Distribution of bone thickness in the human mandibular ramus - a CBCT-based study.

BACKGROUND: The bone thickness of the human mandibular ramus is an important parameter in mandibular surgeries. The aim of this study was to systematically measure the bicortical bone thickness, the ramus dimensions and the position of the lingula. The measurements were tested on significant correlations to the patients' parameters. METHODS: Based on CBCT scans 150 rami were reconstructed as 3D polygon surfaces. An anatomical grid was adapted to the ramus surface to mark the bone thickness measurement points and to achieve comparability between the measurements on different mandibles. The bone thickness, ramus height, ramus width and the gonion angle were measured. A cluster analysis was performed with these parameters to identify clinically relevant groups with anatomical similarities. RESULTS: The median distribution of the bone thickness was calculated and visualized in a pseudo-colour map. The mean ramus height was 44.78 mm, the mean width was 31.31 mm and the mean gonion angle was 124.8°. The average distance from the lingula to the dorsal tangent was 53% of the total width and its distance to the caudal tangent was 65% of the total height. Significant correlations between the bone thickness and the ramus proportions could be identified. Age and sex had no significant influence on the mean bone thickness. The measured rami could be divided into two groups by cluster analysis. CONCLUSION: The dimensions of the human mandibular ramus can be determined from 3D reconstructed surface models from CBCT scans. Measurements could be made comparable by applying an anatomically oriented grid. A cluster analysis allowed the differentiation of two groups with different bone thickness distributions and geometries, which can be used for the optimization of osteosynthesis systems and their precision of adaptation to different ramus morphologies.

A prospective comparison of octyl-2-cyanoacrylate and suture in standardized facial wounds.

Regarding the cosmetic results of wound closure using tissue adhesives as opposed to sutured wounds, most published studies are performed on children and with non-standardized lacerations, which makes it difficult to transfer the results to facial incisional wounds in adults. There are also conflicting conclusions about the cosmetic results. The purpose of this randomized prospective study was to compare the cosmetic outcomes of wound closure with sutures and octyl-2-cyanoacrylate in standardized facial wounds in adults. To compare very similar facial wounds, the infraorbital cut (lower eyelid incision) was used in 45 patients. The assessment was performed by patients and surgeons blind to the data. Phase-shifting profilometry was used to measure the profile of the scars. No early complications were observed in any group. The wound depth in the tissue adhesive group was significantly greater than in the suture group. There were no differences in the overall cosmetic results among all patients in the two groups. Interestingly, in the younger patients the result of the sutured wounds was superior to that of the adhesive-treated patients. The Dermabond skin adhesive provides a means of closure of facial surgical wounds without early complications, but adjustment of the edges of the wound and the cosmetic result in younger patients are less successful than with thin sutures.

[Objective assessment of cosmetic outcome of scars]. / Möglichkeiten zur objektiven Beurteilung von Narben.

AIM OF THE STUDY: Cosmetic outcome of surgical treatment in the facial region is influenced by the appearance of the scar. The purpose of this investigation was to evaluate the objectivity and validity of various methods for the assessment of scars. MATERIAL AND METHODS: 45 patients undergoing facial surgery were examined three months after surgery. Three maxillofacial surgeons evaluated the wounds in a blinded manner using a visual analog scale (VAS). The patients also used the VAS for evaluation of their own scar. The surface of the scars was also measured by optical profilometry. Finally, the colour of the scars was analysed using both the RGB colour model and the HSV colour model. RESULTS: Interestingly, there was no significant correlation between the values of R (red) as assessed by the three surgeons. However, there was a very strong correlation between the values of H (hue) as assessed by the three raters. The appearance of the surface was more important in the patients' evaluation than in the raters' assessment. CONCLUSION: The hue of a scar as measured in terms of the H value in the HSV colour model is an objective and reliable measure for assessing the cosmetic outcome of facial surgery.

[Investigation of influencing variables on the computer-aided simulation of contacts in dynamic occlusion based on optically digitized plaster casts]. / Untersuchungen zu den Einflussgrössen auf die computergestützte Simulation von Kontakten in der dynamischen Okklusion anhand optisch digitalisierter Situationsmodelle.

In dentistry, mechanical articulators with which mandibular movements can be reproduced in dentals casts play a major role. Commonly used semiadjustable articulators, however, have major limitations: On the one hand, the movement of the mandible is not reproduced exactly, on the other, they do not provide time-related information on jaw movement. Both problems can be solved by replacing the mechanical articulator by a digital simulation ("virtual articulator") based on digitized plaster casts and electronically recorded masticatory movements. We present a system for the 3D measurement of plaster casts in a skull-related, anatomical coordinate system using the fringe projection technique, and electronically recorded condylar movements. Using numerical algorithms, the contacts between upper and low jaw, and the angle of rotation of the temporomandibular joint can be computed for each movement in dynamic occlusion. Taking the data recorded from a patient as an example, the influence of the accuracy of the digitization of plaster casts on the computation of the rotation of the temporomandibular joint is discussed in relation to the anatomy of the masticatory apparatus.

Digital radiography and electronic data storage from the perspective of legal requirements for record keeping.

In some countries physicians and dentists are required by law to keep medical and dental records. These records not only serve as personal notes and memory aids but have to be in accordance with the necessary standard of care and may be used as evidence in litigation. Inadequate, incomplete or even missing records can lead to reversal of the burden of proof, resulting in a dramatically reduced chance of successful defence in litigation. The introduction of digital radiography and electronic data storage presents a new problem with respect to legal evidence, since digital data can easily be manipulated and industry is now required to provide adequate measures to prevent manipulations and forgery.

Evaluation of accuracy of insertion of dental implants and prosthetic treatment by computer-aided navigation in minipigs.

The survival of loaded implants is critically dependent on their biomechanical stability. We have used a computer-guided navigation technique to evaluate the accuracy of computer-assisted insertion for immediately-loaded implants in minipigs. On the basis of computed tomographical data, the Robodent system was used for preoperative planning and guidance of inserting the implant. An optical tracking system allowed positioning of the implant and immediate prosthetic rehabilitation by inserting it in a plaster model and during the operation. Postoperative computed tomograms (CT) showed that the implants were placed precisely in the preoperatively planned position. The accuracy achieved corresponded well with the spatial resolution of the CT used. Immediate placement of the prefabricated crowns resulted in favourable occlusal positioning. Histological cross-sections showed that the implants were biomechanically stable. The accuracy of insertion of oral implants illustrated here suggests that insertion and prosthetic modelling of implants may benefit from computer-assisted navigation.

[Computer-assisted development of epitheses after optical recording of facial defects]. / Rechnergestützte Gestaltung von Epithesen nach optischer Abformung von Gesichtsdefekten.

A major drawback of conventional impression techniques used for customizing facial prostheses is the fact that pressure applied deforms soft tissue, thus reducing accuracy and causing patient discomfort. A possible solution is the use of optical 3-D coordinate measuring techniques, such as the fringe projection technique, which enables precise and contact-free recording of facial surfaces. The application of this method is demonstrated on a patient who lost his left eye and part of the jaw bone during surgery for cancer. 3-D CAD software that supports the construction of a facial prosthesis from the data obtained has been developed. For this purpose, spline functions are used to define border curves, and the intact half of the face is used as a model for the prosthetic surface. The resulting digital data are used to construct first a model made of synthetic resin, and then a final wax model with the aid of rapid prototyping techniques.

Bone loading pattern around implants in average and atrophic edentulous maxillae: a finite-element analysis.

INTRODUCTION: Oral implants placed in the maxilla, especially the posterior region, have a lower success rate than those placed in the mandible. Poor bone quantity and quality have been suggested as a reason for this differential success rate. OBJECTIVE: The purpose of this study was, therefore, to evaluate stress and strain distributions around loaded implants in the normal and atrophic maxilla by finite-element (FE) analyses. MATERIAL: FE models of a solitary implant were generated to determine stresses and strains in the bone adjacent to the implant surface under loading conditions. STUDY DESIGN: Different bony situations and implant lengths were used in a FE model. Static loads were applied axially and the resulting stresses and strains calculated. RESULTS: Bone quality and quantity play a major role in decreasing bone strains adjacent to the implant surface under loading. It was found that stresses were more homogeneously distributed when more spongy bone was present. Decreased bone height was found to have less pronounced effects on strain and stress alterations than poor bone quality. Atrophic bony dimensions in combination with poor bone quality were associated with surface strains exceeding physiological levels (> 6,000 microstrains). CONCLUSION: Our investigation indicates that supraphysiological bone strains adjacent to the implant surface should be expected under mechanical loading in the atrophic maxilla.

The influence of maxillary central incisor position in complete dentures on /s/ sound production.

STATEMENT OF PROBLEM: The insertion of prosthodontic restorations often leads to speech defects, most of which are transient but nevertheless a source of concern to the patient. For the dental practitioner, there are few guidelines on designing a prosthetic restoration with maximum phonetic success. PURPOSE: This study investigated the effect of different maxillary central incisor positions on phonetic patterns. MATERIAL AND METHODS: The inclination angle of central incisor blocks in duplicate complete maxillary dentures was changed in a range of -30 degrees to +30 degrees from the original position (0 degrees). Test words and sentences were acoustically analyzed. Spectral parameters such as first peak, noise band (defined by upper and lower limits of the most intensively blackened frequency area), Fast Fourier Transformation power spectrum, energy spectrum, and time were investigated. Influences of oral stereognosis, hearing, and age as cofactors on /s/ articulation were also taken into account. RESULTS: The change of incisor block angle in both directions usually caused a poorer execution of the /s/ sound. The labial angulation seemed to have a greater effect than the palatal angulation. The most significant changes were those in the noise band and energy spectrum. CONCLUSION: Immediate phonetic adaptation of prosthetic restorations in the maxillary incisor region can be achieved only if the original position of the natural teeth is transferred to the denture. Although these misarticulations are, in most cases, likely to disappear within a few weeks, they may persist and even lead to psychosocial problems. A better understanding of the causes of misarticulation and the limits of adaptation according to certain morphologic parameters of dentures is important.

Three-dimensional quantification of color-marked occlusal paths on anatomically oriented casts.

STATEMENT OF PROBLEM: The analysis of occlusal contacts on mounted diagnostic casts is an important task in prosthetic diagnostics. However, it is still restricted mainly to qualitative aspects because existing measuring techniques fail to provide 3-dimensional data for more than a few single points in acceptable time. PURPOSE: The aim of this study was to develop a method for quantifying occlusal contacts and paths by using anatomically oriented diagnostic casts and to design the method to allow fast acquisition of digital 3-dimensional coordinates. MATERIAL AND METHODS: Plaster casts with color-marked contacts were digitized optically with a profilometric system based on the fringe projection technique. Digital camera images taken simultaneously were used to define the contact areas by marking them either manually or automatically with the help of image-processing routines. Three-dimensional coordinates were determined by finding the corresponding points within the profilometric data set. RESULTS: Color-marked contact areas on diagnostic casts were successfully digitized with a computer-controlled, automatic setup in approximately 30 seconds. The accuracy of the acquired 3-dimensional data was estimated to be better than 60 microm in lateral and 30 microm in height resolution. The data set was visualized and evaluated in a skull related coordinate system. SUMMARY: This study verified the use of a new tool to quantify color-marked occlusal contacts on diagnostic casts in terms of spatial coordinates. The resulting digital data may be stored easily and analyzed numerically as well as visualized 3-dimensionally with computer graphic equipment. Because the anatomic orientation of the casts is maintained throughout the measurement process, it is possible to compare the data with electronically registered condyle paths and therefore to investigate, for example, their relation to the corresponding guidance paths of the frontal teeth and the canines in dynamic occlusion.

A pivoting appliance for intracavitary brachytherapy in patients with reduced mouth opening.

PURPOSE: The risks of radiotherapy to normal tissues are well known. In many cases, a tumor patient suffering a relapse cannot undergo radiotherapy a second time. One exception may be the local application of brachytherapy. Afterloading devices allow the position of radiating materials near the site for treatment exactly according to three-dimensional treatment planning. This report shows the technical procedure for the fabrication of an intracavitary afterloading radiation device. MATERIALS AND METHODS: A 48-year-old woman who had received neutron radiotherapy and tumor surgery for adenoid cystic carcinoma had to be treated for relapse. The mouth opening was limited to 15 mm. The mixing tip of a silicone impression system was used as an axis for a pivoting appliance. RESULTS: Two years after reradiation, the patient was free of relapse symptoms, although an increased limitation of mouth opening was recorded. CONCLUSION: Even if the mouth opening is severely limited after tumor surgery and/or radiation, intracavitary brachytherapy still can be performed in edentulous patients using a pivoting device.

[Effect of dental prosthesis on the voice]. / Der Einfluss der Zahnprothese auf die Stimme.

It is well known that alterations to the oral cavity caused by dental prostheses may affect speech articulation, although influences on the voice are not assumed. In addition to the vocal fundamental frequency, vibrations of the vocal chords generate overtones. Through the shape of the larynx and the upper airway, resonances and antiresonances are formed, and in this way overtones are amplified to a variable extent. Nozzle changes caused by a dental prosthesis in the oral cavity may possibly influence overtones but influences on the vocal fundamental frequency seem unlikely. The influence of dental prostheses on the voice is demonstrated in a patient who owned two different dental prostheses. The fundamental frequency rose by up to five semitones during speech and his vocal range increased by up to four semitones when a thin denture was used instead of a normal denture. When the position of the mandible was checked by intraoral needle point placement, a more rostral position of the mandible was recorded with the thin denture than with the normal denture. Sagittal magnetic resonance tomography imaging also showed that the larynx was in a more cranial position. This change was presumed to be due to an upward movement of the larynx induced by the tongue, which itself was found to be in a more cranial position with the thin denture. In this situation, increased tension of the laryngeal muscles were believed to induce a rise in fundamental frequency, shifting the voice range toward higher frequencies. These findings show that dental prostheses can cause vocal changes in individual cases. The etiology of this occurrence is still not clear. Its consequences, however, should be known to the dentist, ENT surgeon and phoniatrist if patients notice changes in their voice after having altered or replaced their dentures.

Can dental prostheses influence vocal parameters?

STATEMENT OF THE PROBLEM: Alterations to the oral cavity caused by dental prostheses can affect speech articulation, whereas the influence of dental prostheses on the voice is unknown. For 1 patient, the fundamental frequency rose by up to 5 semitones during speech and his voice range was enlarged by up to 4 semitones when a thin denture was used instead of his normal denture. In this patient, intraoral needlepoint registration revealed a more rostral position of the mandible with the thin denture when compared with the normal denture. PURPOSE: This study evaluated the effects of such changes on phonation by varying the dentures of 20 subjects in line with those of the first patient. MATERIAL AND METHODS: The volumes of the test dentures were reduced and the vertical and horizontal dimensions of occlusion were varied. The influences of these changed dentures on speaking fundamental frequency, voice range (in semitones), and lowest and highest frequencies of the voice range were examined with a Homoth phonomat. RESULTS: A statistically significant influence of the different dentures on the investigated voice parameters was not proven; however, audible changes to the voice parameters for persons were documented. CONCLUSIONS: Variations of thickness and or volume of dentures and of the vertical and horizontal dimension of occlusion may result in unpredictable audible changes to the voice. Patients should be informed about possible effects of modified or new dentures on their voice.

Three-dimensional acquisition and visualization of dental arch features from optically digitized models.

A method for the acquisition and evaluation of 3D coordinates from anatomically oriented plaster casts is presented, which is based on optical phase shifting profilometry (a fringe projection technique). With the computer-controlled setup, measurements from different views can be combined to obtain a complete three dimensional reconstruction of the model surface. To allow faster evaluation, the result is converted into a range image. From this digital data set the characteristic features like cusp tips can be identified and located semi-automatically. Based on these marks, quantitative values for differences between situation models like local displacements, e.g. during orthodontic treatment, can be determined. The results are visualized as interactively controllable 3D computer graphics, which helps to make spatial relations clearer.

Dentistry and speech production. Correlations between the morphology of the articulation zone and acoustics exemplified in /s/ articulation.

Many factors are thought to be responsible for misarticulation. Maxillomandibular or dental irregularities play an important role as one of these factors. Correlations between morphological changes in dental status and speech disorders are well known, but different opinions are discussed in the literature. A reciprocal relationship between dysfunction and various dental irregularities is assumed. The objective of our review and experimental investigations was to document the influence of dental irregularities on speech articulation as exemplified by the second articulation zone and /s/ articulation. The second articulation zone was experimentally changed by application of dental cement to the palatal surface of the upper incisors. Various words were spoken before and just after the change to the frontal teeth. The /s/ articulations were acoustically analyzed by means of sonography and compared with each other. Although this modification of the teeth, which was identical in all probands, leads to /s/ misarticulation from the standpoint of auditory analysis, interindividual differences were recorded by acoustic means. It is thus possible to differentiate objectively between acoustically correct and incorrect /s/ articulation. Speech and articulation are, however, such complex mechanisms that it is impossible to characterize them by simple causal connections with maxillomandibular or dental irregularities.