An innovative universal protocol for orthognathic surgery three-dimensional virtual simulation.

The aim of this technical note is to describe a protocol for three-dimensional virtual simulation of orthognathic surgery that has been designed to be easily implemented, without the need for any special clinical apparatus, software brand, or computed tomography sequence. The protocol comprises innovative concepts and simplified steps for image segmentation, creation of a composite skull, control of the condylar position, and sequencing of bimaxillary surgery. This protocol was applied by the developers in about 2000 cases performed between 2015 and 2022, and has become quite popular among local surgeons. Previous preliminary studies have shown that it meets the accuracy standards for clinical use, although further studies with larger numbers of patients are desirable for additional validation.

The untold history of planning in orthognathic surgery: a narrative review from the beginning to virtual surgical simulation.

We aimed to produce a narrative review of planning orthognathic surgery, chronologically. Also, to present flaws of methods and the future of orthognathic surgery planning. The search was carried out mainly in PubMed, SCOPUS, Embase, and Cochrane databases. Also was complemented by manual search in reference lists from identified studies and in grey literature. The first orthognathic surgery was reported in 1849, and it took more than a century for the development of the traditional orthognathic 2D planning. Besides the advances, surgeons observed failures and lacks on 2D method in representing with reliability the facial and maxillary tridimensional structure (3D). With technological developments in 90s and 2000s, methodological improvements were granted, and the 3D protocol was created. The CASS and Charlotte protocols were the earliest 3D planning protocols conceived. Since then, some steps were simplified, and new technologies are being developed and added to create a more reliable and precise way of planning orthognathic surgery.

Osteogenic potential of human dental pulp stem cells cultured onto poly-ε-caprolactone/poly (rotaxane) scaffolds.

BACKGROUND: Bioengineering aims to develop innovative scaffolds to improve cellular activities for tissue regeneration. OBJECTIVES: To evaluate the biological behavior of human dental pulp stem cells (hDPSCs) seeded onto an experimental polymeric-based scaffold comprising poly-ε-caprolactone/poly (rotaxane). MATERIAL AND METHODS: Adhesion, viability, and proliferation as well as alkaline phosphatase (ALP) activity, mineralized nodule formation (alizarin red assay), and expression of genes related to osteogenic differentiation, including ALP, type 1 collagen alpha 1 (COL1A1), Runt-related transcription factor (Runx-2), and osteocalcin (BGLAP/OCN), were evaluated in hDPSCs seeded onto polymeric scaffolds. RESULTS: hDPSCs expressed typical levels of mesenchymal stem cell surface markers. Cell growth increased upon cultivation on polymeric blend scaffold and the cells gained osteoblast-like appearance. Fourteen days after seeding hDPSCs on the scaffolds, irrespective to the culture medium used (clonogenic or mineralization medium), the cells presented ALP activity higher than that of control cells grown in clonogenic medium. The cells cultivated in mineralization medium on the scaffold showed significantly higher expression of all genes than the control cells, except for BGLAP gene expression. At 21 days, the group cultivated on the scaffold and mineralization medium showed maximum level of mineralization. SIGNIFICANCE: Poly-ε-caprolactone/poly (rotaxane) blend is noncytotoxic to hDPSCs and improved genomic and functional osteogenic differentiation. Thus, poly-ε-caprolactone/poly (rotaxane) blend may serve as a promising bioactive biomaterial for bone tissue bioengineering.

Dental implant loss in older versus younger patients: a systematic review and meta-analysis of prospective studies.

The aim of this systematic review was to evaluate implant loss in younger and older patients. An electronic search of four databases (MEDLINE, EMBASE, SCOPUS and the Cochrane Library) was undertaken until May 2016 without time restriction and was supplemented by manual searching. Prospective cohorts were included if they met the following criteria: (i) presence of an exposed group (older subjects) with a minimum age of 60 years; (ii) presence of a control group (younger subjects) with a maximum age of 59 years; and (iii) outcome data considering implant survival or loss. Meta-analyses were performed to evaluate the impact of ageing on implant failure. Of 4152 potentially eligible articles, four were included in the qualitative analysis and quantitative synthesis. The pooled estimates suggest that the risk of implant loss in older patients is not significantly higher (RR = 0·92; 95% CI 0·43-1·96, P = 0·83) when compared to younger subjects. This systematic review suggests that age is not a limiting factor for dental implant therapy.

The influence of statins on osseointegration: a systematic review of animal model studies.

Recent research data have suggested that the beneficial action of statins in bone tissue could improve osseointegration around titanium implants by increasing the bone implant contact (BIC), the expression of bone morphogenetic protein-2 (BMP-2) and vascular endothelial growth factor (VEGF). The aim of this systematic review was to evaluate the influence of statins on osseointegration of titanium implants in animal studies. Two reviewers searched independently four databases (MEDLINE, SCOPUS, WEB OF SCIENCE and the Cochrane Library), until March 15, 2016. The Cochrane Collaboration's Tool for Assessing Risk of Bias was used to assess the quality of the included studies. Papers that reported outcome data considering bone implant contact (BIC), mechanical tests or other histological evaluation were eligible for inclusion. 312 references were eletronically retrieved, 21 full-text papers were screened and 17 studies were included. Thirteen trials presented histomorphometry data on bone implant contact measures. All of them showed a significant improved BIC when using statins. Despite data from included studies point to beneficial effects, standardized studies and with less risk of bias, are needed to clarify the role of statins on osseointegration.

Accuracy of perioperative mandibular positions in orthognathic surgery.

Mandibular position is an important parameter used for the diagnosis of dentofacial deformities, as well as for orthognathic surgery planning and execution. Centric relation (anterior and superior relationship of the mandibular condyles interposed by the thinnest portion of their disks against the articular eminencies), centric occlusion (when lower teeth contact upper teeth at centric relation), and maximal intercuspation (complete interdigitation of lower and upper teeth) are not often addressed as factors that influence the results of orthognathic surgery, although these relationships are critical to ensure accuracy during the surgery. The present study assessed occlusal measurements taken before and after the induction of general anaesthesia from consecutive orthognathic surgery subjects. The variables assessed included the differences between these occlusal measurements, patient age, gender, type of deformity, and type of proposed orthognathic surgical procedure. The results demonstrated statistically significant differences for mandibular retrusion from maximal intercuspation to centric occlusion position, whereas the mandible appeared not to change significantly from centric occlusion after the induction of general anaesthesia. Patient age and the type of deformity appeared to influence the results. While in most instances centric occlusion can be adequately reproduced under general anaesthesia, for some specific orthognathic cases more accurate results might be obtained if the mandible-first sequence is used.

Adjuvant aqueous ozone in the treatment of bisphosphonate induced necrosis of the jaws: report of two cases and long-term follow-up.

Bisphosphonate induced necrosis of the jaws (BONJ) does not have a unique protocol of treatment and many therapeutic approaches have been arising in oral medicine with debatable results. A male and a female attended the University Oral Surgery Clinic presenting oral bone lesions induced by intravenous and oral bisphosphonates respectively as complications of dental extraction. Treatment included daily mouthwashes and weekly intra oral irrigations with 4 mg/L of aqueous-ozone, antibiotic therapy and sequential superficial debridment for sequestrectomies. Long-standing follow-ups showed complete mucosa covering of exposed bone area and resolution of purulent secretion. Antibacterial and antifungal properties of aqueous ozone may have played important roles in the treatment. The outcome measured intra oral examination and panoramic radiographs of the affected bone. The application of aqueous ozone daily mouthwashes and weekly professional irrigation were safe; free from adverse effects, easily of handling and worked as an important adjuvant therapeutic strategy for the treatment of BONJ.

Mucormycosis in an immunocompetent patient: follow-up of 1 year after treatment.

Mucormycosis is a rare acute fatal fungal infection. It is typically observed in diabetic or immunocompromised patients but not in systemically healthy individuals. Here, we describe an unusual mucormycosis case in an immunocompetent patient who had clinical signs of a maxillary sinusitis and associated osteomyelitis at the first examination. He was treated by surgery and removal of the necrotic bone and amphotericin B medication. At 1-year follow-up he shows complete recovery.