Effect of Orthognathic Surgery on Pre-existing Temporomandibular Disorders.

The management of patients with pre-existing temporomandibular disorders (TMDs) undergoing orthognathic surgery remains a subject of ongoing debate. This study aimed to profile these individuals and evaluate the correlation between orthognathic surgery and alterations in TMD indicators and symptoms. We conducted a retrospective cohort investigation involving patients with skeletal malocclusion and established TMDs. Variables of interest encompassed the performance of orthognathic surgery, documented TMDs (including temporomandibular joint (TMJ) sounds, TMJ pain, muscle discomfort, and jaw locking), and patients' self-assessments of TMJ and muscle pain using a visual analog scale (VAS). The primary outcome measures focused on changes in TMD indicators and symptoms. Among the study cohort, 73.4% exhibited skeletal class III malocclusion, while 26.6% presented with skeletal class II malocclusion. Notably, patients classified as skeletal class III were significantly younger than their skeletal class II counterparts (mean age: 23.06±5.37 vs. 26.71±7.33; P=0.034). The most prevalent pre-existing TMD complaint was TMJ sounds (65.5%), followed by TMJ pain (39.1%), muscle discomfort (23.4%), and jaw locking (12.5%). Skeletal class II patients were more likely to experience TMJ sounds compared to skeletal class III patients (88.2% vs. 57.4%; P=0.022). Statistically significant improvements were observed in the VAS assessments among class III patients following surgery. A majority of patients with pre-existing TMDs seeking orthognathic surgery exhibited skeletal class III malocclusion and were younger than those with skeletal class II malocclusion. Importantly, orthognathic surgery was associated with positive changes in TMD indicators and symptoms in these patients.

Facial Asymmetry Caused by Mandibular Condylar Hyperplasia: A Two Center Study.

BACKGROUND: Condylar hyperplasia is a non-neoplastic overgrowth of the mandibular condyle. The disorder is progressive and causes gradual jaw deviation, facial asymmetry, and dental malocclusion. The only treatment capable of stopping hyperplastic growth is surgical condylectomy to remove the upper portion of the condyle containing the deranged growth center. When this procedure is conducted in proportion to the length of the healthy side it may also correct the jaw deviation and facial asymmetry. OBJECTIVES: To assess the degree to which condylectomy corrects the asymmetry and to determine the proportion of patients after condylectomy who were satisfied with the esthetic result and did not desire further corrective surgery. METHODS: We conducted a retrospective analysis of medical records of patients who underwent condylectomy that was not followed by corrective orthognathic surgery for at least 1 year to determine the degree of correction of chin deviation and lip cant. Patient satisfaction from treatment or desire and undergo further corrective surgery was reported. RESULTS: Chin deviation decreased after condylectomy from a mean of 4.8° to a mean of 1.8° (P < 0.001). Lip cant decreased after condylectomy from a mean of 3.5° to a mean of 1.5° (P < 0.001). Most patients (72%) were satisfied with the results and did not consider further corrective orthognathic surgery. CONCLUSIONS: Proportional condylectomy could be a viable treatment to both arrest the condylar overgrowth and achieve some correction of the facial asymmetry.

Increased Prevalence of Generalized Joint Hypermobility Observed in Patients With Recurrent Temporomandibular Joint Dislocation.

BACKGROUND: Generalized joint hypermobility (GJH), determined by the Beighton score, is a fundamental part of diagnosing benign joint hypermobility syndrome (BJHS), which may also present extra-articular manifestations, and is determined by the Brighton criteria. PURPOSE: This study was designed to investigate whether there is an association between recurrent temporomandibular joint (TMJ) dislocation and these disorders. STUDY DESIGN, SETTING, AND SAMPLE: A retrospective cross-sectional study was conducted. Hospital-based patients with a history of recurrent TMJ dislocation were compared to population-based patients that did not experience TMJ dislocations or any other TMJ disorders. Age and sex matching were performed between the study groups. All subjects reached the age of skeletal maturity. PREDICTOR VARIABLE: A history of recurrent TMJ dislocations. MAIN OUTCOME VARIABLES: Measurements of Beighton score (range from 0 to 9 with a score of ≥ 4 indicating GJH) and correspondence to the Brighton criteria (with at least two "major" criteria or one "major" criterion plus two "minor" criteria or four "minor" criteria indicating BJHS). COVARIATES: Included age and sex. ANALYSES: Mann-Whitney U-test for continuous variables and the χ2 test or Fisher's exact test for categorical variables. Statistical significance was set at P < .05. RESULTS: A total of 68 participants were included, of whom 34 patients presented with recurrent TMJ dislocations compared with a control population of 34. The Mean participants were 31.35 ± 8.06 years, and 29.4% (n = 20) were males. Of the dislocation group, 16 (47.0%) patients had a Beighton score of 4 or higher. The Beighton sum score was significantly higher, with a TMJ dislocation group mean score of 3.06 ± 2.8, compared with a control score of 0.82 ± 1.1 (P = .001). A total of 58.8% (n = 20) of the TMJ dislocation group participants met the Brighton criteria versus none (0.0%) of the control group (P = .001). CONCLUSION: We found an association between recurrent TMJ dislocation and GJH. An association with BJHS was also found, based mainly on articular manifestations. Early detection of these disorders in patients suffering from recurrent TMJ dislocation may help identify individuals at increased risk for joint instabilities and allow the implementation of appropriate preventive management strategies.

"Proportional Condylectomy" for Vertical Condylar Hyperplasia Without Intermaxillary Elastics: Clinical Results and Patient Satisfaction.

OBJECTIVES: First, to investigate the clinical outcome of 'proportional condylectomy' for patients with active unilateral condylar hyperplasia without complementary treatment by intermaxillary elastics and, second, to examine their level of satisfaction regarding function and esthetics. STUDY DESIGN: A retrospective observational descriptive study was conducted. All patients included in the study suffered from active unilateral condylar hyperplasia with a vertical component. The length of the condylar-ramus unit was measured on both sides by an multidetector computed tomography scan. The difference was calculated and resected from the hyperplastic condyle during the operation. Facial, occlusal, and skeletal changes were evaluated using photographic and radiologic records, and a satisfaction questionnaire regarding function and esthetics was completed. P <0.05 was considered significant. RESULTS: Fifteen patients were included in the study. The mean participants' age was 27.93±13.06 years, and the mean follow-up duration was 12.40±6.55 months. The mean chin deviation improved by 58.47% ( P =0.001). Mean lip commissure plane tilt was improved by 61.31% ( P =0.001). Six months postoperatively, all patients exhibited centered dental midlines ( P =0.001). Occlusal plane tilt was significantly improved by 70.02% ( P =0.001), and high patient satisfaction was recorded. Twenty-six percent (4/15) of patients did not require the complementary orthodontic treatment, and none of them required complementary orthognathic surgery. CONCLUSIONS: 'Proportional condylectomy' for patients with active unilateral vertical condylar hyperplasia without complementary treatment by intermaxillary elastics is a predictable procedure in terms of function and esthetics.

Are There Cephalometric Measurements Associated With Recurrent Temporomandibular Joint Dislocation?

PURPOSE: Several theories have been proposed for the etiology of recurrent temporomandibular joint (TMJ) dislocation. The purpose of the present study was to determine whether there are cephalometric measurements associated with this phenomenon. METHODS: A retrospective case-control study was performed, which included individuals who suffered from recurrent TMJ dislocation and a control group composed of patients who suffered from unrelated odontogenic infections and did not have any TMJ disorder. All the patients were referred to the Department of Oral and Maxillofacial Surgery at the Hadassah Medical Center between 2010 and 2021 and underwent multidetector computed tomography of the jaws. The main predictor variable was a history of recurrent TMJ dislocations. Covariates included age and gender. The primary outcome variable was a set of 11 cephalometric measurements. A statistical analysis was performed with the Mann-Whitney U-test for continuous variables and the Chi-squared test or Fisher's exact test for categorical variables, followed by a logistic regression model. Multiple comparisons were made by using the Benjamini-Hochberg method. RESULTS: The total 32 subjects included in the analysis consisted of 16 patients presenting with bilateral recurrent TMJ dislocation and a control population of 16 patients. The mean age was 34.19 ± 12.7 years, 40.6% (n = 13) were males, with no statistically significant differences between the groups. An increased overbite was detected in the TMJ dislocation group, whereas over-jet was greater among the control group, although not statistically significant. Skeletal ratio analysis showed that the TMJ dislocation group had a statistically significantly greater Articulare-Gonion length (46.96 mm ± 5.2 mm vs 43.01 mm ± 5.3 mm; P = .043) and a lower angle of occlusal plane to Frankfort horizontal (4.56o ± 5.7o vs 9.60o ± 3.9o; P = .007), Y-axis (58.01o ± 4.9o vs 61.72o ± 3.3o; P = .019), and Frankfurt mandibular plane (24.10o ± 6.1o vs 30.14o ± 4.7o; P = .004). CONCLUSIONS: Specific cephalometric measurements are associated with recurrent TMJ dislocation. The high Articulare-Gonion length and the low rates of occlusal plane to Frankfort horizontal angle, Y-axis, and Frankfurt mandibular plane found in the study population suggest that the resultant vertically oriented elevator muscles may be considered a predisposing factor for this phenomenon.

The efficacy of a protective protocol for oral and maxillofacial surgery procedures in a COVID-19 pandemic area-results from 1471 patients.

OBJECTIVE: To examine the effectiveness of an empiric protection protocol during oral surgical treatments in a COVID-19 pandemic area and to evaluate the potential effect of postponed dental procedures on the frequency of facial infections during a lockdown period. METHODS: We performed a retrospective analysis of a case series of a broad-spectrum of oral surgeries in a COVID-19 pandemic area. Data collection included patient age, type of procedure performed, and COVID-19 status of staff and patients. Data were analyzed using descriptive statistics. RESULTS: Between February 21 and April 23, 2020, 1471 patients were treated in the outpatient clinic (n=1404) and under general anesthesia (n=67). All procedures were carried out under a strict empiric protective protocol that included patient screening, personal protective equipment allocation protocol, frequent staff testing, and patient testing before general anesthesia. Treatments included emergency and urgent elective procedures. Only one staff member was confirmed positive for COVID-19 during routine weekly testing, and an independent epidemiologic investigation suggested he was likely infected outside of hospital facilities. CONCLUSIONS: Our empiric protective protocol was found to be effective in preventing staff cross-infection with COVID-19 in an oral and maxillofacial surgery setting. CLINICAL RELEVANCE: To the best of our knowledge, this is the first report that provides data regarding oral surgical activity in a COVID-19 pandemic area. Our suggested protective protocol may assist oral surgeons in continuing dental services in a safe manner.

Short Dental Implants (5 to 7 mm) with Expandable Apex in the Posterior Maxilla-Preliminary Results.

PURPOSE: The purpose of this study was to examine whether the use of short dental implants with an expandable compressive design could be a proper alternative to the conventional sinus elevation procedure in cases of deficient alveolar ridge height in the posterior maxillary area. MATERIALS AND METHODS: Fifty patients with 73 short dental implants with an expandable compressive design who were treated for posterior maxillary alveolar ridges of 5 to 7 mm in the vertical dimension between 2012 and 2018 were included in a retrospective study. All patients had a minimum postrehabilitation period of 1 year. Patient demographics, implant properties, primary stability, and implant success and survival rates were analyzed. RESULTS: The total success rate was 97.2%, with two failed implants at implant uncovering. The mean bone loss was 1.03 mm. No difference in bone loss was found between sexes or age groups. CONCLUSION: The results of this study suggest that short dental implants with an expandable apical compressive design could be an alternative to sinus elevation procedures in selected cases of vertically deficient maxillary alveolar ridges.

Vertical Alveolar Augmentation Using BMP-2/ACS/Allograft with Printed Titanium Shells to Establish an Early Vascular Scaffold.

Traditional reconstruction of major alveolar ridge deficiency has required autogenous cortical cancellous particulate bone grafts, often augmented with particulate allogeneic components. Now there is a new concept to consider, that of orthoalveolar form. This paradigm shift involves components of the tissue engineering triad of inductive growth factors combined with a matrix and stem cells, together with osteotomies or devices designed for space maintenance. Reported here is early experience with computer technology used to redesign deficient alveolar ridges deriving ideal alveolar-shaped bone-forms made from powdered titanium, sintered by laser at high temperature using rapid prototype technology.

Computerized Navigation for Minimal Invasive Retrieval of Displaced Dental Implants in the Lower Jaw.

Displaced dental implants in the mandible may constitute a clinical challenge for both physicians and patients. The complex anatomy of the floor of the mouth, together with its subsequent violation due to implant displacement makes implant allocation and retrieval a challenging procedure. Computerized navigation surgery (CNS) has been previously described and proved successful in various surgical modalities. In this article, the authors present a recommended protocol for the use of CNS for the retrieval of displaced dental implants in the mandible and describe the workflow through the stages of diagnosis, preoperative surgical planning, and the surgical procedure.

Removal of dental implants displaced into the maxillary sinus: A case series.

PURPOSE: To present a retrospective case series of displaced dental implants in the maxillary sinus. MATERIALS AND METHODS: Patients with unintentional displacement of dental implants in the maxillary sinus over a 5-year period who underwent or were candidates for surgical implant removal were included. The patients' characteristics, medical history, clinical and imaging results, and post-removal outcome were retrospectively assessed. RESULTS: Out of 14 patients, 13 underwent surgical removal. In one case the implant spontaneously exiled into the nose before surgery. The timespan between dental implantation and presentation ranged from 3 months to 9 years. Imaging evaluation showed a displaced implant (100%), oroantral fistula (65%), complete opacification of the maxillary sinus (28%), circumferential opacification (21%), isolated maxillary sinus outflow obstruction (7%) and a sinus which appeared normal (43%). Symptoms and signs included nasal obstruction (36%), purulent secretions (36%), facial pain (21%), tenderness on percussion (21%) and foul smell (14%). Two patients (14%) were asymptomatic. Intraoperative inspection of nine sinuses revealed mucosal changes and purulent secretions in 55% of patients. In all cases the implant had migrated from the maxillary sinus floor towards the natural ostium. Endoscopic removal was carried out successfully in all operated cases. All sinuses eventually healed. CONCLUSIONS: Migration of displaced implants and mucosal changes may occur over a short period, eventually causing secondary sinusitis. We therefore favour surgical removal. Surgery should be as close as possible to displacement in order to minimise mucosal inflammation and to prevent unnecessary manipulation during surgical removal. Conflict of interest statement: None of the authors report any financial interests or potential conflict of interests.

Necrotizing sialometaplasia related to vomiting and silastic ring vertical gastroplasty.

Necrotizing sialometaplasia (NS) is a self-limiting, ulcerated, benign process, affecting minor salivary glands most commonly in the palate. The comorbidity of eating disorders with NS is rare. We present a patient with bilateral NS who suffered from frequent episodes of vomiting. Review of the literature revealed a handful of such cases. The possible role of vomiting in the pathogenesis of NS is argued.

Topical application of slow-release simvastatin as a bone substitute in bone defects in the rat tibia: a pilot study.

PURPOSE: It is hypothesized that local application of statins positively affects bone formation. The aim of this study was to evaluate the potential effect of topical slow-release simvastatin as a bone substitute on the healing of bone defects in rat tibia. MATERIALS AND METHODS: Granules of slow-releasing hydroxypropyl methylcellulose, with or without simvastatin, were inserted into critical-size defects in the tibiae of 16 rats (8 in the study group, 8 in the control group). Bone static and dynamic histomorphometric variables were examined at 2, 4, 6, and 8 weeks postsurgery. RESULTS: All indices examined in the study group indicated improved healing relative to the control group, although statistical significance was not demonstrated for all variables. In the static histomorphometric analysis, osteoid thickness and volume were significantly higher in the study group, but the fraction of trabecular surface covered with active osteoblasts, the fraction of trabecular surface covered with osteoid, and total calcified bone volume were not significantly higher in the experimental group. In the dynamic histomorphometric analysis, the mineral apposition rate, determined by time-repeated calcein labeling, was significantly higher in the study group than in the control group. Experimental time and dosage effects were observed for most bone values in the study group. CONCLUSION: The findings indicate that topical application of simvastatin for the treatment of bone defects enhances the process of healing. Dosage and the methodology of administration require further calibration.