Moving an ankylosed central incisor using orthodontics, surgery and distraction osteogenesis.

When a dentist replants an avulsed tooth, the repair process sometimes results in the cementum of the root and the alveolar bone fusing together, with the replanted tooth becoming ankylosed. When this occurs, the usual process of tooth movement with bone deposition and bone resorption at the periodontium cannot function. If dental ankylosis occurs in the maxillary incisor of a growing child, the ankylosed tooth also cannot move vertically with the subsequent vertical growth of the alveolar process. This results in the ankylosed tooth leaving the plane of occlusion and often becoming esthetically objectionable. This report describes a 12-year-old female with a central incisor that was replanted 5 years earlier, became ankylosed, and left the occlusal plane following subsequent normal vertical growth of the alveolar process. When growth was judged near completion, the tooth was moved back to the occlusal plane using a combination of orthodontics, surgical block osteotomy, and distraction osteogenesis to reposition the tooth at the proper vertical position in the arch. This approach had the advantage of bringing both the incisal edge and the gingival margin of the clinical crown to the proper height in the arch relative to their antimeres. Previous treatment procedures for ankylosed teeth have often involved the extraction of the affected tooth. When this is done, a vertical defect in the alveolar process results that often requires additional bone surgery to reconstruct the vertical height of the alveolar process. If the tooth is then replaced, the replacement tooth must reach from the final occlusal plane to the deficient ridge. This results in an excessively long clinical crown with a gingival height that does not match the adjacent teeth.

Lasers in oral and maxillofacial surgery.

Because of their many advantages, lasers have become indispensable in OMS as a modality for soft tissue surgery. Based on manufacturer estimates, approximately 10% to 20% of all oral and maxillofacial surgeons have one or more lasers in their offices, and most surgeons have access to lasers in the hospital. Lasers not only enhance the current surgical options for treatment, but also have expanded the scope of practice. There are many uses for lasers in OMS, and the advent of new wavelengths will undoubtedly lead to new procedures that can be performed with them. One [figure: see text] elusive use is hard tissue surgery. Although the Er:YAG has been approved for hard tissue use in the United States and currently is being used in general dentistry, it is still not yet practical or proven for large-volume osseous or extraction surgery, in which the greatest opportunity for innovation and clinical use exists. With future research, it is possible that the right wavelength laser will be developed for this purpose, allowing an increased base of procedures performed with lasers in OMS.

Genioplasty: a case for advancement osteotomy.

Despite personal preferences and training background that may influence the choice of which genioplasty technique to use, the osteoplastic technique has a better patient satisfaction rate (albeit slight), better soft tissue predictability, and less detrimental postoperative complications when compared with alloplastic augmentation of the chin. In addition, the osteoplastic technique is a more versatile procedure that can be used to correct any type of chin deformity and it has less of the limitations and contraindications associated with the alloplastic techniques.

Telemedicine consultations in oral and maxillofacial surgery.

PURPOSE: The purpose of this study was to evaluate the efficiency of telemedicine consultation for preoperative assessment of patients. PATIENTS AND METHODS: A retrospective study of 43 patients was done to evaluate the efficiency of telemedicine consultation in adequately assessing patients for dentoalveolar surgery with general anesthesia and nasotracheal intubation. Efficiency was defined as the ability to conduct surgery with general anesthesia at the immediately following clinic appointment without the need for further preoperative testing, evaluation, or consultation. Thirty-five of these patients were subsequently treated. RESULTS: Ninety-five percent (33) of patients were able to undergo surgery with general anesthesia at the immediate appointment, and 100% of patients were assessed correctly, using telemedicine consultation. Two of the patients were assessed as American Society of Anesthesiologists Class III during telemedicine consultation and required further evaluation before surgery could be scheduled. No surgical procedure was canceled, and there were no anesthetic complications attributable to inadequate preoperative assessment of patients during telemedicine consultation. CONCLUSIONS: This study confirms that telemedicine consultations are as reliable as those conducted by traditional methods. Because of the reorganization of health care and the ways it is financed, it may be more economical to move data from place to place than to move doctors from place to place. Telecommunication is an efficient and cost-effective mechanism to provide preoperative evaluation in situations in which patient transport is difficult or costly.

Comparison of morbidity of outpatient general anesthesia administered by the intravenous or inhalation route.

PURPOSE: This study compares the morbidity between subjects receiving general anesthesia either by an intravenous or inhalation route for the extraction of impacted third molars in an outpatient setting. PATIENTS AND MATERIALS: Forty ASA Class I subjects, 21 females and 19 males (age range, 17 to 43 years), who presented for the extraction of four impacted third molars, were studied. Subjects were alternately assigned to receive general anesthesia either by the intravenous route (group I) or the inhalation route via an endotracheal tube (group II). The parameters for comparison included psychomotor recovery, cardiovascular changes 20% above or below baseline, the frequency of nausea and vomiting perioperatively and at 48 hours, occurrence of laryngospasm and bronchospasm, the frequency of sore throat both perioperatively and at 48 hours, procedure time, and recovery time. The Trieger dot test was administered to patients at three different intervals to evaluate psychomotor recovery. All parameters were recorded for each subject and compared both within and between groups. RESULTS: There was no statistical difference found between groups I and II with regard to psychomotor recovery, the frequency of nausea and vomiting, bronchospasm, laryngospasm, or median recovery time (P < .05). However, there was greater variability in both elevation and depression of blood pressure from baseline in the intubated subjects (P < .05). These deviations were both expected and easily managed. The probability of sore throat was greater in the intubated subjects (P < .05) than the nonintubated subjects. Procedure time, although a weak association, was nonetheless found to be significantly greater for the intubated group than for the intravenous group (P < .05). SUMMARY: The results show greater cardiovascular variability, increased probability of sore throat, and slightly lengthened procedure time with the administration of general anesthesia by an inhalational route via an endotracheal intubation. However, there was no difference with regard to psychomotor recovery, recovery time, the probability of nausea and vomiting, or incidence of laryngospasm or bronchospasm.

Risk of preeclampsia in second-trimester triploid pregnancies.

OBJECTIVE: To determine the magnitude of the risk and the predictive clinical characteristics for development of preeclampsia when triploidy is diagnosed in the second trimester. METHODS: A retrospective analysis of databases maintained by the cytogenetics laboratories at the University of Iowa and University of North Carolina was performed to identify all cases of triploidy. We examined the karyotype, maternal serum screening (particularly the hCG level), ultrasound results, and evidence of maternal hypertensive disease. RESULTS: Seventeen cases of triploidy were identified between 1987 and 1996. Preeclampsia or hypertension complicated six of these cases with onset between 15 and 22.5 weeks' gestation. In these six cases, the serum hCG level was extremely high. Serum screening results were available in seven cases in which preeclampsia did not develop, and the hCG levels were under 0.09 multiples of the median in five of the seven cases. In all six cases in which preeclampsia or hypertension developed, there was sonographic evidence of placentomegaly. Sonographic findings in 16 of 17 cases revealed fetal growth restriction, oligohydramnios, fetal anomalies, placentomegaly, or a combination of these. CONCLUSION: In our series of pregnancies complicated by triploidy, the risk of developing preeclampsia or hypertension in the second trimester was 35%. It appears that elevated serum hCG levels and placentomegaly are associated with a higher risk of preeclampsia but low hCG levels are not. This information is important in counseling patients who are hesitant to terminate a pregnancy purely for a fetal abnormality, even if the anomaly is lethal.

Variability of facial photographs for use in treatment planning for orthodontics and orthognathic surgery.

Facial photographs are commonly used preoperatively for recording and analyzing skeletofacial and dentofacial deformities prior to orthodontics and/or orthognathic surgery. This study was undertaken to determine the reproducibility of facial photographs over time in any individual patient. Twenty subjects had full-facial frontal and lateral, frontal smile, and lip-to-tooth length (incisor show at rest) photographs taken on 5 different days over a 7- to 14-day period. A total of 18 linear and angular measurements were made on each set of photographs. Standard errors of the 18 measurements over time were generally moderate but varied widely, suggesting that facial photographs have the potential to provide reliable diagnostic information in some cases. In any individual patient, however, there were some variations within measurements that were clinically unacceptable. Measurements made from pictures of the smile were significantly less reliable than those taken at rest, and measurements of vertical head posture and lower lip length were found to be the least reliable. This study suggests that some measurements from facial photographs are generally reproducible over time, but significant individual variations do occur.

Augmentation of the anterior temporal fossa after temporalis muscle transfer.

Pedicled transfer of the temporalis muscle has proven to be a reliable and versatile procedure in reconstructive craniomaxillofacial surgery. Excluding those complications related to the coronal incision, little specific attention has been given in the literature to the prevention or treatment of the esthetic defect that remains after muscle transfer. This article describes a case in which block porous high-density polyethylene was used to eliminate the residual defect of the anterior temporal fossa after transmaxillary pedicled transfer for closure of a large oral-antral communication. The implant provided an esthetically pleasing augmentation of the defect. A discussion and analysis of the implant materials available for reconstruction of this region is also presented.

Tantalum implants as markers for evaluating postoperative orthognathic surgical changes.

The stability of sagittal split osteotomy advancements is not always 100% predictable. Assessment of postsurgical changes has historically relied on clinical evaluation of dental changes and superimposition of serial cephalograms, both of which have been shown to have serious drawbacks. A technique that improves the analysis of postsurgical changes is described in this paper; tantalum pin implants are placed in the osteotomized segments of patients undergoing surgical advancements. Implants eliminate many of the problems (orthodontic, growth, and remodeling changes) related to superimposition of presurgical and postsurgical cephalograms. Using this technique, surgical changes can be precisely analyzed, and the contribution of each factor of postsurgical relapse can be determined. This information, concerning the magnitude and direction of postsurgical changes, aids in following an individual's progress and increases the accuracy of large group studies by eliminating sources of variability in radiographic and clinical interpretation.

Effect of a resorbable bone graft material on orthodontic tooth movement through surgical defects in the cat mandible.

beta-Tricalcium phosphate ceramic, a resorbable synthetic bone material, was implanted into surgically created alveolar defects mesial to the mandibular first premolars of 12 adult male cats. Similar defects on the contralateral side were allowed to heal naturally. Six weeks later, nickel-titanium coiled springs were ligated between the mandibular canine and first premolar on both sides and activated to deliver 100 g of force. The distance between the canine and first premolar was measured with dial calipers at 0, 3, 6, and 9 weeks after appliance placement. Regression analysis of amount of tooth movement between the two teeth showed no significant difference between grafted and control sides. This suggests that placement of a resorbable synthetic bone material may have useful applications in situations where loss of alveolar width following extractions may compromise orthodontic tooth movement.

Biotechnical and other factors affecting orthognathic surgery.

Orthognathic surgery is a rapidly growing biotechnologic interaction involving alterations of facial form and dental occlusion. This article describes some of the important and complex psychological, sociological, ethical, and public policy issues involved. Advances in the latter issues are necessary for advancement of the field.

The association of mucocutaneous lichen planus and chronic liver disease.

A possible association between mucocutaneous lichen planus and chronic liver disease has been previously postulated in the medical literature. Despite the frequency with which lichen planus occurs in the oral cavity, little mention of such a relationship has been made in the dental literature. A case of lichen planus occurring in a patient with primary biliary cirrhosis and a review of the subject are therefore presented.

Hyperbaric oxygen in the treatment of osteoradionecrosis: a review of its use and efficacy.

Hyperbaric oxygen (HBO) therapy is an established technology that is proving to be effective in the treatment of osteoradionecrosis. However, the studies that have shown this treatment modality to be effective have not established the optimum pressures, times of exposure, and frequency and number of treatment necessary for healing. In addition, most of the studies used HBO as an adjunctive treatment in the management of refractory osteoradionecrosis. The efficacy of HBO as a primary treatment modality has not as yet been established. Strictly controlled clinical trials are necessary for identification of patients who are likely to respond to HBO without aggressive surgery, to delineate a timetable for treatment of patients with HBO, and to coordinate surgery with HBO to resolve osteoradionecrosis when a significant amount of bone loss is involved.

Acute cytoreduction techniques in the early treatment of hyperleukocytosis associated with childhood hematologic malignancies.

Early and effective cytoreduction for high peripheral white blood cell counts in pediatric patients with acute leukemia may be helpful in preventing complications secondary to hyperviscosity. It also may be a useful adjunct to systemic chemotherapy. As an alternative to automated apheresis for this purpose, manual exchange transfusion is efficacious and does not require hemapheresis instrumentation and disposables and the related special staff. Two patients, a neonate with acute myeloblastic leukemia and a white blood cell count of 422.2 k/microliter as well as a 2 1/2-year-old with an admission diagnosis of acute promyelocytic leukemia and a white blood cell count of 617.4 k/microliter, underwent manual exchange hemotherapy for acute cytoreduction. The procedures were tolerated well, and significant leukocyte removal was achieved, with the respective leukocyte reductions being 81.1 and 68.7%. The techniques available for pediatric cytoreduction are compared, with emphasis on their efficiency and safety and appropriateness for very small children.

Anaphylactic transfusion reaction associated with a possible anti-A2m(1).

A 42-year-old leukaemic black male developed shortness of breath, itching, hot flushes, substernal pain, marked hypotension, and cardiorespiratory arrest after the infusion of 50 ml of pooled platelet concentrates. The patient had had one previous and uneventful red blood cell transfusion. Serologic studies of this patient's post-transfusion serum showed the presence of an antibody against one denatured IgA2 protein with the phenotype A2m(1 + 2-). All of the platelet donors were A2m(1) positive. The patient was successfully transfused with platelets from donors with the phenotype A2m(1 - 2+). Although 35.8% of Blacks and 30.0% of Chinese are A2m(1) negative, this is the first reported transfusion reaction associated solely with the occurrence of a possible anti-A2m(1) in an individual of the type A2m(1 - 2+).