Dental Implants Can Facilitate Orthognathic Surgery in a Patient With Severe Maxillary Atrophy.

The surgical treatment of dentofacial deformities is performed routinely and predictably in dentate patients. However, when dealing with the edentulous maxilla, treatment becomes more challenging and less predictable. In these cases, the combination of orthognathic surgery and osseointegrated implants could be a viable alternative to enable fixed rehabilitation. A patient with an edentulous and atrophic maxilla with maxillomandibular discrepancy and high esthetic requirement was treated with a combination of osseointegrated implants and orthognathic surgery. The rehabilitative sequence was composed of maxillary grafting procedures, installation of dental implants, placement of a fixed implant-supported prosthesis, and bimaxillary orthognathic surgery. During provisional restoration before orthognathic surgery, smaller teeth were used, allowing achievement of appropriate tooth length for the final restoration, even after natural and expected postoperative relapse. This restorative approach provided an implant-supported fixed prosthesis without prosthetic compensation and with optimum esthetics and biomechanics.

Incidence of osteonecrosis of the jaw among users of bisphosphonates with selected cancers or osteoporosis.

PURPOSE: To quantify the incidence of osteonecrosis of the jaw (ONJ) by bisphosphonate exposure among two cohorts of patients. METHODS: In a retrospective cohort study, we identified cohort members via health insurance claim diagnosis codes and identified potential cases of ONJ that were confirmed with medical record review. One cohort included patients aged ≥40 years with breast or prostate cancer or multiple myeloma; the other cohort included men aged ≥60 years and women ≥50 years with osteoporosis. For each cohort, we calculated sex- and age-standardized incidence of ONJ by exposure to oral bisphosphonates and intravenous bisphosphonates. RESULTS: In the cancer cohort (n = 46 542), sex- and age-standardized incidence of ONJ (n = 26 probable or possible cases) adjusted for abstraction proportion was 0.29 per 1000 person-years (95% confidence interval [CI], 0.07-0.52) among those unexposed to bisphosphonates and 5.3 (95%CI, 1.9-8.7) after intravenous bisphosphonate use. Controlling for covariates, the rate ratio for intravenous use versus no use was 8.8 (95%CI, 2.0-38). Patients with multiple myeloma had a rate 4.5 times that of patients with breast cancer. In the osteoporosis cohort (n = 31 244), sex- and age-standardized ONJ (n = 11 probable or possible cases) incidence was 0.26 per 1000 person-years (95%CI, 0.06-0.47) among those unexposed to bisphosphonate and 0.15 (95%CI, 0.00-0.36) after oral bisphosphonate use. CONCLUSION: Among patients with selected cancers, incidence of ONJ was higher among those with multiple myeloma and users of intravenous bisphosphonates.

Alternative bone expansion technique for implant placement in atrophic edentulous maxilla and mandible.

This clinical review is an evaluation of the effectiveness of the split ridge bone augmentation technique performed in the atrophic maxilla and mandible with buccolingual bony defects. The osseointegration success of implant placement in the area of split ridge bone augmentation is assessed and compared to implant success rates indicated in the literature. This evaluation includes 15 patients who were treated with alveolar split ridge bone augmentation at Tufts University School of Dental Medicine. During initial consultation, all patients were diagnosed with a buccolingual bone dimension of 3-5 mm on the edentulous alveolar crest. This bony buccolingual dimension was inadequate for placement of implants of desirable width and correct angulation as dictated by the prosthetic requirements. Crestal split augmentation technique involved a surgical osteotomy that was followed by alveolar crest split and augmentation after buccolingual bony plate expansion, prior to implantation. Implants were placed either immediately or 3 weeks after the initial augmentation. No fixation was used to stabilize the buccal bony cortex after the completion of the augmentation. All patients were placed on periodic follow-ups for a 24-month period postoperatively. Implant success was determined with the use of Buser's Criteria. In total, 33 implants were placed in 15 patients. The overall success rate of osseointegration of the endosseous implants placed in the area of split ridge bone augmentation was found to be 97%. One patient presented with facial bone resorption and implant mobility 4 months after the surgery. The implant was removed and the area was reconstructed with autogenous bone graft and later implanted with an endosseous implant. Our results indicate that the split crest bone augmentation technique is a valid reconstructive procedure that can be used to augment the buccolingual alveolar defect prior to implant placement providing good bone foundation for placement of implants with desirable width in favorable angulation. In comparison to traditional bone grafts techniques, crestal split ridge bone augmentation enables placement of dental implants immediately or 3 weeks after augmentation and eradicates the possible morbidity of the donor sites.

Effects of mandibular retropositioning, with or without maxillary advancement, on the oro-naso-pharyngeal airway and development of sleep-related breathing disorders.

PURPOSE: Literature suggests that patients without pre-existing sleep-related breathing disorders who undergo orthognathic surgery for treatment of facial asymmetry may experience changes in their oropharyngeal airway. Mandibular retropositioning can compromise the posterior airway space, alter the physiologic airflow through the upper airway, and predispose patients to development of obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: This study was a retrospective cohort analysis of 26 patients who underwent mandibular retropositioning with or without maxillary advancement within the past 5 years at Tufts University School of Dental Medicine. Pre- and postoperative lateral cephalometric radiographs were analyzed with digital DOLPHIN software (Dolphin Imaging, Chatsworth, CA) for evidence of changes to the posterior airway dimension. In addition, patients were evaluated postoperatively with SNAP polysomnography (model 4/6; SNAP Laboratories, Wheeling, IL) for evidence of OSAS. RESULTS: Results indicated that mandibular retropositioning greater than or equal to 5 mm decreased the posterior airway space below 11 mm (30.75%, P = .03) and showed evidence of soft palate elongation greater than 32 mm (15.39%, P = .037) in a significant number of patients. However, as determined by cephalometric analysis, mandibular retropositioning greater than or equal to 5 mm in combination with maxillary advancement had no significant effect on the posterior airway space or soft palate. CONCLUSION: Postoperative SNAP polysomnography showed higher incidence of mild to moderate OSAS in patients who underwent mandibular retropositioning greater than or equal to 5 mm (69.25%) compared with patients who underwent mandibular retropositioning in combination with maxillary advancement (38.46%, P = .039).

General manifestations of Behçet's syndrome and the success of CO2-laser as treatment for oral lesions: a review of the literature and case presentation.

This article reviews the oral manifestations of Behçet's Syndrome that have been discussed in the literature and presents the success of the use of CO2-laser for recurrent aphthous stomatitis (RAS). Behçet's Syndrome is a multisystem inflammatory disease that has the capacity to affect nearly every human system. It is characterized by a wide range of clinical features. In particular the defining symptom in most cases is recurrent aphthous stomatitis present in the oral cavity. RAS is the most common inflammatory ulcerative condition to affect the oral cavity and is characterized by localized, painful ulcers that may be a manifestation of more complicated diseases, such as Behçet's Syndrome. There is no effective treatment for RAS. In most cases, RAS is managed by anesthetic topical treatments, topical or systemic steroids, or antibiotics. More recently, though, there has been evidence of possible benefit from treatment of aphthous lesions with CO2-lasers. Our experience treating a patient who suffered from Behçet's Syndrome and RAS showed transient pain relief with the use of CO2 ablative laser as a monotherapy.

Update on Analgesic Medication for Adult and Pediatric Dental Patients.

This article is an update on pain management in the dental care setting for adult and pediatric patients. The 3 main categories of analgesic medications are examined: (1) opioids, (2) nonsteroidal antiinflammatory drugs (NSAIDs), and (3) nonopioid, non-NSAID medications. Pharmacology, side effects, patient selection, and treatment strategies and principles are examined. The information provided is aimed to facilitate the clinical perspective and update the oral health care clinician on providing safe and effective analgesia to adult and pediatric patients.