Can platelet-rich fibrin accelerate neurosensory recovery following sagittal split osteotomy? A double-blind, split-mouth, randomized clinical trial.

Neurosensory disturbance (NSD) is common following sagittal split osteotomy (SSO) surgery. The aim of this study was to evaluate the effect of platelet-rich fibrin (PRF) on neurosensory recovery following SSO. This double-blind, split-mouth, randomized clinical trial was performed on patients undergoing bilateral SSO. PRF was applied to one side (selected using computer randomization) after the osteotomy and before fixation. The other side served as the control. The two-point discrimination test and a brush directional stroke test were used to assess NSD at 6 and 12 months postoperative. Self-reported paresthesia was documented using a 10-point visual analogue scale (VAS). Twenty-one patients were included in the study. The results of the two-point discrimination test and the number of subjects who reported a true direction in the brush directional stroke test differed significantly between the treatment and control sides (P=0.001). The recovery of NSD (self-reported paresthesia) was better on the treatment side than on the control side (P=0.001). PRF may enhance the recovery of paresthesia following SSO.

Clinical outcomes of dental implants after use of tenting for bony augmentation: a systematic review.

The reconstruction of severely atrophic ridges is often challenging and complicated. We searched the Medline, Embase, and Cochrane databases for articles up to October 2015 that reported the success of all types of tenting for bony regeneration. We extracted data on the size and site of the defect, the number of patients, vertical and horizontal augmentation, survival of dental implants, and complications. Thirteen studies were included, which yielded data on 423 patients with 1111 dental implants. Follow-up periods were more than five years, severely resorbed mandibles were augmented vertically by up to 10mm, and the survival rate of the implants was over 97%. The mean (SD) gain in horizontal width by screw tenting was 3 (0.63)mm, and over 97.6% of dental implants in cortical tenting investigations survived. A tenting approach may reduce the need for large autogenous bone grafts in the reconstruction of severely atrophic ridges and local bony defects, and improves the survival of implants.

Assessment of compression and strength of divergent screws mounted on miniplates for fixation of mandibular fractures: an in vitro experimental study.

An efficient band of tension is critical for the adequate fixation of mandibular fractures, so fixation devices that compress are helpful. We aimed to evaluate the possibility of creating compression using screws inserted divergently into miniplates placed in the tension zone of mandibular fractures and record the effects on the strength of fixation. For this in vitro experimental study we prepared 20 sheep hemimandibles. After angle fractures had been created, the specimens were divided into standard and study groups (n=10 in each). In the standard group the tension zones were fixed in the standard manner with 4-hole miniplates and 4 parallel screws. Those in the study group were fixed as for the standard group but with 4×45° divergent screws. The differences in the gap in the fracture line before and after fixation were measured as indicators of compression. The strength of fixation was also assessed with a universal testing machine in vitro. The amount of compression was significant only in the study group (p<0.001), and there was no difference in the strength of fixation between the two groups (p=0.7). We conclude that divergent drilling and insertion of screws creates more horizontal force when miniplates are used, and results in reduction in the size of the probable gap in the fracture line. Insertion of divergent screws in miniplates may create compression between fractured segments without jeopardising the strength of fixation.

Effects of maxillary advancement and impaction on nasal airway function.

The effects of Le Fort I osteotomy on the nasal airway are controversial. This study aimed to evaluate nasal airway changes after Le Fort I. 25 patients underwent conventional Le Fort I osteotomy and were separated into three groups depending on the type of surgery they underwent. 11 patients needed maxillary impaction, 9 underwent maxillary advancement, and 5 had both maxillary impaction and advancement. Rhinological examinations, anterior rhinomanometry and acoustic rhinometry were carried out 1 week before surgery and 3 months after that. Wilcoxon and χ(2) tests were used for data analysis. The samples included 19 females and 6 males with a mean age of 22.4 ± 3.32 years. Rhinomanometric assessment showed that total nasal airflow was increased from 406 ± 202 ml/s to 543 ± 268 ml/s in all three groups. Significant decrease in nasal airway resistance was seen in all three groups. Acoustic rhinometry revealed a significant decrease in total nasal volume but an increase in the cross-sectional areas of isthmus nasi (IN) and inferior concha. The rhinomanometric measurements showed improvements in the total nasal airflow after Le Fort I osteotomy with alar base cinch suture in cases where the impaction was not higher than 5.5mm.

A composite buccal flap for alar based defect reconstruction: a technical note.

It is difficult to reconstruct an alar defect with cartilage involvement. Here in the authors report a case of traumatic alar loss during childhood in which an alar reconstruction was carried out with a composite auricular graft put over the pedicle buccal flap which was rotated and passed through the intraoral side. The lining skin and auricular cartilage for the flap was obtained from the auricular region which was acceptable for the patient. All procedures were performed under general anesthesia. One year follow up revealed satisfactory results with minimal contracture of the graft.