Staged therapeutic approach for rehabilitation of severe asymmetric Class II dentofacial deformity secondary to long standing unilateral temporomandibular joint ankylosis.

Despite being one of the most pervasive debilitating skeletal problems in the craniofacial region, surgical-orthodontic management of long-standing asymmetric Class II dentofacial deformities is often a unique challenge posed to the clinicians. This case report describes the encouraging results of systematically sequenced and staged therapeutic approach adopted for successful rehabilitation of an adult patient with asymmetric Class II dentofacial deformity with mandibular micrognathia secondary to unilateral TMJ ankylosis. Concurrent gap arthroplasty and bilateral distraction of mandibular body were performed during the first operation for functional restoration of mandibular movements and correction of mandibular micrognathia and associated asymmetry. After 13 months of post-distraction orthodontic treatment, Le Fort I osteotomy for inferior repositioning and sagittal advancement of maxilla was performed during the second operation, in conjunction with adjunctive alloplastic reconstruction of inferior border of mandible for optimization of facial aesthetics. Postsurgical orthodontic detailing facilitated achievement of stable, balanced interdigitation. The total active treatment period was 29 months. After treatment, both the skeletal disharmony and the functional stability were significantly improved with establishment of functional occlusion. The morphological and functionally acceptable results were reasonably well-maintained during three-year follow-up. The merits of mandibular osteodistraction vs. conventional mandibular orthognathic surgery and the potential advantages of staged surgical approach are discussed.

Effects of orofacial myofunctional therapy on masticatory function in individuals submitted to orthognathic surgery: a randomized trial.

OBJECTIVES: The esthetic and functional results of orthognathic surgery of severe dentofacial deformities are predictable, however there are differences regarding the effects on stomatognathic system. The aim was to investigate the effects of orofacial myofunctional therapy (OMT) on the masticatory function in individuals with dentofacial deformity submitted to orthognathic surgery (OGS). MATERIAL AND METHODS: Forty-eight individuals (18-40 years) were evaluated, 14 undergoing OMT (treated group-TG), 10 without this treatment (untreated group-UTG) and 24 in a control group with normal occlusion; for clinical aspects the data of an individual was missed (n=46). Chewing was performed using the Expanded protocol of orofacial myofunctional evaluation with scores (OMES-E). Muscle tone and mobility were also analyzed before (P0), three (P1) and six months (P2) after OGS. Surface electromyography of the masseter and temporalis muscles was performed, considering the parameters amplitude and duration of act and cycle, and the number of masticatory cycles. The OMT consisted of ten therapeutic sessions along the postoperative period. The results were compared using parametric and non-parametric tests. RESULTS: TG showed higher scores in P1 and P2 than P0; for the masticatory type the scores in P2 were significantly higher than P0. In addition, the proportion of individuals with adequate tone of lower lip and adequate tongue mobility for TG increased significantly from P1 and P2 in relation to P0. The EMG results showed a decrease in act and cycle duration in P2 in relation to P0 and P1 for the TG; furthermore the values were close to controls. An increase in the number of cycles from P0 to P2 was also observed, indicating faster chewing, which may be attributed to an improvement of balanced occlusion associated with OMT. CONCLUSION: There were positive effects of OMT on the clinical and electromyography aspects of chewing in individual submitted to orthognathic surgery.

Effects of orofacial myofunctional therapy on masticatory function in individuals submitted to orthognathic surgery: a randomized trial

Abstract Objectives: The esthetic and functional results of orthognathic surgery of severe dentofacial deformities are predictable, however there are differences regarding the effects on stomatognathic system. The aim was to investigate the effects of orofacial myofunctional therapy (OMT) on the masticatory function in individuals with dentofacial deformity submitted to orthognathic surgery (OGS). Material and Methods: Forty-eight individuals (18-40 years) were evaluated, 14 undergoing OMT (treated group-TG), 10 without this treatment (untreated group-UTG) and 24 in a control group with normal occlusion; for clinical aspects the data of an individual was missed (n=46). Chewing was performed using the Expanded protocol of orofacial myofunctional evaluation with scores (OMES-E). Muscle tone and mobility were also analyzed before (P0), three (P1) and six months (P2) after OGS. Surface electromyography of the masseter and temporalis muscles was performed, considering the parameters amplitude and duration of act and cycle, and the number of masticatory cycles. The OMT consisted of ten therapeutic sessions along the postoperative period. The results were compared using parametric and non-parametric tests. Results: TG showed higher scores in P1 and P2 than P0; for the masticatory type the scores in P2 were significantly higher than P0. In addition, the proportion of individuals with adequate tone of lower lip and adequate tongue mobility for TG increased significantly from P1 and P2 in relation to P0. The EMG results showed a decrease in act and cycle duration in P2 in relation to P0 and P1 for the TG; furthermore the values were close to controls. An increase in the number of cycles from P0 to P2 was also observed, indicating faster chewing, which may be attributed to an improvement of balanced occlusion associated with OMT. Conclusion: There were positive effects of OMT on the clinical and electromyography aspects of chewing in individual submitted to orthognathic surgery.

Laser therapy for neurosensory recovery after saggital split ramus osteotomy / Terapia con láser para la recuperación neurosensorial después de la osteotomía de la rama dividida sagital

Dental-skeletal anomalies are treated by combining orthodontic treatment with orthognathic surgery. This mainly involves performing sagittal osteotomy of the mandibular branch. This technique offers many advantages, but its main disadvantage is paraesthesia of the inferior alveolar nerve. There are several treatments focused on promoting neurological recovery, one of which is low intensity laser. The aim of this study was to make a clinical evaluation of the efficacy of low intensity laser therapy in the neurosensory recovery of tissues after sagittal osteotomy of the mandible. A group of twelve patients with the need of surgical correction of their dental-skeletal anomaly underwent orthognathic surgery with bilateral mandibular sagittal osteotomy. Patients were treated unilaterally and blinded with a low intensity infrared GaAlAs laser of 808nm, and compared with the contralateral site as a control group, following the course of the inferior dental nerve. The parameters used were of 100mW of power, irradiation of 3.6W/cm2, 2.8J of energy per point, an energy density of 100J/cm2, to 28s in each point with a distance of 1cm between points. The treatment included two sessions per week with a minimum of 10 sessions, starting 48h after surgery. Mechanical and thermal evaluations were performed in the first, fourth, seventh and tenth sessions. A significant improvement was observed in the subjective response of the patients on the treated side. The treatment of neurosensory disorders with low-intensity infrared laser has been shown to be effective in accelerating recovery, providing greater patient comfort, and presenting advantages over other existing methods (AU)

Las anomalías dentoesqueléticas son tratadas combinando el tratamiento de ortodoncia con la cirugía ortognática, principalmente, mediante la osteotomía sagital de rama mandibular. Esta técnica ofrece muchas ventajas, pero dentro de sus principales desventajas se encuentra la parestesia del nervio dentario inferior. Existen varios tratamientos enfocados a promover la recuperación neurológica y uno de ellos es el tratamiento con láser de baja intensidad. Esta investigación tuvo como objetivo hacer una evaluación clínica de la eficacia de la terapia con láser de baja intensidad en la recuperación neurosensorial de los tejidos tras la osteotomía sagital de la mandíbula. Un grupo de 12 pacientes con necesidad de corrección de su anomalía dentoesquelética fueron intervenidos con cirugía ortognática mediante la osteotomía sagital de rama mandibular bilateral. Los pacientes fueron tratados en el postoperatorio de manera unilateral y ciega con láser infrarrojo de baja intensidad de 808nm, medio activo de gaaias, y comparados con el lado contralateral como control, siguiendo el recorrido del nervio dentario inferior. Los parámetros utilizados fueron de 100 mW de potencia, irradiación de 3,6 W/cm2, 2,8 J de energía por punto, una densidad de energía de 100 J/cm2, a 28 s en cada punto con una distancia de 1cm entre puntos, 2 sesiones por semana, con un mínimo de 10 sesiones a partir de las 48 horas después de la cirugía. Se realizaron evaluaciones mecánicas y térmicas en la primera, cuarta, séptima y décima sesión. Se observó una mejora significativa en la respuesta subjetiva de los pacientes en el lado tratado. El tratamiento de los trastornos neurosensoriales con el láser de baja intensidad de infrarrojos ha demostrado ser eficaz en la aceleración de la recuperación, proporciona una mayor comodidad al paciente y presenta ventajas sobre otros métodos existentes (AU)

Prótese parcial removível obturadora - uma reabilitação oral que devolve o bem-estar físico e mental / Removable partial denture obturator - an oral rehabilitation that restores physical and mental well-being

As deformidades bucomaxilofaciais são constrangedoras e embaraçosas ao portador. Estes pacientes apresentam-se com sérios problemas psíquicos, familiares e sociais tornando-se indivíduos traumatizados, complexados e diminuídos física e psicologicamente. As causas dessas deformidades podem ser congênitas, causadas por más formações/distúrbios de desenvolvimento, ou adquiridas, causadas por mutilações de origem patológica, como as doenças necrosantes e as oncologias cirúrgicas, ou traumáticas, como acidentes de trabalho, trânsito e intencionais.

Maxillofacial deformities may cause awkward and embarrassing bearer. These patients present serious psychological, family and social issues becoming traumatized and complexed. These deformities can have congenital origin, malformations and developmental disorders, or can be caused by pathological mutilation such as necrotizing diseases and surgical oncology, or traumas such as traffic and work accidents

Prosthetic rehabilitation of maxillary dentoalveolar defects with fixed dental prostheses: two clinical reports.

Traumatic injuries or congenital malformations may cause soft and hard tissue defects resulting in the loss of alveolar bone and attached mucosa. Restoring the defective area presents a challenge for clinicians. The prosthetic rehabilitation of 2 patients with maxillary dentoalveolar defects with 2 different prosthetic designs is presented. The esthetic and functional requirements of the patients were fulfilled.

Prosthetic Management and Analysis of Combined Extraoral-Intraoral Maxillofacial Defects Complicated with Microstomia. A Report of Three Cases.

Different prosthetic treatment plans for three patients with variable degrees of acquired maxillofacial defects were reported and analyzed. Combined extraoral-intraoral prostheses were selected to restore the three cases. Two patients were rehabilitated using two separated prostheses, while the third one was restored with a coupled two-unit prosthesis. The design of extraoral-intraoral prosthesis either separated or connected, is influenced by the condition and nature of the residual tissues, defect configuration, patient needs, degree of tissue damage and the anticipated success rate or complications with the treatment. It was observed that separating the intraoral part from that of the extraoral resulted in better retention, stability, and more comfort to the patient with combined defects. Furthermore, fabrication and repair of each part is technically easier as perceived it can be carried out independently and the patient can continue to use one-part and send the other for repair. Another advantage is the reduction of size and weight of the prosthesis.

Prosthetic rehabilitation of a cleidocranial dysplasia patient with vertical maxillofacial deficiency: a clinical report.

Cleidocranial dysplasia (CCD) is a rare congenital disorder characterized by skeletal and dental anomalies. This clinical report describes the prosthodontic approach to treating a CCD patient who presented with decreased facial height and relative mandibular protrusion due to maxillary hypoplasia after orthodontic treatment. Functional and esthetic rehabilitation was achieved using telescopic detachable prostheses in the maxilla and osseointegrated implants and metal-ceramic fixed dental prostheses in the mandible. These treatment approaches precluded the need for orthognathic surgical correction and presented a favorable prognosis during the 5-year observation period.