Cephalometric for Orthognathic Surgery (COGS) Analysis for Saudi Population

ABSTRACT Objective: To establish the cephalometric (Ceph.) norm by Ceph. for orthognathic surgery (COGS) analysis for Saudi population. Material and Methods: 500 adult Saudi samples (250 males and 250 females) with the age range of 18-30 years old were selected for this study. The selections of samples were based on a normal occlusal relationship, no history of facial trauma and no previous orthodontic treatment. Lateral Ceph. radiographs were tracing by CASSOS software and analyzed by SPSS software according to COGS analysis. Results: Significant differences were showed between the Saudi males and females on most of the Ceph. parameters. The Saudi males had a convex facial profile with chin prominent and more bimaxillary protrusion, upper and lower lip protrusion than the Saudi females. Conclusion: This study evaluated the craniofacial morphological difference between the male and the female population in Saudi Arabia by using COGS analysis. The finding of this study will help for better diagnosis of orthodontic and orthognathic surgical treatment planning and identify the morphological facial characteristics of Saudi patients.

Bacterial Colonization and Dental Implants: A Microbiological Study

Abstract Objective: To compare colony forming unit (CFU) of oral bacterial from buccal mucosa and lingual buccal tongue among patients with a dental implant and normal oral hygiene individuals without a dental implant. Material and Methods: Twenty-six individuals with a dental implant and twenty-six individuals without dental implants were included in this study. The samples were sent to the laboratory to culture with Brain Heart Infusion Broth (BHI), prepared serial dilution and then spread to the blood agar. CFU was counted when a single layer of bacteria is formed on the blood agar at any dilution level. An independent-T test was used to compare the means different of CFU oral bacterial between control and test groups from buccal mucosa and lingual buccal mucosa, respectively. Results: Buccal mucosa control group (186.19 ± 5.61) and test group (186.65 ± 6.24) (p>0.05). The result from the lingual buccal tongue control group (198.38 ± 6.12) and test group (197.96 ± 6.50) (p>0.05). There was no significant difference between the control group and test group CFU bacterial load. Conclusion: The presence of implants in the oral cavity do not interfere or worsen the oral condition; nevertheless, the effect of implants surrounding oral flora is similar to natural teeth.

Periodic Assessment of Peri-implant Tissue Changes: Imperative for Implant Success.

AIM: The aim of this study was to evaluate the changes in the peri-implant hard and soft tissues and implant stability and to assess the correlation of bone loss and peri-implant probing depth with implant stability. MATERIALS AND METHODS: Twenty-one patients with implants were included in this study and implants were assessed by resonance frequency analysis (RFA). Bone levels of the implants were assessed by measuring mesial and distal bone levels from the periapical radiograph, and soft tissue was assessed from probing depth using a periodontal probe. Implants were assessed for stability and probing depth at pre-loading, at 3 months and 6 months post-loading. RFA and probing depth were statistically compared from different time points. Correlation of probing depth and marginal bone loss with implant stability was also determined. RESULTS: The average change in implant stability quotient (ISQ) measurements from pre-loading to 6 months post-loading was found to be statistically significant (p <0.005). The average probing depth reduced from 1.767 mm at pre-loading to 1.671 mm at post-loading 3 months, and 1.600 mm at post-loading 6 months. At 6 months of function, radiographic examination yielded 0.786 mm mesial bone loss and 0.8 mm distal bone loss. It was found to be statistically significant (p <0.005) but within an acceptable range. No significant correlation was found between implant stability and bone loss; and implant stability and probing depth. CONCLUSION: The study revealed an increasing trend in implant stability values with the time that indicates successful osseointegration. Increasing mean values for mesial and distal bone loss were also found. CLINICAL SIGNIFICANCE: The success of dental implants is highly dependent on the quality of bone and implant-bone interface, i.e., osseointegration. The most important factors that influence the survival rate of an implant is initial stability. The present study found the changes in the peri-implant hard and soft tissues and implant stability. This article, while being a prospective study, may show the evidence of successful osseointegration by increasing trend in implant stability (RFA) values with time which can help to the clinician in the long-term management of implants.

Epidemiology of Maxillofacial Fractures at a Teaching Hospital in Malaysia: A Retrospective Study.

BACKGROUND/AIM: Epidemiology of maxillofacial fractures (MFF) varies between populations. This study investigated the epidemiology of MFF treated at the Oral and Maxillofacial Surgery (OMFS) Unit, Hospital Universiti Sains Malaysia (USM). METHODS: A retrospective review of 473 medical records of patients with MFF treated from June 2013 to December 2015 was conducted. Information on demographic characteristics of patients, aetiology of injury, types of MFF, and treatment was obtained. Descriptive analysis, Pearson's chi-squared test, and multiple logistic regression analysis were conducted. The level of significance was set at 0.05. RESULTS: Most patients treated for MFF were males (82.2%), aged 30 and below (63.1%), and from Malay ethnic (97.4%). Road traffic accident was the most common cause of MFF (83.1%), with motorcycle accident accounting for most injuries (73.6%). Orbital wall fracture was the most frequent MFF type (51.2%). About half of MFF patients (51.4%) were treated conservatively. Patients aged more than 20 years old were at higher odds of sustaining orbital wall fracture (AOR= 1.76; 95% CI: 1.214-2.558; P= 0.003) but were at lower odds of sustaining mandibular fracture (AOR= 0.47; 95% CI: 0.315-0.695; P= 0.001) than patients who are 20 years old and younger. Helmet use among motorcyclists was significantly associated with the nasal, orbital wall, and maxillary sinus wall fractures (P= 0.006, 0.010, and 0.004, respectively). CONCLUSION: Motorcycle accident was the most common cause of MFF in Kelantan, Malaysia. Ages of patient and helmet use were associated with the type of MFF sustained. This study provides important information to facilitate the planning of MFF prevention strategies among motorcyclists and emphasizes the importance of using a helmet when riding a motorcycle.

Association of traumatic head injuries and maxillofacial fractures: A retrospective study.

BACKGROUND/AIMS: The association of traumatic head injury (THI) with maxillofacial fractures (MFF) is a major health concern worldwide. In spite of the close anatomical proximity of maxillofacial bones to the cranium, the association of THI with MFF is controversial. The aim of this study was to assess the association between THI and MFF. Other factors associated with THI in patients with MFF were also investigated. MATERIALS AND METHODS: A hospital-based retrospective study was conducted at the OMFS Unit, Hospital USM, Kelantan, Malaysia. From 12 June 2013 to 31 December 2015, 473 patient records with MFF were reviewed to evaluate the association of THI and MFF. RESULTS: A total of 331 patients (69.98%) presented with concomitant THI. The most common associated THI were cranial bone fractures (68.6%) followed by intracranial injuries and concussion. A significant association existed between the Glasgow coma scale (GCS) score and the presence of THI concomitant MFF with P-value <.001. The univariable logistic regression analysis revealed that age group (31-40 years), cause of injury (road traffic accident-RTA), all midface fracture types and most of the mandibular fracture types were statistically associated with the presence of THI. The multivariable logistic regression analysis revealed that the cause of the injury (RTA) and MFF types (nasal bone, zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and the alveolar process of mandible fractures) were statistically significantly associated with THI in patients with MFF. CONCLUSION: There was a high prevalence of THI among patients with MFF (69.98%). RTA, nasal bone, zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and mandibular alveolar process fractures were significantly associated with THI in patients who sustained a MFF.

Temporomandibular joint ankylosis in a child: an unusual case with delayed surgical intervention.

BACKGROUND: The Temporomandibular Joint (TMJ) ankylosis in child is rare and yet the causes still remain unclear. This condition that affects the feeding and possible airway obstruction do not only worry the parents, but also possesses as a great challenge to the surgeons. Furthermore, it interferes with the facial skeletal and dento-alveolar development in the on growing child. CASE PRESENTATION: In this case report, we presented the management of a 7 year old with left TMJ ankylosis discovered since infant. Clinical and imaging investigations were consistent with left temporomandibular joint ankylosis (Type IV) possible secondary to childhood septic arthritis. Left gap arthroplasty via modified Al Kayat Bramley and retromandibular approach was performed, with interpositional arthroplasty placement of temporalis fascia graft. No complications from the surgery except reduced mouth opening were seen. Possible contributing factors to this less than satisfactory mouth opening are adressed. CONCLUSION: We describe here, an unusual childhood temporomandibular joint ankylosis possible due to septic arthritis with delayed surgical intervention. The aetiology, classifications, timing and choice of surgical techniques along with its considerations and complications are discussed. Although there is no consensus on the surgical treatment of TMJ ankylosis, early mobilisation, aggressive physiotherapy and close follow-up are advocated by many authors for successful treatment.

Bone Forming Potential of An-Organic Bovine Bone Graft: A Cone Beam CT study.

PURPOSE: An-organic bovine bone graft is a xenograft with the potential of bone formation. The aim of this study was to evaluate the bone density using cone beam computed tomography scans around functional endosseous implant in the region of both augmented maxillary sinus with the an-organic bovine bone graft and the alveolar bone over which the graft was placed to provide space for the implants. MATERIALS AND METHODS: Sterile freeze dried bovine bone graft produced by National Tissue Bank, University Sains, Malaysia was used for stage-1 implant placement with maxillary sinus augmentation in a total of 19 subjects with 19 implants. The age of all subjects ranged between 40-60 years with a mean age 51±4.70. All subjects underwent a follow up CT scan using PlanmecaPromax 3D(®) Cone beam computed tomography scanner at the Radiology department, Hospital University Sains, Malaysia. The collected data was then analysed to evaluate bone density in Hounsfield Units using PlanmecaRomexis" Imaging Software 2.2(®) which is specialized accompanying software of the cone beam computed tomography machine. RESULTS: There was bone formation seen at the site of the augmented sinus. A significant increase (p<0.005) in bone density was reported at the augmented site compared to the bone density of the existing alveolar bone. CONCLUSION: An-organic bovine bone graft is an osteoconductive material that can be used for the purpose of maxillary sinus augmentation.