Does Maxillomandibular Fixation Technique Affect Occlusion Quality in Segmental LeFort I Osteotomy?

BACKGROUND: Segmental maxillary osteotomies require precise occlusal control due to variability in individual segment positioning. The role of maxillomandibular fixation (MMF) technique on occlusal control has not been validated. PURPOSE: The purpose is to measure and compare the accuracy of occlusal positioning among MMF techniques. STUDY DESIGN, SETTING, SAMPLE: This was a double-blinded in vitro study on experiment models to simulate a 3-piece LeFort I osteotomy. The models were constricted posteriorly and expanded using 3 different MMF techniques and compared to the unaltered baseline occlusion. Based on sample size calculation, 32 separate attempts were made for each MMF technique. PREDICTOR VARIABLE: The predictor variable was MMF technique (brackets, MMF screws, and embrasure wires). MAIN OUTCOME VARIABLES: The primary outcome variable was the visual occlusal analysis score, a 1.00 to 4.00 continuous scale measuring the similarity of the achieved occlusion to the planned (control) occlusion assessed by an oral and maxillofacial surgeon and an orthodontist. High visual occlusal analysis score indicated greater occlusal accuracy, with 3.50 defined as the threshold for accuracy. The secondary outcome variable was the linear error of the achieved occlusion at the canine and first molar teeth, with lower error indicating greater accuracy. An a priori accuracy threshold of 0.5 mm was set for this variable. COVARIATES: None. ANALYSES: Kruskal-Wallis test with post hoc testing was used to analyze the difference in the outcome variables of interest. P value < .05 was considered statistically significant. RESULTS: Thirty-two attempts for each technique showed that brackets had higher VAOS than MMF screws and embrasure wires (median differences 1.49 and 0.48, P < .001), and had lower linear occlusal error (median differences 0.35 to 0.99 mm, P < .001). CONCLUSION AND RELEVANCE: MMF technique influences the quality of occlusal control, with greater visual rating scores and lower linear errors seen with brackets than with embrasure wires or MMF screws.

The Role of the Pediatric and General Dentist in Management of Odontogenic Infections: An Algorithmic Approach From Triage to Management.

Odontogenic infections are preventable yet common in adults and children, and can progress to life-threatening levels if not definitively managed in a timely manner. Children with odontogenic infections often first present to the pediatric or general dental practice, making pediatric and general dentists key players in the management of odontogenic infections. While the pediatric or general dentist can definitively manage several types of infections, their critical role goes well beyond treatment to include timely and appropriate triage as well as facilitation of care when the severity of the infection exceeds the scope of their practice. Thorough and efficient triage allows the dentist to determine the most appropriate timing and setting of definitive care, thus preventing avoidable delays or inefficient use of health care resources. The purpose of this narrative review is to discuss key concepts in the overall management of odontogenic infections in children, with a focus on the clinical significance of each concept, in an algorithmic format.

What Is the Effect of COVID-19 Social Distancing on Oral and Maxillofacial Trauma Related to Domestic Violence?

PURPOSE: To understand the impact of social distancing policies on the incidence and severity of oral and maxillofacial trauma (OMT) secondary to interpersonal violence (IPV) and domestic violence (DV). METHODS: The authors designed a retrospective cohort study enrolling subjects who presented to an urban Level 1 trauma center in Seattle, WA, for the evaluation and management of OMT between January 1 and December 31 in the years 2018 through 2020. The primary predictor variable was evaluation of OMT during periods with (2020: investigational group) or without (2018 or 2019: control group) social distancing policies in place. The primary outcome variables were the mechanism and severity of injury, defined as IPV, DV or neither, the abbreviated injury scale (AIS) and the injury severity score (ISS). Descriptive, univariate and bivariate analyses were performed with statistical significance at P < .05. RESULTS: Eight hundred twenty-eight subjects; 737 (89%) IPV and 91(11%) IPV due to DV. The incidence of OMT secondary to IPV or DV was unchanged (P = .81, P = .57 respectively). There was a nonsignificant increase in ISS for IPV (P = .07) and no change for DV (P = .46). AIS scores were unchanged for IPV (P = .36). For DV, AIS scores were lower in 2020 when compared to 2019 (P = .04) but unchanged from 2018 (P = .58). At least half of the DV victims were male (50% in 2018, 59% in 2019, and 53% in 2020). Of these, 65% were under 18, and represented the pediatric majority (62%). A nonsignificant increase in non-white subjects presenting with DV in 2020 (P = .15) was seen. CONCLUSIONS: The COVID-19 pandemic did not change the number or severity of OMT cases secondary to IPV or DV in this region of Washington. Pediatric males were more likely to be victims of DV.

Inhibition of oral biofilm formation by zwitterionic nonfouling coating.

Inhibition of oral biofilm formation is critical to prevent and treat dental caries and periodontal diseases. In this study, we synthesized zwitterionic poly(carboxybetaine) (pCB) based polymer as a nonfouling coating to provide anti-bacterial properties to tooth surfaces. Four catechol derived l-3,4-dihydroxyphenylalanine (DOPA) groups were conjugated to pCB to serve as a surface anchoring group. The pCB-(DOPA)4 polymer was coated on the hydroxyapatite (HA) and enamel samples by simple immersion and characterized by Raman spectroscopy. The nonfouling effectiveness of the pCB based coating was determined by protein adsorption and bacterial adhesion assays. The coating was transparent on sample surfaces. The protein adsorption was significantly reduced to 8.2% and 6.9%, respectively, on pCB-(DOPA)4 coated HA and enamel samples. The pCB-(DOPA)4 -coated samples also demonstrated significantly fewer adhered Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus mutants compared to the control. This novel coating material provides an innovative approach to resist biofilm formation on tooth surfaces and has great potential in future dental clinical applications.