Comparison of three-dimensional soft tissue changes according to the split pattern after sagittal split osteotomy in patients with skeletal class III malocclusion.

OBJECTIVES: This study aimed to analyse the changes in soft tissue and hard tissue stability associated with the split pattern, i.e. long split (LS) or short split (SS), after sagittal split osteotomy. MATERIALS AND METHODS: Patients who underwent sagittal split ramus osteotomy were classified into LS or SS groups according to postoperative computed tomography images. They were examined via lateral cephalography and three-dimensional (3D) optical scanning before surgery (T0) and 1 (T1), 3 (T2), and 12 (T3) months after surgery. Six standard angles (SNA, SNB, ANB, FMA, FMIA, and IMPA) were used as measures of hard tissue change. The two sets of 3D data were superimposed, and the volumetric differences were calculated as the soft tissue change. The areas evaluated were delimited by 10 × 20-mm rectangles in the frontal aspect and a 25 × 25-mm square in the lateral aspect. RESULTS: A total of 42 sides (26 patients) were analysed, including 20 (16 patients) in the SS group and 22 (16 patients) in the LS group. We found no significant differences in cephalographic angle or soft tissue changes in the frontal aspect between the SS and LS groups. We found significant differences in the subauricular region from T0-T1 (p = 0.02), T0-T2 (p = 0.03), and T0-T3 (p = 0.037) in terms of soft tissue changes in the lateral aspect. The volume increase associated with posterior mandibular movement was greater in the LS group. CONCLUSIONS: We found that LS patients with mandibular prognathism exhibited increased subauricular volumes following mandibular setback. CLINICAL RELEVANCE: It is essential to predict the postoperative facial profile before surgery. The split pattern after sagittal split osteotomy affects the postoperative profile of patients with mandibular prognathism.

Radiologic Risk Factors for Persistent Mandibular Nerve Neurosensory Disturbance Following Sagittal Split Osteotomy.

PURPOSE: Neurosensory disturbance (NSD) occurring in the lower lips and chin is a major postoperative complication related to bilateral sagittal split osteotomy (SSO). The purpose of this study is to identify preoperative radiographic findings following SSO procedure associated with persistent NSD. METHODS: This retrospective cohort study analyzed data for consecutive patients who underwent SSO. Primary predictor variables, including ramus width, mandibular body height, mandibular angle length, gonial angle, distance from mental foramen to distal aspect of mandibular second molar (MFD), and measurement of bone marrow space (BMS), were examined in a series of radiographic images. The primary outcome variable was NSD. Patients with NSD were divided into 2 groups based on findings obtained 1 year postoperatively: persistent, for those with NSD remaining after 1 year, and transient, when NSD occurred for less than 1 year. Covariates included sex and age. Comparisons were analyzed by use of Mann-Whitney U test or χ2 test. Multivariate analysis was performed using step-wise logistic regression to determine significant factors related to persistent NSD. A P value .005 or less was considered statistically significant. RESULTS: Of the 349 sides investigated, the persistent NSD group consisted of 59 sides (16.9%), while the transient NSD group consisted of 290 sides (83.1%). The occurrence of persistent NSD was correlated with age (P < .05), MFD (P < .001), mandibular body height (P < .05), and BMS (P < .001). Multivariate logistic analysis also showed a significant association of MFD (P < .001) and BMS (P < .001). CONCLUSIONS: Preoperative MFD and BMS are radiographic findings that are associated with an increased risk for persistent NSD following SSO procedure.

Wound healing effect of autologous fibrin glue and polyglycolic acid sheets in a rat back skin defect model.

Fibrin glue from autologous plasma may prevent viral infection and allergic reaction. Moreover, this biomaterial contains growth factors such as TGF-ß and VEGF that promote reconstruction of the mucous membrane by stimulating fibroblast proliferation and angiogenesis. Thus, autologous fibrin glue is predicted to improve healing better than commercial fibrin glue. Here, we evaluated the effects of autologous fibrin glue on the crucial early phase of wound healing. Epithelial defects were introduced in rats and covered with polyglycolic acid (PGA) sheets with or without commercial or autologous fibrin glue. Wound healing was assessed for six weeks by histology and immunohistochemistry. Our results demonstrate that wounds covered with PGA sheets and autologous fibrin glue achieved efficient wound healing without complications such as local infection or incomplete healing. The rate of recovery of the regenerating epithelium in this group was superior to that in wounds covered with PGA sheets and commercial fibrin glue. Immunohistochemistry of laminin, cytokeratin, and VEGF confirmed fine and rapid epithelial neogenesis. Collectively, our results indicate that covering surgical wounds with autologous fibrin glue promotes wound healing and epithelialization, improves safety, and reduces the risks of viral infection and allergic reaction associated with conventional techniques.

Mandible fractures and dental injuries related to road traffic accidents over a 12-year period-Retrospective multicentre study.

BACKGROUND/AIM: Road traffic accidents (RTAs) are a common cause of maxillofacial injuries. The aim of this retrospective multicentre study was to investigate the characteristics of maxillofacial fractures and dental injuries that occurred in RTAs in Miyagi, Japan. MATERIALS AND METHODS: The records of 404 patients with maxillofacial injuries treated at the Oral and Maxillofacial Surgery Departments of four different institutions over a period of 12 years were analysed. Ninety-nine of these patients had suffered these injuries in an RTA. RTA-related cases were divided according to age, gender, presentation month, presentation day of the week, transportation mode, time of accident, fracture sites and fracture mechanism. RESULTS: There were 72 males and 27 females who suffered injuries as the result of an RTA, for a male-to-female ratio of 2.7:1.0, with a mean age of 35.3 years (range, 1-86 years old). Most of the accidents occurred in June and on a Wednesday, and most of the affected patients were riding a bicycle at the time. The number of patients with maxillofacial injuries related to bicycle riding showed an increasing trend in recent years. Mandible fractures were the most prevalent, followed by dental injuries and maxilla fractures. In cases with a single fracture of the mandible, the symphysis was the most frequent site, while in those with multiple fractures, the association of symphysis and bi-lateral condyle fractures was the greatest. For bicycle-related accidents, a single fracture in the mandible occurred more often than multiple fractures. CONCLUSIONS: The number of RTA-related injuries while bicycle riding showed an increasing trend with mandible fractures commonly seen in those cases. Efforts to reduce maxillofacial injuries related to bicycle accidents are needed.

Influence of oestrogen deficiency and excessive mechanical stress on condylar head of mandible.

OBJECTIVE: We assessed the aetiology of idiopathic condylar resorption by examining the effects of oestrogen and compressive mechanical stress under a low systemic oestrogen condition in temporomandibular joints (TMJ) caused by an ovariectomy. MATERIALS AND METHODS: Female rabbits were divided into non-ovariectomy (non-OVX) and ovariectomy (OVX) groups. A cortical osteotomy was performed with a custom device that was increased in length by 0.25 mm every 12 hr for 1 week after the operation, during which the TMJs in the rabbits received compressive mechanical stress. Samples from both groups were examined with micro-computed tomography and histological staining. RESULTS: Area and depth of bone resorption were both greater in the OVX group. Furthermore, a significantly earlier and greater prevalence of sub-condylar bone resorption was noted in that group, while cells positive for tartrate-resistant acid phosphatase were increased in the OVX group. CONCLUSIONS: The present findings suggest that oestrogen induced a much greater amount of bone resorption on the anterior surface of the condylar head at an earlier stage in the TMJs of the present model rabbits. Thereafter, restoration of TMJ function appeared to occur in a normal manner.

The Accuracy of Maxillary Position Using a Computer-Aided Design/Computer-Aided Manufacturing Intermediate Splint Derived Via Surgical Simulation in Bimaxillary Orthognathic Surgery.

PURPOSE: The purpose of this study was to assess the clinical interventions and the accuracy of maxillary reposition using a computer-aided design/computer-aided manufacturing (CAD/CAM) splint derived via surgical simulation. MATERIALS AND METHODS: The retrospective study comprised 24 patients who underwent bimaxillary surgery. The patients were assigned to 1 of 2 groups by a way of maxillary repositioning. One group received conventional intermediate wafers and the other CAD/CAM wafers during Le Fort I osteotomy. We recorded operation time, blood loss, the operative accuracy. Accuracy was analyzed by 3-dimensional computed tomography images before and immediately after the operation. The evaluation points were the right maxillary first incisor (U1), the right maxillary second molar (M2-right), and the left maxillary second molar (M2-left). RESULTS: The 2 groups did not differ significantly in operation time and blood losses. The vertical axis of U1 data differed significantly between the 2 groups (P = 0.008). None of the horizontal, vertical, or anteroposterior axis of M2-right data differed significantly, and anteroposterior axis of M2-left data differed significantly (P = 0.0296). The CAD/CAM group 3-dimensional distance errors were less than those of the conventional group for all points. CONCLUSION: Placement of CAD/CAM splint allowed highly accurate repositioning; the accuracy exceeded that afforded by conventional model surgery using a facebow and articulator.

Mandibular fractures and dental injuries sustained during baseball and softball over 14 years in a Japanese population: A retrospective multicentre study.

BACKGROUND/AIM: Active participation in sports is a risk factor for maxillofacial fractures. The aim of this retrospective multicentre study was to survey and evaluate the characteristics of mandibular fractures, and dental injuries that occurred during the practice of baseball and softball in Sendai, Japan. MATERIAL AND METHODS: The records of 454 patients with maxillofacial fractures from three departments of Oral and Maxillofacial Surgery across a period 14 years were analysed. Fifty-one patients with 56 mandible fractures and dental injuries that occurred playing baseball or softball were included in this multicenter retrospective study. Patients were divided according to age, gender, sites of fractures, mechanism of fractures and treatment methods. RESULTS: There were 42 males and nine females, with a male-to-female ratio of 4.7:1.0. The mean age was 19.9 years old (range: 13-47 years old). As for the site, body of the mandible fractures prevailed, followed by the condyle, symphysis and angle. Fractures were mostly caused by the impact of a ball (42; 82.4%), followed by collisions with another player (5; 9.8%) and direct strike of a bat (4; 7.8%). All patients with mandibular fractures were treated with open reduction and internal fixation, except for six patients with condylar head fractures who were managed conservatively. CONCLUSIONS: The impact of a thrown ball against the batter's mandible can cause a condylar fracture when playing baseball and softball.

Fall-related mandible fractures in a Japanese population: A retrospective study.

BACKGROUND/AIM: Maxillofacial trauma is frequent and represents a heavy burden for patients and society. The aim of this study was to investigate the characteristics and management of mandibular fractures caused by falls. MATERIAL AND METHODS: One hundred thirty-nine patients with 185 mandible fractures caused by falls were included in this retrospective study. The patients were grouped according to age, gender, fitness level (as classified by the American Society of Anesthesiology physical status classification), the month of the accident, sites of fractures and treatment methods. RESULTS: Most adult and fit patients were treated with open reduction and internal fixation, except for intracapsular condyle fractures. Conservative management was chosen for paediatric patients and in all cases deemed at high risk for lengthy procedures under general anaesthesia (physical status III according to the American Society of Anesthesiology). Young patients were mainly males, whereas geriatric patients were mainly females. In cases of single-site fracture, condylar fractures were the most prevalent. In cases with multiple sites, the association of condyle and symphysis fractures was the most frequent. CONCLUSIONS: The results show an increasing trend in geriatric condyle fractures, especially in females. The epidemiology of fall-related mandibular fractures is subject to the influence of seasonal, historical, cultural and demographic factors.

Do Mandibular Third Molars Play a Role in Fractures of the Mandibular Angle and Condyle?

INTRODUCTION: The relationship between impacted mandibular third molars with angle and condylar fractures is subject of many publications, yet their conclusions differ widely, hence the authors wanted to investigate this topic in their patients. METHODS: The authors designed a retrospective study including 241 patients who presented with angle and/or mandibular condyle fractures over a 13-year period at the authors' institution. The study variable was the presence/absence of third molars. The authors used the Pell and Gregory system to classify their position, whereas the angulation was classified using Archer classification. The outcome variables were the presence of angle and condylar fractures. Other study variables included fracture etiology. RESULTS: Assaults were the most frequent cause of angle fractures (62.7%), whereas falls were mostly responsible for condylar fractures (79.6%). Angle fractures were mostly isolated (66.3%), whereas condylar fractures were mostly associated with other fractures (62.6%). The majority of the angle fractures occurred in patients with third molars (63.6%), on the contrary the majority of the condylar fractures occurred in patients without mandibular third molars (78.3%). Angle fractures were mostly associated with fully erupted or superficially impacted third molars (90,9%). Finally in the presence of mesioangulated third molars, condylar fractures did not happen in 83.8% of patients. CONCLUSIONS: According to the authors' findings, fully erupted or superficially impacted mandibular third molars are a risk factor for angle fractures but at the same time a protective factor for the condyle. On the contrary, the absence of mandibular third molars "strengthens" the angle and represents a risk factor for condylar fractures.

Evaluation of the treatment modalities for neurosensory disturbances of the inferior alveolar nerve following retromolar bone harvesting for bone augmentation.

SUBJECTS: The purpose of this study was to evaluate the treatment modalities for neurosensory disturbances (NSDs) of the inferior alveolar nerve occurring after retromolar bone harvesting for bone augmentation procedures before implant placement. METHODS: One hundred four patients, of which 49 and 55 exhibited vertical or horizontal alveolar ridge defects in the mandible and maxilla, respectively, were enrolled. Nineteen patients underwent block bone grafting, 38 underwent guided bone generation or autogenous bone grafting combined with titanium mesh reconstruction, and 47 underwent sinus floor augmentation. Using a visual analog scale, we examined subjective symptoms and discomfort related to sensory alteration within the area of the NSDs in these patients. NSDs were clinically investigated using a two-point discrimination test with blunt-tipped calipers. In addition, neurometry was used for evaluation of trigeminal nerve injury. We tested three treatment modalities for NSDs: follow-up observation (no treatment), medication, and stellate ganglion block (SGB). RESULTS: A week after surgery, 26 patients (25.0%) experienced NSDs. Five patients received no treatment, 10 patients received medication, and 11 patients received SGB. Three months after surgery, patients in the medication and SGB group achieved complete recovery. Current perception threshold values recovered to near-baseline values at 3 months: recovery was much earlier in this group than in the other two groups. SGB can accelerate recovery from NSDs. CONCLUSIONS: Our results justify SGB as a reasonable treatment modality for NSDs occurring after the harvesting of retromolar bone grafts.

Elderly patients with maxillofacial trauma: study of mandibular condyle fractures.

BACKGROUND/AIM: The aim of this study was to investigate the trends and characteristic features of mandibular condyle fractures in elderly patients in terms of etiology, patterns, and treatment modalities. PATIENTS AND METHODS: Records of 201 patients aged 65 years and older, who were treated for maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Kyushu Dental University, and Tohoku University from January 2002 to December 2013, were retrospectively analyzed. Patient records and radiographs were examined, with the following information: relevant medical history, cause of fracture, the presence and state of premolars and molars in the maxilla and mandible, number and location of mandible fracture, and method of treatment. As for the state of premolars and molars, premolars or molars in the mandible in contact with the maxilla were regarded as contacted. RESULTS: A fall was responsible for the majority of the fractures (173/201). With condyle fractures, there was a significant difference between the contacted and non-contacted group in regard to incidence. Furthermore, there was a significantly greater number of cases with symphysis and condyle combination fractures in the non-contacted group (70.9%) than in the contacted group (51.9%). As for the method of treatment, arthrocentesis was the most commonly employed. CONCLUSIONS: The present findings suggest that contacted molars in the maxilla and mandible have an influence on condyle fractures in elderly individuals.

Evaluation of mandibular reconstruction with particulate cancellous bone marrow and titanium mesh after mandibular resection due to tumor surgery.

There are numerous treatment modalities for mandibular defects after tumor surgery. Autogenous particulate cancellous bone marrow graft combined with titanium mesh (PCBM-MESH) is an alternative procedure. The purpose of this study was to evaluate PCBM-MESH for mandibular reconstruction. There were a total of 10 cases from 2000 to 2011. Mandibles were successfully reconstructed in 9 cases; however, reconstruction failed in 1 case. Overall, the recovery of facial contours was excellent; conversely, the evaluation of prosthetic treatment varied widely. Thus, we suggest 3 steps for mandibular reconstruction: (1) recover the continuity of bone segments; (2) simulate optimum facial contours and dental occlusion; and (3) perform the occlusion with dental prostheses. PCBM-MESH is a valuable method for mandibular defects-particularly for restoring facial contours and a favorable alveolar ridge.

Static and dynamic guided bone regeneration using a shape-memory polyethylene terephthalate membrane: An experimental study in rabbit mandible.

BACKGROUND: Periosteal expansion (PEO) results in the formation of new bone in the space created between existing bone by expanding the periosteum. PEO has already been performed on rabbit parietal bone and effective new bone formation has been demonstrated. In this study, the utility of a polyethylene terephthalate (PET) membrane as an activator was evaluated in the more complex morphology of the mandible. METHODS: A PET membrane coated with hydroxyapatite (HA)/gelatine was placed in the rabbit mandibular bone at lower margin of mandibular molar region underneath periosteum, and screw-fixed. In the experimental group, the membrane was bent and screw-fixed along the lateral surface of the bone, with removal of the outer screw after 7 days followed by activation of the membrane. The experimental group was divided into two subgroups: with and without a waiting period for activation. Three animals were euthanized at 3 weeks and another three at 5 weeks postoperatively. Bone formation was assessed using micro-CT as well as histomorphometric and histological methods. RESULTS: No PET membrane-related complications were observed. The area of newly formed bone and the percentage of new bone in the space created by the stretched periosteum did not significantly differ between the control and experimental groups. However, in the experimental group a greater volume was present after 5 weeks than after 3 weeks. Histologically, bone formation occurred close to the site of cortical bone perforation, with many sinusoidal vessels extending through the perforations in the new bone into the overlying fibrous tissue. Inflammatory cells were not seen in the bone.

Microvascular reconstruction for oral cancer in older adult patients: the impact of age on surgical outcomes.

OBJECTIVE: Flap complications continue to be a challenge in microsurgical reconstruction for older adults. We aimed to evaluate the impact of age on surgical outcomes after microvascular reconstruction. STUDY DESIGN: We retrospectively investigated 103 patients with oral squamous cell carcinoma who had undergone microvascular reconstruction surgery to compare microsurgical reconstruction, common postoperative complications, and flap success rates in geriatric (>75 years) and non-geriatric (<75 years) patients. We also evaluated differences based on the American Society of Anesthesiologists Physical Status score. RESULTS: We found no significant differences between the geriatric and non-geriatric groups in peri-operative, postoperative, or general complications. Conversely, we found that delirium and aspiration pneumonia were significantly more likely to occur in geriatric patients and that multiple medical complications were significantly more likely to occur in geriatric patients with a high American Society of Anesthesiologists score. CONCLUSION: Microvascular reconstruction can be performed effectively and without excessive complications in geriatric patients, and age should not be considered a contraindication for this procedure. Comorbidities play a stronger role in the prediction of adverse events.

Visualization of droplets and aerosols in simulated dental treatments to clarify the effectiveness of oral suction devices.

PURPOSE: The hazards of aerosols generated during dental treatments are poorly understood. This study aimed to establish visualization methods, discover conditions for droplets/aerosols generated in simulating dental treatments and identify the conditions for effective suction methods. METHODS: The spreading area was evaluated via image analysis of the droplets/aerosols generated by a dental air turbine on a mannequin using a light emitting diode (LED) light source and high-speed camera. The effects of different bur types and treatment sites, reduction effect of intra-oral suction (IOS) and extra-oral suction (EOS) devices, and effect of EOS installation conditions were evaluated. RESULTS: Regarding the bur types, a bud-shaped bur on the air turbine generated the most droplets/aerosols compared with round-shaped, round end-tapered, or needle-tapered burs. Regarding the treatment site, the area of droplets/aerosols produced by an air turbine from the palatal plane of the anterior maxillary teeth was significantly higher. The generated droplet/aerosol area was reduced by 92.1% by using IOS alone and 97.8% by combining IOS and EOS. EOS most effectively aspirated droplets/aerosols when placed close (10 cm) to the mouth in the vertical direction (0°). CONCLUSIONS: The droplets/aerosols generated by an air turbine could be visualized using an LED light and a high-speed camera in simulating dental treatments. The bur shape and position of the dental air turbine considerably influenced droplet/aerosol diffusion. The combined use of IOS and EOS at a proper position (close and perpendicular to the mouth) facilitated effective diffusion prevention to protect the dental-care environment.

Distribution and anti-nociceptive function of endomorphin-1 in the rat cranial sensory ganglia.

Distribution of endomorphin-1 (EM-1) was immunohistochemically investigated in the rat cranial sensory ganglia. Small to medium-sized neurons in the trigeminal (TG), petrosal (PG), and jugular ganglia (JG) expressed EM-1-immunoreactivity. However, EM-1-immunoreactive (-ir) neurons were infrequent in the nodose ganglion. In the brainstem, EM-1-ir varicose fibers were detected in the superficial layer of the medullary dorsal horn and the caudal part of the nucleus tractus solitarius. By trichrome immunofluorescence analysis, approximately 70% of EM-1-ir neurons were also immunoreactive for transient receptor potential vanilloid 1 (TRPV1) in all the examined ganglia. Additionally, 56.8% of EM1-ir TG neurons and approximately 30% of EM-1-ir PG and JG neurons showed calcitonin gene-related peptide (CGRP)-immunoreactivity. By a retrograde tracing method, several TG, PG, and JG neurons innervating the facial and external ear canal skin expressed EM-1-immunoreactivity. However, EM-1-ir neurons innervating the tooth pulp, circumvallate papilla, and pharynx were relatively rare. Thus, EM-1 expression and its coexistence with TRPV1 and CGRP in the cranial sensory neurons may depend on their various peripheral targets. EM1-ir neurons probably project to the superficial layer of the medullary dorsal horn and caudal part of the nucleus tractus solitarius. EM-1 may be involved in nociceptive transmission from the skin.

Detection of oral cancer and oral potentially malignant disorders using artificial intelligence-based image analysis.

BACKGROUND: We aimed to construct an artificial intelligence-based model for detecting oral cancer and dysplastic leukoplakia using oral cavity images captured with a single-lens reflex camera. SUBJECTS AND METHODS: We used 1043 images of lesions from 424 patients with oral squamous cell carcinoma (OSCC), leukoplakia, and other oral mucosal diseases. An object detection model was constructed using a Single Shot Multibox Detector to detect oral diseases and their locations using images. The model was trained using 523 images of oral cancer, and its performance was evaluated using images of oral cancer (n = 66), leukoplakia (n = 49), and other oral diseases (n = 405). RESULTS: For the detection of only OSCC versus OSCC and leukoplakia, the model demonstrated a sensitivity of 93.9% versus 83.7%, a negative predictive value of 98.8% versus 94.5%, and a specificity of 81.2% versus 81.2%. CONCLUSIONS: Our proposed model is a potential diagnostic tool for oral diseases.

Horizontal alveolar distraction osteogenesis for dental implant: long-term results.

OBJECTIVES: The aim of the present study was to present the results of patients followed for at least 3 years who underwent horizontal distraction osteogenesis DO and a final implant prosthesis. MATERIAL AND METHODS: A total of 13 sites in 12 patients (three men, nine women; mean age 45.4 years, range 21-63 years) who presented with severe horizontal atrophy of a partially edentulous maxilla or mandible were treated using horizontal DO. The horizontal distraction device was set on the transport bone which was osteotomized as bone splitting method and fixed to the segment using microscrews. RESULTS: The median of latency period was 9 days (range: 7-17); the median of amount of device activation was 5.6 mm (range: 4.4-9.6); the median of distraction period was 14 days (range: 8-24); and the median of consolidation period, from the end of activation until implant placement, was 13 weeks (range: 11-20). The median of actual gain in bone width at the end of the consolidation period was 3.6 mm (range: 1.1-5.6). A total of 35 implants were inserted in the augmented area with primary implant stability. The median of follow-up from the start of prosthetic loading was 5.4 years. Consequently, the implant survival and success rates were 100% and 94.2%, respectively. CONCLUSION: This article reports the long-term results of horizontal alveolar DO using a mesh device for patients with an atrophic alveolar region. Our results confirm that this technique is a predictable and effective regenerative procedure for implant preprosthetic treatment in patients with severe horizontal atrophy of the alveolar ridge.

Qualitative bone CT as a tool to assess vascularization in irradiated bone: an animal study.

OBJECTIVE: The purpose of this paper was to find a correlation between laser doppler flowmetry (LDF) and the bone mineral density quotient (BMDQ) to evaluate irradiated bone quality preoperatively. MATERIALS AND METHODS: Premolars and molars were extracted from six minipigs. After a three-month healing period, three animals received irradiation at a total dose of 24 Gy. Three months after irradiation, quantitative computed tomography was performed using a calibration bone phantom to determine the 120-position BMDQ in the alveolar bone. A drill template was created to define the exact location for measurement. LDF was then recorded after osteotomy of the residual alveolar ridge. The correlation between the BMDQ and LDF was investigated. RESULTS: There was a linear negative correlation between LDF and BMDQ in non-irradiated bone (r = -0.435, P = 0.001) and less pronounced also in irradiated bone (r = -0.309, P = 0.017). In both non-irradiated and irradiated bone, we found distinct differences between the maxilla and mandible with respect to BMDQ. However, a clear difference in mandibular and maxillary vascularity was only seen in non-irradiated bone. CONCLUSION: In non-irradiated bone, LDF and BMDQ were inversely correlated. In irradiated bone, the BMDQ alone is not an adequate preoperative tool for evaluating bone quality because it was not correlated with bone perfusion.

Increased levels of interleukin-6 in synovial lavage fluid from patients with mandibular condyle fractures: correlation with magnetic resonance evidence of joint effusion.

PURPOSE: The aim of the present study was to investigate the relation between magnetic resonance (MR) evidence of joint effusion and concentrations of proinflammatory cytokines, including interleukin (IL)-1ß and IL-6, in washed-out synovial fluid samples obtained from patients with mandibular condyle fractures. PATIENTS AND METHODS: Twenty-five joints in 23 patients with mandibular condyle fractures were examined. Computed tomography was used to determine the position of the fracture and MR examination was performed in all cases. Twenty-five joints underwent temporomandibular joint (TMJ) irrigation before surgical treatment for the fractures. The detection rates and concentrations of the tested cytokines were determined, and their relations to evidence of joint effusion and positions of the condylar fractures were analyzed. RESULTS: Six TMJ fractures were found in the head, 10 in the upper neck, 4 in the lower neck, and 5 in the subcondyle. MR evidence of joint effusion was observed in 17 of 25 TMJs (68.0%). The detection rate and concentration of IL-6 were significantly higher in patients with MR evidence of joint effusion and those with high condylar fractures. Moreover, there was a correlation between joint effusion grade and IL-6 concentration. CONCLUSIONS: The present findings showed a correlation between MR evidence of joint effusion and concentration of IL-6 in washed-out synovial fluid samples collected from patients with mandibular condyle fractures. These results may provide support for arthrocentesis as a reasonable treatment modality for high condylar fractures.