Skeletal stability in orthognathic surgery with the surgery first approach: a systematic review.

The surgery first approach (SFA) is a therapeutic strategy used in orthognathic surgery that is constantly evolving. With this approach, the pre-surgical orthodontic treatment can be eliminated, the maxilla and the mandible are surgically repositioned into the desired position, and the therapy is ended with a short orthodontic phase. Several studies have reported that the SFA is an acceptable approach, but postoperative stability is unclear. In this study, a systematic review on the SFA was performed. The PubMed, Google Scholar, Scopus, LexisNexis, Web of Science, and Cochrane Library databases were accessed. Studies from which data could be extracted on skeletal stability based on specific cephalometric points were included. The search yielded 2766 publications. Application of the selection criteria resulted in a final group of 14 articles. Five hundred and sixty patients with class III malocclusion underwent orthognathic surgery, 339 with the SFA. Study parameters such as evaluation time points and reference planes varied, making it impossible to perform a meta-analysis. The studies suggest that surgery with the SFA is as stable as surgery with the conventional approach. However, all articles described stability using a penultimate time point of 'after surgery' and not 'after debonding'; hence orthodontic movements and consequent mandibular movements could have influenced cephalometric measurements. Thus, to verify the real stability of the SFA, further research with longer follow-up periods is required, with evaluation at the same time points.

Risks in surgery-first orthognathic approach: complications of segmental osteotomies of the jaws. A systematic review.

OBJECTIVE: To date, no systematic review has been undertaken to identify the complications of segmental osteotomies. The aim of the present systematic review was to analyze the type and incidence of complications of segmental osteotomies, as well as the time of subjective and/or clinical onset of the intra- and post-operative problems. MATERIALS AND METHODS: A search was conducted in two electronic databases (MEDLINE - Pubmed database and Scopus) for articles published in English between 1 January 2000 and 30 August 2015; only human studies were selected. Case report studies were excluded. Two independent researchers selected the studies and extracted the data. Two studies were selected, four additional publications were recovered from the bibliography search of the selected articles, and one additional article was added through a manual search. RESULTS: The results of this systematic review demonstrate a relatively low rate of complications in segmental osteotomies, suggesting this surgical approach is safe and reliable in routine orthognathic surgery. CONCLUSIONS: Due to the small number of studies included in this systematic review, the rate of complication related to surgery first approach may be slightly higher than those associated with traditional orthognathic surgery, since the rate of complications of segmental osteotomies must be added to the complication rate of basal osteotomies. A surgery-first approach could be considered riskier than a traditional one, but further studies that include a greater number of subjects should be conducted to confirm these findings.

Evaluation of an oral appliance in patients with mild to moderate obstructive sleep apnea syndrome intolerant to continuous positive airway pressure use: Preliminary results.

Obstructive sleep apnea syndrome (OSAS) is a phenomenon of repeated, episodic reduction, or cessation of airflow (hypopnea/apnea) as a result of upper airways obstruction. First-line treatment in younger children is adenotonsillectomy, although other available treatment options in middle-aged adults include continuous positive airways pressure (CPAP) and airway adjuncts. Oral appliances (OA) are a viable treatment alternative in patients with OSAS.The objective of this study was to assess, in a 1-year follow-up study, an OA in OSAS patients. The participants were subjected to polysomnographic examination with a validated device (MicroMESAM). Eight participants were fitted with a Thornton Adjustable Positioner (TAP). The participants were asked to wear the test appliance for 7 nights, and in case of compliance, for 6 months. The selected patients record their usage of the appliance and any adverse effects in a treatment journal. The research focused on the following outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea index) and the effect of oral appliances on daytime function.In conclusion, the results suggest that OA have a definite role in the treatment of snoring and sleep apnea.

Qualitative and quantitative assessment of plaque bacteria in pediatric patients, patients undergoing orthodontic treatment, combined orthdontic-surgical treatment and implant-prosthetic rehabilitation.

AIM: The aim of this paper was to describe the qualitative and quantitative changes occurring within the oral bacterial flora of several groups of patients following oral prevention protocols during the stages of the dental treatment they required. METHODS: Three hundred patients were enrolled in the study. The selected patients were categorized into different groups to receive preventive strategies according to their needs and treatment required. Plaque samples from each patient were collected at different intervals according to the treatment they were undergoing. These were then assessed under a microscope to carry out a quantitative and qualitative assessment of the plaque. RESULTS: The Mean Plaque Index Score of most patients generally decreased during the various treatment phases and hence the overall bacterial count. However, we noticed a slight increase in the plaque index in patients undergoing orthodontic surgery after placement of the orthodontic appliance and patients undergoing combined orthodontic-surgical treatment during the intermaxillary fixation phase. We generally found that the coccoidal bacterial form was the most prevalent. CONCLUSION: Patients who were adequately instructed and motivated through oral hygiene prevention strategies, showed a significant decrease in the plaque levels and in the overall bacterial components between the first visit and the successive sample taking. Even though we noticed a slight increase in the plaque index in patients undergoing the intermaxillary fixation phase, this decreased immediately once the phase ended and the patients managed to return to the routine oral hygiene care. This highlights the importance of constant motivation and oral hygiene instruction reinforcement.

The use of silicon elastomer in maxillofacial rehabilitation as a substitute for or in conjunction with resins.

Maxillofacial prosthetic rehabilitation aims to restore anatomic function when serious tissue defects are present, as a result of congenital factors, trauma, or surgery. The aims are both aesthetic and functional, and results are obtained using devices that contain, reconstruct, and fill. This study introduces a technique using methods and materials that are acceptable to the patient in that they satisfy chewing, phonetic, and aesthetic functions, while respecting bone structure and restoring function to the soft tissues without causing trauma to them. Our techniques do not use innovative materials, but ones that are structurally different and that, until now, have not been connected with attachment systems. Acrylic resin, acetylic resin, and silicon are used, each in such a way as to take maximum advantage of each material's characteristics and thus give the best results.

Immunological patterns during regular intensive training in athletes: quantification and evaluation of a preventive pharmacological approach.

The effects of regular intensive exercise training on immune system homeostasis and the potential value of treatment with an immunostimulating agent were assessed in this randomized, double-blind, placebo-controlled, parallel-group study. A total of 60 athletes were studied over a 3-month period of regular intensive physical activity. After 1 and 3 months there were significant decreases in the immunoglobulin levels in the whole athlete population compared with baseline values. Specifically there were significant decreases in immunoglobulin M and immunoglobulin G (G1 and G2 subclasses). There was also a significant decrease in natural killer cells and a slight but significant increase in B and T lymphocytes. In the thymomodulin-treated group, unlike the placebo group, there was no significant decrease in the immunoglobulin G2 subclass and there was a significant increase in the T-helper cell subpopulation. The clinical relevance of these immunological findings should be evaluated in larger clinical and epidemiological studies.