitative and meta-analysis results showed no significant improvement in bone healing with PRF-treated sockets compared with the naturally healing sockets. Within the limitations of the available evidence, PRF seems to have no beneficial role in bone healing after extraction of the mandibular third molars. Future standardized randomized controlled clinical trials are required to estimate the effect of PRF on socket regeneration. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Cost analysis of mandibular distraction versus tracheostomy in neonates with Pierre Robin sequence.

PubMed

Runyan, Christopher M; Uribe-Rivera, Armando; Karlea, Audrey; Meinzen-Derr, Jareen; Rothchild, Dawn; Saal, Howard; Hopkin, Robert J; Gordon, Christopher B

2014-11-01

To evaluate costs associated with surgical treatment for neonates with Pierre Robin sequence (PRS). Retrospective cohort study. Cincinnati Children's Hospital Medical Center. With Institutional Review Board approval, we retrospectively studied neonates with PRS treated from 2001 to 2009 with either tracheostomy (Trach), mandibular distraction (MD), or Trach with subsequent MD (Trach+MD). Actual charges over a 3-year period associated with operative costs, hospital stay, imaging and sleep studies, clinic visits, and related emergency room visits were collected. Home tracheostomy care charges were estimated individually for each patient. Charges were compared using regression and appropriate statistical analyses. Forty-seven neonates were included in the study (MD, n = 26; Trach, n = 12; Trach+MD, n = 9). Trach group patients had 2.6-fold higher charges than the MD group despite no difference in length of hospital stay. This difference increased to 7.3-fold when including home trach care-related costs. Trach+MD group patients had longer hospital lengths of stay and higher operation room (OR) fees, but no increased total charges compared with the Trach only group. For patients with severe PRS, mandibular distraction provides significant cost savings over tracheostomy ($300,000 per patient over 3 years). Increased costs with tracheostomy come from greater hospital-related charges, more frequent airway procedures, a higher incidence of gastrostomy tube feeds, and home trach care costs. A careful examination of long-term outcomes will be critical as mandibular distraction continues to gain acceptance for treatment of PRS. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.

Effectiveness of 1% versus 0.2% chlorhexidine gels in reducing alveolar osteitis from mandibular third molar surgery: A randomized, double-blind clinical trial

PubMed Central

Bravo-Pérez, Manuel; Sánchez-López, José D.; Muñoz-Soto, Esther; Romero-Olid, María N.; Baca-García, Pilar

2013-01-01

Purpose: Alveolar osteitis (AO) is the most common postoperative complication of dental extractions. The purpose of this study was to compare the effectiveness of 1% versus 0.2% chlorhexidine (CHX) gel in reducing postoperative AO after surgical extraction of mandibular third molars, and assess the impact of treatment on the Oral HealthRelated Quality of Life (OHRQoL). Material and Methods: This clinical study was a randomized, double-blind clinical trial. Eighty eight patients underwent surgical extraction of one retained mandibular third molar with the intra-alveolar application of 0.2% CHX gel. Afterwards, they were assigned to one of two groups: 1% CHX gel (n=42) or 0.2% CHX gel (n=46). The patients applied the gel twice a day to the wound for one week. All patients were evaluated for AO. Results: In the 0.2% CHX gel group, 13% of AO incidence was found, while in the 1% CHX gel group, AO incidence was 7%, a difference that was not statistically significant. Variables such as sensation of pain and inflammation at baseline and during one week, as well as OHRQoL of the patients at 24 hours and 7 days post-extraction, gave no statistically significant differences. Conclusions: There are no significant differences in AO after surgical extraction of mandibular third molars, when comparing applying 1% CHX gel twice a day for 7 days with 0.2% CHX gel. Key words:Alveolar osteitis, chlorhexidine gel, third molar. PMID:23722126

Radiographic study of the mandibular retromolar canal: an anatomic structure with clinical importance.

PubMed

von Arx, Thomas; Hänni, Andrea; Sendi, Pedram; Buser, Daniel; Bornstein, Michael M

2011-12-01

The retromolar canal is an anatomic structure of the mandible with clinical importance. This canal branches off from the mandibular canal behind the third molar and travels to the retromolar foramen in the retromolar fossa. The retromolar canal might conduct accessory innervation to the mandibular molars or contain an aberrant buccal nerve. Patients referred for panoramic radiography were consecutively enrolled, provided a limited cone-beam computed tomography (CBCT) scan had also been taken in the area of interest. Radiographs were retrospectively screened for the presence of a retromolar canal, and linear measurements (distance to second molar, height, width) were taken. One hundred twenty-one sides in 100 patients were evaluated (100 unilateral and 21 bilateral cases). A total of 31 retromolar canals were identified with CBCT (25.6%). Only 7 of these canals were also seen on the corresponding panoramic radiographs. The existence of a retromolar canal was not statistically related to gender or side. With regard to the linear measurements, the mean distance from the retromolar canal to the second molar was 15.16 mm (±2.39 mm), the mean height of the canal was 11.34 mm (±2.36 mm), and the mean width was 0.99 mm (±0.31 mm). This radiographic study documents a frequency of 25% for the presence of a retromolar canal. The clinician is advised to preserve this anatomic variation when performing surgery in the retromolar area and to consider additional locoregional anesthesia in the case of failed mandibular block anesthesia. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Teaching mandibular implant-Supported overdentures in dental schools in North America - a survey.

PubMed

Ben-Gal, G; Ziv, Y; Weiss, E I; Zabrovsky, A

2017-05-01

Mandibular two-implant overdentures are considered the minimum standard of care for edentulous patients and provide an excellent performance, as well as satisfaction to the patients. Dental schools are required to promote the teaching of current treatment options in order to enable students to master state-of-the-art procedures. The purpose of this study was to examine how the theoretical and practical aspects of mandibular two-implant overdentures are taught in dental schools in North America. Data were collected via an online questionnaire that included questions regarding the theoretical and clinical courses, surgical procedure and imaging method. Of 75 schools, 36 responded to the survey. Almost all the schools teach the subject theoretically, but it is not mandatory for students to perform in most of the schools. Only a minority (23%) of the mandibular dentures made by students are implant-supported. Almost all of the schools (94%) use two implants to support overdentures, and Locator abutment is used almost exclusively. The prevalent imaging for the surgical procedure is CT scans, although 30% of the schools use panoramic radiograph. None of the schools loads the implants immediately after surgery. Some clear trends are apparent in the current survey: the use of two implants, no use of bar connectors and delayed loading of the implants. It is likely that graduates will not have sufficient clinical skills and will need continuing education to be familiar with the required procedures, both surgical and prosthetic. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Total mandibular subapical osteotomy and Le Fort I osteotomy using piezosurgery and computer-aided designed and manufactured surgical splints: a favorable combination of three techniques in the management of severe mouth asymmetry in Parry-Romberg syndrome.

PubMed

Scolozzi, Paolo; Herzog, Georges

2014-05-01

Although its pathogenesis remains obscure, Parry-Romberg syndrome (PRS) has been associated with the linear scleroderma en coup de sabre. PRS is characterized by unilateral facial atrophy of the skin, subcutaneous tissue, muscles, and bones with at least 1 dermatome supplied by the trigeminal nerve. Facial asymmetry represents the most common sequela and can involve the soft tissues, craniomaxillofacial skeleton, dentoalveolar area, and temporomandibular joint. Although orthognathic procedures have been reported for skeletal reconstruction, treatment of facial asymmetry has been directed to augmentation of the soft tissue volume on the atrophic side using different recontouring or volumetric augmentation techniques. Total mandibular subapical osteotomy has been used in the management of dentofacial deformities, such as open bite and mandibular dentoalveolar retrusion or protrusion associated with an imbalance between the lower lip and the chin. Management of orthognathic procedures has been improved by the recent introduction of stereolithographic surgical splints using computer-aided design (CAD) and computer-aided manufacturing (CAM) technology and piezosurgery. Piezosurgery has increased security during surgery, especially for delicate procedures associated with a high risk of nerve injury. The present report describes a combined total mandibular subapical osteotomy and Le Fort I osteotomy using piezosurgery and surgical splints fabricated using CAD and CAM for the correction of severe mouth asymmetry related to vertical dentoalveolar disharmony in a patient with PRS. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Prospects for Political Transition in the Islamic Republic of Iran

DTIC Science & Technology

1999-12-01

education, health, and other fields.蕔 Nevertheless, they have also suffered setbacks. Azar Nafisi , of Johns Hopkins University School of...Advanced International Studies describes two such setbacks in the following: 129 Azar Nafisi , "Overload of injustice," St. Paul: Star-Tribune (11 February...133 Nafisi . 134 "Iran’s Parliament Authorizes Gender Segregation of Health Services & Censorship of Women’s Issues," Bethesda: Sisterhood Is

Control Strategies for Reducing Heating, Ventilating, and Air Conditioning (HVAC) Energy Consumption in Single Buildings.

DTIC Science & Technology

1983-03-01

economizer and enthalpy cycles, scheduled temperature reset, chiller control and chilled water reset, boiler control and hot water temperature reset...temperature reset, chiller control and chilled water reset, boiler control and hot water temperature reset, and condenser water temperature reset. Recent...day-night setback. Day-night setback is the strategy of reducing the heating space temperature setpoint or raising the cooling space temperature

Selection and Implementation of Single Building EMCS (Energy Monitoring and Control Systems).

DTIC Science & Technology

1983-08-01

Setpoint Night Setback 161 Figure 20: Dual Setpoint Night Setback/up 162 Figure 21: Centrifugal Chiller Reset 166 Figure 22: Centrifugal Chiller Capacity...Program outputs. Hot water temperature. Application notes. A dedicated local loop controller may be implemented. Chiller optimization . The chiller ... optimization program can be implemented in chilled water plants with multiple chillers . Based on chiller operating data and the energy input requirements

Setback Distances as a Conservation Tool in Wildlife-Human Interactions: Testing Their Efficacy for Birds Affected by Vehicles on Open-Coast Sandy Beaches

PubMed Central

Schlacher, Thomas A.; Weston, Michael A.; Lynn, David; Connolly, Rod M.

2013-01-01

In some wilderness areas, wildlife encounter vehicles disrupt their behaviour and habitat use. Changing driver behaviour has been proposed where bans on vehicle use are politically unpalatable, but the efficacy of vehicle setbacks and reduced speeds remains largely untested. We characterised bird-vehicle encounters in terms of driver behaviour and the disturbance caused to birds, and tested whether spatial buffers or lower speeds reduced bird escape responses on open beaches. Focal observations showed that: i) most drivers did not create sizeable buffers between their vehicles and birds; ii) bird disturbance was frequent; and iii) predictors of probability of flushing (escape) were setback distance and vehicle type (buses flushed birds at higher rates than cars). Experiments demonstrated that substantial reductions in bird escape responses required buffers to be wide (> 25 m) and vehicle speeds to be slow (< 30 km h-1). Setback distances can reduce impacts on wildlife, provided that they are carefully designed and derived from empirical evidence. No speed or distance combination we tested, however, eliminated bird responses. Thus, while buffers reduce response rates, they are likely to be much less effective than vehicle-free zones (i.e. beach closures), and rely on changes to current driver behaviour. PMID:24039711

Orthodontic treatment of a complex open-bite malocclusion with temporary anchorage devices: a case report.

PubMed

Waldman, Alexander B

2010-08-01

Orthodontic temporary anchorage devices provide a novel alternative to orthognathic surgery for the treatment of severe anterior open-bite malocclusions. These implantable devices provide skeletal anchorage for maxillary molar intrusion, allowing for mandibular autorotation and subsequent open-bite closure. This case demonstrates step-by-step treatment of a 41-year-old woman with a severe open-bite malocclusion. Detailed orthodontic mechanics are described at every stage of treatment.

Novel Treatment Planning of Hemimandibular Hyperplasia by the Use of Three-Dimensional Computer-Aided-Design and Computer-Aided-Manufacturing Technologies.

PubMed

Hatamleh, Muhanad M; Yeung, Elizabeth; Osher, Jonas; Huppa, Chrisopher

2017-05-01

Hemimandibular hyperplasia is characterized by an obvious overgrowth in the size of the mandible on one side, which can extend up to the midline causing facial asymmetry. Surgical resection of the overgrowth depends heavily on the skill and experience of the surgeon. This report describes a novel methodology of applying three-dimensional computer-aided-design and computer-aided-manufacturing principles in improving the outcome of surgery in 2 mandibular hyperplasia patients. Both patients had their cone beam computer tomography (CBCT) scan performed. CMF Pro Plan software (v. 2.1) was used to process the scan data into virtual 3-dimensional models of the maxilla and mandible. Head tilt was adjusted manually by following horizontal reference. Facial asymmetry secondary to mandibular hypertrophy was obvious on frontal and lateral views. Simulation functions were followed including mirror imaging of the unaffected mandibular side into the hyperplastic side and position was optimized by translation and orientation functions. Reconstruction of virtual symmetry was assessed and checked by running 3-dimensional measurements. Then, subtraction functions were used to create a 3-dimensional template defining the outline of the lower mandibular osteotomy needed. Precision of mandibular teeth was enhanced by amalgamating the CBCT scan with e-cast scan of the patient lower teeth. 3-Matic software (v. 10.0) was used in designing cutting guide(s) that define the amount of overgrowth to be resected. The top section of the guide was resting on the teeth hence ensuring stability and accuracy while positioning it. The guide design was exported as an .stl file and printed using in-house 3-dimensional printer in biocompatible resin. Three-dimensional technologies of both softwares (CMF Pro Plan and 3-Matic) are accurate and reliable methods in the diagnosis, treatment planning, and designing of cutting guides that optimize surgical correction of hemimandibular hyperplasia at timely and cost-effect manner.

The influence of third molars in the line of mandibular angle fractures on wound and bone healing.

PubMed

Ulbrich, N; Ettl, T; Waiss, W; Gosau, M; Moralis, A; Reichert, T E; Mueller, S

2016-07-01

The objective of this study was to evaluate postoperative complications after removal or retention of the third molar in the line of mandibular angle fractures. This retrospective study included the data of 98 patients with a molar in the line of a mandibular angle fracture treated with internal reduction and mini-plate fixation at our department over 9 years. Patients were classified into two groups: tooth removal during osteosynthesis (n = 45) and tooth retention (n = 55). The primary target criterion was the incidence of minor (outpatient treatment, local measures) and major (surgical revision, rehospitalisation) complications. Time between trauma and surgery was 1.4 days (range 0 to 12), and the average follow-up 291 days (range 66 to 863). Regarding the eruption status, 26 of 52 (50.0 %) impacted third molars, 11 of 19 (57.9 %) incompletely erupted and 8 of 27 (29.6 %) completely erupted molars had been removed during open reduction. Overall, 17 (17.3 %) patients had postoperative minor (n = 7) or major (n = 10) complications, in detail 10/45 (22.0 %) patients after tooth removal and 7/55 (13 %) patients after tooth retention (p = 0.286). Complication rates between impacted and incompletely erupted third molars (impacted molars 15.0 %, incompletely erupted molars 10.0 %) did not differ significantly, but completely erupted molars had a complication rate of 26.0 %. Mandibular angle fractures with a completely erupted third molar show the highest complication rate after open reduction and osteosynthesis. Retention of a non-infectious third molar facilitates open reduction and does not increase the complication risk. The study helps with the decision of removing or retention of a third molar during surgical treatment of a mandibular angle fracture.

Orthognathic surgery in the young cleft patient: preliminary study on subsequent facial growth.

PubMed

Wolford, Larry M; Cassano, Daniel Serra; Cottrell, David A; El Deeb, Mohamed; Karras, Spiro C; Goncalves, Joao Roberto

2008-12-01

This study evaluated the long-term effects of orthognathic surgery on subsequent growth of the maxillomandibular complex in the young cleft patient. We evaluated 12 young cleft patients (9 male and 3 female patients), with a mean age of 12 years 6 months (range, 9 years 8 months to 15 years 4 months), who underwent Le Fort I osteotomies, with maxillary advancement, expansion, and/or downgrafting, by use of autogenous bone or hydroxyapatite grafts, when indicated, for maxillary stabilization. Five patients had concomitant osteotomies of the mandibular ramus. All patients had presurgical and postsurgical orthodontic treatment to control the occlusion. Radiographs taken at initial evaluation (T1) and presurgery (T2) were compared to establish the facial growth vector before surgery, whereas radiographs taken immediately postsurgery (T3) and at longest follow-up (T4) were used to determine postsurgical growth. Each patient's lateral cephalograms were traced, and 16 landmarks were identified and used to compute 11 measurements describing presurgical and postsurgical growth. Before surgery, all patients had relatively normal growth. After surgery, cephalograms showed statistically significant growth changes from T3 to T4, with the maxillary depth decreasing by -3.3 degrees +/- 1.8 degrees , Sella-nasion-point A by -3.3 degrees +/- 1.8 degrees, and point A-nasion-point B by -3.6 degrees +/- 2.8 degrees. The angulation of the maxillary incisors increased by 9.2 degrees +/- 11.7 degrees. Of 12 patients, 11 showed disproportionate postsurgical jaw growth. Maxillary growth occurred predominantly in a vertical vector with no anteroposterior growth, even though most patients had shown anteroposterior growth before surgery. The distance increased in the linear measurement from nasion to gnathion by 10.3 +/- 7.9 mm. Four of 5 patients operated on during the mixed dentition phase had teeth that erupted through the cleft area. A variable impairment of postoperative growth was seen with the 2 types of grafting material used. No significant difference was noted in the effect on growth in patients with unilateral clefts versus those with bilateral clefts. The presence of a pharyngeal flap was noted to adversely affect growth, whereas simultaneous mandibular surgery did not. After surgery, 11 of 12 patients tended toward a Class III end-on occlusal relation. Orthognathic surgery may be performed on growing cleft patients when mandated by psychological and/or functional concerns. The surgeon must be cognizant of the adverse postsurgical growth outcomes when performing orthognathic surgery on growing cleft patients with the possibility for further surgery requirements. Performing maxillary osteotomies on cleft patients would be more predictable after completion of facial growth.

Open reduction and internal fixation of intra-articular fractures of the mandibular condyle: our first experiences.

PubMed

Vesnaver, Ales

2008-10-01

Treatment of intra-articular fractures of the mandibular condyle head is conservative at most institutions dealing with facial fractures. Recently, reports had been published about benefits of surgical treatment in these fractures. From July 2004 until the end of June 2006, 13 patients with 16 displaced intra-articular fractures of the mandibular condyle were treated with open reduction and internal fixation at the Department of Oral and Maxillofacial Surgery in Ljubljana, Slovenia, using the preauricular approach and the lag screw technique. Twelve of the 13 patients could open their mouths for 40 mm or more, and 10 had a deflection of the chin of less than 2 mm upon maximal opening. None of the patients experienced pain upon rest, palpation, or chewing. Occlusion was not noted as altered in any of the cases, neither subjectively, nor on examination. There were no cases of postoperative weakness of the temporal branch of the facial nerve. Surgical treatment of intra-articular condyle fractures using the preauricular approach achieves a good exposure and enables proper reduction. Stable fixation of fractured bony fragments can be achieved using the lag screw technique. Another benefit of open exposure is revision and repair of TMJ soft tissues. With the appropriate surgical technique, the surgical procedure is safe and leads to good results.

Soft, hard-tissues and pharyngeal airway volume changes following maxillomandibular transverse osteodistraction: Computed tomography and three-dimensional laser scanner evaluation.

PubMed

Bianchi, Francesca Antonella; Gerbino, Giovanni; Corsico, Marina; Schellino, Eleonora; Barla, Niccolò; Verzè, Laura; Ramieri, Guglielmo

2017-01-01

Maxillomandibular transverse osteodistraction (MMTOD) is an alternative approach to the traditional treatment for transverse maxillary and mandibular deficiencies and crowding. The aim was to report soft and hard-tissues changes and airway volume variation. In this study, skeletally mature, non-syndromic patients with transverse maxillary and mandibular hypoplasia, who underwent a MMTOD between 2010 and 2012, were included. Surgical changes were analysed using clinical evaluation, three-dimensional facial surface data and computed tomography analysis before (T0) and after the completion of post-op orthodontic treatment (T1). Nineteen patients (eight males and eleven females; average age: 26.3 years) were enrolled. MMTOD produces facial changes in the cheek, paranasal areas, nasal base and chin. Facial changes are mostly explained by the underlying skeletal movements, which are essentially represented by the transverse enlargement of both the maxilla and the mandible. Following MMTOD, the airway volume and the lateral dimension of the cross-sectional airway increased significantly. MMTOD is a technique that allows an increase in airway volume and in both maxillary and mandibular arch perimeters simultaneously by increasing skeletal width. Facial appearance is improved and a stable occlusion is obtained. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Occurrence of the Retromolar Foramen in Dry Mandibles of South-Eastern Part of India: A Morphological Study with Review of the Literature

PubMed Central

Potu, Bhagath Kumar; Kumar, Vinod; Salem, Abdel-Halim; Abu-Hijleh, Marwan

2014-01-01

The retromolar foramen (RMF) is a rare anatomical structure situated in the retromolar fossa behind the third molar tooth. When it is present, the foramen is connected with the mandibular canal and is believed to transmit neurovascular structures that provide accessory source to the mandibular molars and the buccal area. Reports from the literature show that the presence of RMF could pose a challenge in complete blockage of the inferior alveolar nerve during mandibular surgeries. We report the incidence of retromolar foramen from ninety-four dry mandibles of south-eastern part of Karnataka State, India. The foramen was observed in 11 mandibles out of 94 included in the study (11.7%). In three mandibles, the foramen was present bilaterally (3.2%) and in three it was on the left side (3.2%) and in five it was on the right side (5.3%). For the first time, we also measured the dimensions of the retromolar area and distance of the foramen from third molar tooth to understand its risks during the surgical extraction of the lower third molar tooth. A thorough review of the literature has also been done to compare the present findings with the studies reported from the various populations. PMID:25489487

Real-time mandibular angle reduction surgical simulation with haptic rendering.

PubMed

Wang, Qiong; Chen, Hui; Wu, Wen; Jin, Hai-Yang; Heng, Pheng-Ann

2012-11-01

Mandibular angle reduction is a popular and efficient procedure widely used to alter the facial contour. The primary surgical instruments, the reciprocating saw and the round burr, employed in the surgery have a common feature: operating at a high-speed. Generally, inexperienced surgeons need a long-time practice to learn how to minimize the risks caused by the uncontrolled contacts and cutting motions in manipulation of instruments with high-speed reciprocation or rotation. A virtual reality-based surgical simulator for the mandibular angle reduction was designed and implemented on a CUDA-based platform in this paper. High-fidelity visual and haptic feedbacks are provided to enhance the perception in a realistic virtual surgical environment. The impulse-based haptic models were employed to simulate the contact forces and torques on the instruments. It provides convincing haptic sensation for surgeons to control the instruments under different reciprocation or rotation velocities. The real-time methods for bone removal and reconstruction during surgical procedures have been proposed to support realistic visual feedbacks. The simulated contact forces were verified by comparing against the actual force data measured through the constructed mechanical platform. An empirical study based on the patient-specific data was conducted to evaluate the ability of the proposed system in training surgeons with various experiences. The results confirm the validity of our simulator.

Root anatomy and canal configuration of the permanent mandibular first molar: clinical implications and recommendations.

PubMed

de Pablo, Oliver Valencia; Estevez, Roberto; Heilborn, Carlos; Cohenca, Nestor

2012-01-01

Root canal anatomy may present clinicians with a complex clinical challenge that requires diagnostic approaches, access modification, and clinical skills to successfully localize, negotiate, disinfect, and seal the root canal system. This article discusses the clinical implications of endodontic therapy on permanent mandibular first molars. The number of roots on the mandibular first molar is directly related to ethnicity. Canal morphology has a significant effect on treatment protocol: Mesial roots present two canals on a regular basis, adopting 2-2 and 2-1 as the most common configurations. A third canal is present in 2.6% of the population. The most common configuration in the distal root is type I (62.7%), followed by type II (14.5%) and type IV (12.4%). Diagnosis and treatment of complex root canal systems often require specialized training that may be beyond the scope of the average general practitioner. Access modifications are required to find extra roots and/or canals. The instrumentation of the third root requires a different access and small, flexible instruments, given the curvature that is usually present buccally in the apical third. The incidence of isthmuses is 55% in the mesial root and 20% in the distal root. This anatomical configuration should be taken into consideration during endodontic treatment as well as during periapical surgery.

Puerto Rico: Information for Status Deliberations

DTIC Science & Technology

1990-03-01

Rico has suffered a temporary setback from the destruction caused by Hurricane Hugo , both the availability and quality of the island’s housing stock...34"ý Prnce omi Puerto Rico aw (US li ANTIUDAN (U.S.) ,M S oh’ Montserrat (UK) !tGuadsiffupe (FR.) HONDURAS DOMdINICA Caribbean Sea Rosea q Martinique...Housing (the most recent data available). While the island has suffered a temporary setback because of the destruction caused by Hurricane Hugo

Effect of Temperature Set-Back on Heat Pump Performance

DTIC Science & Technology

1981-04-01

OF TEMPERATURE SET-BACK ON HEAT PUMP PERFORMANCE S. E. Kurtz SEPt 41981 Johns - Manville Sales Corporation S . Research and Development Center Ken...letter. The replies were catalogued according to their applicability. 13 -. 4 : "J.i Johns - Manville Sales Corporation Research & Development Center Ken...Caryl Harich De:nver Colorado 80217 July 28, 19ý8) Dear Sir: Johns - Manville Research and Development Center has been. engaged co study the potential

Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial.

PubMed

Majid, Omer Waleed; Al-Mashhadani, Bashar Adil

2014-06-01

The purpose of the present study was to compare the effect of oral bromelain (4 × 250 mg) versus oral diclofenac sodium (4 × 25 mg) on pain, swelling, trismus, and quality of life (QOL) after surgical removal of impacted lower third molars. A randomized, double-blind, placebo-controlled study was planned. The sample included patients requiring extraction under local anesthesia of a single partial bony impacted mandibular third molar. The patients were randomly distributed into 1 of 3 groups: bromelain, diclofenac, and placebo. Treatment started 1 day before surgery and continued for 4 days. The predictor variable was the type of the drug given to the patients. The outcome variables were pain, swelling, and trismus, which were measured at 1, 3, and 7 days postoperatively. The other study variables included QOL measures to assess the patients' perception regarding the effect of surgery on their well-being and daily activities. A validated questionnaire was used to measure QOL. The data were analyzed using analysis of variance, multiple measures analysis of variance, or Pearson's χ(2) test, as appropriate. P < .05 was considered significant. A total of 45 subjects requiring surgical removal of a single impacted mandibular third molar under local anesthesia were included in the present study. The bromelain and diclofenac groups both showed a significant reduction in pain compared with the placebo group at all intervals (P < .05). Diclofenac also resulted in a significant reduction of swelling at 3 and 7 days, and bromelain resulted in an insignificant reduction. A nonsignificant reduction in trismus occurred in both treatment groups compared with the placebo group. Both treatment groups also showed a significant difference in the effect on QOL in most subscales and total scores (P < .05). The effect was comparable between the 2 treatment groups for all parameters and at all intervals. The results of our study have shown that oral bromelain is an effective therapy to improve the QOL after surgical removal of impacted lower third molars, with an effect on the postoperative sequelae comparable to that of preemptive diclofenac sodium. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

The effects of steroids in preventing facial oedema, pain, and neurosensory disturbances after bilateral sagittal split osteotomy: a randomized controlled trial.

PubMed

Widar, F; Kashani, H; Alsén, B; Dahlin, C; Rasmusson, L

2015-02-01

A randomized, prospective, controlled trial was conducted to determine the efficacy of single and repeated betamethasone doses on facial oedema, pain, and neurosensory disturbances after bilateral sagittal split osteotomy. Thirty-seven patients (mean age 23.62 years, range 17-62 years) with either mandibular prognathism or retrognathism were enrolled consecutively into the study and divided into three groups: control (n=12), repeated dose 4+8+4mg betamethasone (n=14), single dose 16mg betamethasone (n=11). The intake of diclofenac and paracetamol was assessed individually. Measurements of facial oedema, pain, and sensitivity in the lower lip/chin were obtained 1 day, 7 days, 2 months, and 6 months postoperatively. Furthermore, we investigated the possible influences of gender, age, total operating time, amount of bleeding, postoperative hospitalization, and advancement versus setback of the mandible. A significant difference (P=0.017) was observed in percentage change between the two test groups and the control group regarding facial oedema (1 day postoperatively). Less bleeding was associated with improved pain recovery over time (P=0.043). Patients who required higher postoperative dosages of analgesics due to pain had significantly delayed recovery of the inferior alveolar nerve at 6 months postoperatively (P<0.001). Betamethasone did not reduce neurosensory disturbances over time. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Clinical assessment scoring system for tracheostomy (CASST) criterion: Objective criteria to predict pre-operatively the need for a tracheostomy in head and neck malignancies.

PubMed

Gupta, Karan; Mandlik, Dushyant; Patel, Daxesh; Patel, Purvi; Shah, Bankim; Vijay, Devanhalli G; Kothari, Jagdish M; Toprani, Rajendra B; Patel, Kaustubh D

2016-09-01

Tracheostomy is a mainstay modality for airway management for patients with head-neck cancer undergoing surgery. This study aims to define factors predicting need of tracheostomy and define an effective objective criterion to predict tracheostomy need. 486 patients undergoing composite resections were studied. Factors analyzed were age, previous surgery, extent of surgery, trismus, extent of mandibular resection and reconstruction etc. Factors were divided into major and minor, using the clinical assessment scoring system for tracheostomy (CASST) criterion. Sixty seven (13.7%) patients required tracheostomy for their peri-operative management. Elective tracheostomies were done in 53 cases during surgery and post-operatively in 14 patients. All patients in whom tracheostomies were anticipated had a score of seven or more. A decision on whether or not an elective tracheotomy in head and neck surgery is necessary and can be facilitated using CASST criterion, which has a sensitivity of 95.5% and a negative predictive value (NPV) of 99.3%. It may reduce post-operative complications and contribute to safer treatment. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Predictive Value of Panoramic Radiography for Injury of Inferior Alveolar Nerve After Mandibular Third Molar Surgery.

PubMed

Su, Naichuan; van Wijk, Arjen; Berkhout, Erwin; Sanderink, Gerard; De Lange, Jan; Wang, Hang; van der Heijden, Geert J M G

2017-04-01

The purpose of the present systematic review was to assess the added value of panoramic radiography in predicting postoperative injury of the inferior alveolar nerve (IAN) in the decision-making before mandibular third molar (MM3) surgery. MEDLINE and EMBASE were searched electronically to identify the diagnostic accuracy of studies that had assessed the predictive value of 7 panoramic radiographic signs, including root-related signs (darkening of the root, deflection of the root, narrowing of the root, and dark and bifid apex of the root) and canal-related signs (interruption of the white line of the canal, diversion of the canal, and narrowing of the canal) for IAN injury after MM3 surgery. A total of 8 studies qualified for the meta-analysis. The pooled sensitivity and specificity of the 7 signs ranged from 0.06 to 0.49 and 0.81 to 0.97, respectively. The area under the summary area under the receiver operating characteristic curve ranged from 0.42 to 0.89. The pooled positive predictive value (PPV) and negative predictive value (NPV) ranged from 7.5 to 26.6% and 95.9 to 97.7%, respectively. The added value of a positive sign for ruling in an IAN injury (PPV minus the prior probability) ranged from 3.4 to 22.2%. The added value of a negative sign for ruling out an IAN injury (NPV minus [1 minus the prior probability]) ranged from 0.1 to 2.2%. For all 7 signs, the added value of panoramic radiography is too low to consider it appropriate for ruling out postoperative IAN in the decision-making before MM3 surgery. The added value of panoramic radiography for determining the presence of diversion of the canal, interruption of the white line of the canal, and darkening of the root can be considered sufficient for ruling in the risk of postoperative IAN injury in the decision-making before MM3 surgery. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

An In Vitro Evaluation of the Use of Resin Liners to Reduce Microleakage and Improve Bond Strength of Amalgam Restorations

DTIC Science & Technology

1991-01-01

posterior teeth, but also to provide a substructure for cast restorations and to seal endodontically treated roots following surgery.5 Although...in class V cavity preparations in the canines, mandibular second molars , and maxillary bicuspids of dogs. Evaluations were performed 48 hours, 30, 60...Cavit and amalgam prevented leakage under both temperature treatment conditions. Mormati and Chan4 8 immersed extracted molars restored with either

Finite Element Simulation and Additive Manufacturing of Stiffness-Matched NiTi Fixation Hardware for Mandibular Reconstruction Surgery

PubMed Central

Jahadakbar, Ahmadreza; Shayesteh Moghaddam, Narges; Amerinatanzi, Amirhesam; Dean, David; Karaca, Haluk E.; Elahinia, Mohammad

2016-01-01

Process parameters and post-processing heat treatment techniques have been developed to produce both shape memory and superelastic NiTi using Additive Manufacturing. By introducing engineered porosity, the stiffness of NiTi can be tuned to the level closely matching cortical bone. Using additively manufactured porous superelastic NiTi, we have proposed the use of patient-specific, stiffness-matched fixation hardware, for mandible skeletal reconstructive surgery. Currently, Ti-6Al-4V is the most commonly used material for skeletal fixation devices. Although this material offers more than sufficient strength for immobilization during the bone healing process, the high stiffness of Ti-6Al-4V implants can cause stress shielding. In this paper, we present a study of mandibular reconstruction that uses a dry cadaver mandible to validate our geometric and biomechanical design and fabrication (i.e., 3D printing) of NiTi skeletal fixation hardware. Based on the reference-dried mandible, we have developed a Finite Element model to evaluate the performance of the proposed fixation. Our results show a closer-to-normal stress distribution and an enhanced contact pressure at the bone graft interface than would be in the case with Ti-6Al-4V off-the-shelf fixation hardware. The porous fixation plates used in this study were fabricated by selective laser melting. PMID:28952598

Finite Element Simulation and Additive Manufacturing of Stiffness-Matched NiTi Fixation Hardware for Mandibular Reconstruction Surgery.

PubMed

Jahadakbar, Ahmadreza; Shayesteh Moghaddam, Narges; Amerinatanzi, Amirhesam; Dean, David; Karaca, Haluk E; Elahinia, Mohammad

2016-12-19

Process parameters and post-processing heat treatment techniques have been developed to produce both shape memory and superelastic NiTi using Additive Manufacturing. By introducing engineered porosity, the stiffness of NiTi can be tuned to the level closely matching cortical bone. Using additively manufactured porous superelastic NiTi, we have proposed the use of patient-specific, stiffness-matched fixation hardware, for mandible skeletal reconstructive surgery. Currently, Ti-6Al-4V is the most commonly used material for skeletal fixation devices. Although this material offers more than sufficient strength for immobilization during the bone healing process, the high stiffness of Ti-6Al-4V implants can cause stress shielding. In this paper, we present a study of mandibular reconstruction that uses a dry cadaver mandible to validate our geometric and biomechanical design and fabrication (i.e., 3D printing) of NiTi skeletal fixation hardware. Based on the reference-dried mandible, we have developed a Finite Element model to evaluate the performance of the proposed fixation. Our results show a closer-to-normal stress distribution and an enhanced contact pressure at the bone graft interface than would be in the case with Ti-6Al-4V off-the-shelf fixation hardware. The porous fixation plates used in this study were fabricated by selective laser melting.

Endoscope-Assisted Enucleation of Mandibular Odontogenic Keratocyst Tumors.

PubMed

Romano, Antonio; Orabona, Giovanni D A; Abbate, Vincenzo; Maglitto, Fabio; Solari, Domenico; Iaconetta, Giorgio; Califano, Luigi

2016-09-01

The keratocyst odontogenic tumor (KCOT) represents a rare and benign but locally aggressive developmental cystic lesion usually affecting the posterior aspect of the mandible bone, the treatment of which has always been raising debate, since Philipsen first described it as a distinct pathological entity in 1956.Recent studies have proposed the use of endoscope-assisted surgical technique, due to the possibility given by the endoscope of improving the effectiveness of the treatment of these lesions thanks to a better visualization of operative field and though a better understanding of the pathology. In this article, we would like to present our experience with the endoscope-assisted treatment of KCOT of the posterior region of the mandible.From April 2000 to April 2012, 32 patients treated for KCOT were enrolled in our retrospective study: patients were divided in 2 groups according to the type of treatment, that is, 18 were treated with traditional enucleation surgery (TES), and 14 patients underwent endoscopic assisted enucleation surgery (EES).Fischer exact test and Kaplan-Meier curves were used to compare the outcomes between the 2 focusing on the recurrence and complication rates. In the TES group, patients we found a higher recurrence rate (39%) and higher postoperative complication rate at 5-year follow-up.Our data suggested, though, that EES seems to be a feasible alternative for the treatment of posterior mandibular KCOT. Further studies and larger series are needed to confirm these results.

Craniofacial morphology and sleep apnea in children with obstructed upper airways: differences between genders.

PubMed

Di Francesco, Renata; Monteiro, Roberta; Paulo, Maria Luiza de Melo; Buranello, Fernando; Imamura, Rui

2012-06-01

To correlate sleep apnea with craniofacial characteristics and facial patterns according to gender. In this prospective survey we studied 77 male and female children (3-12 years old) with an upper airway obstruction due to tonsil and adenoid enlargement. Children with lung problems, neurological disorders and syndromes, obstructive septal deviation, previous orthodontic treatment, orthodontic surgeries or oral surgeries, or obesity were excluded. Patients were subjected to physical examinations, nasal fiberoptic endoscopy, teleradiography for cephalometric analysis, and polysomnography. Cephalometric analysis included the following skeletal craniofacial measurements: facial axis (FA), facial depth (FD), mandibular plane angle (MP), lower facial height (LFH), mandibular arch (MA), and vertical growth coefficient (VERT) index. The prevalence of sleep apnea was 46.75% with no statistical difference between genders. Among children with obstructive sleep apnea (Apneia Hypopnea Index - AHI ≥ 1) boys had higher AHI values than girls. A predominance of the dolichofacial pattern (81.9%) was observed. The following skeletal craniofacial measurements correlated with AHI in boys: FD (r(s)=-0.336/p=0.020), MP (r(s)=0.486/p=0.00), and VERT index (r(s)=-0.337/p=0.019). No correlations between craniofacial measurements and AHI were identified in girls. Craniofacial morphology may influence the severity of sleep apnea in boys but not in girls. Copyright © 2012 Elsevier B.V. All rights reserved.

Analgesic effects of preinjection low-level laser/light therapy (LLLT) before third molar surgery: a double-blind randomized controlled trial.

PubMed

Tuk, Jacco G C; van Wijk, Arjen J; Mertens, Ine C; Keleş, Zühal; Lindeboom, Jérôme A H; Milstein, Dan M J

2017-09-01

The aim of this study was to evaluate the analgesic effects of low-level laser therapy (LLLT) on preinjection sites in patients scheduled for third molar removal. This double-blind randomized controlled trial included 163 healthy patients undergoing third molar extractions. The study participants were randomly divided into an LLLT and a placebo group. Objective and subjective data sets were obtained from physiologic feedback (heart rate and sweat response) and a questionnaire, respectively. In the LLLT group, each targeted injection site was irradiated twice with 198 mW continuous wave for 30 seconds with a 0.088 cm 2 focal spot at an applied energy of 5.94 J and fluence of 67.50 J/cm 2 . Measurements were recorded from 4 time-points during data acquisition. There was no significant difference between the LLLT and placebo groups in pain experience scores associated with the injected sites for maxillary or mandibular third molar extractions. Mean heart rates before and during injection were lower in the LLLT group than in the placebo group for both maxillary and mandibular regions. No statistically significant differences were observed for any remaining parameters. The present data indicated that preinjection LLLT did not effectively decrease the pain felt during local anesthetic injections before third molar surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of incisor extraction on jaw and tongue motor representations within face sensorimotor cortex of adult rats.

PubMed

Avivi-Arber, Limor; Lee, Jye-Chang; Sessle, Barry J

2010-04-01

Loss of teeth is associated with changes in somatosensory inputs and altered patterns of mastication, but it is unclear whether tooth loss is associated with changes in motor representations within face sensorimotor cortex of rats. We used intracortical microstimulation (ICMS) and recordings of cortically evoked muscle electromyographic (EMG) activities to test whether changes occur in the ICMS-defined motor representations of the left and right jaw muscles [masseter, anterior digastric (LAD, RAD)] and tongue muscle [genioglossus (GG)] within the cytoarchitectonically defined face primary motor cortex (face-M1) and adjacent face primary somatosensory cortex (face-S1) 1 week following extraction of the right mandibular incisor in anesthetized (ketamine-HCl) adult male Sprague-Dawley rats. Under local and general anesthesia, an "extraction" group (n = 8) received mucoalveolar bone surgery and extraction of the mandibular right incisor. A "sham-extraction" group (n = 6) received surgery with no extraction. A "naive" group (n = 6) had neither surgery nor extraction. Data were compared by using mixed-model repeated-measures ANOVA. Dental extraction was associated with a significantly increased number of sites within face-M1 and face-S1 from which ICMS evoked RAD EMG activities, a lateral shift of the RAD and LAD centers of gravity within face-M1, shorter onset latencies of ICMS-evoked GG activities within face-M1 and face-S1, and an increased number of sites within face-M1 from which ICMS simultaneously evoked RAD and GG activities. Our novel findings suggest that dental extraction may be associated with significant neuroplastic changes within the rat's face-M1 and adjacent face-S1 that may be related to the animal's ability to adapt to the altered oral state. (c) 2009 Wiley-Liss, Inc.

Treatment in Borderline Class III Malocclusion: Orthodontic Camouflage (Extraction) Versus Orthognathic Surgery

PubMed Central

Rabie, A-Bakr M.; Wong, Ricky W.K.; Min, G.U.

2008-01-01

Aims: To investigate the differences in morphological characteristics of borderline class III patients who had undergone camouflage orthodontic treatment or orthognathic surgery, and to compare the treatment effects between these two modalities. Materials and Methods: Cephalograms of 25 patients (13 orthodontic, 12 surgical) with class III malocclusion were analyzed. All had a pretreatment ANB angle greater than -5º. Results: Using discriminant analysis, only Holdaway angle was selected to differentiate patients in the pretreatment stage. Seventy-two per cent patients were correctly classified. In the orthodontic group, reverse overjet was corrected by retraction of the lower incisors and downward and backward rotation of the mandible. The surgical group was corrected by setback of the lower anterior dentoalveolus and uprighting of the lower incisors. No difference was found in posttreatment soft tissue measurements between the two groups. Conclusions: Twelve degree for the Holdaway angle can be a guideline in determining the treatment modalities for borderline class III patients, but the preferences of operators and patients are also important. (2) Both therapeutic options should highlight changes in the lower dentoalveolus and lower incisors. (3) Both treatment modalities can achieve satisfactory improvements to the people. PMID:19088881

Current Concepts in Hip Preservation Surgery

PubMed Central

Adler, Kelly L.; Cook, P. Christopher; Geisler, Paul R.; Yen, Yi-Meng; Giordano, Brian D.

2016-01-01

Context: Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes. Evidence Acquisition: PubMed and CINAHL databases were searched to identify relevant scientific and review articles through December 2014 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, postoperative rehabilitation, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest. Study Design: Clinical review. Level of Evidence: Level 4. Results: Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle. Conclusion: Effective postoperative rehabilitation must consider modifications and precautions specific to the particular surgical techniques used. Proper postoperative rehabilitation after hip preservation surgery may help optimize functional recovery and maximize clinical success and patient satisfaction. PMID:26733593

Surgical treatment of class II malocclusion in the orthodontic boundaries: a case report.

PubMed

Bandeca, Matheus Coelho; Porto, Alessandra Nogueira; Valieri, Sidnei; Valieri, Matheus; Borges, Alvaro H; Mattos, Fernanda Zanol

2014-01-01

The aim of this study was to report a clinical case of treatment of Class II division I malocclusion with facial aesthetic impairment, whose therapeutic approach comprised the association of orthodontic treatment with orthognathic surgery. The treatment for the present case consisted of decompensation oflower incisors and extraction oftwo lower premolars, in order to obtain horizontal discrepancy allowing the surgery for mandibular advancement. At the end of treatment, we could clinically observe a Class I molar/canine relationship, normal overbite and overjet, presence of lip seal, type I facial profile with considerable aesthetic improvement. We can conclude that the ortho-surgical treatment is a therapeutic alternative providing the best prognosis in terms of aesthetic correction in patients with unpleasant facial profile.

Latissimus dorsi (LD) free flap and reconstruction plate used for extensive maxillo-mandibular reconstruction after tumour ablation.

PubMed

Li, Bo-Han; Jung, Hun Jong; Choi, Sung-Won; Kim, Soung-Min; Kim, Myung-Jin; Lee, Jong-Ho

2012-12-01

The purpose of this study was to consider the indications and evaluate the clinical advantages and disadvantages including, results and complications, of immediate reconstruction using a latissimus dorsi (LD) free flap and reconstruction plate (R-plate) in advanced oro-mandibular tumour resection. Our cohort included 116 patients who underwent LD free flap and R-plate reconstruction. Flap survival, postoperative function, donor/recipient site complication and aesthetics were evaluated. Our series demonstrated a 99.1% flap survival rate. One case required a contralateral LD free flap reconstruction after the initial flap failed due to pedicle kinking. Twelve patients needed the plate to be removed and replaced (n=4, plate fracture; n=2, plate exposure) or definite reconstruction with free fibular flap and implant installation. Donor site complications included seroma accumulation, scarring, and discomfort of the shoulder girdle. The size of the skin paddle ranged from 6 × 10 cm to 12 × 18 cm (12 were double paddled).The facial contour was acceptable without sagging of the flap. The flap was tolerant to irradiation and was resistant to the exposure of the plate at the symphyseal arch. Our series of primary reconstruction with LD free flaps and R-plates showed the retention of mandibular function and the reconstruction of considerably large soft tissue can be achieved successfully. This reconstruction scheme can be indicated for large-volume defects in the oro-mandibular area when the area cannot be covered by a single osteocutaneous free flap, has undergone extensive oncologic resection for advanced or high recurrence rate malignancy and when immediate postoperative chemotherapy and/or irradiation is necessary. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Evaluation of the efficacy of mandibular conventional and implant prostheses in a group of Turkish patients: a quality of life study.

PubMed

Cakir, Onur; Kazancioglu, Hakki Oguz; Celik, Gozde; Deger, Sabire; Ak, Gulsum

2014-07-01

The aim of this study was to compare the satisfaction and quality of life (QoL) in a group of patients using mandibular complete dentures, implant-retained overdentures, removable partial dentures (RPDs), or implant-supported fixed partial dentures (FPDs). A total of 116 patients (aged 36 to 81, mean age 58 ± 10.03 years) were assigned to four groups (n = 29) and treated with mandibular implant-retained overdentures, implant-supported FPDs (two implants/three unit FPDs), conventional complete dentures, or RPDs. The groups were well matched in terms of gender, age, and the edentulous period. All patients had edentulous maxillary arches and completely or partially edentulous mandibles. All prostheses were mandibular prostheses. The OHIP-14, OHQoL-UK, and SF-36 surveys were used to determine QoL before implant surgery and 1 year after prosthetic treatment. The baseline and 1-year data from 116 patients were analyzed. A significant improvement was found among the QoL scales for all groups (p < 0.05). The most significant improvement was found in the implant-retained overdenture group (15.67 ± 2.47), while the least improvement was found among the implant-supported FPD group (5.14 ± 2.08). The SF-36 test revealed no differences between the before and after treatment scores for general health, pain, vitality, social function, and physical function difficulties (p > 0.05). The only significant difference was found for mental health (p = 0.011). A positive influence on oral health-related QoL was observed in all groups. The QoL values were the most improved in the implant-retained overdenture group. © 2014 by the American College of Prosthodontists.

A modeling investigation of the impact of street and building configurations on personal air pollutant exposure in isolated deep urban canyons.

PubMed

Ng, Wai-Yin; Chau, Chi-Kwan

2014-01-15

This study evaluated the effectiveness of different configurations for two building design elements, namely building permeability and setback, proposed for mitigating air pollutant exposure problems in isolated deep canyons by using an indirect exposure approach. The indirect approach predicted the exposures of three different population subgroups (i.e. pedestrians, shop vendors and residents) by multiplying the pollutant concentrations with the duration of exposure within a specific micro-environment. In this study, the pollutant concentrations for different configurations were predicted using a computational fluid dynamics model. The model was constructed based on the Reynolds-Averaged Navier-Stokes (RANS) equations with the standard k-ε turbulence model. Fifty-one canyon configurations with aspect ratios of 2, 4, 6 and different building permeability values (ratio of building spacing to the building façade length) or different types of building setback (recess of a high building from the road) were examined. The findings indicated that personal exposures of shop vendors were extremely high if they were present inside a canyon without any setback or separation between buildings and when the prevailing wind was perpendicular to the canyon axis. Building separation and building setbacks were effective in reducing personal air exposures in canyons with perpendicular wind, although their effectiveness varied with different configurations. Increasing the permeability value from 0 to 10% significantly lowered the personal exposures on the different population subgroups. Likewise, the personal exposures could also be reduced by the introduction of building setbacks despite their effects being strongly influenced by the aspect ratio of a canyon. Equivalent findings were observed if the reduction in the total development floor area (the total floor area permitted to be developed within a particular site area) was also considered. These findings were employed to formulate a hierarchy decision making model to guide the planning of deep canyons in high density urban cities. © 2013 Elsevier B.V. All rights reserved.

Setback distances between small biological wastewater treatment systems and drinking water wells against virus contamination in alluvial aquifers.

PubMed

Blaschke, A P; Derx, J; Zessner, M; Kirnbauer, R; Kavka, G; Strelec, H; Farnleitner, A H; Pang, L

2016-12-15

Contamination of groundwater by pathogenic viruses from small biological wastewater treatment system discharges in remote areas is a major concern. To protect drinking water wells against virus contamination, safe setback distances are required between wastewater disposal fields and water supply wells. In this study, setback distances are calculated for alluvial sand and gravel aquifers for different vadose zone and aquifer thicknesses and horizontal groundwater gradients. This study applies to individual households and small settlements (1-20 persons) in decentralized locations without access to receiving surface waters but with the legal obligation of biological wastewater treatment. The calculations are based on Monte Carlo simulations using an analytical model that couples vertical unsaturated and horizontal saturated flow with virus transport. Hydraulic conductivities and water retention curves were selected from reported distribution functions depending on the type of subsurface media. The enteric virus concentration in effluent discharge was calculated based on reported ranges of enteric virus concentration in faeces, virus infectivity, suspension factor, and virus reduction by mechanical-biological wastewater treatment. To meet the risk target of <10 -4 infections/person/year, a 12 log 10 reduction was required, using a linear dose-response relationship for the total amount of enteric viruses, at very low exposure concentrations. The results of this study suggest that the horizontal setback distances vary widely ranging 39 to 144m in sand aquifers, 66-289m in gravel aquifers and 1-2.5km in coarse gravel aquifers. It also varies for the same aquifers, depending on the thickness of the vadose zones and the groundwater gradient. For vulnerable fast-flow alluvial aquifers like coarse gravels, the calculated setback distances were too large to achieve practically. Therefore, for this category of aquifer, a high level of treatment is recommended before the effluent is discharged to the ground surface. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Evaluation of total alloplastic temporo-mandibular joint replacement with two different types of prostheses: A three-year prospective study

PubMed Central

Gonzalez-Perez-Somarriba, Borja; Centeno, Gabriel; Vallellano, Carpóforo; Montes-Carmona, Jose-Francisco

2016-01-01

Background Temporo-Mandibular Joint (TMJ) replacement has been used clinically for years. The objective of this study was to evaluate outcomes achieved in patients with two different categories of TMJ prostheses. Material and Methods All patients who had a TMJ replacement (TMJR) implanted during the study period from 2006 through 2012 were included in this 3-year prospective study. All procedures were performed using the Biomet Microfixation TMJ Replacement System, and all involved replacing both the skull base component (glenoid fossa) and the mandibular condyle. Results Fifty-seven patients (38 females and 19 males), involving 75 TMJs with severe disease requiring reconstruction (39 unilateral, 18 bilateral) were operated on consecutively, and 68 stock prostheses and 7 custom-made prostheses were implanted. The mean age at surgery was 52.6±11.5 years in the stock group and 51.8±11.7 years in the custom-made group. In the stock group, after three years of TMJR, results showed a reduction in pain intensity from 6.4±1.4 to 1.6±1.2 (p<0.001), and an improvement in jaw opening from 2.7±0.9 cm to 4.2±0.7 cm (p<0.001). In the custom-made group, after three years of TMJR, results showed a reduction in pain intensity from 6.0±1.6 to 2.2±0.4 (p<0.001), and an improvement in jaw opening from 1.5±0.5 cm to 4.3±0.6 cm (p<0.001). No statistically significant differences between two groups were detected. Conclusions The results of this three-year prospective study support the surgical placement of TMJ prostheses (stock prosthetic, and custom-made systems), and show that the approach is efficacious and safe, reduces pain, and improves maximum mouth opening movement, with few complications. As such, TMJR represents a viable technique and a stable long-term solution for cranio-mandibular reconstruction in patients with irreversible end-stage TMJ disease. Comparing stock and custom-made groups, no statistically significant differences were detected with respect to pain intensity reduction and maximum mouth opening improvement. Key words:Temporo-mandibular joint, temporo-mandibular joint replacement, prosthesis, biomaterials, biomedical engineering, computer-aided design and manufacturing. PMID:27475697

JPRS Report, China Red Flag No 15, 1 August 1987

DTIC Science & Technology

1987-10-07

9-13) (Xiao Ke) • • • • • 1* Consolidate and Develop a New Type of Army-Government and Army-People Relationship (pp 14-17) (Wang Fang, Li Qing...the Socialist Commodity Economy (pp 44-46) ( Li Guangyuan) 78 ’Emotional Investment’ Viewed From Various Angles (p 47) (Lei Ke) 85 Singing the...counted as a setback, but it was precisely during the setback of the great revolution that our Army was founded. During the 25,000- li Long March

Attachment Levels and Crevicular Depths at the Distal of Mandibular Second Molars Following Removal of Adjacent Third Molars.

DTIC Science & Technology

1981-02-01

attachment by determining the distance between the bottom of the crevice and the cemento -enamel junction prior to surgery were unsuccessful, but they were...measuring from the tips of the distolingual and distobuccal cusps and the midpoint of the distal marginal ridge (the cemento -enamel junction could not be...The cemento -enamel junction, usually used as a refer- ence point for determining attachment level, could not be visualized on the distal of the

A 5-year perspective on a removable overdenture appliance for a patient with osteonecrosis of the jaw, a mandibular resection, and rampant caries.

PubMed

Login, Gary R

2016-08-01

A 78-year-old man with a history osteonecrosis of the jaw and 2 subsequent surgeries to repair a fractured mandible had a condition that contraindicates most dentoalveolar procedures to restore his failing dentition. A Snap-On-Smile overdenture restored his opportunity for natural speech, occlusal function, and esthetics. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Toward Patient Specific Long Lasting Metallic Implants for Mandibular Segmental Defects

NASA Astrophysics Data System (ADS)

Shayesteh Moghaddam, Narges

Mandibular defects may result from tumor resection, trauma, or inflammation. The goals of mandibular reconstruction surgeries are to restore mandible function and aesthetics. To this end, surgeons use a combination of bone grafts and metallic implants. These implants have drastically different mechanical properties than the surrounding bone. As a result, the stress distribution in the mandible changes after surgery. The long-term abnormal stress/strain distribution may lead to either graft failure due to bone resorption as a result of stress shielding, or hardware failure due to stress concentrations. During the healing period of six to nine months it is important that complete immobilization, bringing mandibular micro-motion down to the level of 200-500 mum during chewing, is achieved. After this period it is desired that bone undergo normal stress for long-term success of the treatment. Although current high stiffness fixation hardware accomplishes this immobilization during the healing period, the hardware continues to alter the normal stress-strain trajectory seen during chewing once the engrafted bone heals. Over the long-term, the immobilized and stress-shielded engrafted bone tends to resorb. On the other hand, hardware fracturing or/and screw loosening is observed as the stress is concentrated at certain locations on the hardware. Equally as important is the permanent loss of chewing power due to the altered stress-strain relationships. The first stage of this research is to study the problems encountered following a mandibular segmental defect reconstructive surgery. To this end, we constructed a finite element model of a healthy mandible, which includes cortical and cancellous bone, teeth (enamel and dentin components), and the periodontal ligament. Using this model, we studied a healthy adult mandible under maximum molar bite force for stress, strain, displacement, and reaction force distribution. For mandibular segmental defect reconstruction the current standard of care consists of the use of Surgical Grade 5 titanium also known as Ti-6Al-4V hardware and either a single or double fibula barrel vascularized bone graft. We expanded our model to simulate the effects of this surgery. The expanded model includes both single and double barrel fibular bone graft repair of a right M1-M3 containing section of the mandible, Ti-6Al-4V fixation hardware and screws. We found that the stiffness mismatch between the fixation hardware and the bone causes stress shielding on the host mandible and the bone graft, and stress concentration at the fixation hardware and screws. The simulations results show that while a double-barrel graft is preferred, in the long-term it does not create the optimal outcome due to the abnormal stress pattern. To improve the long-term outcome with metallic implants it is essential to recreate the normal stress pattern. To achieve this outcome we investigated the use of porous nitinol as a substitute for the currently used titanium hardware. While NiTi already has a lower stiffness than titanium, it is possible to add porosity to further reduce the stiffness to be closer to that of cortical bone. The ultimate goal is to create fixation hardware that has sufficient stiffness for immobilization while recreating the normal stress pattern in the bone. Using a finite element model of devices fabricated from Surgical Grade 5 titanium and NiTi, we have found that stiffness-tuned NiTi hardware with conventional geometries should result in recreation of normal stress-strain trajectories and better treatment outcome. Finally, to further improve the outcome, we suggest the use of a two-stage mechanism Bone Bandaid which supports both the immobilization/healing and regenerative phases of mandibular segmental defect treatment. This device is made of two materials. The stiff Ti-6Al-4V portion provides the support during the healing period and is disengaged afterwards. The second material is a NiTi wire-frame to facilitate normal stress distribution after the initial healing period. The titanium part of this fixation hardware is released following radiological verification that the surgical osteotomies have healed. The release procedure is performed under local anesthetic via a microsurgical tool. With the titanium fixation hardware no longer functional, the NiTi webbing would act as a superstructure, like a skin, to the underlying grafted cortical bone. This device facilitates stress transduction through the normal stress-strain trajectories, allows restoration of power, drives cortical bone remodeling and strengthening, provides long-term strength, and a good bone bed for dental implants. If bone chips are used, instead of single or double bone graft, the webbing is more likely to support the bone chips while they are being incorporated with the mandible. We have performed computer simulation to investigate the two stages of the operation of the device. Our FEA results indicate that the Bone Bandaid supports both the immobilization needed during healing and the distribution of stress through the engrafted bone once it has healed. (Abstract shortened by ProQuest.).

Low-level Laser Therapy on Postoperative Pain after Mandibular Third Molar Surgery

PubMed Central

Hamid, May Ayad

2017-01-01

Introduction: The analgesic effect of low-level laser therapy (LLLT) after mandibular third molar (MTM) extraction is controversial. The aim is to evaluate the effect of intraoral LLLT on postoperative pain after MTMs extraction. Methods: Thirty patients with bilateral symmetrical impacted MTMs underwent surgical extractions. Experimental and control sides were randomly selected to receive LLLT or placebo. Following suturing, a dental assistant applied 810 nm gallium aluminum arsenide (GaAlAs) at three points for 30 s each with a total energy of 9 J. Pain was recorded on a visual analog scale on the 7 successive days. Results: Data analyzed by IBM SPSS Statistics 23 for Windows with P ≤ 0.05 significance level. LLLT appeared to have a high significant effect on pain reduction; however, there was a mild increase in pain after the 4th day. Conclusion: Intraoral 810 nm GaAlAs is effective in reducing postoperative pain when a dose of 32.86 J/cm2 is used. PMID:29264287

[Prospective randomized study regarding the effect of the preoperative antibiotic and chlorhexidine rinse on wound healing after mandibular third molar surgery].

PubMed

Kaposvári, István; Körmöczi, Kinga; László, Zsuzsa Beáta; Oberna, Ferenc; Horváth, Ferenc; Joób-Fancsaly, Árpád

2017-01-01

The study compares the antibiotic prophylaxis combined with postoperative antibiotic therapy to preoperative chlorhexidine rinse combined with postoperative antibiotic therapy in preventing complications after surgical removal of a mandibular third molar. 71 healthy patients in four groups were enrolled in the study: I. prophylactic dose of 2000 mg of amoxicillin clavulanate, continued with amoxicillin clavulanate postoperatively; II. prophylactic dose of 600 mg of clindamycin, continued with clindamycin postoperatively; III. prophylactic chlorhexidin rinsing, continued randomized amoxicillin clavulanate or clindamycin postoperatively; IV. control, with clindamycin postoperatively. The pain was smaller in the prophylaxis groups. Alveolitis occurred only in the control group: 2 patients. Wound opening occurred in 22,2 % in group IV., 14,2 % in group II, 10 % in group I., 5 % in group III. We consider completing the indicated postoperative antibiotic prescription with antibiotic or antiseptic prophylaxis. Chlorhexidin prophylaxis could have the same positive effect. Orv. Hetil., 2017, 158(1), 13-19.

Question mark ears, temporo-mandibular joint malformation and hypotonia: auriculo-condylar syndrome or a distinct entity?

PubMed

Priolo, M; Lerone, M; Rosaia, L; Calcagno, E P; Sadeghi, A K; Ghezzi, F; Ravazzolo, R; Silengo, M

2000-10-01

We report a boy with prominent, peculiarly malformed ears, abnormality of the ramus of the mandible and hypotonia. An isolated peculiar bilateral ear deformity named 'question mark ear' has been delineated in plastic reconstruction surgery reviews [Cosman et al., 1970 Plast Reconstr Surg 46:454-457; Cosman (1984) Plast Reconstr Surg 73:572-576; Takato et al. (1989) Ann Plast Surg 22:69-73; Brodovsky (1997) Plast Reconstr Surg 100:1254-1257; Park (1998) Plast Reconstr Surg 101:1620-1623; Al-Quattan (1998) Plast Reconstr Surg 102:439-441] and a similar deformity of the ear and changes in the temporo-mandibular joint and condyle has been described by Jampol et al. [(1998) Am J Med Genet 75:449-452] and by Guion-Almeida et al. [(1999) Am J Med Genet 86:130-133]. The present case may be the third description of this malformation complex with additional clinical features characterized by hypotonia and mild developmental delay, or possibly a new distinct entity.

Transient recycling of resected bone to facilitate mandibular reconstruction--a technical note.

PubMed

Lee, Jing-Wei; Tsai, Shin-Sheng; Kuo, Yao-Lung

2006-10-01

Mandibular reconstruction requires considerable sculptural skills. The intriguingly complex configuration of the structure is difficult to reproduce. It is thus imperative for surgeons to seek a technique that improves the precision of the reconstruction. A 55-year-old male presented with a full thickness cancer (T4+) of his left cheek. Radical ablative surgery resulted in an extensive loss of bone and soft tissue mandating major reconstruction. The resected bony specimen was thoroughly denuded, autoclaved, and then placed back into its original site so that the mandible resumed its pre-surgical configuration. A reconstruction plate was applied to maintain structural stability, then the "recycled bone" was used as a template and replaced with a free fibular graft. The patient fared well and a follow-up panoramic radiograph demonstrated good alignment and symmetry of the reconstructed mandible. This method is a viable option for segmental mandibulectomy defect repair in selected cases. Using this technique, it is possible to restore the original bony contour expediently and accurately.

Comparison of various approaches for the treatment of fractures of the mandibular condylar process.

PubMed

Handschel, Jörg; Rüggeberg, Tim; Depprich, Rita; Schwarz, Frank; Meyer, Ulrich; Kübler, Norbert R; Naujoks, Christian

2012-12-01

Fractures of the mandibular condyle process are the most common fractures of the lower jaw. Unfortunately, the type of treatment is still a matter of debate. The aim of this investigation was to compare the outcome of different treatment approaches regarding function and surgical side-effects. 111 fractures of the mandibular condyle representing all types according to the classification of Spiessl and Schroll were included. Both closed reduction (CR) and open reduction with internal fixation (ORIF) including the retromandibular/transparotid, submandibular, preauricular and intraoral approach were performed. The clinical examination included functional and aesthetic aspects at least 1 year after the fracture. The majority of fractures (45%) were classified into Type II and IV according to Spiessl and Schroll followed by fractures without any displacement or dislocation (29.7%). The submandibular approach showed the worst outcome regarding permanent palsy of the facial nerve and hypertrophic scarring. No significant differences between the various approaches were detected in the functional status in any diagnosis group. Inferior condylar neck fractures benefit from ORIF by an intraoral approach whereas in high condylar neck fractures the retromandibular/transparotid approach shows the best results. Fractures of the condylar head were almost all treated by CR and our results cannot contribute to the debate of CR vs. ORIF in this type of fracture. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Impaction of lower third molars and their association with age: radiological perspectives.

PubMed

Ryalat, Soukaina; AlRyalat, Saif Aldeen; Kassob, Zaid; Hassona, Yazan; Al-Shayyab, Mohammad H; Sawair, Faleh

2018-04-04

Third molars are the most commonly impacted teeth, and their extraction is the most commonly performed procedure in oral and maxillofacial surgery. The aim of the present study is to describe the pattern of mandibular third molar impaction and to define the most appropriate age for prophylactic extraction of mandibular third molar teeth. A total of 1198 orthopantomographs (OPGs) with 1810 impacted lower third molars were reviewed by two authors. The pattern of eruption in relation to patient's age was examined using standard radiographic points and angles. Statistical analysis was performed using SPSS for Windows release 16.0 (SPSS Inc., Chicago, IL, USA). In patients older than 20 years, vertical pattern of impaction was the most common (21.4%); while in young patients; horizontal impaction was more common (21.3%). Furthermore, there was a constant pattern of increase in Pell-Gregory ramus class 1 with increasing age, as the prevalence of class 1 was 0% at age 18 years compared to 54.9% at the age of 26 years. Frequency of vertical impaction of lower third molars was seen more at an older age (> 20 years) in this study, with an increase in the retromolar space. Late extraction of mandibular third molar teeth (i.e. after the age of 20) is therefore recommended when prophylactic extraction is considered.

Regeneration of a Tooth in a Tissue-Engineered Mandible After Resection of a Central Giant Cell Tumor. Demonstrating Evidence of Functional Matrix Theory and Ectodermal Origin of Teeth in a Human Model-A Case Report.

PubMed

Melville, James C; Couey, Marcus A; Tong, Matthew S; Marx, Robert E

2017-04-01

Central giant cell tumors (CGCTs) are uncommon lesions occurring in the jaw. They are benign but locally destructive osteolytic lesions. They usually occur in pediatric patients 5 to 15 years of age. Multiple noninvasive modalities of treatment (intralesional steroids, interferon, calcitonin, and denosumab) have been described for those lesions, but for those that are refractory to treatment, enucleation and curettage or resection is a curative surgery. This case report describes a pediatric patient who was diagnosed with an aggressive CGCT of the left mandible encompassing the right angle to the condyle. The lesion became refractory to noninvasive treatments and immediate resection and reconstruction was performed using principles of tissue engineering. After 5 years of close observation, the patient showed normal morphology and growth of his mandible, but surprisingly developed a left mandibular third molar (tooth 17) in the site of the mandibular resection and reconstruction. This is the first case report in the literature to show the spontaneous development of teeth in a human reconstructed mandible, contributing evidence toward the functional matrix theory of mandibular growth and ectodermal origin of teeth. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Aesthetic restoration in maxillo-mandibular malformations: the role of genioplasty

PubMed Central

Ungari, Claudio; Riccardi, Emiliano; Reale, Gabriele; Agrillo, Alessandro; Rinna, Claudio; Mitro, Valeria; Filiaci, Fabio

2015-01-01

Summary Aim The aim of this study was to determinate how orthognatic surgery aids to cure many skull and face abnormalities and to help re-establishing the correct occlusive relation thanks to the repositioning of the maxillo-mandibular skeleton basis. Methods The study included 183 male patients and 338 female patients, with an average age of 23 years. The sample series was divided according to specific pathologies. All patients underwent surgical procedures and the therapeutic strategy was determined based on the anomalies presented. Results 113 patients had a II class dental skeletal occlusion, 180 patients had a III class dental-skeletal occlusion and 222 patients had skull-facial abnormalities. 5 patients underwent only a genioplasty, 82 patients underwent a genioplasty associated with BSSO, 175 patients underwent a genioplasty associated with Le Fort I osteotomy and the remaining 253 patients underwent a genioplasty associated with BSSO and Le Fort I osteotomy. Conclusion The experience shows that genioplasty has been successfully introduced in orthognathic surgical therapeutic procedures, for dental-skeleton abnormalities and mandibular asymmetries treatment. In recent years, the evolution of computer systems has allowed an accurate assessment and programming, by means of the three-dimensional display, which are of great help in the course of diagnosis and evaluation of the displacements to be carried out, in order to obtain optimal aesthetic results. PMID:26941899

Modified Interim Mandibular Advancement (MIMA) Appliance for Symptomatic Correction of Obstructive Sleep Apnea

PubMed Central

Singh, Harpreet; Mishra, Harsh Ashok; Gupta, Ankur

2016-01-01

Obstructive Sleep Apnea (OSA) is a chronic, progressive, multifactorial, life-threatening disorder that causes significant impact on patient’s life. Patients with OSA [Apnea/Hypopnea Index (AHI)>30] who cannot tolerate Continuous Positive Airway Pressure (CPAP) therapy or are not surgical candidates may benefit from oral appliances. This paper describes interim appliance devised from existing Hawley’s retainer in patients with OSA. A 38-year-old man of athletic built with history of orthodontic treatment six months back due to esthetic concerns and wearing upper Hawley’s retainer, reported with chief complaint of frequent nocturnal awakening along with excessive daytime somnolence. Based on diagnostic aids, he was diagnosed with Class II Division 1 malocclusion with severe mandibular retrusion. Sleep test revealed AHI score of 34, suggestive of severe OSA. With ENT and Oral surgeon concurrence, mandibular advancement of 7mm with Bilateral Sagital Split Osteotomy (BSSO) with distraction was contemplated as a viable functional and curative stable treatment plan. Because of non-adherence and non-compliance with CPAP therapy and on request of patient, an interim anterior positioning appliance was devised to facilitate comfortable sound sleep till the time surgery is impending. After three months of wearing this customized appliance, improved quality of sleep was discernible; both subjectively as reported by patient and objectively using sleep test (AHI=9.8). PMID:27656589

Occurrence of a 'bad' split and success of initial mandibular healing: a review of 524 sagittal ramus osteotomies in 262 patients.

PubMed

Posnick, J C; Choi, E; Liu, S

2016-10-01

The purpose of this study was to assess the prevalence of a 'bad' split after sagittal ramus osteotomies (SRO) and report the results of initial mandibular healing. A retrospective cohort study derived from patients treated by a single surgeon at one institution between 2004 and 2013 was performed. An index group consisting of a series of subjects with a spectrum of bimaxillary dentofacial deformities also involving the chin and symptomatic chronic obstructive nasal breathing was identified. The SRO design, bicortical screw fixation technique, and perioperative management were consistent. Outcome variables included the occurrence of a 'bad' split and the success of initial SRO healing. Two hundred sixty-two subjects undergoing 524 SROs met the inclusion criteria. Their average age was 25 years (range 13-63 years) and 134 were female (51%). Simultaneous removal of a third molar was performed during 209 of the SROs (40%). There were no 'bad' splits. All subjects achieved successful bone union, the planned occlusion, and return to a chewing diet and physical activities by 5 weeks after surgery. The presence of a third molar removed during SRO was not associated with an increased frequency of a 'bad' split or delayed mandibular healing. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

The use of a single titanium microplate in displaced pediatric parasymphysial mandibular fractures.

PubMed

Abdullah, Walid A

2009-07-01

The objective of this study was to evaluate the use of one titanium microplate in the fixation of displaced pediatric parasymphysial mandibular fractures. The study was conducted on 7 children in the mixed dentition stage with displaced parasymphysial fracture. Patients' age ranged between 5 years 9 months and 8 years 4 months with an average of 7 years 1 month. Fractured bone segments were exposed, reduced and then fixed using 1.5 linear microplates at the inferior border of the mandible using monocortical screws, with 1.5 mm in diameter and 5 mm in length. Stainless steel wire was used as a tension band by ligating the teeth around the fracture line. Patients were followed up for occlusion and stability clinically and radiographically (panoramic X-ray and CT). According to clinical and radiographic post-operative follow-up, none of the patients showed displacement of the fixed bony segments. The present study concluded that using one microplate with 1.5 monocortical microscrews and dental tension band by a stainless steel wire could be adequate for fixing displaced pediatric parasymphysial mandibular fractures. This technique has the following advantages: decreases the amount of titanium used, decreases the risk of injury of the roots and teeth buds, and decreases the cost and time of surgery.

Tinnitus in patients with temporo-mandibular joint disorder: Proposal for a new treatment protocol.

PubMed

Attanasio, Giuseppe; Leonardi, Alessandra; Arangio, Paolo; Minni, Antonio; Covelli, Edoardo; Pucci, Resi; Russo, Francesca Yoshie; De Seta, Elio; Di Paolo, Carlo; Cascone, Piero

2015-06-01

The present study was designed to verify the correlation between tinnitus and temporomandibular joint dysfunction.86 consecutive patients were enrolled in the study, all affected by subjective tinnitus without hearing impairment, from both genders, age between 18 and 60 years old. The final number of patients included in the study was 55. All patients received a temporo-mandibular joint examination. All the patients were asked to rate the severity of their symptoms before and after treatment using a VAS scale and the Tinnitus Handicap Inventory (THI) and they followed a standardized protocol for the investigation of tinnitus. All the subjects were monitored by the same researcher and they underwent the same splint treatment. The comparison between pre- and posttreatment phase scores showed in patients with predisposition of TMD and with TMD a statistically significant decrease of THI and VAS values. The characteristics of tinnitus and the degree of response to treatment confirmed the relationship between tinnitus and TMD. The authors believe that, when the most common causes of tinnitus, such as otologic disorders and neurological diseases are excluded, it is correct to evaluate the functionality of the temporo-mandibular joint and eventually treat its pathology to obtain tinnitus improvement or even resolution. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Analgesic efficacy of lysine clonixinate plus tramadol versus tramadol in multiple doses following impacted third molar surgery.

PubMed

Perez-Urizar, J; Martínez-Rider, R; Torres-Roque, I; Garrocho-Rangel, A; Pozos-Guillen, A

2014-03-01

This study compared the analgesic and anti-inflammatory efficacy, trismus control, and tolerability of the combination of lysine clonixinate and tramadol (LCT) versus tramadol (T) alone after surgical removal of impacted mandibular third molars. This study was a double-blind, randomized clinical trial, including two study groups of 20 patients each, who exhibited acute pain subsequent to surgical extraction of two mandibular third molars. Pain intensity was quantified over a 96-h period using a visual analogue scale and a 5-point verbal rating scale. Secondary indicators of analgesic and anti-inflammatory efficacy, trismus control, and tolerability were determined. Patients administered LCT exhibited better therapeutic effects that those administered T. Fifty percent of patients in the LCT group rated this therapy as 'excellent analgesia' compared with only 10% in the T group. The onset of the analgesic effect of LCT was significantly faster, without any therapeutic failures. There were no significant differences between the groups with regard to anti-inflammatory effect or trismus. The results of this study suggest that the postsurgical analgesic efficacy of LCT in combination (LC 125 mg + T 25 mg) is superior to that obtained with T alone, administered at the standard dose of 50 mg, for up to 96 h after the extraction of both impacted mandibular third molars. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

The use of a single titanium microplate in displaced pediatric parasymphysial mandibular fractures

PubMed Central

Abdullah, Walid A.

2009-01-01

Objective The objective of this study was to evaluate the use of one titanium microplate in the fixation of displaced pediatric parasymphysial mandibular fractures. Materials and methods The study was conducted on 7 children in the mixed dentition stage with displaced parasymphysial fracture. Patients’ age ranged between 5 years 9 months and 8 years 4 months with an average of 7 years 1 month. Fractured bone segments were exposed, reduced and then fixed using 1.5 linear microplates at the inferior border of the mandible using monocortical screws, with 1.5 mm in diameter and 5 mm in length. Stainless steel wire was used as a tension band by ligating the teeth around the fracture line. Patients were followed up for occlusion and stability clinically and radiographically (panoramic X-ray and CT). Results According to clinical and radiographic post-operative follow-up, none of the patients showed displacement of the fixed bony segments. Conclusion The present study concluded that using one microplate with 1.5 monocortical microscrews and dental tension band by a stainless steel wire could be adequate for fixing displaced pediatric parasymphysial mandibular fractures. This technique has the following advantages: decreases the amount of titanium used, decreases the risk of injury of the roots and teeth buds, and decreases the cost and time of surgery. PMID:23960466

[Effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar].

PubMed

Xue, Peng; Hou, Rui; Shang, Lei; Ma, Yuanyuan; Wu, Fang; Zhang, Sijia

2014-10-01

To investigate the effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar. Ninety-Six patients had their bilateral third molars removed through a split-mouth, double-blind, controlled, clinical trial in two visits. On one side amoxicillin (or clindamycin) was used (antibiotics group) from 1 h pre-operation to 3 d post-operation. On the other side, placebo was used (placebo group) the same time. Postoperative inflammatory complications including alveolar osteitis (AO), surgical site infection (SSI), pre-buccal site infection and anterior isthmus faucium space infection were monitored and recorded 2 d and 10 d after the surgery. The pain, swelling, and trismus were also recorded. All 96 patients completed the study. Two AO (2.1%), one SSI (1.0%) and seven other infections were observed in the treatment group. Also three AO (3.1%), one SSI (1.0%) and eleven other infections were observed in the placebo group. However, no statistically significant differences were found in the incidence of various postoperative inflammatory complications and reactions between the groups (P > 0.05). There was no significant difference on the postoperative reaction, except pain on 10 d. Patients who had inflammatory infection recovered well with symptomatic anti-infection treatment. The use of amoxicillin (or clindamycin) cannot effectively prevent and reduce the postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar.

Mandible reconstruction with free fibula flaps: Outcome of a cost-effective individual planning concept compared with virtual surgical planning.

PubMed

Rommel, Niklas; Kesting, Marco Rainer; Rohleder, Nils Hagen; Bauer, Florian Martin Josef; Wolff, Klaus-Dietrich; Weitz, Jochen

2017-08-01

The free osteomyocutaneous fibular flap has become one of the primary options for mandibular reconstruction, because of the later introduction and development of virtual surgical planning (VSP). However, VSP is associated with high additional pre-operative effort and costs. Therefore, the purpose of the study was to develop a new individual cost-effective pre-operative planning concept for free fibula mandible reconstruction and to compare it with VSP regarding clinical parameters and post-operative outcome. 31 patients undergoing mandibular reconstruction with a microvascular free fibular flap were divided into two groups and retrospectively reviewed. For the first group A (18 of 31 patients), an individual method with stererolithographic (STL) models, silicon templates and hand-made cutting guides was used (about 250 € planning costs/patient). For the second group B (13 of 31 patients), VSP including pre-fabricated cutting guides was used (about 2500 € planning costs/patient). We found no statistically significant differences with respect to intra-operative time of mandibular reconstruction, duration of hospitalisation or post-operative complications between the two groups (p ≥ 0.05). The surgical outcomes and operative efficiency of this individual and cost-effective planning concept are comparable with the much more expensive complete VSP concept. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Risk factors for postoperative complications following oral surgery.

PubMed

Shigeishi, Hideo; Ohta, Kouji; Takechi, Masaaki

2015-01-01

The objective of this study was to clarify significant risk factors for postoperative complications in the oral cavity in patients who underwent oral surgery, excluding those with oral cancer. This study reviewed the records of 324 patients who underwent mildly to moderately invasive oral surgery (e.g., impacted tooth extraction, cyst excision, fixation of mandibular and maxillary fractures, osteotomy, resection of a benign tumor, sinus lifting, bone grafting, removal of a sialolith, among others) under general anesthesia or intravenous sedation from 2012 to 2014 at the Department of Oral and Maxillofacial Reconstructive Surgery, Hiroshima University Hospital. Univariate analysis showed a statistical relationship between postoperative complications (i.e., surgical site infection, anastomotic leak) and diabetes (p=0.033), preoperative serum albumin level (p=0.009), and operation duration (p=0.0093). Furthermore, preoperative serum albumin level (<4.0 g/dL) and operation time (≥120 minutes) were found to be independent factors affecting postoperative complications in multiple logistic regression analysis results (odds ratio 3.82, p=0.0074; odds ratio 2.83, p=0.0086, respectively). Our results indicate that a low level of albumin in serum and prolonged operation duration are important risk factors for postoperative complications occurring in the oral cavity following oral surgery.

Evaluation of recovery in lip closing pressure and occlusal force and contact area after orthognathic surgery.

PubMed

Ueki, Koichiro; Moroi, Akinori; Sotobori, Megumi; Ishihara, Yuri; Marukawa, Kohei; Iguchi, Ran; Kosaka, Akihiko; Ikawa, Hiroumi; Nakazawa, Ryuichi; Higuchi, Masatoshi

2014-10-01

The purpose of this study was to evaluate the relationship between lip closing force, occlusal contact area and occlusal force after orthognathic surgery in skeletal Class III patients. The subjects consisted of 54 patients (28 female and 26 male) diagnosed with mandibular prognathism who underwent sagittal split ramus osteotomy with and without Le Fort I osteotomy. Maximum and minimum lip closing forces, occlusal contact area and occlusal force were measured pre-operatively, 6 months and 1 year post-operative. Maximum and minimum lip closing forces, occlusal contact area and occlusal force increased with time after surgery, however a significant increase was not found in the occlusal contact area in women. In increased ratio (6 months/pre-operative and 1 year/pre-operative), the maximum lip closing force was significantly correlated with the occlusal contact area (P < 0.0001). This study suggested that orthognathic surgery could improve the occlusal force, contact area and lip closing force, and an increase ratio in maximum lip closing force was associated with an increased ratio in occlusal contact area. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

A financial analysis of maxillomandibular fixation versus rigid internal fixation for treatment of mandibular fractures.

PubMed

Schmidt, B L; Kearns, G; Gordon, N; Kaban, L B

2000-11-01

The aim of this study was to compare the cost-effectiveness of mandibular fracture treatment by closed reduction with maxillomandibular fixation (CRF) with open reduction and rigid internal fixation (ORIF). This was a retrospective study of 85 patients admitted to the Oral and Maxillofacial Surgery Service at San Francisco General Hospital and treated for mandibular fractures from January 1 to December 31, 1993. The patients were divided into 2 groups: 1) those treated with CRF and 2) those treated with ORIF. The outcome variables were length of hospital stay, duration of anesthesia, and time in operating room. The charge for primary fracture treatment included the fees for the operation and hospitalization without any complications. Within the group of 85 patients treated for mandibular fractures in 1993, 10 patients treated with CRF and 10 patients treated with ORIF were randomly selected, and hospital billing statements were used to estimate the average charge of primary treatment. The average charge to manage a major postoperative infection also was estimated based on the billing statements of 10 randomly selected patients treated in 1992 (5 treated with CRF, 5 with ORIF) who required hospital admission for the management of a complication. The average total charge was computed by using the average charge for primary treatment plus the incidence of postoperative infection multiplied by the average charge for management of that complication. Eighty-five patients were included in the study. The average charge for primary treatment was $10,100 for the CRF group and $28,362 for the ORIF group. The average charge for the inpatient management of a major postoperative infection was $26,671 for the CRF group and $39,213 for the ORIF group. The average total charge for management of a mandible fracture with CRF was $10,927; the total charge for the ORIF group was $34,636. The results of this retrospective study suggest that the use of CRF in the management of mandibular fractures at our institution provides considerable savings over treatment by using ORIF. The use of ORIF should be reserved for patients and fracture types with specific indications.

Single dental implant retained mandibular complete dentures – influence of the loading protocol: study protocol for a randomized controlled trial

PubMed Central

2014-01-01

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). PMID:24884848

Sequencing of bimaxillary surgery in the correction of vertical maxillary excess: retrospective study.

PubMed

Salmen, F S; de Oliveira, T F M; Gabrielli, M A C; Pereira Filho, V A; Real Gabrielli, M F

2018-06-01

The aim of this study was to evaluate the precision of bimaxillary surgery performed to correct vertical maxillary excess, when the procedure is sequenced with mandibular surgery first or maxillary surgery first. Thirty-two patients, divided into two groups, were included in this retrospective study. Group 1 comprised patients who received bimaxillary surgery following the classical sequence with repositioning of the maxilla first. Patients in group 2 received bimaxillary surgery, but the mandible was operated on first. The precision of the maxillomandibular repositioning was determined by comparison of the digital prediction and postoperative tracings superimposed on the cranial base. The data were tabulated and analyzed statistically. In this sample, both surgical sequences provided adequate clinical accuracy. The classical sequence, repositioning the maxilla first, resulted in greater accuracy for A-point and the upper incisor edge vertical position. Repositioning the mandible first allowed greater precision in the vertical position of pogonion. In conclusion, although both surgical sequences may be used, repositioning the mandible first will result in greater imprecision in relation to the predictive tracing than repositioning the maxilla first. The classical sequence resulted in greater accuracy in the vertical position of the maxilla, which is key for aesthetics. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Florid cemento-osseous dysplasia mimicking apical periodontitis: A case report.

PubMed

Rekabi, Ali Reza; Ashouri, Rezvan; Torabi, Molok; Parirokh, Masoud; Abbott, Paul V

2013-12-01

Cemento-osseous dysplasia may present as a focal, periapical or florid lesion in the mandible or maxilla. The lesion may sometimes appear similar to peri-radicular lesions on a periapical radiograph. This report presents a case with irreversible pulpitis and root resorption as well as a mixed radiolucent/radiopaque lesion around a mandibular molar tooth root. Root canal treatment was performed and because of the radiographic signs of root resorption and the patient's fear of having a malignant disease, periapical surgery was also performed. The histopathology report confirmed the presence of florid cement-osseous dysplasia which was mimicking apical periodontitis. Follow-up radiography 12 months after the surgery illustrated complete healing of the radiolucent area. © 2011 The Authors. Australian Endodontic Journal © 2011 Australian Society of Endodontology.

Effect of submucosal dexamethasone injection on postoperative pain, oedema, and trismus following mandibular third molar surgery: a prospective, randomized, double-blind clinical trial.

PubMed

Mojsa, I M; Pokrowiecki, R; Lipczynski, K; Czerwonka, D; Szczeklik, K; Zaleska, M

2017-04-01

The aim of this study was to investigate the effect of the submucosal injection of 1ml dexamethasone (4mg/ml) on pain, swelling, and trismus following the extraction of retained lower third molars. Ninety patients (mean age 23.5 years) were split randomly into three equal study groups (30 patients in each): the 'before' group received dexamethasone 15min before surgery and placebo 15min after surgery; the 'after' group received placebo 15min before surgery and dexamethasone 15min after surgery; the 'placebo' group received placebo 15min before surgery and placebo 15min after surgery. Postoperative pain was recorded by the patients using a visual analogue scale, numerical rating scale, and the McGill Pain Questionnaire at 1, 2, 4, 6, 8, 12, and 24h after surgery. The patients also recorded the total number of analgesic doses consumed during the 24h after the procedure. Swelling (determined using linear measurements of the face) and trismus (determined through measurement of maximum mouth opening) were assessed at 48h, 72h, and 7 days following surgery. Better control of pain, swelling, and trismus was demonstrated for dexamethasone in comparison to placebo. Postoperative dexamethasone provided better pain control than preoperative dexamethasone. There was no difference in total rescue analgesic intake between the preoperative and postoperative dexamethasone groups. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Does Topical Ozone Therapy Improve Patient Comfort After Surgical Removal of Impacted Mandibular Third Molar? A Randomized Controlled Trial.

PubMed

Sivalingam, Varun P; Panneerselvam, Elavenil; Raja, Krishnakumar V B; Gopi, Gayathri

2017-01-01

To assess the influence of topical ozone administration on patient comfort after third molar surgery. A single-blinded randomized controlled clinical trial was designed involving patients who required removal of bilateral impacted mandibular third molars. The predictor variable was the postoperative medication used after third molar surgery. Using the split-mouth design, the study group received topical ozone without postoperative systemic antibiotics, whereas the control group did not receive ozone but only systemic antibiotics. The 2 groups were prescribed analgesics for 2 days. The assessing surgeon was blinded to treatment assignment. The primary outcome variables were postoperative mouth opening, pain, and swelling. The secondary outcome variable was the number of analgesic doses required by each group on postoperative days 3 to 5. Data analysis involved descriptive statistics, paired t tests, and 2-way analysis of variance with repeated measures (P < .05). SPSS 20.0 was used for data analysis. The study sample included 33 patients (n = 33 in each group). The study group showed statistically relevant decreases in postoperative pain, swelling, and trismus. Further, the number of analgesics required was smaller than in the control group. No adverse effects of ozone gel were observed in any patient. Ozone gel was found to be an effective topical agent that considerably improves patient comfort postoperatively and can be considered a substitute of postoperative systemic antibiotics. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Clinical outcomes of three different types of hardware for the treatment of mandibular angle fractures: a comparative retrospective study.

PubMed

Elsayed, S A; Mohamed, F I; Khalifa, G A

2015-10-01

A retrospective study was conducted to compare the clinical outcomes of three different types of hardware that are used in mandibular angle fracture fixation. Thirty patients were selected from the hospital database. The patients were categorized into the following groups: group A, in which a single 2.0-mm locking miniplate was used; group B, in which a single rigid 2.3-mm plate was used; and group C, in which a single lag screw was inserted. All patients were followed for 6 months. With regard to intraoperative variables, significant differences were found among the groups in the duration of surgery and cost. Group C had the shortest surgical time, followed by group A and then group B. Two patients, one in group A and one in group B, suffered an occlusal discrepancy after surgery. Of the group A patients, two exhibited wound dehiscence and one had an infection. One patient in group B had an exposed plate. Sensory nerve involvement was noted in three group C patients and one group B patient. The lag screw was associated with the fewest complications and exhibited all of the advantages of plating systems in the treatment of angle fracture. The lag screw involved the least hardware and a short operating time, however the differences were not significant. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Blast injury face: An exemplified review of management

PubMed Central

Kumar, Vijay; Singh, Arun Kumar; Kumar, Parmod; Shenoy, Yogesh Ramdas; Verma, Anoop K.; Borole, Ateesh Jayram; Prasad, Veerendra

2013-01-01

Facial injuries are extremely common due to increased incidence of vehicular and industrial trauma and warfare injuries. But isolated injury to the face due to low voltage cells exploding is rare. In blast injury, the force can cause massive soft tissue injury, along with injury to facial fractures and damage to adnexa. Facial injury is not life threatening unless associated with other injuries of the skull and airway. The major risks to airway in facial trauma are due to anatomic alteration of patient's airway through bony and soft tissue disruption and increased chances of aspiration. The past several decades have seen a rapid growth in the range of procedures available for reconstructive purposes. However, the essential preliminary management is a must and needs to be structured. The patient, a 10-year-old boy, was joining three pencil batteries in series and twisting the wire with his teeth when one battery exploded causing severe injuries to midface and mandibular region. After stabilization, the patient was taken up for surgery. A cap splint with zygomatic suspension was done for the maxilla, and wiring of residual mandibular segments with lining and skin cover provided by a deltopectoral flap was done. Reconstructive surgeries for reconstruction of the upper lip and maintenance of oral continence were planned for the future. The present case stresses the importance of educating the masses about unsafe handling of low voltage devices, management of airway, massive soft tissue injury, along with facial fractures and damage to adnexa. PMID:24163550

Iterations of computer- and template assisted mandibular or maxillary reconstruction with free flaps containing the lateral scapular border--Evolution of a biplanar plug-on cutting guide.

PubMed

Cornelius, Carl-Peter; Giessler, Goetz Andreas; Wilde, Frank; Metzger, Marc Christian; Mast, Gerson; Probst, Florian Andreas

2016-03-01

Computer-assisted planning and intraoperative implementation using templates have become appreciated modalities in craniofacial reconstruction with fibula and DCIA flaps due to saving in operation time, improved accuracy of osteotomies and easy insetting. Up to now, a similar development for flaps from the subscapular vascular system, namely the lateral scapular border and tip, has not been addressed in the literature. A cohort of 12 patients who underwent mandibular (n = 10) or maxillary (n = 2) reconstruction with free flaps containing the lateral scapular border and tip using computer-assisted planning, stereolithography (STL) models and selective laser sintered (SLS) templates for bone contouring and sub-segmentation osteotomies was reviewed focussing on iterations in the design of computer generated tools and templates. The technical evolution migrated from hybrid STL models over SLS templates for cut out as well as sub-segmentation with a uniplanar framework to plug-on tandem template assemblies providing a biplanar access for the in toto cut out from the posterior aspect in succession with contouring into sub-segments from the medial side. The latest design version is the proof of concept that virtual planning of bone flaps from the lateral scapular border can be successfully transferred into surgery by appropriate templates. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Periodontal therapy for severe chronic periodontitis with periodontal regeneration and different types of prosthesis.

PubMed

Kinumatsu, Takashi; Umehara, Kazuhiro; Nagano, Kyosuke; Saito, Atsushi

2014-01-01

We report a patient with severe chronic periodontitis requiring regenerative periodontal surgery and different types of prosthesis in the maxillary and mandibular regions. The patient was a 57-year-old woman who presented with the chief complaint of occlusal pain. An initial clinical examination revealed that 73% of sites had a probing depth of ≥4 mm, and 60% of sites exhibiting bleeding on probing. Radiographic examination revealed vertical bone defects in the molar region and widening of the periodontal ligament space around teeth #17 and 24. Initial periodontal therapy was implemented based on a clinical diagnosis of severe chronic periodontitis. Surgical periodontal therapy was subsequently performed at selected sites. Periodontal regenerative therapy using enamel matrix derivative was performed on #14, 15, and 35-37. Tunnel preparation was performed on #46 as it had a 2-wall vertical bony defect and Degree 3 furcation involvement. Other sites with residual periodontal pockets were treated by modified Widman flap surgery. After a re-evaluation, functional rehabilitation was implemented with a removable maxillary partial denture and a fixed mandibular bridge. No further deterioration was observed in the periodontal condition of most of the teeth during a 2-year period of supportive periodontal therapy (SPT). The patient is currently still undergoing SPT and some minor problems remain. However, the results suggest that treatment and subsequent maintenance for severe periodontitis with traumatic occlusion can be successful as long as the appropriate periodontal and prosthodontic treatment is planned and careful SPT carried out.

Evaluating the Effect of Minimizing Screws on Stabilization of Symphysis Mandibular Fracture by 3D Finite Element Analysis.

PubMed

Kharmanda, Ghias; Kharma, Mohamed-Yaser

2017-06-01

The objective of this work is to integrate structural optimization and reliability concepts into mini-plate fixation strategy used in symphysis mandibular fractures. The structural reliability levels are next estimated when considering a single failure mode and multiple failure modes. A 3-dimensional finite element model is developed in order to evaluate the ability of reducing the negative effect due to the stabilization of the fracture. Topology optimization process is considered in the conceptual design stage to predict possible fixation layouts. In the detailed design stage, suitable mini-plates are selected taking into account the resulting topology and different anatomical considerations. Several muscle forces are considered in order to obtain realistic predictions. Since some muscles can be cut or harmed during the surgery and cannot operate at its maximum capacity, there is a strong motivation to introduce the loading uncertainties in order to obtain reliable designs. The structural reliability is carried out for a single failure mode and multiple failure modes. The different results are validated with a clinical case of a male patient with symphysis fracture. In this case while use of the upper plate fixation with four holes, only two screws were applied to protect adjacent vital structure. This behavior does not affect the stability of the fracture. The proposed strategy to optimize bone plates leads to fewer complications and second surgeries, less patient discomfort, and shorter time of healing.

External root resorption after orthodontic treatment: a study of contributing factors

PubMed Central

Jung, Yun-Hoa

2011-01-01

Purpose The purpose of this study was to examine the patient- and treatment-related etiologic factors of external root resorption. Materials and Methods This study consisted of 163 patients who had completed orthodontic treatments and taken the pre- and post-treatment panoramic and lateral cephalometric radiographs. The length of tooth was measured from the tooth apex to the incisal edge or cusp tip on the panoramic radiograph. Overbite and overjet were measured from the pre- and post-treatment lateral cephalometric radiographs. The root resorption of each tooth and the factors of malocclusion were analyzed with an analysis of variance. A paired t test was performed to compare the mean amount of root resorption between male and female, between extraction and non-extraction cases, and between surgery and non-surgery groups. Correlation coefficients were measured to assess the relationship between the amount of root resorption and the age in which the orthodontic treatment started, the degree of changes in overbite and overjet, and the duration of treatment. Results Maxillary central incisor was the most resorbed tooth, followed by the maxillary lateral incisor, the mandibular central incisor, and the mandibular lateral incisor. The history of tooth extraction was significantly associated with the root resorption. The duration of orthodontic treatment was positively correlated with the amount of root resorption. Conclusion These findings show that orthodontic treatment should be carefully performed in patients who need the treatment for a long period and with a pre-treatment extraction of teeth. PMID:21977469

External root resorption after orthodontic treatment: a study of contributing factors.

PubMed

Jung, Yun-Hoa; Cho, Bong-Hae

2011-03-01

The purpose of this study was to examine the patient- and treatment-related etiologic factors of external root resorption. This study consisted of 163 patients who had completed orthodontic treatments and taken the pre- and post-treatment panoramic and lateral cephalometric radiographs. The length of tooth was measured from the tooth apex to the incisal edge or cusp tip on the panoramic radiograph. Overbite and overjet were measured from the pre- and post-treatment lateral cephalometric radiographs. The root resorption of each tooth and the factors of malocclusion were analyzed with an analysis of variance. A paired t test was performed to compare the mean amount of root resorption between male and female, between extraction and non-extraction cases, and between surgery and non-surgery groups. Correlation coefficients were measured to assess the relationship between the amount of root resorption and the age in which the orthodontic treatment started, the degree of changes in overbite and overjet, and the duration of treatment. Maxillary central incisor was the most resorbed tooth, followed by the maxillary lateral incisor, the mandibular central incisor, and the mandibular lateral incisor. The history of tooth extraction was significantly associated with the root resorption. The duration of orthodontic treatment was positively correlated with the amount of root resorption. These findings show that orthodontic treatment should be carefully performed in patients who need the treatment for a long period and with a pre-treatment extraction of teeth.

Innovative Surgical Management of the Synovial Chondromatosis of Temporo-Mandibular Joints: Highly Conservative Surgical Technique.

PubMed

Ionna, Franco; Amantea, Massimiliano; Mastrangelo, Filiberto; Ballini, Andrea; Maglione, Maria Grazia; Aversa, Corrado; De Cecio, Rossella; Russo, Daniela; Marrelli, Massimo; Tatullo, Marco

2016-07-01

Synovial chondromatosis (SC) is an uncommon disease characterized by a benign nodular cartilaginous proliferation arising from the joint synovium, bursae, or tendon sheaths. Although the temporomandibular joint is rarely affected by neoplastic lesions, SC is the most common neoplastic lesion of this joint. The treatment of this disease consists in the extraoral surgery with a wide removal of the lesion; in this study, the authors described a more conservative intraoral surgical approach. Patient with SC of temporomandibular joint typically refer a limitation in the mouth opening, together with a persistent not physiological mandibular protrusion and an appearance of a neoformation located at the right preauricular region: the authors reported 1 scholar patient. After biopsy of the neoformation, confirming the synovial chondromatosis, the patient underwent thus to the surgical excision of the tumor, via authors' conservative transoral approach, to facilitate the enucleation of the neoformation. The mass fully involved the pterygo-maxillary fossa with involvement of the parotid lodge and of the right TMJ: this multifocal extension suggested for a trans-oral surgical procedure, in the light of the suspicion of a possible malignant nature of the neoplasm. Our intraoral conservative approach to surgery is aimed to reduce the presence of unaesthetic scars in preauricular and facial regions, with surgical results undoubtedly comparable to the traditional surgical techniques much more aggressive. Our technique could be a valid, alternative, and safe approach to treat this rare and complex kind of oncological disease.

A Prospective Randomized Clinical Study of the Influence of Primary Closure or Dressing on Post-operative Morbidity after Mandibular Third Molar Surgery

PubMed Central

Egbor, Peter E; Saheeb, Birch D

2014-01-01

Objective: The aim of the following study is to determine the effect of primary closure or dressing on post-operative morbidity after impacted lower third molar surgery. Materials and Methods: This was a randomized clinical study of 72 patients who had surgical extraction of impacted mandibular third molars. The subjects were divided into two groups of A and B. Group A had total closure (primary closure) and Group B had whitehead varnish dressing of the socket. Pain, swelling and trismus were evaluated pre-operatively using visual analogue scale, flexible tape measuring method and inter-incisal distance measurement with Vernier Callipers respectively as well as post-operatively on 1st, 2nd, 3rd, 5th and 7th day. Results: The study participants consisted of 27 males and 45 females in a ratio 1:1.7. With a mean age of 24.7 ± 4.9 years (range 19-33 years) for Group A and 25.5 ± 4.3 years (range 20-39 years) for Group B. Post-operative pain was not significantly affected by the closure techniques (P > 0.05). Dressing was found to significantly reduce the degree of swelling and trismus peaking on the 2nd day (P = 0.0207 and P = 0.010 respectively). Conclusion: The use of dressing was more effective than primary closure to reduce the degree of swelling and trismus though its effect on post-operative pain reduction was not significant. PMID:25191094

Diagnostic value of NobelGuide to minimize the need for reconstructive surgery of jaws before implant placement: a review.

PubMed

Scotti, Roberto; Pellegrino, Gerardo; Marchetti, Claudio; Corinaldesi, Guiseppe; Ciocca, Leonardo

2010-01-01

To test if using a CAD/CAM system might reduce the necessity of bone augmentation in patients with atrophic maxillary arches before implant therapy. Twenty male and female patients consecutively scheduled for bone augmentation of the jaw before implant surgery were included in this study, with a total of 29 jaws (maxillary and mandibular) to analyze for the implant-supported fixed prosthesis group and 19 maxillary arches for the implant-supported removable prosthesis group. NobelGuide System (Nobel Biocare), Autocad System (Autodesk), and routine manual CT measurements of available bone were used in this study. The total results of the mean values of the fixed prosthesis group plus the mean values of the removable prosthesis group showed a statistically significant difference between the NobelGuide intervention score and both manual (P = .004) and Autocad (P = .001) measurements. The NobelGuide System represents a viable diagnostic device to reduce the entity or avoid bone reconstructive surgery before implant placements in the atrophic maxilla and mandible.

Successful subtotal orbitectomy in a cat with osteoma

PubMed Central

Corgozinho, Katia B; Cunha, Simone CS; Siqueira, Ricardo S; Souza, Heloisa JM

2015-01-01

Case summary A 14-year-old Siamese neutered male cat was evaluated for anorexia and a left periorbital mass. Skull radiographic findings showed a well-defined lesion resembling new compact bone formation without destruction. A subtotal orbitectomy was indicated. The tumor was removed intact with a normal tissue margin of at least 1 cm. There were no postsurgical complications. Histopathologic examination revealed an osteoma. The cat returned to normal appetite and activity 15 days after surgery. Six months after surgery, there were no gross signs of recurrence. Relevance and novel information Periorbital tumors are infrequently diagnosed in companion animals and most are malignant. In this case, the diagnosis was orbital osteoma. The most commonly affected bone for osteoma in cats is the mandibular bone; few cases have been identified in orbital bones. Orbital surgery has the potential to be challenging owing to complex anatomy, difficult exposure and the tendency to bleed. Surgical complications are common. In this case, although the disease was advanced, subtotal orbitectomy was successfully performed. PMID:28491397

Analysis and evaluation of relative positions of mandibular third molar and mandibular canal impacts

PubMed Central

Kim, Hang-Gul

2014-01-01

Objectives This study used cone-beam computed tomography (CBCT) images to categorize the relationships between the mandibular canal and the roots and investigated the prevalence of nerve damage. Materials and Methods Through CBCT images, contact and three-dimensional positional relationships between the roots of the mandibular third molar and the mandibular canal were investigated. With this data, prevalence of nerve damage according to the presence of contact and three-dimensional positional relationships was studied. Other factors that affected the prevalence of nerve damage were also investigated. Results When the mandibular third molar and the mandibular canal were shown to have direct contact in CBCT images, the prevalence of nerve damage was higher than in other cases. Also, in cases where the mandibular canal was horizontally lingual to the mandibular third molar and the mandibular canal was vertically at the cervical level of the mandibular third molar, the prevalence of nerve damage was higher than in opposite cases. The percentage of mandibular canal contact with the roots of the mandibular third molar was higher when the mandibular canal was horizontally lingual to the mandibular third molar. Finally, the prevalence of nerve damage was higher when the diameter of the mandibular canal lumen suddenly decreased at the contact area between the mandibular canal and the roots, as shown in CBCT images. Conclusion The three-dimensional relationship of the mandibular third molar and the mandibular canal can help predict nerve damage and can guide patient expectations of the possibility and extent of nerve damage. PMID:25551092

An assessment of the footprint and carrying capacity of oil and gas well sites: The implications for limiting hydrocarbon reserves.

PubMed

Clancy, S A; Worrall, F; Davies, R J; Gluyas, J G

2018-03-15

We estimate the likely physical footprint of well pads if shale gas or oil developments were to go forward in Europe and used these estimates to understand their impact upon existing infrastructure (e.g. roads, buildings), the carrying capacity of the environment, and how the proportion of extractable resources maybe limited. Using visual imagery, we calculate the average conventional well site footprints to be 10,800m 2 in the UK, 44,600m 2 in The Netherlands and 3000m 2 in Poland. The average area per well is 541m 2 /well in the UK, 6370m 2 /well in The Netherlands, and 2870m 2 /well in Poland. Average access road lengths are 230m in the UK, 310m in The Netherlands and 250m in Poland. To assess the carrying capacity of the land surface, well pads of the average footprint, with recommended setbacks, were placed randomly into the licensed blocks covering the Bowland Shale, UK. The extent to which they interacted or disrupted existing infrastructure was then assessed. For the UK, the direct footprint would have a 33% probability of interacting with immovable infrastructure, but this would rise to 73% if a 152m setback was used, and 91% for a 609m setback. The minimum setbacks from a currently producing well in the UK were calculated to be 21m and 46m from a non-residential and residential property respectively, with mean setbacks of 329m and 447m, respectively. When the surface and sub-surface footprints were considered, the carrying capacity within the licensed blocks was between 5 and 42%, with a mean of 26%. Using previously predicted technically recoverable reserves of 8.5×10 11 m 3 for the Bowland Basin and a recovery factor of 26%, the likely maximum accessible gas reserves would be limited by the surface carrying capacity to 2.21×10 11 m 3 . Copyright © 2017 Elsevier B.V. All rights reserved.

Musical intervention reduces patients' anxiety in surgical extraction of an impacted mandibular third molar.

PubMed

Kim, Yu-Kyoung; Kim, Soung-Min; Myoung, Hoon

2011-04-01

Patients undergoing impacted mandibular third molar (IMTM) extraction often have severe perioperative anxiety, which may lead to increased perceptions of pain and vital sign instability throughout surgery. Intraoperational musical interventions have been used during operations to decrease patient anxiety levels. We investigated the anxiolytic effects of musical intervention during surgical extraction of an IMTM. We tested the hypothesis that musical intervention would have positive effects on patients' vital signs, anxiety levels, and perceptions of pain. We recruited 219 patients with IMTM surgery to participate in this study. Participants were randomly assigned to a music-treated group (106 subjects) or a control group (113 subjects). In a preoperative meeting, patient demographic data were collected, and the patients' favorite songs were selected. For the music-treated group, their selected music was played from the time of arrival to the operating room until the end of the operation. Perioperative anxiety and perceptions of pain were assessed using the Dental Anxiety Scale and the Visual Analog Scale, respectively. Patients' vital signs (blood pressure, heart rate, and respiratory rate) were monitored throughout the surgery. One-way analysis of covariance using perioperative anxiety as a covariant was performed to compare intraoperative anxiety levels and perioperative perceptions of pain between the 2 groups. Repeated measures analysis of variance was used to compare changes in vital signs across surgical stages between the 2 groups. Vital signs changed significantly throughout surgery according to the stage of the procedure. For both groups, vital signs increased from baseline and reached peak values at the time of the initial incision and then decreased quickly and plateaued within normal limits. There were no significant differences between groups in blood pressure; however, the music-treated group showed a significantly smaller change in heart rate than the control group. The music-treated group reported significantly less intraoperative anxiety than the nonmusic-treated control group when controlling for preoperative anxiety levels (F = 4.226, P < .05). These results support the hypothesis that the use of patient-chosen music during surgical extraction of an IMTM significantly lowers patient intraoperative anxiety levels. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Use of three-dimensional, CAD/CAM-assisted, virtual surgical simulation and planning in the pediatric craniofacial population.

PubMed

Gray, Rachel; Gougoutas, Alexander; Nguyen, Vinh; Taylor, Jesse; Bastidas, Nicholas

2017-06-01

Virtual Surgical Planning (VSP) and computer-aided design/computer-aided manufacturing (CAD/CAM) have recently helped improve efficiency and accuracy in many different craniofacial surgeries. Research has mainly focused on the use in the adult population with the exception of the use for mandibular distractions and cranial vault remodeling in the pediatric population. This study aims to elucidate the role of VSP and CAD/CAM in complex pediatric craniofacial cases by exploring its use in the correction of midface hypoplasia, orbital dystopia, mandibular reconstruction, and posterior cranial vault expansion. A retrospective analysis of thirteen patients who underwent 3d, CAD/CAM- assisted preoperative surgical planning between 2012 and 2016 was performed. All CAD/CAM assisted surgical planning was done in conjunction with a third party vendor (either 3D Systems or Materialise). Cutting and positioning guides as well as models were produced based on the virtual plan. Surgeries included free fibula mandible reconstruction (n = 4), lefort I osteotomy and distraction (n = 2), lefort II osteotomy with monobloc distraction (n = 1), expansion of the posterior vault for correction of chiari malformation (n = 3), and secondary orbital and midface reconstruction for facial trauma (n = 3). The patient's age, diagnosis, previous surgeries, length of operating time, complications, and post-surgery satisfaction were determined. In all cases we found presurgical planning was helpful to improve accuracy and significantly decrease intra-operative time. In cases where distraction was used, the planned and actual vectors were found to be accurate with excellent clinical outcomes. There were no complications except for one patient who experienced a wound infection post-operatively which did not alter the ultimate reconstruction. All patients experienced high satisfaction with their outcomes and excellent subjective aesthetic results were achieved. Preoperative planning using CAD/CAM and VSP allows for safe and precise craniofacial reconstruction in complex pediatric cases with a reduction of operative time. Copyright © 2017 Elsevier B.V. All rights reserved.

Frontal Changes in the Lower Face After Clockwise Rotation of the Maxillomandibular Complex Without Perisurgical Orthodontic Treatment in Angle Class I and Skeletal Class III Women.

PubMed

Lee, Sang Woo; Cho, Jeongmok; Kim, Kikap; Ahn, Seung Hyun

2017-06-01

Orthognathic surgery has become more popular to slenderize a wide lower face and to improve facial esthetics in Asian patients with normal occlusion. Clockwise rotation (CR) of the maxillomandibular complex (MMC) steepens the mandibular plane. This study performed a quantitative analysis on the influence of CR on slenderness of the lower face from the frontal view. This retrospective study included 36 female patients with Angle Class I occlusion and skeletal Class III pattern. The subjects underwent CR of the MMC without perioperative orthodontic treatment and change in the occlusion only for the purpose of esthetic improvement. Linear and angular variables were measured on a cephalogram and three-dimensional computed tomography (3D CT) obtained before and at least 6 months after surgery. Data were analyzed using paired t tests and Spearman correlations. Univariate regression analysis was used to predict the postoperative change according to the amount of posterior impaction. The mean posterior impaction was 3.81 mm. All mandibular plane angle (MPA) measurements were increased (ranged from 5.69° to 13.12°, p < 0.001), exhibiting a significant correlation with the amount of posterior impaction. Bigonial width measurements were decreased after surgery (ranged from 4.97 to 5.51 mm, p < 0.001). Among the MPAs derived from the 3D CT, the coronal projection from the frontal view exhibited a discrepancy between right and left side. The changes in linear and angular measurements in this study indicate that the lower face becomes narrower and more slender as the MMC rotates in a clockwise direction. Orthognathic surgery with CR has the advantage of increasing the MPAs and obtaining natural soft tissue contouring while minimizing the amount of bone resection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266c .

SLOPE STABILITY EVALUATION AND EQUIPMENT SETBACK DISTANCES FOR BURIAL GROUND EXCAVATIONS

DOE Office of Scientific and Technical Information (OSTI.GOV)

MCSHANE DS

2010-03-25

After 1970 Transuranic (TRU) and suspect TRU waste was buried in the ground with the intention that at some later date the waste would be retrieved and processed into a configuration for long term storage. To retrieve this waste the soil must be removed (excavated). Sloping the bank of the excavation is the method used to keep the excavation from collapsing and to provide protection for workers retrieving the waste. The purpose of this paper is to document the minimum distance (setback) that equipment must stay from the edge of the excavation to maintain a stable slope. This evaluation examinesmore » the equipment setback distance by dividing the equipment into two categories, (1) equipment used for excavation and (2) equipment used for retrieval. The section on excavation equipment will also discuss techniques used for excavation including the process of benching. Calculations 122633-C-004, 'Slope Stability Analysis' (Attachment A), and 300013-C-001, 'Crane Stability Analysis' (Attachment B), have been prepared to support this evaluation. As shown in the calculations the soil has the following properties: Unit weight 110 pounds per cubic foot; and Friction Angle (natural angle of repose) 38{sup o} or 1.28 horizontal to 1 vertical. Setback distances are measured from the top edge of the slope to the wheels/tracks of the vehicles and heavy equipment being utilized. The computer program utilized in the calculation uses the center of the wheel or track load for the analysis and this difference is accounted for in this evaluation.« less

A split-mouth randomized clinical trial to evaluate the performance of piezosurgery compared with traditional technique in lower wisdom tooth removal.

PubMed

Mantovani, Edoardo; Arduino, Paolo Giacomo; Schierano, Gianmario; Ferrero, Luca; Gallesio, Giorgia; Mozzati, Marco; Russo, Andrea; Scully, Crispian; Carossa, Stefano

2014-10-01

The surgical removal of mandibular third molars is frequently accompanied by significant postsurgical sequelae, and different protocols have been described to decrease such adverse events. The aim of this study was to investigate the performance of piezosurgery compared with traditional rotating instruments during mandibular third molar removal. A single-center, randomized, split-mouth study was performed using a consecutive series of unrelated healthy patients attending the Oral Surgery Unit of the University of Turin for surgical removal of bilateral mandibular third molar teeth. Each patient was treated, at the same appointment, using bur removal on 1 side of the mandible and a piezoelectric device on the contralateral side. The primary outcomes reported were postoperative pain, objective orofacial swelling, and surgical duration; secondary outcomes were gender, age, and possible adverse events. Analysis of variance or paired t test was used as appropriate to test any significant differences at baseline according to each treatment subgroup, and categorical variables were analyzed by χ(2) test. The study sample consisted of 100 otherwise healthy patients. The mean pain evaluation reported by patients who underwent surgery with piezosurgery was significantly lower than that reported after bur (conventional) removal, reaching statistical difference after 4 days (P = .043). The clinical value of orofacial swelling at day 7, normalized to baseline, was lower in the piezosurgery group (P < .005). The average surgical duration was significantly shorter in the bur group than in the piezosurgery group (P < .05). Three patients having bur removal developed short-term complications (2 dry sockets and 1 temporary paraesthesia), which totally resolved by 4 weeks. To date, this prospective investigation is the largest reported split-mouth study on piezosurgery for lower third molar tooth removal. This study also compared surgeons with different degrees of experience. It is evident that using a piezoelectric device can enhance the patient experience and decrease postoperative pain and swelling. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Impact of the lower third molar presence and position on the fragility of mandibular angle and condyle: A Three-dimensional finite element study.

PubMed

Antic, Svetlana; Vukicevic, Arso M; Milasinovic, Marko; Saveljic, Igor; Jovicic, Gordana; Filipovic, Nenad; Rakocevic, Zoran; Djuric, Marija

2015-07-01

The aim of the present study was to investigate the influences of the presence and position of a lower third molar (M3) on the fragility of mandibular angle and condyle, using finite element analysis. From computed tomographic scans of a human mandible with normally erupted M3, two additional virtual models were generated: a mandibular model with partially impacted M3 and a model without M3. Two cases of impact were considered: a frontal and a lateral blow. The results are based on the chromatic analysis of the distributed von Mises and principal stresses, and calculation of their failure indices. In the frontal blow, the angle region showed the highest stress in the case with partially impacted M3, and the condylar region in the case without M3. Compressive stresses were dominant but caused no failure. Tensile stresses were recorded in the retromolar areas, but caused failure only in the case with partially impacted M3. In the lateral blow, the stress concentrated at the point of impact, in the ipsilateral and contralateral angle and condylar regions. The highest stresses were recorded in the case with partially impacted M3. Tensile stresses caused the failure on the ipsilateral side, whereas compressive stresses on the contralateral side. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.