Influence of Orthognathic Surgery on Oral Health and Quality of Life.

ABSTRACT: Orthognathic surgery is a common treatment modality for moderate to severe dentofacial deformities. This study aimed to determine the early postoperative changes in quality of life (QoL) after orthognathic surgery.Twenty patients were evaluated preoperatively (T0), postoperatively after 1 month (T1), and postoperatively after 3 months (T2). Short Form Oral Health Impact Profile and Orthognathic Quality of life Questionnaire were used as generic oral health-related and condition-specific QoL measures.Oral Health Impact Profile -14 and Orthognathic Quality of life Questionnaire scores significantly decreased from T0-T2. Physical pain, psychological disability, social disability, and handicap scores significantly decreased during this interval. Facial esthetic, function, awareness of facial deformity, and social aspects of deformity were also found to significantly improve. No significant difference was found between age groups; female patients had significantly greater preoperative Oral Health Impact Profil-14 scores than did male patients.Orthognathic surgery not only enhances the skeletal and facial relations, but also has significant positive effects on the patients' QoL, oral health, and psychological status.

Reconstruction and Implant-Supported Rehabilitation of an Iatrogenically Caused Maxillary Alveolar Defect.

Defects of the oral and maxillofacial region may arise from several reasons such as trauma, infection, cyst, tumor, medication related osteonecrosis of the jaw, and misuse of some irritant agents. For reconstruction, autogenous grafts remain the gold standard among the alternatives. In our case, a 42-year-old woman referred to our clinic for implant-supported fixed bridge rehabilitation of her edentulous and defected left 2nd premolar and 1st molar region. In examinations, devitalizing agent-dependent large defect was observed. Anterior iliac crest (AIC) grafting technique was preferred for reconstruction. Consecutively, 16-week bone healing and 3-month implant osseointegration periods were uneventful. After fabrication of the implant-supported fixed bridge, the patient was followed up for 2.5 years with no signs of bone resorption, gingival inflammation, and pain. AIC grafting and implant-borne fixed bridges seem stable and satisfactory methods for large maxillofacial defects.

Effects of Piezoelectric Surgery on Bone Regeneration Following Distraction Osteogenesis of Mandible.

The aim of this study is to compare the bone healing in the distraction gap following the osteotomy performed with piezoelectric and conventional devices for the distraction osteogenesis in the rabbit mandibles. Twelve rabbits were randomly divided into 2 groups; 6 for piezoelectric device and 6 for rotary instruments. After 3 days of latency period, distraction was started at a rate of 1 mm per day for 10 days. All the animals were sacrificed after 4 weeks of consolidation phase for histological and histomorphological evaluation. Histological evaluation revealed thick trabecular bone formation in all of the specimens. Inflammation scores were chronic minimal. The mean percentages of the bone area in distraction gap are 62% in group P and 57% in group R. However, the difference between 2 groups was not statistically significant (P > 0.05). Our results revealed a slight increase in bone formation in the distraction gap in piezo-osteotomy groups histologically though not statistically supported. However, there is still a need for more histological studies with larger sample sizes evaluating the bone structure following piezo-osteotomies.

Spontaneous Healing of Mandibular Noncontinuous Defect Caused by Medication-Related Osteonecrosis of the Jaw.

BACKGROUND: Bisphosphonates are used throughout supportive cancer therapies for the treatment of osteoporosis and metastatic bone diseases, but they invariably induce medication-related osteonecrosis of the jaw (MRONJ). This medicational modality may induce consequential losses that can lead to spontaneous or surgical therapy related bone fractures or defects. MRONJ stages and treatment alternatives are described in the current procedures. Accordingly, treatments for stages 0 and 1 are conservative whereas the treatment for stage 3 is surgical resection of the necrotic bone. Stage III MRONJ therapy is still controversial within the scope of conceivable bone fractures or defects. When the development of MRONJ is refractory to conventional treatment modalities, surgical management can be suggested. The aim of this study was to evaluate the results of the surgical treatment of MRONJ as part of a medical patient. METHODS: A 72-year-old man was referred to our department for extensive pain of the left mandibular region that occurred after tooth extraction. It was identified in his medical history that he had received a nitrogen-containing intravenous bisphosphonate (Zometa; Novartis, East Hanover, NJ) therapy for prostate cancer. He had been administered 4 mg. IV Zolenat 9 times during the first year of therapy, followed by 2 doses of the same amount of Zolenat in the second year. RESULTS: The treatment started with a therapy that combined antibiotics and antibacterial mouth rinse with chlorhexidine for maintaining oral hygiene. After the maturity of the sequestrum was identified through radiographic examination, the patient was treated by the segmental resection of the extensive necrotic bone, resulting in discontinuity of the mandibular corpus. Two years later, spontaneous bone healing occurred along the residual defect on the mandible. CONCLUSION: Treatment options for the defects resulting from MRONJ are still under debate, and no evidence-based guidelines are available. However, due to the results displayed in this patient; it may be a sound approach to closely follow up and observe MRONJ-related bone to prevent additional complications.

Finite-Element Analysis of a New Designed Miniplate which is Used via Intraoral Approach to the Mandible Angle Fracture: Comparison of the Different Fixation Techniques.

The mandible is the largest facial bone as well as the most commonly fractured bone in the maxillofacial region. Despite numerous studies conducted to identify optimal treatment modalities and plates configurations for intraoral and transoral approaches, no definitive conclusion has been reached. This study used finite element analysis (FEA) to assess 4 scenarios for treatment of an angle fracture (6-hole noncompression miniplate; 6-hole single plate/Champy's technique, 3D strut plate; 2 parallel 4-hole noncompression miniplates). Analysis included segmental displacement and Von Mises Stress evaluations of a 3D reconstruction of a human mandible. Von Mises Stress values for plates did not vary significantly among treatment groups. Moreover, no significant differences were observed in cumulative displacement of segments subjected to vertical and horizontal loads, with all treatment configurations demonstrating clinical acceptability.

Evaluation of preoperative model surgery and the use of a maxillary sinus surgical template in sinus floor augmentation surgery.

Maxillary sinus augmentation is an accepted technique for dental implant placement in presence of insufficient maxillary bone. There are various techniques in the literature, either by crestal or lateral approach in maxillary sinus augmentation that have high percentage of success, while all have complications. Schneiderian membrane perforation is the most common complication encountered during surgery. The aim of this study was to evaluate the benefits of preoperative model surgery and the ease of use of a maxillary sinus surgical template (MSST) during maxillary sinus augmentation surgery with a lateral approach. Ten patients included in the study needed rehabilitation of a partially or totally edentulous maxilla with an implant-supported fixed prosthesis and requiring sinus augmentation. A questionnaire was asked to performing surgeons, and study results showed the use of an MSST was found to be effective in terms of adaptation (62.5%), window preparation (87.5%), ease of elevation (95.9%), ease of grafting (95.9%), reduction of perforation risk (91.7%), and achieving immobility during the procedure (62.5%); however, the use of an MSST was also found to prolong the surgical procedure (100%) and restrict the view of the surgical area (79.2%). Maxillary sinus augmentation appears to be a useful tool for locating an appropriate entrance to the sinus cavity, allowing for safe elevation of the sinus membrane and effectively grafting the sinus floor.

Evaluation of the temporomandibular joint morphology and condylar position with cone-beam computerized tomography in patients with internal derangement.

OBJECTIVES: To evaluate the relationship between internal derangement and morphological features of the temporomandibular joint by comparing joint morphology between patients with ID and control patients. METHODS: The current study prospectively is evaluated the cone-beam computed images of 106 ID patients and 122 patients with asymptomatic joints; recorded angular and linear measurements. The relationships between these measurements and ID are investigated; the differences between the two groups using paired t tests. RESULTS: There were significant differences in the values of articular slope and the condyle height/glenoid fossa depth (CH/GFD) ratio between patients in the ID and control groups (p < 0.05). There was also a relationship between these parameters and the gender of patients with ID. The condylar position was posterior in the ID group. CONCLUSION: Posteriorly and superiorly located condyles with an increased CH/GFD ratio, condyles located eccentrically, and a steeper posterior slope may be risk factors for ID.

Evaluation of patient satisfaction after botulinum toxin A injection for the management of masticatory myofascial pain and dysfunction - A pilot study.

Objective: To evaluate patient satisfaction with botulinum toxin type A injections for the management of masticatory myofascial pain and dysfunction. Methods: The study group included 25 patients with myofascial pain and dysfunction. Maximum mouth opening (MMO), measured with a ruler, and pain, measured on a 10-cm visual analog scale (VAS), were assessed before treatment and six weeks after treatment. Satisfaction with the treatment, measured on a 10-cm VAS, was obtained six weeks post-treatment. Results: The mean satisfaction score six weeks post-injection was 6.74/10, with a significant improvement in both MMO and pain. Satisfaction was positively correlated with a decrease in pain. Discussion: Botulinum toxin type A injections were well tolerated for the treatment of masticatory myofascial pain and dysfunction in patients with temporomandibular disorder. Improvements were observed in both MMO and pain, with most patients satisfied with the management of pain.

Efficacy of platelet rich fibrin in the reduction of the pain and swelling after impacted third molar surgery: randomized multicenter split-mouth clinical trial.

BACKGROUND: Impacted third molar removal is a routine procedure in oral and maxillofacial surgery. Platelet-rich fibrin (PRF) is a second generation platelet concentration which is produced by simplified protocol. The aim of this study was to assess the effectiveness of PRF in the healing process by evaluating the changes in pain and swelling after third molar surgery. METHODS: Fifty-six patients (23 male, 33 female) who provide the inclusion criteria were selected to participate in this study. The evaluation of the facial swelling was performed by using a horizontal and vertical guide. The pain was evaluated in the postoperative period using a visual analog scale (VAS) of 100 mm. RESULTS: Horizontal and vertical measurements showed more swelling at the control side (without PRF) in 3th day postoperatively (p < 0.05). There were no statistically significant differences regarding pain among the groups. CONCLUSION: As a conclusion, PRF seems to be effectiveness on postoperative horizontal swelling after third molar surgery. PRF could be used on a routine basis after third molar extraction surgery.

Biomechanical evaluation of malleable noncompression miniplates in mandibular angle fractures: an experimental study.

The purpose of this experimental study was to test the reliability of a single malleable titanium miniplate using Champy's method of fixing fractures of the mandibular angle. Eighteen sheep hemimandibles were used to evaluate 2 plating techniques. The groups were tested with either a single non-compression titanium miniplate or a single malleable titanium miniplate. A cantilever bending biomechanical test model was used for the samples. Each group was tested with vertical forces using a servohydraulic testing unit. The displacement values in each group at each 10N stage up to 90N were compared using 2-way analysis of variance (ANOVA). The displacement values for the 2 groups differed significantly (p<0.01). The variance analyses showed that the biomechanical behaviour of a single non-compression miniplate was better than that of a single malleable miniplate. The non-compression miniplate fixed by screws had greater resistance to occlusal loads than the malleable plate fixed by screws, and the malleable plate alone was not sufficient to withstand the early postoperative bite force.