Rectangular body ostectomy for the treatment of severe mandibular prognathism.

OBJECTIVE: The aim of this article was to present the surgical technique and the outcomes of rectangular body ostectomy in the treatment of severe mandibular prognathism. METHODS: Mandibular setback by bilateral rectangular body ostectomies combined with Le Fort I level maxillary advancement was performed. The deep bony concavity of paranasal area was grafted with bone blocks harvested from the ostectomized segments of the mandible. RESULTS: Satisfactory functional and aesthetic outcomes were obtained by rectangular body ostectomy combined with Le Fort I level maxillary advancement and an acceptable profile was provided for the patient. CONCLUSIONS: The mandibular rectangular ostectomy remains a safe and versatile procedure with predictable results in well-selected cases.

Early detection of alterations in the resonance frequency assessment of oral implant stability on various bone types: a clinical study.

This study was undertaken to evaluate the relation between bone quality and alterations of implant stability quotient values measured during the initial phase of healing. Nineteen patients treated with 106 implants were included in the current study. The mean bone density of the implant recipient area was measured using Simplant 11 software incorporated in the computerized tomography (CT) machine. Mean bone density measurements were recorded in Hounsfield units. The implant recipient sites were subdivided into 5 groups according to bone quality. The numbers of the structures on the recipient site belonging to D1 and D5 types showed no statistical significance and were excluded. Standard 2-stage surgical technique was utilized to prepare the surgical sites. The implant stability quotient (ISQ) value at implant placement was recorded and did not influence the treatment procedure. The ISQ was measured by an Osstell instrument. The ISQ was further registered on the 21st and 60th days. SPSS statistical software was used for the statistical analysis. In comparison with the time of insertion, the mean values of the ISQ were decreasing for the first 21 days. However, on subsequent days, the ISQ values of all bone types have increased and on the 60th day reached the values recorded at the time of insertion. Analysis of the relation between changes in stability and bone type does not reveal statistical significance. With knowledge of the current clinical study, it can be concluded that bone quality in the recipient bone site does not effect changes in implant stability at the early stages of the osseointegration process.

Retrospective radiographic evaluation of the anterior loop of the mental nerve: comparison between panoramic radiography and spiral computerized tomography.

PURPOSE: This study compares the prevalence and the length of mental loops, which were measured with panoramic radiographs and spiral computerized tomographs (SCT). MATERIALS AND METHODS: Seventy-three panoramic radiographs and 73 SCTs were taken for preoperative planning of implant placement in the interforaminal region of the anterior mandible. The bone quality of both mental regions in each patient was determined by 1 experienced calibrated clinician, and the cross-sectional images of the SCTs were evaluted for bone quality according to the Lekholm and Zarb classification. Panoramic radiographs and cross-sectional SCT images were examined carefully by the same calibrated clinician to determine the presence and to measure the length of the mental loop in each patient. The relationship between these radiographs was also examined and correlated with bone quality. Paired samples t test and Pearson's correlations were used to examine the agreement between 2 radiographic methods at each bone quality. A 5% level of significance was chosen. RESULTS: The prevalence of the mental loop in panoramic radiographs and spiral CT images was 28% and 34%, respectively. The mental loop was identified more frequently in spiral CT images regardless of bone quality. The demonstration of the mental loop between radiographic methods was more pronounced in poor bone quality. The mean length of the mental loop in panoramic radiographs was 3.71 +/- 1.35 mm and 3.00 +/- 1.41 mm in SCT. Measurements for panoramic radiographs were higher than those for spiral CT images. There was a correlation of r = 0.66 (P = .01) between the 2 radiographic methods, indicating agreement. CONCLUSIONS: SCT demonstrated a higher prevalence of mental loops than panoramic radiographs. SCT can be more useful to visualize and measure the mental loop in low bone qualities. Panoramic radiographs significantly overestimate (P = .02 in type 3, P = .01 in type 4) mental loop length, which were measured in spiral CT images in poor bone quality, but there is a close correspondence between these 2 radiographs in higher quality bone.

Cephalometric evaluation of patients treated by maxillary anterior segmental distraction: a preliminary report.

OBJECTIVE: The aim of this study was to evaluate the cephalometric results of distraction osteogenesis in patients with premaxillary deficiency. MATERIAL AND METHODS: In this study, an individual tooth-borne distraction device was used for advancement of the maxillary anterior segment. Unilateral or bilateral distraction was performed for 7 patients, according to the specific requirements of the individuals. Cephalometric radiographs were taken before treatment (T0), after distraction (T1), and after consolidation for 8 weeks (T2). RESULTS: Cephalometric analysis revealed that the premaxilla was moved forward and upward and the length of palatal plane increased. CONCLUSION: These alterations improved the soft tissue profile and solved the space deficiency of the maxilla by increasing the arch perimeter.

Osteochondroma of the mandibular condyle: report of a case and review of the literature.

Osteochondromas rarely affect the mandibular condyle. An unusual case of an osteochondroma occurring in the left mandibular condyle in a 40-year-old man who presented with mandibular deviation and malocclusion is reported; this represents the 37th documented case in the English-language literature. The tumor was resected through condylectomy. Four-year follow-up assessments revealed satisfactory function and occlusion, without evidence of recurrence of the tumor.

Treatment of temporomandibular joint ankylosis with temporalis superficial fascia flap.

Temporomandibular joint (TMJ) ankylosis is characterized by the formation of bony or fibrous mass, which replaces the normal articulation and limitation of mouth opening. This study aims to determine the efficacy of arthroplasty and interpositional fascia flap in the treatment of unilateral and bilateral TMJ ankylosis in three young adult men. Our operative protocol for unilateral and bilateral TMJ ankylosis entailed resection of ankylotic mass, intraoral ipsilateral and bilateral arthroplasty, interpositional tissue transfer to the TMJ with temporalis superficial fascia flap, maxillomandibular fixation, and early mobilization and aggressive physiotherapy. Early postoperative initial exercise, physiotherapy, and strict follow-up play an important role in preventing postoperative adhesions. The temporalis superficial facia flap is an autogenous graft that has the advantages of close proximity to the TMJ minimal surgical morbidity, and successful clinical results. It was found to be a valuable option for TMJ ankylosis reconstruction.

Evaluation of the dental health of the young adult male population in Turkey.

This study aimed to determine the prevalence of dental caries in military recruits and to assess the relation of dental caries with socioeconomic and demographic factors, and sugar consumption behavior, and to generalize the findings for the young adult male population to draw a picture of dental health status of this population segment in Turkey. In this cross-sectional study conducted between August and October 2000 in a military basic training center in Turkey, 2,766 male recruits of the age of 20 were examined by dental specialists to determine their mean number of decayed, missing, or filled teeth (DMFT) scores and were administered a questionnaire for capturing their demographic characteristics and sugar consumption behavior. The mean DMFT score for the 20-year-old male population in Turkey was found to be 5.97. DMFT scores were weakly correlated with income level and urbanization. Sugar consumption was strongly correlated with DMFT scores. The mean number of teeth with fillings component was strongly correlated with income level, moderately with the subject's education, and weakly with the mother's education, father's education, and urbanization. DMFT scores for the young adult male population in Turkey were strongly associated with sugar consumption behavior, whereas they were weakly or not at all associated with demographic factors such as education level, income level, and urbanization.

Evaluation of oral or rectal midazolam as conscious sedation for pediatric patients in oral surgery.

This study was undertaken with a view to determine the acceptance and treatment possibilities of midazolam, depending upon its oral and rectal application for pediatric patients requiring an oral surgery procedure (tooth extraction) and having a pretreatment behavioral score of 1 or 2 according to the Frankl Scale. Oral (0.5 mg/kg) and rectal (0.35 mg/kg) midazolam was compared in view of acceptance of the mode of treatment and local anesthesia, level of amnesia, and adverse effects. Although oral or rectal midazolam application has similar characteristics in respect to ease of working, the oral midazolam application should generally be preferred because it is more easily accepted by pediatric patients.

Premaxillary distraction osteogenesis with an individual tooth-borne appliance.

Distraction osteogenesis defines a technique of bone generation and osteosynthesis by the distraction of native preexisting bone. The technique offers a promising treatment alternative for patients with maxillary hypoplasia and a retrognathic mandible. In this case report, the steps in the treatment of an 18.2-year-old girl with premaxillary hypoplasia and anterior crossbite are described. The patient was treated with a distraction osteogenesis technique, and premaxillary advancement was performed using an individual tooth-borne distraction device. The surgical operation consisted of a classical segmental maxillary osteotomy carefully respecting the palatal periosteum. The distractor was cemented in the mouth after the surgical procedures. The patient was observed during a seven-day latency period, after which the device was activated 0.5 mm every 12 hours. The anterior crossbite was eliminated in one week, and the treatment was finished with fixed orthodontic appliances.

Dystrophic calcifications arising in the masseter muscle: a case report.

Calcium salt deposits in the presence of normal calcium/phosphorus metabolism involving tissues that do not physiologically calcify are referred to as dystrophic calcification. The condition may be associated with a variety of systemic disorders. Additionally, injured tissue of any kind is predisposed to dystrophic calcification. The case of a 21-year-old man with two isolated dystrophic calcifications in the right masseter muscle is presented. Dystrophic calcifications should be studied carefully and differentiated from lesions resulting from other syndromes that manifest calcification of soft tissues. The lack of a classification system of soft tissue calcifications complicates the management and study of the condition.

Histological Characteristics of Ligaments between Middle Ear and Temporomandibular Joint.

OBJECTIVES: To examine histological aspects of the ligaments between the middle ear and temporomandibular joint and suppose a theoretical role of their structural characteristics on mobility of mallear ossicle. METHODS: The ligaments were obtained by microdissection of middle cranial fossa on both sites of 15 cadavers fixed in formalin solution and were sectioned longitudinally (7-10 mum thickness). The sections were stained with Verhoff's Van Gieson's stain (VVG) for demonstration of elastic fibers and visualized at X2.5 and X10 magnifications under light microscopy. RESULTS: Anterior mallear ligament (AML) and sphenomandibular ligaments (SML) were consisted of collagen fibres in analyzed specimens. The discomallear ligament (DML) was constituted of rich collagenous fibres. One specimen of DML harvested between petrotympanic fissure and retrodiscal-capsular intersection site contained elastic fibers dispersed in cotton-bowl appearance between collagen fibers. In the light of functional tests performed in previous studies, it could be extrapolated that presence of elastic fibers in the DML may prevent excessive forces conducted to mallear head by elongation of elastic fibers. CONCLUSIONS: Collagenous fibres have no ability to stretch along their axis which may lack compensatory mechanism to prevent mallear head mobility.

Hemangiomas of the head and neck with phleboliths: clinical features, diagnostic imaging, and treatment of 3 cases.

Hemangiomas are benign vascular lesions and are classified into cavernous, capillary, and mixed types. Phleboliths are calcified nodules that can be regarded as a pathognomic feature of hemangioma. The treatment of the hemangiomas is based on location, accessibility, depth of invasion, age, and cosmetic considerations. Surgical extirpation is a mainstay of treatment when indicated. Three cases of head and neck hemangioma are reported with clinical and imaging findings.

Barrier membrane and bone graft treatments of dehiscence-type defect at existing implant: a case report.

Dehiscence-type bony defects may occur after implant application because of microbial action as well as of biomechanical and occlusal overload. The aim of the treatment of a periimplant defect is to arrest the progression of the bone loss and to achieve a maintainable site for the implant. In these situations, barrier membranes and bone graft materials can be used to achieve complete bone healing around dental implants. Bone regeneration is possible in a periimplant bony defect of a functioning implant if the proper surgical technique is utilized and the etiologic cause is eradicated. This study presents the surgical coverage of a periimplant bony defect around an implant that was inserted 7 years ago. The surgical correction was made using a barrier membrane in conjunction with bone graft materials. A follow-up of 6 months seemed to reveal radiographic bone regeneration.