Orthodontic microsurgery for rapid dental repositioning in dental malpositions.

PURPOSE: Malposition of dental elements can be easily corrected when the patient is young; however, the opposite is true for adults. Middle-age patients normally request a rapid solution, but they usually also have associated pathologic features, such as advanced periodontal disease, dental migration, and ankylosis. Shortening the orthodontic treatment time is possible but not easy to achieve. We applied piezosurgical bone cuts to 10 patients affected by different dental malformations to determine the effects of a shorter treatment time. MATERIALS AND METHODS: A total of 10 patients (8 women and 2 men) were treated using the monocortical tooth dislocation and ligament distraction technique. We included 5 patients with dental ankylosis (group A, with a range of 4 to 5 mm of dental intrusion into the bone), who presented with at least 4 elements included in the mandible, and 5 preoperative patients affected by maxillary hypoplasia and transverse maxillary diameter reduction (group B, with a range of 6 to 8 mm measured at the first molar palatal cusp). RESULTS: Dental repositioning was achieved within 18 to 25 days for the dental intrusion group (group A) and within 68 to 150 days for the preoperative group (group B). The average period was 20 days for group A and 100 days for both dental arches in group B. The decrease in orthodontic treatment time was 70% for the ankylotic teeth and 65% for the preoperative group. We observed no periodontal or gingival damage, although all 10 patients experienced moderate edema and pain. CONCLUSIONS: This method of shortening the orthodontic treatment time is simple, and performing osteotomic lines laterally and apically to the tooth radix on the bone has proved useful in reducing the treatment time. In addition, the technique is very easy to use and has a low incidence of side effects.

MR Imaging of total hip arthroplasty: comparison among sequences to study the sciatic nerve at 1.5 T.

PURPOSE: This study was done to test a series of MR sequences for evaluating the sciatic nerve after total hip arthroplasty (THA). MATERIAL AND METHODS: The study protocol was approved by the institutional review board. Informed consent was obtained from all patients. Twenty-five patients (11 men and 14 women mean age: 62.3±5.7 years) with THA were included in this prospective study. MRI protocol included sequences that were preliminarily tailored for nerve imaging in patients with THA: proton density (PD)-weighted turbo SE, T1-weighted turbo SE (TSE) 3 mm thickness, T1-weighted turbo SE (TSE) 6 mm thickness, T1-weighted turbo SE with high bandwidth (TSE hBW), T2- weighted TSE, T2-weighted with fat saturation and short-tau inversion recovery (STIR). For each sequence, we evaluated the visibility of the sciatic nerve using a semiquantitative score (0=total masking; 1=insufficient visibility; 2=sufficient visibility; 3=optimal visibility). The sum of the scores given to each sequence was divided by the maximal sum, obtaining a percentage visibility index. Friedman and sign tests were used for statistical analysis. RESULTS: MR examination time was approximately 40 min. No patients reported pain, heat or symptoms related to nerve stimulation. The visibility index ranged between 88% and 70% for the first four sequences. The T1-weighted TSE hBW sequence had the best visibility index (P<.05). The visibility indexes of the first four sequences were significantly higher (P<.004, sign test) than those of the remaining three sequences. CONCLUSION: The sciatic nerve could be studied at 1.5 T in patients following THA. The nerve is better visualized with T1-weighted TSE hBW sequences. On T2-weighted sequences and STIR, the visibility of the nerve is low.

How often do patients ask for the results of their radiological studies?

OBJECTIVES: To measure how often patients ask directly about their test results at the end of imaging studies. METHODS: A total of 1,171 outpatients underwent ultrasonography (384), CT (382) or MR of the extremities (405). Demographic features including age, sex, educational background, anxiety and type of examination (initial examination vs follow-up) were considered. Statistical analysis was carried out by means of the chi-square test. RESULTS: Of the 1,171 patients, 525 (45%) asked for information about the results of their studies. Only 88/382 (23%) patients asked after CT; 224/405 (55.3%) asked after MR, and 213/384 (55.5%) asked after US (CT vs US and vs MR p < 0.001). There was a highly significant trend regarding education (36.4% with elementary schooling; 41.5% with intermediate education; 55.1% with higher schooling or university degrees; p < 0.001). No other differences were noted. CONCLUSION: We believe these results show the importance of the direct doctor-patient relationship during radiological studies. Communication, time to talk and provision of information are probably the most important things patients want from their doctors. Our study suggests that this is also relevant in radiology and, when given the opportunity to meet the radiologist, patients appreciate the interaction.

Orthodontic microsurgery: a new surgically guided technique for dental movement.

Eight patients with malocclusions were treated with a new orthodontic-surgical technique that reduces the duration of treatment compared to conventional techniques. The monocortical tooth dislocation and ligament distraction (MTDLD) technique combines two different dental movements that work separately but simultaneously on opposite root surfaces. On the root surface corresponding to the direction of movement, vertical and horizontal microsurgical corticotomies are performed around each tooth root with a piezosurgical microsaw to eliminate cortical bone resistance. The immediate application of strong biomechanical forces produces rapid dislocation of the root and the cortical bone together. On the root surface opposite the direction of movement, the force of dislocation produces rapid distraction of ligament fibers. During the osteogenic process that follows, application of normal orthodontic biomechanics achieves the final tooth movement. All eight patients underwent periodontal and radiologic examinations for more than 1 year after treatment. No periodontal defects were observed in any of the patients, including one with a severe malocclusion and a thin periodontal tissue biotype. Compared to traditional orthodontic therapy, the average treatment time with the MTDLD technique in the mandible and maxilla was reduced by 60% and 70%, respectively.