Implant-supported Dental Prosthesis and Orthognathic Surgery for Rehabilitation of Patients with Obstructive Sleep Apnea / Prótese Dentária Implanto-suportada e Cirurgia Ortognática para Reabilitação de Pacientes com Apneia Obstrutiva do Sono

ABSTRACT: Among the treatment options for Obstructive Sleep Apnea (OSA) we have surgery to correct dentofacial deformities. OSA patients are routinely and predictably submitted to surgical treatment for dentofacial deformities. Frequently, orthognathic surgery and osseointegrated implants may be necessary to enable fixed rehabilitation. Patients submitted to orthognathic surgery have a transient decrease in blood supply after maxillary and mandibular osteotomy procedures, which can impair the results in these cases. This case report aimed to present and discuss the conflicting situation of an OSA patient in need of orthognathic surgery and dental implants. The treatment consisted of: (1) extraction of all teeth; (2) complete rehabilitation of the upper and lower jaw with dental implants and prosthesis without compensation; (3) bimaxillary orthognathic surgery to re-establish the maxillomandibular relationship and increase the upper airway volume. This rehabilitation sequence was a safe alternative for a case of Class II OSA, and rapidly achieved a final restoration with enhanced esthetics, functionality, biomechanics, maintenance of oral hygiene, and patient satisfaction. (AU)

RESUMO: Entre as opções de tratamento da Apneia Obstrutiva do Sono (AOS) temos a cirurgia para correção das deformidades dentofaciais. Freqüentemente, a combinação de cirurgia ortognática e implantes osseointegráveis pode ser necessária para permitir a reabilitação dental. Pacientes submetidos à cirurgia ortognática apresentam diminuição transitória do suprimento sanguíneo após procedimentos de osteotomia maxilar e mandibular, o que pode prejudicar os resultados nestes casos. Este relato de caso teve como objetivo apresentar e discutir a situação de um paciente com AOS que necessita de cirurgia ortognática e implantes dentários. O tratamento consistiu em: (1) extração de todos os dentes; (2) reabilitação completa da mandíbula superior e inferior com implantes dentários e próteses sem compensação; (3) cirurgia ortognática bimaxilar para restabelecer a relação maxilomandibular e aumentar o volume das vias aéreas superiores. Essa sequência de reabilitação foi uma alternativa segura para um caso de AOS Classe II, e rapidamente alcançou uma reabilitação com estética, funcionalidade, biomecânica aprimorada, manutenção da higiene oral e satisfação do paciente. (AU)

Individualized Surgical Orthodontic Rehabilitation of Class III Dentofacial Deformities.

INTRODUCTION: Treatment of Class III dentofacial deformities present a complex clinical challenge. MATERIALS AND METHODS: This article demonstrates the successful surgical-orthodontic rehabilitation of two patients with skeletal Class III deformities. Meticulously planned and well-executed conventional combination of presurgical orthodontics, orthognathic surgery and postsurgical orthodontic therapy helped optimally achieve an aesthetic facial profile, pleasing smile and well-interdigitated occlusion. RESULTS: The results showed excellent stability at 3-year follow-up in both cases. DISCUSSION: Various clinical criteria and protocol crucial for realization of stable aesthetic, structural and functional outcomes are also 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.

Comportamiento de la oclusión dentaria en pacientes operados de cirugía ortognática / Behavior of dental occlusion in patients undergoing orthognathic surgery

Introducción: la cirugía ortognática corrige las alteraciones del componente esquelético en las anomalías dentomaxilofaciales. Estas deformidades provocan deficiente relación de los huesos maxilares, afectando la oclusión dentaria y sus funciones. Objetivo: identificar el comportamiento de la oclusión dentaria en pacientes que fueron intervenidos por cirugía ortognática. Materiales y Métodos: se realizó un estudio observacional descriptivo con el objetivo de identificar características oclusales en pacientes intervenidos por cirugía ortognática. Se utilizaron las variables: relación de molares, guías de función lateral, tipo de masticación, interferencias oclusales en movimiento de protrusión y de lateralidad. Resultados: se observaron pacientes con relación de molares en mesioclusión, lo cual es un indicio de recidiva de la neutroclusión que había sido alcanzada. La intervención quirúrgica de mayor incidencia fue la retroposición mandibular acompañada de centralización. Existió una gran mejoría de la función masticatoria. La mayoría de los pacientes, se encontraban libres de interferencias oclusales. Conclusiones: los examinados se encontraron entre los grupos de edades de 24 a 38 años, y el sexo femenino predominó con un 60,5 %. El 13, 2 % de los sujetos presentaron mesioclusión, con mayor incidencia en los casos intervenidos con retroposición y centralización de la mandíbula. Predominó la función canina en los movimientos de lateralidad. La mayoría de los pacientes se encontraban libres de interferencias oclusales, representando el 71,1 % de los pacientes estudiados.

Introduction: the orthognatic surgery corrects the alterations of the skeletal component in dentomaxillafacial anomalies. These deformations cause deficient relations of the maxillary bones, affecting the dental occlusion and its functions. Objective: to identify dental occlusion behavior in patients undergoing orthognatic surgery. Materials and methods: an observational, descriptive study was carried out with the objective of identifying oclussal characteristics in patients who underwent orthognatic surgery. The used variables were: molars relation, guides of lateral functioning, kinds of chewing, occlusive interferences in protrusion movements and in movements of laterality. Results: patients were found with molars relation of mesiooclussion, which is an indication of recidivism in the achieved neutroclussion. The surgical intervention with higher incidence was mandibular retro positioning accompanied by centralization. There it was a great improvement of the chewing function. Most of the patients were free of oclussal interferences. Conclusions: the assessed patients were in the age-groups from 24 to 38 years, and female sex predominated with 60.5 %. 13.2 % of the subjects had mesiocclusion, with higher incidence in the cases surgically treated with jaw retroposition and centralization. The canine tooth function in the lateral movements predominated. Most of the patients were free from occlusive interferences, being 71.1 % of the studied patients.

Comportamiento de la oclusión dentaria en pacientes operados de cirugía ortognática / Behavior of dental occlusion in patients undergoing orthognathic surgery

Introducción: la cirugía ortognática corrige las alteraciones del componente esquelético en las anomalías dentomaxilofaciales. Estas deformidades provocan deficiente relación de los huesos maxilares, afectando la oclusión dentaria y sus funciones. Objetivo: identificar el comportamiento de la oclusión dentaria en pacientes que fueron intervenidos por cirugía ortognática. Materiales y Métodos: se realizó un estudio observacional descriptivo con el objetivo de identificar características oclusales en pacientes intervenidos por cirugía ortognática. Se utilizaron las variables: relación de molares, guías de función lateral, tipo de masticación, interferencias oclusales en movimiento de protrusión y de lateralidad. Resultados: se observaron pacientes con relación de molares en mesioclusión, lo cual es un indicio de recidiva de la neutroclusión que había sido alcanzada. La intervención quirúrgica de mayor incidencia fue la retroposición mandibular acompañada de centralización. Existió una gran mejoría de la función masticatoria. La mayoría de los pacientes, se encontraban libres de interferencias oclusales. Conclusiones: los examinados se encontraron entre los grupos de edades de 24 a 38 años, y el sexo femenino predominó con un 60,5 %. El 13, 2 % de los sujetos presentaron mesioclusión, con mayor incidencia en los casos intervenidos con retroposición y centralización de la mandíbula. Predominó la función canina en los movimientos de lateralidad. La mayoría de los pacientes se encontraban libres de interferencias oclusales, representando el 71,1 % de los pacientes estudiados. (AU)

Introduction: the orthognatic surgery corrects the alterations of the skeletal component in dentomaxillafacial anomalies. These deformations cause deficient relations of the maxillary bones, affecting the dental occlusion and its functions. Objective: to identify dental occlusion behavior in patients undergoing orthognatic surgery. Materials and methods: an observational, descriptive study was carried out with the objective of identifying oclussal characteristics in patients who underwent orthognatic surgery. The used variables were: molars relation, guides of lateral functioning, kinds of chewing, occlusive interferences in protrusion movements and in movements of laterality. Results: patients were found with molars relation of mesiooclussion, which is an indication of recidivism in the achieved neutroclussion. The surgical intervention with higher incidence was mandibular retro positioning accompanied by centralization. There it was a great improvement of the chewing function. Most of the patients were free of oclussal interferences. Conclusions: the assessed patients were in the age-groups from 24 to 38 years, and female sex predominated with 60.5 %. 13.2 % of the subjects had mesiocclusion, with higher incidence in the cases surgically treated with jaw retroposition and centralization. The canine tooth function in the lateral movements predominated. Most of the patients were free from occlusive interferences, being 71.1 % of the studied patients.(AU)

[Evaluation of healing time of osteochemonecrosis of the jaw after surgery: Single-center retrospective study and review of the literature]. / Évaluation des délais de guérison des ostéochimionécroses des maxillaires après traitement chirurgical : étude rétrospective monocentrique et revue de la littérature.

INTRODUCTION: Osteochemonecrosis of the jaw (ONJ) is a chronic ischemic bone exposure. It has an increasing incidence. ONJ is mainly related to bisphosphonate and denosumab therapies in oncologic settings. Healing is considered uncertain ad as occurring slowly. International recommendations suggest to treat ONJ symptomatically in a first attempt. A surgical procedure, potentially aggressive, should be carefully weight up in patients in poor condition and whose life expectancy is often limited. However, surgical treatment seems to allow for a high rate of clinical remission. Postoperative remission periods, when mentioned in the studies, are disparate. The aim of our study was to clarify the remission period of ONJ after surgical management. METHOD: A retrospective study was conducted on all patients operated for an ONJ at stage 2 and 3 in the Department for Oral and Maxillofacial Surgery - University Hospital of Besançon (France) from January 2006 to September 2015. Healing was defined as complete mucosal closure and asymptomatic site. Stage of the disease, the number and the type of surgery and the time between the last operation and the healing was noticed. These data were compared to an exhaustive review of the literature on PubMed with the following key-words: "osteonecrosis" AND "jaw" AND "surgery" AND "management". Only the articles giving the healing period were included. RESULTS: Regarding the single-center retrospective study, the files of 23 patients could be included. Fifteen percent of the patients benefited from several procedures under general anesthesia. Twenty percent had a stage 3 ONJ and 80 % had a stage 2 ONJ. Twenty-five interventions were performed on 23 sites in 20 patients. Immediate healing after surgery occurred in 35 % of the patients. At 6 months after surgery, 57 % of the treated areas were healed. Twenty percent of the patients had died. The healing rate did not improve further after 6 months postoperatively. Regarding the review of the literature, 7 articles could be included. The mean postoperative healing period was 60.7 % at 6 months, 71.1 % at 12 months and 69.5 % at 18 months. DISCUSSION: Our study shows that the postoperative healing rate of ONJ lies between 57 and 66.7 % at 6 months and that this rate was optimized in the order of 10 % to 12months and stable at 18months postoperatively. The ONJ of our series were partially or fully linked to other drugs than bisphosphonates in 70 % of the cases: 50 % were related to denosumab, alone or in combination and 35 % were related to an association with antiangiogenics, bevacizumab mainly.

Enxerto ósseo microvascularizado na reconstrução mandibular: relato de caso / Microvascular bonegraft in mandibular reconstruction: case report

Os defeitos mandibulares podem ser causados por uma variedade de fatores, incluindo os traumas, osteomielite, osteonecrose, como também por tumores benignos ou malignos. A não reparação desses defeitos pode causar desfiguração facial, redução da capacidade mastigatória, dificuldade da fala, além de afetarem severamente a qualidade de vida dos pacientes. O ideal é que as reconstruções mandibulares devam não apenas restaurar a altura anatômica e o contorno na região ausente mas também permitirem o reestabelecimento funcional e psicossocial. Atualmente, existem várias formas de reconstrução óssea descritas na literatura. O enxerto ósseo livre normalmente é utilizado para defeitos menores que 7cm apresentando bons resultados. Para defeitos maiores, o enxerto ósseo vascularizado estaria melhor indicado, pois a irrigação imediata minimiza os riscos de insucesso da reconstrução. Nesses casos, uma opção viável é o enxerto de crista ilíaca, por fornecer segmento ósseo significante tanto em altura quanto em espessura, além da possibilidade de incluir vasos importantes para a realização da anastomose microvascular. Este trabalho relata um caso de reconstrução mandibular com uso do enxerto microvascularizado de crista ilíaca em paciente portador de ameloblastomasubmetido a ressecção óssea extensa... (AU)

The mandibular defects may be caused by a variety of factors, including trauma, osteomyelitis, osteonecrosis, well as benign or malignant tumors. Failure to repair these defects can cause facial disfigurement, reduced chewing ability, speech difficulty, and severely affect the quality of life of patients. Ideally, mandibular reconstructions shouldn't only restore the anatomic height and missing contour in the region, but also allow the functional and psychosocial reestablishment. Actually, there are several forms of bone reconstruction described in the literature, and the free bone graft is indicated for minor defects that 7cm with good results.Vascularised bone graft is indicated for larger defects, because the immediate irrigation minimizes the risks of failure of the reconstruction. A viable option is the iliac crest bone graft, because it provides significant bone segment both in height and thickness, and can include important blood vessels to the anastomosis. This case reports a reconstruction with microvascularized iliac crest bone graft in patient with ameloblastoma subjected to extensive bone resection... (AU)

Regression analysis of correlated ordinal data using orthogonalized residuals.

Semi-parametric regression models for the joint estimation of marginal mean and within-cluster pairwise association parameters are used in a variety of settings for population-averaged modeling of multivariate categorical outcomes. Recently, a formulation of alternating logistic regressions based on orthogonalized, marginal residuals has been introduced for correlated binary data. Unlike the original procedure based on conditional residuals, its covariance estimator is invariant to the ordering of observations within clusters. In this article, the orthogonalized residuals method is extended to model correlated ordinal data with a global odds ratio, and shown in a simulation study to be more efficient and less biased with regards to estimating within-cluster association parameters than an existing extension to ordinal data of alternating logistic regressions based on conditional residuals. Orthogonalized residuals are used to estimate a model for three correlated ordinal outcomes measured repeatedly in a longitudinal clinical trial of an intervention to improve recovery of patients' perception of altered sensation following jaw surgery.

Inflatable hollow obturator prostheses for patients undergoing an extensive maxillectomy: a case report.

The presence of a large palatal or maxillary defect after partial or total maxillectomy for tumor, trauma or congenital deformation poses a challenge to prosthodontists, particularly when the use of an implant cannot be considered. This case report described the use of an air valve in a hollow silicone obturator to manufacture an inflatable obturator that could be extended further into undercut area to retain itself. The inflatable obturator exhibited adequate retention, stability and border sealing, thereby improving the masticatory,pronunciation and swallowing functions of patients. It may be a suitable alternative treatment option to an implant-retained obturator.