RESUMO
PURPOSE: Evaluate the impact of counterclockwise rotation of the occlusal plane (CCWROP) on pharynx morphology and polysomnography in maxillomandibular advancement (MMA) surgery to treat obstructive sleep apnea (OSA) patients. METHODS: Prospective clinical trial of patients with OSA treated by MMA. Computed tomography and polysomnography were performed pre- and postoperatively and the parameters were compared. The surgery classified the patients into two groups: with (R) and without (NR) CCWROP. RESULTS: The study sample comprised 38 individuals: R (n = 19) and NR (n = 19). An anterior mandible advancement of 0.71 mm was identified for each degree of CCWROP (p < 0.001). As for polysomnography, the apnea-hypopnea index was reduced by 80% and 62% in R and NR, showing final values of 6.8 and 13.0, respectively. The apnea index changed equally in both groups. Reduction of 68 and 26% in the hypopnea index was observed for R and NR, respectively, with no statistically significant difference. Total volume increased by 45% in R and 30% in NR. Retropalatal and retrolingual volumes increased by 49% and 4% in R and 43% and 15% in NR, respectively. The minimum axial area increased by 92% in the retropalatal region and 97% in the retrolingual region in R, whereas these increases were of 76% and 31% in NR, respectively. CONCLUSION: Anterior mandibular advancement of 0.71 mm for each degree of CCWROP is of great importance for surgical planning. As a result of this resource, individuals in R presented better results than those in NR in all parameters assessed, especially regarding the retrolingual region.
Assuntos
Avanço Mandibular , Procedimentos Cirúrgicos Ortognáticos , Faringe/cirurgia , Polissonografia , Apneia Obstrutiva do Sono/cirurgia , Adulto , Feminino , Humanos , Masculino , Avanço Mandibular/métodos , Avanço Mandibular/normas , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Ortognáticos/métodos , Procedimentos Cirúrgicos Ortognáticos/normas , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos ProspectivosRESUMO
BACKGROUND: The optimal age for cleft palate repair continues to be debated, with little discussion of surgical risk related to operative timing. This study of 3088 cleft palate patients analyzed the impact of surgical timing on perioperative and 30-day postoperative outcomes. METHODS: Primary cleft palate repairs were identified in the National Surgical Quality Improvement Program database from 2012 to 2015. Data were combed for total postoperative complications, rates of readmission and reoperation, operating room time, and length of stay. Bivariate analyses were performed comparing 3-month periods from months 6 to 18, and months 0 to 5, 18 to 23, 24 to 29, and 30 to 59. RESULTS: Despite a higher proportion of isolated soft palate closure, children operated on before 6 months had a higher complication rate than children at other ages (7.1 percent versus 3.2 percent; OR, 2.4; p = 0.04), and higher rates of both readmission (3.6 percent versus 1.4 percent; OR, 3.6; p = 0.02) and reoperation (2.4 percent versus 0.5 percent; OR, 4.7; p = 0.04). There were no differences in short-term outcomes for any other age group younger than 5 years, and no differences in hospital length of stay among any age groups. CONCLUSIONS: The authors' findings suggest a relative contraindication to operation before 6 months. As there were no differences between any other age groups, long-term speech optimization should continue to be the primary consideration for operative planning. These findings improve the current rationale for palatoplasty timing, and can aid surgeons and parents in the surgical decision-making process. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Assuntos
Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Ortognáticos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Distúrbios da Fala/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Fatores Etários , Pré-Escolar , Fissura Palatina/complicações , Feminino , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Procedimentos Cirúrgicos Ortognáticos/normas , Palato Duro/anormalidades , Palato Duro/cirurgia , Palato Mole/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Reoperação/estatística & dados numéricos , Distúrbios da Fala/etiologia , Tempo para o Tratamento/normasRESUMO
INTRODUCTION: Learning facial fracture management principles can be challenging for surgical trainees. Residents must assimilate nuances of fixation techniques, skeletal biomechanics, and hardware use while managing acute work-flow limitations. This study aims to design a standardized-schematic for teaching facial fracture management and evaluate its performance improving resident operative planning. METHODS: Printable schematics of the facial skeleton with soft-tissue overlay were developed. Instructions on depicting fracture pattern, incisions, plating sequence, loadbearing/sharing plates, locking/nonlocking screws, and mono/bicortical screws were given. Senior residents (n=5) evaluated computed tomography of 3 mandibular fractures and submitted 3 operative plans per case: first without guidance, then with written instruction, and finally using the schematic (n=45). Performance was graded on content and conceptual correctness. Data on time to completion was obtained. Likert-scale surveys assessing understanding, communication, and operative planning were given RESULTS:: Schematic use improved operative plan content and facilitated communication of resident operative schemes. Of 7 content domains spanning approach, plating strategy, and screw selection, a mean of 2.3, 3.7, and 6.5 were included with no guidance, written instruction, and schematic use respectively. Information on approach (P=0.001), plating type (P=0.02), screw location (P<0.000), screw depth (P=0.000), and screw locking status (P=0.000) were improved when comparing pre- and postintervention plans. Mean time to completion was 8 minutes and 54âseconds. All subjects "agreed" (n=2) or "strongly agreed" (n=3) that schematic use aided planning and communication. CONCLUSIONS: Simple, guided interventions can enhance surgical training by identifying knowledge gaps, improving visuospatial conceptualization, and facilitating targeted discussions with attendings.
Assuntos
Fraturas Mandibulares/diagnóstico por imagem , Procedimentos Cirúrgicos Ortognáticos/educação , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas , Humanos , Fraturas Mandibulares/cirurgia , Procedimentos Cirúrgicos Ortognáticos/normas , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The purpose of this study was to prospectively test the accuracy of computer-aided orthognathic surgery comparing the virtual surgical planning with the three-dimensional (3D) outcome. METHODS: Patients that underwent computer-assisted orthognathic surgery were retrospectively evaluated. The postoperative results were compared with the surgical plan, superimposing the postoperative computed tomography (CT) scan onto the virtual plan. Surface-based superimpositioning of the postoperative CT scan onto the 3D preoperative plan was carried out to visualize the discrepancy between preoperative virtual plan and postoperative 3D CT result. RESULTS: A total of 17 consecutive patients that underwent two-jaw computer-assisted orthognathic surgery were enrolled in the study.The average linear differences for selected points were <1âmm in 12 patients out of 17. In 5 patients out of 17, the average differences for selected points were <2âmm. CONCLUSIONS: An overall high degree of accuracy between the virtual plan and the postoperative result was found.
Assuntos
Desenho Assistido por Computador , Mandíbula , Maxila , Planejamento de Assistência ao Paciente , Adulto , Precisão da Medição Dimensional , Feminino , Humanos , Imageamento Tridimensional/métodos , Itália , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Maxila/diagnóstico por imagem , Maxila/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Procedimentos Cirúrgicos Ortognáticos/normas , Avaliação de Processos e Resultados em Cuidados de Saúde , Cuidados Pré-Operatórios , Estudos Retrospectivos , Cirurgia Assistida por Computador/métodosRESUMO
INTRODUCTION: The smile poses a challenge in the treatment of class III. Untreated, the class III patient presents excessive maxillary torque and a predominant display of the mandibular incisors, a sign that becomes more visible with age. Functional orthopedics restores the aesthetic appearance of the smile by maxillary protraction (sometimes temporarily because 20% of cases will still need surgery). Depending on the initial severity of the case (-4.5 mm AoBo would be the threshold value), the options are compensation or surgical correction. In both cases, the profile is improved but without normalising the cephalometric values. In recent years, the number of published cases treated by compensations (often using skeletal anchorage) has multiplied with broader indications, particularly for Asian patients in whom Le Fort I surgery gives questionable aesthetic results. Attention must be focused on the occlusal plane rotation which alters the smile by displaying the mandibular incisors. Nevertheless, surgery can handle the most severe cases with a greater degree of improvement. AIM: The aim of this article is to determine the cephalometric cut-off values for an acceptable smile in Class III patients. MATERIALS AND METHODS: We performed a search on Pubmed using the following keywords: Class III, anterior cross bite, smile, camouflage, orthognathic surgery; then secondarily, using references supplied by the articles found. We then analysed the data. RESULTS: The ortho-surgical protocol associated with extractions of maxillary first premolars appears to be the way to obtain the best results in terms of the smile (versus surgery without extractions and versus orthodontic compensations) because it is, in fact, the only way to restore the normal position and torque of the maxillary incisors, thus increasing their display during smiling.
Assuntos
Estética Dentária , Má Oclusão Classe III de Angle/cirurgia , Ortodontia Corretiva/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Sorriso/fisiologia , Humanos , Má Oclusão Classe III de Angle/epidemiologia , Ortodontia Corretiva/normas , Procedimentos Cirúrgicos Ortognáticos/normas , Resultado do TratamentoAssuntos
Ortodontia Corretiva/normas , Cefalometria/normas , Arco Dental/anatomia & histologia , Oclusão Dentária , Pesquisa em Odontologia , Humanos , Má Oclusão/classificação , Má Oclusão/terapia , Mandíbula/anatomia & histologia , Desenho de Aparelho Ortodôntico , Braquetes Ortodônticos , Fios Ortodônticos , Procedimentos Cirúrgicos Ortognáticos/normas , Planejamento de Assistência ao Paciente , Filosofia Odontológica , Dente/anatomia & histologia , Coroa do Dente/anatomia & histologia , Resultado do TratamentoAssuntos
Governança Clínica , Auditoria Odontológica , Licenciamento em Odontologia , Guias de Prática Clínica como Assunto , Cirurgia Bucal/normas , Acreditação/normas , Conjuntos de Dados como Assunto , Pesquisa em Odontologia/normas , Traumatismos Faciais/cirurgia , Humanos , Dente Serotino/cirurgia , Procedimentos Cirúrgicos Ortognáticos/normas , Avaliação de Processos e Resultados em Cuidados de Saúde , Sociedades Odontológicas , Odontologia Estatal/normas , Cirurgia Bucal/legislação & jurisprudência , Dente Impactado/cirurgia , Reino UnidoAssuntos
Cirurgia Ortognática , Congressos como Assunto , França , Humanos , Cirurgia Ortognática/organização & administração , Cirurgia Ortognática/normas , Cirurgia Ortognática/tendências , Procedimentos Cirúrgicos Ortognáticos/normas , Procedimentos Cirúrgicos Ortognáticos/tendências , EditoraçãoRESUMO
The objectives of dental and maxillary defect management have changed over the last decade. Occlusal improvement is required, but it is expected to come with a good esthetic result for patients, especially for adults, and mentioned or not preoperatively. Thus, the maxillofacial surgeon must include complementary data in his therapeutic scheme, beyond the one provided by the cephalometric analysis. This chapter was drafted in pluridisciplinary mode to this end. A psychological approach and post-operative satisfaction are crucial factors that were studied prospectively (MD Battini and Courtois) and are a part of this chapter. Esthetic labial standard are also described, based on the results of a retrospective study (MD Hardy, Laure and Goga). Doctor Belhaouari presents solutions to embellish lips with filling products, initially or later. Finally, the complementary surgical techniques that can be used during orthognatic surgery are listed: lipofilling, rhinoplasty, surgery of mandibular angles, apposition of piriform aperture.
Assuntos
Procedimentos Cirúrgicos Ortognáticos/normas , Satisfação do Paciente , Melhoria de Qualidade , Cirurgia Plástica/normas , Adulto , Face , Humanos , Procedimentos Cirúrgicos Ortognáticos/métodosRESUMO
BACKGROUND: Combined orthognathic-orthodontic treatment can be lengthy and expensive. It is therefore important to evaluate the effectiveness of proposed treatment and the likely outcomes. OBJECTIVES: To determine the demographic and surgical details of patients who received orthognathic-orthodontic treatment at Christchurch Hospital, New Zealand, and to assess treatment using the Severity and Outcome Index (SOI). METHODS: An observational and retrospective study was conducted of patients who received surgical orthodontic treatment between 2005 and 2012 at Christchurch Hospital. Pre- and post-treatment lateral cephalometric radiographs of 93 patients were evaluated. Seven cephalometric parameters were assessed using the Severity and Outcome Index. A severity score ranged from 0 for the most severe to 7 for the least severe, while the outcome score ranged from 0 for the worst to 7 for the best outcome. RESULTS: Class II patients had a severity score of 3.4 and the best outcome score of 6.2. Class III patients had a severity score of 3.3 and an outcome score of 6.1. Patients with an anterior open bite (AOB) had the worst severity score of 3.0, and the worst outcome score of 5.9. The overall treatment outcome scores for all groups were statistically significantly greater than the severity scores, which increased from 3.4 to 6.1 (p < 0.05). CONCLUSIONS: Favourable outcomes were achieved for a group of patients with a high need for treatment. Christchurch Hospital appeared to be treating cases of increased severity and gained better treatment outcomes when compared with a United Kingdom (UK) national audit.
Assuntos
Ortodontia Corretiva/normas , Procedimentos Cirúrgicos Ortognáticos/normas , Adolescente , Adulto , Cefalometria/métodos , Feminino , Seguimentos , Humanos , Índice de Necessidade de Tratamento Ortodôntico , Masculino , Má Oclusão Classe I de Angle/cirurgia , Má Oclusão Classe I de Angle/terapia , Má Oclusão Classe II de Angle/cirurgia , Má Oclusão Classe II de Angle/terapia , Má Oclusão Classe III de Angle/cirurgia , Má Oclusão Classe III de Angle/terapia , Avaliação das Necessidades , Mordida Aberta/cirurgia , Mordida Aberta/terapia , Osteogênese por Distração/métodos , Osteotomia/métodos , Osteotomia de Le Fort/métodos , Osteotomia Sagital do Ramo Mandibular/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemAssuntos
Procedimentos Cirúrgicos Ortognáticos/normas , Odontologia Baseada em Evidências/normas , Músculos Faciais/fisiopatologia , Humanos , Avanço Mandibular/normas , Maxila/cirurgia , Terapia Miofuncional/normas , Ortodontia/normas , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Complicações Pós-Operatórias , RecidivaRESUMO
PURPOSE: To measure oral and maxillofacial surgery (OMS) chief resident case experience, including autonomy, and discover the role of this experience in developing resident confidence and determining the scope of practice on completion of training. MATERIALS AND METHODS: A cross-sectional study was conducted using an online questionnaire made available to residents near the completion of their final year of training in United States OMS training programs. Predictors were the case numbers and autonomy level. Outcomes were the anticipated frequency of practice, confidence to meet the standard of care, and changes in anticipated practice scope. Each was measured in 10 domains within the scope of OMS. RESULTS: Eighty-four residents (44%) completed the 116-item questionnaire. All respondents were "very confident" in their ability to meet the standard of care in mandibular trauma and dentoalveolar surgery. Autonomy was associated with the confidence to meet the standard of care in midface trauma, temporomandibular joint, orthognathic, cosmetic, pathology, reconstructive, and craniofacial surgery. Associations were noted between primary surgeon cases and confidence in midface trauma, temporomandibular joint, orthognathic, cosmetic, and craniofacial surgery. Case numbers were associated with an anticipated frequency of practice within the domains of midface trauma, temporomandibular joint, cosmetic, and pathology surgery. CONCLUSIONS: Results of this study suggest an association between a resident's surgical case experience (overall exposure and autonomy) and that resident's future plans for practice and confidence to meet the standard of care in this specialty. OMS training curricula should evolve to incorporate an evaluation of competence and an appropriate transfer of responsibility and experience to residents, thus maximizing confidence and future practice opportunities.
Assuntos
Atitude do Pessoal de Saúde , Internato e Residência , Autonomia Profissional , Prática Profissional , Autoimagem , Cirurgia Bucal/educação , Adulto , Estudos Transversais , Implantação Dentária Endóssea/normas , Estética Dentária , Ossos Faciais/lesões , Feminino , Humanos , Masculino , Traumatismos Mandibulares/cirurgia , Traumatismos Maxilofaciais/cirurgia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Bucais/normas , Procedimentos Cirúrgicos Ortognáticos/normas , Planejamento de Assistência ao Paciente , Procedimentos de Cirurgia Plástica/normas , Padrão de Cuidado , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/cirurgiaAssuntos
Cefalometria/normas , Má Oclusão Classe III de Angle/cirurgia , Procedimentos Cirúrgicos Ortognáticos/normas , Pontos de Referência Anatômicos , Humanos , Masculino , Mandíbula/cirurgia , Osteotomia Sagital do Ramo Mandibular , Planejamento de Assistência ao Paciente , Postura , Prognatismo/cirurgia , Padrões de Referência , Reprodutibilidade dos Testes , Adulto JovemRESUMO
PURPOSE: The purpose of the present study was to evaluate the accuracy of our newly developed approach to digital dental model articulation. MATERIALS AND METHODS: Twelve sets of stone dental models from patients with craniomaxillofacial deformities were used for validation. All the models had stable occlusion and no evidence of early contact. The stone models were hand articulated to the maximal intercuspation (MI) position and scanned using a 3-dimensional surface laser scanner. These digital dental models at the MI position served as the control group. To establish an experimental group, each mandibular dental model was disarticulated from its original MI position to 80 initial positions. Using a regular office personal computer, they were digitally articulated to the MI position using our newly developed approach. These rearticulated mandibular models served as the experimental group. Finally, the translational, rotational, and surface deviations in the mandibular position were calculated between the experimental and control groups, and statistical analyses were performed. RESULTS: All the digital dental models were successfully articulated. Between the control and experimental groups, the largest translational difference in mandibular position was within 0.2 mm ± 0.6 mm. The largest rotational difference was within 0.1° ± 1.1°. The averaged surface deviation was 0.08 ± 0.07. The results of the Bland and Altman method of assessing measurement agreement showed tight limits for the translational, rotational, and surface deviations. In addition, the final positions of the mandibular articulated from the 80 initial positions were absolutely agreed on. CONCLUSION: The results of our study have demonstrated that using our approach, the digital dental models can be accurately and effectively articulated to the MI position. In addition, the 3-dimensional surface geometry of the mandibular teeth played a more important role in digital dental articulation than the initial position of the mandibular teeth.
Assuntos
Algoritmos , Oclusão Dentária , Modelos Dentários , Procedimentos Cirúrgicos Ortognáticos/normas , Planejamento de Assistência ao Paciente/normas , Pontos de Referência Anatômicos/anatomia & histologia , Simulação por Computador , Arco Dental/anatomia & histologia , Humanos , Imageamento Tridimensional/métodos , Incisivo/anatomia & histologia , Lasers , Mandíbula/anatomia & histologia , Dente Molar/anatomia & histologia , RotaçãoRESUMO
The quality of care delivered to 74 patients undergoing orthognathic surgery was assessed using a patient satisfaction questionnaire and data collected from hospital case records. Surgical complications, hospital services, patient satisfaction, and impact on quality of life, were the main aspects considered. The majority of patients reported that their treatment objectives had been achieved and that they were satisfied with the quality of care provided. The main concern of the patients regarding the clinic was the waiting time before an appointment could be offered. Eating and breathing difficulties and low mood after surgery were the main reported complications. Sixty-three patients experienced post-operative weight loss. The importance of a nutritious, high calorie soft diet should be emphasised and the use of menthol inhalations following maxillary osteotomies should be considered more frequently. Clinicians should be aware of post-operative low mood, which may require psychological support. We developed a sensitive assessment battery with comprehensive parameters to audit quality of orthognathic surgery service, and recommend that a similar approach should be considered by teams which undertake management of orthognathic patients.
Assuntos
Clínicas Odontológicas/normas , Unidade Hospitalar de Odontologia/normas , Procedimentos Cirúrgicos Ortognáticos/normas , Equipe de Assistência ao Paciente/normas , Garantia da Qualidade dos Cuidados de Saúde , Administração por Inalação , Adulto , Afeto , Auditoria Odontológica , Ingestão de Alimentos/fisiologia , Feminino , Seguimentos , Humanos , Hipestesia/etiologia , Masculino , Maxila/cirurgia , Mentol/administração & dosagem , Descongestionantes Nasais/administração & dosagem , Procedimentos Cirúrgicos Ortognáticos/psicologia , Osteotomia/métodos , Satisfação do Paciente , Complicações Pós-Operatórias , Qualidade de Vida , Respiração , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Traumatismos do Nervo Trigêmeo/etiologia , Redução de PesoRESUMO
Hemangiopericytoma is a vascular tumor which comprises only 1% of all vascular tumors. The frequency of occurrence in the head and neck accounts for about 16-33% of all hemangiopericytomas. In this paper we discuss the surgical management, the difficulties in decision-making and treatment-planning in a case of a maxillary tumor in a five-year-old boy with a two-year follow-up. A five-year-old boy presented with a large unilateral maxillary tumor with nasal obstruction. Computed tomography revealed a heterogeneous mass completely occupying the right maxillary sinus and displacing the lateral wall of the nose and nasal septum. The lesion was diagnosed as hemangiopericytoma after histopathological confirmation. The option of surgical resection (total maxillectomy) was carried out after evaluating the available literature. Various treatment modalities like surgery, chemotherapy and radiotherapy were taken into consideration as the tumor has an aggressive nature. Due to the inadequate literature on definitive treatment options for these types of tumors, there was difficulty in arriving at a protocol-based treatment plan.
Assuntos
Protocolos Clínicos/normas , Técnicas de Apoio para a Decisão , Hemangiopericitoma/cirurgia , Neoplasias Maxilares/cirurgia , Planejamento de Assistência ao Paciente/normas , Pré-Escolar , Seguimentos , Hemangiopericitoma/patologia , Humanos , Masculino , Neoplasias Maxilares/patologia , Procedimentos Cirúrgicos Ortognáticos/normas , Resultado do TratamentoRESUMO
This is an overview of the present state of cleft lip and palate care in Nigeria. The aim is to stimulate further discussions on the need to improve standard of care and quality of life in patients with cleft lip and palate deformities. The number of cleft surgeries and surgeons involved in cleft repairs across Nigeria is increasing due to availability of free treatment grants provided by non-governmental organisation; therefore, it has become imperative to assess the quality of surgery and quality of cleft care. It is expected that as the number of repaired cleft lip/palate increases, more patients will require secondary repair, speech therapy, and orthodontics therapy and orthognathic surgery. The following recommendations are made to improve the standard of cleft care in Nigeria: establishment of multidisciplinary team approach, formulation of policy on quality control, establishment of fellowship training in cleft care and establishment of regional specialised cleft care centre.
Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Equipe de Assistência ao Paciente , Qualidade da Assistência à Saúde , Humanos , Nigéria , Procedimentos Cirúrgicos Ortognáticos/normas , Procedimentos Cirúrgicos Ortognáticos/tendênciasRESUMO
Oral and maxillofacial surgeons who perform orthognathic surgery face major changes in their practices, and these challenges will increase in the near future, because the extraordinary advances in technology applied to our profession are not only amazing but are becoming the standard of care as they promote improved outcomes for our patients. Orthognathic surgery is one of the favorite areas of practicing within the scope of practice of an oral and maxillofacial surgeon. Our own practice in orthognathic surgery has completed over 1,000 surgeries of this type. Success is directly related to the consistency and capability of the surgical-orthodontic team to achieve predictable, stable results, and our hypothesis is that a successful result is directly related to the way we take our records and perform diagnosis and treatment planning following basic general principles. Now that we have the opportunity to plan and treat 3-dimensional (3D) problems with 3D technology, we should enter into this new era with appropriate standards to ensure better results, instead of simply enjoying these new tools, which will clearly show not only us but everyone what we do when we perform orthognathic surgery. Appropriate principles need to be taken into account when implementing this new technology. In other words, new technology is welcome, but we do not have to reinvent the wheel. The purpose of this article is to review the current protocol that we use for orthognathic surgery and compare it with published protocols that incorporate new 3D and virtual technology. This report also describes our approach to this new technology.
Assuntos
Cefalometria/métodos , Protocolos Clínicos , Imageamento Tridimensional/métodos , Anormalidades Maxilofaciais/diagnóstico por imagem , Modelos Anatômicos , Procedimentos Cirúrgicos Ortognáticos/métodos , Cirurgia Assistida por Computador/métodos , Relação Central , Cefalometria/instrumentação , Tomografia Computadorizada de Feixe Cônico , Articuladores Dentários , Humanos , Registro da Relação Maxilomandibular , Anormalidades Maxilofaciais/cirurgia , Procedimentos Cirúrgicos Ortognáticos/normas , Planejamento de Assistência ao Paciente , Padrão de Cuidado , Articulação Temporomandibular/diagnóstico por imagem , Interface Usuário-ComputadorRESUMO
The Peer Assessment Rating (PAR) index is commonly used to evaluate occlusal outcomes after orthodontic treatment. We compared the PAR outcomes of 40 consecutively treated orthodontic patients and 40 orthognathic patients to evaluate the standard of care given. A patient-centred questionnaire was used to examine patients' perceptions of the benefits of orthognathic treatment. PAR scores of orthodontic and orthognathic patients improved by a mean of 77% and 74%, respectively, after treatment indicating that excellent to good occlusal results were achieved for both groups. A high quality occlusal outcome is important for all patients as good intercuspation at the end of treatment is thought to improve stability. Most orthognathic patients reported improvements in their dental and facial appearance and thought that the treatment had been beneficial.
Assuntos
Má Oclusão/terapia , Anormalidades Maxilofaciais/cirurgia , Ortodontia Corretiva/normas , Procedimentos Cirúrgicos Ortognáticos/normas , Revisão dos Cuidados de Saúde por Pares , Cuidado Periódico , Humanos , Satisfação do Paciente , Estudos Prospectivos , Reprodutibilidade dos Testes , Padrão de Cuidado , Odontologia Estatal , Inquéritos e Questionários , Resultado do Tratamento , Reino UnidoRESUMO
This retrospective, observational study investigated whether published studies on the use of piezoelectric surgery (PS) in the oral and craniomaxillofacial region fulfilled the requirements of the International Committee of Medical Journal Editors (ICMJE) and the Declaration of Helsinki (DoH) with respect to human subject protections (HSP) and disclosure of financial conflicts (FC). A Medline/PUBMED search was performed in April 2008 to identify all clinical studies on PS, published in English, French and German. Disclosure of HSP (obtaining ethical approval and subjects' informed consent) and FC mentioned in the retrieved articles were analysed. 29 clinical articles were identified in 18 journals, of which 14 journals (78%) required the disclosure of both HSP and FC. Ethical approval was documented in two studies (7%); patient consent was reported in four publications (14%). Four articles disclosed no FC. 21 reports (72%) mentioned neither HSP nor FC. The relationships between funding source and study outcomes could not be identified. Most studies on the use of PS hardly adhered to the regulations recommended by the ICMJE and DoH, and do not mention HSP and FC, indicating the study results with a high degree of suspicion. It is recommended that oral and craniomaxillofacial surgery journals adhere strictly to these regulations because they carry a heavy responsibility regarding the scientific integrity of publications in this specialty.