Can Condylectomy Alone Achieve Facial Symmetry in Patients With Hemimandibular Hyperplasia (Condylar Hyperplasia Type 2)?

The purpose of the present study was to evaluate the 3-dimensional orofacial changes occurring after proportional condylectomy in patients with unilateral condylar hyperplasia type 2 (hemimandibular hyperplasia). Eight patients underwent proportional condylectomy that was not followed by orthognathic surgery or orthodontic treatment for at least 1 year. The precondylectomy and postcondylectomy photographs and radiographs were analyzed cephalometrically and compared. The average length of the condylar segment removed was 13 mm and this resulted in almost equal heights of the ramus-condyle units of both sides. Evaluations in the vertical plane improved after surgery; however, when the preoperative asymmetry was significant, the residual asymmetry continued to be notable after condylectomy. Transverse plane evaluations improved after condylectomy, and chin position was satisfactorily centralized in all patients. In the horizontal plane, mandibular setback occurred, and this was considered favorable when the preoperative skeletal profile was class III, whereas the opposite was when the patient was class I before surgery. The occlusion improved gradually over the postoperative months by the intrusion on the affected side and extrusion on the unaffected side into a bilaterally balanced posterior contacts with residual anterior open bite. In conclusion, condylar hyperplasia type 2 patients with mild asymmetry and low esthetic demands can benefit from proportional condylectomy as the sole treatment to both stop the hyperplastic condylar growth and improve the asymmetry to some extent. Surgeons should be able to predict the change that is expected to occur after proportional condylectomy and discuss this with the patient before surgery.

Computerized three-dimensional design for accurate orienting and dimensioning artificial dental socket for tooth autotransplantation.

OBJECTIVE: To present an improved, accurate, and efficient method for planning and preparing an artificial socket for autotransplantation, by using a three-dimensional (3D) surgical guide and a replica of the transplanted donor tooth. The guide and the tooth replica were fabricated using a computerized 3D simulation. A case treated with this approach is presented. METHOD AND MATERIALS: Cone beam computed tomography (CBCT) and computerized 3D simulations (Simplant plus registration as stereolithography) were used for planning the optimal artificial socket position and dimensions, within the limitations of the alveolar bone borders and the adjacent teeth roots, and for producing a metal replica of the transplanted tooth. The replica was used to assure the correct socket preparation and orientation before extraction and replantation of the donor premolar. RESULTS: The entire procedure time for autotransplantation of a permanent second premolar to the incisor site without the buccal plate was about 45 minutes. At 15 months' follow up, clinical examination of the transplanted tooth demonstrated both normal mobility and no sensitivity to cold stimulation. A radiographic examination revealed continuous root development and pulp obliteration. The adjacent teeth maintained their vitality with no pathologic signs. CONCLUSION: We present an improved technique for autotransplantation based on computerized 3D simulations and guidance for accurate dimensioning and optimal locating of the artificial socket relative to the alveolar bone borders and the adjacent teeth roots. This technique may significantly simplify the autotransplantation procedure and will probably also increase its success rate and use in young patients, even in cases with absence of a buccal plate.