Our experience in complications of orthognathic surgery: a retrospective study on 3236 patients.

BACKGROUND AND OBJECTIVES: From 1989 to 2009, at the Department of Cranio-Maxillo-Facial Surgery, Umberto I Polyclinic, "Sapienza" University of Rome, 3236 patients affected by maxillo-mandibular malformations were submitted to orthognathic surgery, by means of rigid internal fixation. Follow-up highlighted the surgical complications and the possible functional and/or esthetical disorders in the treatment of those pathologies. The data collected have been compared with the ones reported in the literature. MATERIALS AND METHODS: 3236 patients were evaluated clinically and radiographically. The X-rays have been performed before the study, after 24-48 hours, at 6 months and year after surgery. RESULTS: The most frequent surgical complication was the mandibular nerve sensitivity deficit (19%), irreversible only in 2% of the cases. Temporomandibular joint disorders (TMD), which are widely reported in the international literature, have been relevant in our study too. In particular, TMD occurred in those patients who were already affected by the disorder (from 28.3% to 18.1%); besides, in 11% of cases the symptom appeared after surgery and was treated by means of splint or physiotherapy. Infectious complications occurred in 2% of cases and fractures of the bone elements in 1.5% of cases. The other complications quoted internationally occurred in an irrelevant percentage in our study. CONCLUSIONS: We believe that orthognathic surgery complications are quite rare and the percentages reported both in our study and in the literature have to be considered as surgical mistakes related to the surgeon experience or as real complications of the orthognathic surgery. Furthermore, as the success of this kind of surgery depends upon many factors, surgical complications represent only one of the causes of the failure. Other causes could be mistakes in planning, unsuitable orthodontic treatment and, finally, an unsuitable assessment of the patients' esthetical and functional problems.

Computer-assisted implant surgery and immediate loading in edentulous ridges with dental fresh extraction sockets. Two years results of a prospective case series study.

INTRODUCTION: The two-stage surgical approach for implant placement first documented in 1977 by Brånemark, represents today the most used protocol for placing implants. AIM: Aim of this prospective case series study was to compare the clinical and radiological performance of 12 edentulous jaws treated with of a modified prosthetic and surgical protocol for 3D software planning, guided surgery, immediate loading of implants inserted in edentulous jaws and extraction sockets and restored with Cad-Cam Zirconia and titanium full arch frameworks. PATIENTS AND METHODS: This work was designed as a prospective case series study. Twelve patients have been consecutively rehabilitated with an immediately loaded implant supported fixed full prosthesis. A total of 72 implants, Nobel Replace Tapered Groovy; Nobel Biocare AB, Goteborg, Sweden) 26 of which were inserted in fresh extraction sockets, were inserted. Outcome measures were implants survival, radiographic marginal bone-levels and bone remodeling, soft tissue parameters and complications. RESULTS: All patients reached 24 months follow-up, and no patients dropped out from the study. The cumulative survival rate was 100%; after 24 months mean marginal bone remodelling value was: 1.35 ± 0.25, mean PPD value was 2.75 ± 0.40 mm and mean BOP value was 3.8% ± 1.8%. Only minor prosthetic complications were recorded. CONCLUSIONS: These data seem to validate this surgical and prosthetic protocol with valid results when applied in selected cases.

Clinicopathological features of peripheral odontogenic fibromas in dogs and risk factors for their laboratory diagnosis.

OBJECTIVES: To explore clinicopathological features of peripheral odontogenic fibromas in dogs and risk factors for their diagnosis. MATERIALS AND METHODS: Data of cases with a histopathological diagnosis of peripheral odontogenic fibromas were obtained from a UK-based diagnostic laboratory and retrospectively reviewed. Prevalence amongst all biopsy submissions was assessed using binomial tests and Clopper-Pearson intervals. Age at diagnosis was assessed using t-test for independent samples. Lesion location, sex, and neuter status were assessed using χ2 and post hoc binomial tests. Breed odds ratios were calculated using univariable logistic regression modelling. RESULTS: The prevalence of peripheral odontogenic fibromas amongst all biopsy submissions was 2.8% (1001 of 35,328, 95% confidence interval [CI]: 2.7 to 3.0). The mean (sd) age was 8.1 (±2.7) years. The most affected quadrant was the rostral maxilla (40.1%). The ratio of maxillary to mandibular lesions was 1.3:1 (95% CI: 1.1 to 1.5), and for cases of multiple peripheral odontogenic fibromas the ratio of maxillary to mandibular lesions was 2.4:1 (95% CI: 1.1 to 5.6). Males had 1.2 times the odds of suffering of peripheral odontogenic fibromas compared to females (odds ratio [OR]: 1.2, 95% CI: 1.1 to 1.4). Neutering was associated with an increased risk of diagnosis (OR: 1.6, 95% CI: 1.3 to 1.9). Breeds with increased odds of peripheral odontogenic fibromas compared to crossbreed dogs included boxers (OR: 3.78, 95% CI: 2.80 to 5.09), border terriers (OR: 3.21, 95% CI: 2.10 to 4.91) and Basset Hounds (OR: 3.18, 95% CI: 1.58 to 6.44). Breeds with increased odds of multiple simultaneous peripheral odontogenic fibromas compared to crossbreed dogs included: Boxers (OR: 12.02, 95% CI: 7.13 to 20.24), border terriers (OR: 5.05, 95% CI: 2.32 to 11.43) and Staffordshire Bull terriers (OR: 2.42, 95% CI: 1.33 to 4.41). CLINICAL SIGNIFICANCE: Knowledge of clinicopathological features and at-risk breeds for peripheral odontogenic fibroma development can assist clinicians with making a diagnosis. The identification of risk factors provides targets for future research investigating peripheral odontogenic fibroma pathogenesis.

A retrospective analysis of the headache associated with temporomandibular joint disorder.

BACKGROUND: Headache is a common symptom, that can be extremely disabling, affecting 26 million of patients only in Italy. ICHD-II has reported two categories: "primary headaches" and "secondary headaches". Temporomandibular joint disorders can lead to a secondary headaches. AIM: We want to evaluate the prevalence and clinical features of headache among a series of patients having temporomandibular joint disorders and we illustrate the evolution of headache following medical treatament of temporomandibular joint (TMJ) disorders. MATERIALS AND METHODS: This is a retrospective study carried out on chart review of 426 consecutive patients with various degrees of temporomandibular disorders and treated with medical devices from 2007 to 2011. RESULTS: Headache was reported by 73 patients (17.14%). Headache was observed in 36 of 51 patients with lock and in 32 out of 130 patients with mandibular deflections (Table I). The remaining 5 patients with headache had articular noise. CONCLUSIONS: Headache is not a rare finding in a population with temporomandibular dysfunctions and is more often a tension-type rather than trigeminal headache.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ): 5 year experience in the treatment of 131 cases with ozone therapy.

BACKGROUND: Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) are the result of the assumption of such drugs. The most widely used molecules are pamidronate and zoledronic acid, which are pyrophosphate analogues and are usually given to patient with bone remodelling diseases. International literature reports showed an association between this therapy and avascular necrosis, thus leading to review the guidelines for their administer. AIM: The authors present their protocol based upon medical treatment, antibiotic and antimycotic, together with minimally invasive surgery and ozone therapy developed after a 5 year experience to assess the viability of this treatment. MATERIALS AND METHODS: In the last years researchers studied treatment protocols, both medical and surgical, for the management of BRONJ. Among these Ozone therapy is being adopted by several centers. From February 2004 and December 2010 a total number of 131 patients affected by BRONJ have been observed. Collected data include patients' age at the time of disorders, gender, presenting signs and symptoms, primary diagnosis, type and characteristics of the treatment performed, radiological findings and post-treatment results. CONCLUSIONS: At the present time there are no major guidelines in international literature for the treatment of BRONJ, the Authors then propose a therapeutic protocol based upon minimally invasive surgery, antibiotic and anti mycotic therapy with the adoption of ozone as regenerating factor for tissues. In 90% of the cases the results confirmed the procedure with successful outcomes.

Le Fort III osteotomic variants.

INTRODUCTION: Midface hypoplasia is a skeletal defect involving all three space planes, hence needing a three-dimensional repositioning. This research study shows two cases of cranio-facial dysostosis, on which two Le Fort III variants were performed. CASE REPORT: In the first case we report the performing the two types of osteotomy simultaneously. Le Fort I, however, has been performed without any pterygomaxillary disjunctions, thus accomplishing a complete midface mobilization without any variation of the occlusal ratios. In the second case a modified Le Fort III osteotomy has been performed with median disjunction; reduction of the transverse interdacryal diameters and of the pyriform opening. DISCUSSION: Among all osteotomic variants we would like to mention the one introduced by Obwegeser in 1969 where, in patients with acceptable dental occlusal ratios, Le Fort III and Le Fort I have been performed in conjunction. This technique allows a different midface and dental occlusion repositioning. CONCLUSIONS: In adult patients with permanent dentition and normal occlusal ratios this technique may be chosen for a midface advancement without compromising the dento-skeletal relations, in order to achieve the best functional and aesthetical results.

Porous polymer adsorbent media constructed by molecular dynamics modeling and simulations: the immobilization of charged ligands and their effect on pore structure and local nonelectroneutrality.

A molecular dynamics modeling and simulation approach is presented and employed to construct porous dextran polymer ion-exchange adsorbent media. Both the activation step of the surface of the pores of the dextran polymer layer grafted on an agarose surface and the immobilization of charged ligands on the activated surface of the porous dextran polymer layer are considered. For the systems studied in this work, the activation step modifies slightly the pore structure of the base, nonactivated porous dextran polymer, while the immobilization of the ligands on the activated pore surface of the dextran layer changes significantly the pore structure of the activated dextran layer. The density distributions of the counterions and immobilized charged ligands along the direction of net transport in the adsorbent media constructed in this study are found to be nonuniform. The variables that affect the shape and magnitude of the density distributions of the counterions and immobilized charged ligands as well as the total number of charged ligands that can be immobilized on the activated porous dextran layer are identified and presented in this work. Furthermore, the data clearly show that there is local nonelectroneutrality in the porous dextran polymer ion-exchange adsorbent media, and this result has very important practical implications for the operation and performance of separation systems involving ion-exchange adsorbent media (e.g., ion-exchange chromatography systems). Also, the results of this work suggest approaches for (1) controlling the immobilization process of charged ligands and (2) constructing and studying the behavior of chromatographic polymeric monoliths and packed bed columns having a gradient of density of functionalities along the axis of the chromatographic polymeric monolith or packed bed column.

Rational surface design for molecular dynamics simulations of porous polymer adsorbent media.

The construction and use of nonflat agarose surfaces in a simulation box, together with the employment of criteria for the immobilization of a set of dextran polymer chains on the nonflat agarose surfaces whose mathematical physics is compatible with that of the criteria used for the immobilization of the same set of dextran polymer chains on flat agarose surfaces, are shown to generate, through the use of molecular dynamics simulations whose simulation box has linear dimensions along the lateral directions that are the same when flat and nonflat agarose surfaces are used, dextran porous polymer structures whose pore sizes at the outermost surface and in the vicinity of the outermost surface of the porous medium can be controlled by an indirect manner through the variation of the parameters that characterize the nonflat surface. The use of a nonflat surface for the generation of desired large pores requires only a small or modest increase in the number of solvent molecules in the simulation box, while the use of a flat surface for the construction of the same desired large pores requires significant increases in the size of the linear dimensions of the flat surface. This increases so substantially the number of solvent molecules that the computational loads become intractable. The results in this work show that through the use of nonflat surfaces porous dextran polymer layers having pores of desired sizes can be effectively constructed, and this approach could be used for the design and construction of polymer-based porous adsorbent media that could effectively facilitate the transport and adsorption of an adsorbate biomolecule of interest that must be separated from a mixture of components. A useful definition about the properties that a porous polymer structure must have in order to become, for an adsorbate biomolecule of interest of known molecular size, a useful adsorbent medium, is presented and is used to (1) evaluate the porous polymer structures generated through the employment of different nonflat surface models and (2) determine and select the nonflat surface model from a set of nonflat surface models that is effective in producing promising porous structures. Then a procedure is presented by which a set of porous polymer media is generated through the use of the selected nonflat surface model, and the desired porous structure from this set is determined and could be considered to be used for the transport and immobilization of the selected affinity groups/ligands and the subsequent transport and adsorption of the desired to be separated adsorbate.