Patients' perceptions of improvements after bilateral sagittal split osteotomy advancement surgery: 10 to 14 years of follow-up.

INTRODUCTION: The aims of this study were to determine reasons for orthodontic-surgical treatment, to quantify the perceptions of possible improvement 10 to 14 years after treatment, and to assess factors that affect treatment satisfaction and socio-dental impacts on quality of life. METHODS: The participation rate was 36 of 78 patients; their mean age was 45.7 years (SD, 10.7 years; range, 29-62 years). The presurgical anatomic occlusions were measured on dental casts. Visual analog scales allowed the participants to rate their perceived treatment outcome on 7 oral health-related items. A 3-point scale rated satisfaction with orthodontic-surgical treatment. The oral impact of daily performances index was included to assess socio-dental impacts on quality of life. RESULTS: Most responders reported improvements on the 7 items. The most significant change was reported for chewing. "Very satisfied" with the treatment was reported by 13 responders; 19 of 36 persons were "reasonably satisfied." Reporting "very satisfied with treatment" was 8 times more likely when peers had noticed a changed in the participant's appearance after surgery. Sex was significantly associated with quality of life. CONCLUSIONS: The most frequently reported reason for treatment was to improve chewing, and the item that showed the most pronounced improvement was also chewing. Most responders were only reasonably satisfied with the treatment. Whether peers noticed a change in appearance after treatment was a significant factor affecting both treatment satisfaction and reporting a good quality of life.

Long-term follow-up of mandibular condylar fractures in children.

PURPOSE: The aim of this prospective study was to evaluate the long-term clinical and radiographic outcomes of nonsurgically treated mandibular condylar fractures in children. MATERIALS AND METHODS: This study includes 42 children (23 girls and 19 boys) with 54 mandibular condylar fractures. All patients were younger than 18 years at the time of injury and were followed for at least 2 years (mean follow-up 4 years). Treatment was either observation or intermaxillary fixation (rigid and/or guiding elastics). Clinical outcome was categorized as favorable or unfavorable. Condylar remodeling was defined as complete, moderate, or poor on the basis of radiographic findings. RESULTS: Thirty-one patients (74%) presented with favorable and 11 (26%) with unfavorable clinical long-term outcome. Unilateral fractures showed a statistically significant increase of unfavorable clinical outcomes compared with bilateral fractures (P = .018). The radiologic examinations showed complete remodeling in 47 (87%), moderate remodeling in 5 (9%), and poor remodeling in 2 (4%) of the condylar fractures. One patient developed condylar overgrowth. No statistically significant relationship between clinical and radiologic outcome was found. Thirty-five patients (83%) had no subjective symptoms, and 41 (98%) described normal chewing function at the last follow-up examination. CONCLUSIONS: Nonsurgical treatment of mandibular condylar fractures leads to acceptable remodeling of the condylar process, good clinical long-term outcome, and minimal subjective symptoms in most children. Unilateral fractures significantly increase the risk for unfavorable clinical outcome.

Dental or skeletal relapse after sagittal split osteotomy advancement surgery? Long-term follow-up.

PURPOSE: To evaluate the short- and long-term stability of mandibular advancement surgery with sagittal split osteotomy (SSO), and to investigate when relapse occurs and identify variables contributing to relapse. PATIENTS AND METHODS: Thirty-six patients with Class II anomalies were included; the mean age at surgery was 33.0 years. All underwent SSO surgery and clinical and radiologic follow-up at 8 weeks, 1 year, and 13 years. Model analysis, cephalometric analysis, and clinical examinations were performed at each control. RESULTS: Mean overjet relapse from 8 weeks to 13 years was 2.3 mm (range, 0 to 7.0 mm). Between 8 weeks and 1 year, mean overjet relapse was 0.6 mm (range, -1.0 to 4.0 mm), and it was 1.7 mm (range, -1.0 to 6.0 mm) between 1 year and 13 years. Overjet relapse greater than 4 mm was found in 13.9% of the patients. Mean overjet 1 year after surgery was 2.6 mm and was significantly increased compared with 8 weeks (P = .006). Mean overjet 13 years after surgery was 4.3 mm and was significantly increased compared with 1 year (P < .001). Inferior incisor line to nasion-B-point was 29.0° at 8 weeks after surgery and 25.4° at 13 years (P = .001). Insignificant changes in the other cephalometric variables were found at follow-up. CONCLUSION: SSO advancement surgery is a relatively stable technique over time. Mean overjet relapse was found to be 2.3 mm after 13 years, following a continuous pattern over time. The cephalometric variables showed insignificant changes during follow-up, indicating that relapses are mainly of dental and not skeletal origin.

A study of 25 zygomatic dental implants with 11 to 49 months' follow-up after loading.

PURPOSE: The purpose of this study was to evaluate indications, surgical problems, complications, and treatment outcomes related to the placement of zygomatic implants. A second aim was to determine any prosthetic difficulties and complications. MATERIALS AND METHODS: Twenty-five zygomatic implants were placed in 13 patients between April 1999 and December 2001. The patient age range was between 49 and 73 years, with a mean age of 59 years. All patients showed severe resorption of alveolar bone in the maxilla. All but 2 patients were smokers. Two patients had a history of cleft palate surgery, and 2 patients were known to be bruxers. Standard recommended surgical protocol was followed, and treatment was performed under general anesthesia. After abutment surgery, 9 patients received bar-retained overdentures, and 4 patients received fixed prostheses. RESULTS: No implants were lost, and few surgical complications were experienced. The follow-up period was 11 to 49 months. DISCUSSION: Although surgical problems precipitated by difficult anatomy in cleft patients and a patient with reduced interarch access were experienced, the results were favorable. Fabricating a functional and esthetic prosthesis can be a challenge. CONCLUSION: Zygomatic implants provide a treatment option for patients with severe maxillary resorption, defects, or situations where previous implant treatment has failed. In this experience, treatment with zygomatic implants was a predictable method with few complications, even in a group of patients that would not be considered ideal for implant treatment.

Primary chronic osteomyelitis of the jaw--a microbial investigation using cultivation and DNA analysis: a pilot study.

OBJECTIVES: The aims of this study were to investigate the infectious etiology of primary chronic osteomyelitis (PCO) of the jaw using an extraoral sampling approach and molecular methods. STUDY DESIGN: In this pilot study, bone biopsies from the mandibles of 5 patients with PCO were sampled with an extraoral sterile approach. Cultivation and polymerase chain reaction (PCR) were performed. RESULTS: Two of the biopsies yielded growth of Propionebacterium acnes. One biopsy also demonstrated Staphylococcus capitis. The biopsies with bacterial growth were also positive for the same bacteria by PCR analysis. CONCLUSION: No specific bacterial etiology was demonstrated. However, the results of bacterial cultivation and PCR analysis were in agreement. Based on these findings, the molecular procedure used in this study can be considered to be suitable for identification of bacterial specimens in mandibular biopsies. Further studies are needed with larger patient populations to confirm these findings.