A retrospective study of occlusal reconstruction in patients with old jaw fractures and dentition defects.

PURPOSE: This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects. METHODS: Patients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled. Clinical treatment was classified into 3 phases. In phase I, techniques such as orthognathic surgery, microsurgery, and distraction osteogenesis were employed to reconstruct the correct 3-dimensional (3D) jaw position relationship. In phase II, bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions. In phase III, implant-supported overdentures or fixed dentures were used for occlusal reconstruction. A summary of treatment methods, clinical efficacy evaluation, comparative analysis of imageological examinations, and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects. All data are summarized using the arithmetic mean ± standard deviation and compared using independent sample t-tests. RESULTS: In 15 patients with old jaw fractures and dentition defects (an average age of 32 years, ranging from 18 to 53 years), there were 7 cases of malocclusion of single maxillary fracture, 6 of malocclusion of single mandible fracture, and 2 of malocclusion of both maxillary and mandible fractures. There were 5 patients with single maxillary dentition defects, 2 with single mandibular dentition defects, and 8 with both maxillary and mandibular dentition defects. To reconstruct the correct 3D jaw positional relationship, 5 patients underwent Le Fort I osteotomy of the maxilla, 3 underwent bilateral sagittal split ramus osteotomy of the mandible, 4 underwent open reduction and internal fixation for old jaw fractures, 3 underwent temporomandibular joint surgery, and 4 underwent distraction osteogenesis. All patients underwent jawbone augmentation, of whom 4 patients underwent a free composite vascularized bone flap (26.66%) and the remaining patients underwent local alveolar bone augmentation. Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation (73.33%). The 15 patients received 81 implants, of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures. The survival rate of all implants was 93.82%. The final imageological examination of 15 patients confirmed that the malocclusion was corrected, and the clinical treatment ultimately achieved occlusal function reconstruction. The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy, phonetics, aesthetics, and comfort after treatment. CONCLUSION: Occlusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment, consisting of 3D spatial jaw correction, alveolar bone augmentation and soft tissue augmentation, and implant-supported occlusal reconstruction, achieving satisfactory clinical therapeutic efficacy.

Efficacy of occlusal splints in the treatment of temporomandibular disorders: a systematic review of randomized controlled trials.

OBJECTIVE: This systematic review aimed to assess the efficacy of occlusal splints in the treatment of temporomandibular disorders (TMDs). MATERIAL AND METHODS: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Four databases (Medline via Pubmed, Web of Science, Embase and Scopus) were searched, the last search was conducted on April 2020. Randomised controlled trials (RCTs) employing the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) or Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) as diagnostic criteria and including occlusal splint as one of the experimental groups were included in the present study. The data from the included studies were extracted and assessed for risk of bias. RESULTS: Eleven studies were included. The sample size ranged from 12 to 96 subjects. The male to female ratio was 0 to 25%. The mean length of follow-up was 4 months. Occlusal splint had a positive effect on mandibular movements in all included studies. Seven studies showed a positive effect of occlusal splint on chronic pain reduction and pain intensity, while two others showed improvement of temporomandibular joint clicking sounds and locking of the jaws. Moreover, improvements in mouth opening, depression, and anxiety symptoms, were reported in four studies. CONCLUSIONS: An occlusal splint can be considered as a non-invasive treatment approach for patients with TMD, especially those with signs and symptoms of restriction of mandibular movement and pain. Moreover, the present findings highlighted an urgent need of a standardised consensus regarding the prognostic evaluation of TMD.

Study of biodegradable occluder of atrial septal defect in a porcine model.

OBJECTIVE: To evaluate the safety and feasibility of a modified poly(l-lactic acid) (PLLA) atrial septal defect (ASD) occluder. METHODS: Forty-five piglets were divided into two groups: an experimental group (n = 27) and a control group (n = 18). The experimental group underwent percutaneous implantation of a modified PLLA ASD device while the control group underwent percutaneous implantation of a widely used metal ASD device. X-ray imaging, transthoracic echocardiography (TTE), electrocardiogram (ECG), histopathology and electron microscopic examination were performed at 7 days, 1, 3, 6, and 12 months after implantation. RESULTS: Twenty-seven experimental piglets and 18 control piglets were all successfully implanted with modified biodegradable and metal ASD devices, respectively. While both devices exhibited very good occluding effects, the modified PLLA ASD devices were completely endothelialized at 3 months after implantation, and the endothelialization appeared to be more complete compared to the control group. Degradation of the PLLA devices was noted at 12 months follow-up with no loss of integrity at the atrial septum. CONCLUSION: This animal model with implanting of the occluders was effective and not associated with complications. The modified PLLA ASD devices are more controllable and practical than our previous devices. The implanted devices demonstrated good endothelialization and degradability in short and moderate term follow-up. Long-term studies are now underway to further evaluate the biodegradability of this novel device.

A Novel-Design Poly-L-Lactic Acid Biodegradable Device for Closure of Atrial Septal Defect: Long-Term Results in Swine.

OBJECTIVES: The aim of this study is to evaluate the long-term effectiveness and safety of a self-expandable, double-disk biodegradable device made of poly-L-lactic acid (PLLA) for closure of atrial septal defects (ASDs) in swine. METHODS: ASDs were created by transseptal needle puncture followed by balloon dilatation in 20 piglets. The experimental group comprised 18 animals, while the remaining 2 animals were used as controls. Effectiveness and safety were evaluated by rectal temperature, leukocyte count, chest radiography, electrocardiogram, transthoracic echocardiography (TTE), intracardiac echocardiography (ICE), and histologic studies. Animals were followed up at 1, 3, 6, and 12 months. RESULTS: An ASD model was successfully created in 19 animals; 1 piglet died during the procedure. The ASD diameters that were created ranged from 5 to 6.4 mm. Devices were successfully implanted in 17 animals. No animal died during the follow-up studies. Rectal temperatures and electrocardiograms were normal at follow-up, while leukocyte counts transiently increased from 1 to 6 months. Radiography, TTE, ICE, and macroscopic studies demonstrated that PLLA occluders were positioned well, with no shifting, mural thrombus formation, or atrioventricular valve insufficiency. Histologic evaluations showed that PLLA devices were partially degraded in the follow-up study. CONCLUSIONS: ASD closure with the novel PLLA biodegradable device is safe and effective. Longer-term studies are needed to evaluate long-term biodegradability.

[Analysis of the complications following the periareolar reduction mammaplasty using polypropylene mesh as suspension device].

OBJECTIVE: To investigate the cause and the prophylactic measures for the complication following the periareolar reduction mammaplasty using polypropylene mesh as suspension device. METHODS: From Dec. 1999 to Dec. 2005, 78 patients who underwent periareolar reduction mammaplasty using polypropylene mesh as suspension device were analysed. Among them, 47 cases were followed-up for 6 months to 5 years, and their long-term effect was evaluated. RESULTS: Early after operation, complications included seroma (3 cases), infection (3 cases), delayed wound healing (3 cases), and paraesthesia of nipple-areolar complex (1 case). The 47 followed-up patients presented abnormal wave-like skin appearance in superior polar of breast (7 cases), palpable cord-like mammary content in peripheral region of breast (3 cases), widening of periareolar scar and secondary ptosis (2 cases) and paraesthesia of nipple-areolar complex (1 case). All other patients acquired good appearance and felt satisfactory. 2 patients could lactate after operation. 5 patients underwent mammary X-ray radiography after operation. No mesh shadow or calcification was revealed. CONCLUSIONS: Although polypropylene mesh is a good suspension device in reduction mammaplasty, the long-term complication is relatively high because of the hardness of the tissue. More soft tissue is necessary as alternative device for clinical application.