Clinical and Cephalometric Changes in Long-face Patients With Retrogenia Following the Novel B-genioplasty Technique.

BACKGROUND: The chin plays a fundamental role in facial attractiveness. Accordingly, several surgical procedures have been proposed for chin contouring. This study aimed to introduce "B-genioplasty" as a novel genioplasty technique and assess the clinical and cephalometric changes in long-face patients with retrognathia following the novel B-genioplasty. METHODS: This is a cross-sectional study. Subjects with class I occlusion increased lower facial height and retrognathia underwent B-genioplasty in this prospective experimental study. Soft and hard tissue cephalometric measurements were made, and the depth of the notch in the lower border of the mandible was measured on lateral cephalograms at 6 months postoperatively and compared with baseline. Patient satisfaction with the outcome was also assessed. RESULTS: Seventeen subjects were studied. Ten (58%) patients underwent rhinoplasty plus genioplasty. All patients were satisfied with the outcome. The step/notch in the lower border of the mandible was not detected in clinical examination in any patient. The mean notch depth was 0.5±0.83 mm on lateral cephalograms. The change in all soft and hard tissue cephalometric parameters was significant at 6 months postoperatively compared with baseline (P<0.001 for all). CONCLUSION: B-genioplasty caused satisfactory clinical and cephalometric changes in long-face patients with retrognathia, including prevention of step/notch in the inferior border of the mandible, significant reduction of gonial angle, correction of the mandibular plane, and reduction of lower facial height.

Does leucocyte- and platelet-rich fibrin enhance neurosensory recovery after genioplasty? A double-blind, split-mouth, randomised clinical trial.

Neurosensory disturbances (NSD) are common after genioplasty. In this study we aimed to assess the recovery of NSDs with or without leukocyte- and platelet-rich fibrin (L-PRF) following genioplasty. In this double-blind, split-mouth, randomised clinical trial, L-PRF was applied around the mental nerve at the osteotomy site in genioplasty (treatment side). The contralateral side was considered the control side. Two-point discrimination (TPD) test, brush test, and self-reported NSDs (SR-NSD) were used to determine NSD at one, four, and 12 months after genioplasty. Twenty patients were studied. At one and four months after osteotomy, the mean scores of TPD and SR-NSDs were significantly different between the treatment and control sides (p = 0.04, p = 0.01, respectively). The mean of TPD and SR-NSDs was not statistically different on both sides 12 months after operation (p = 0.05, p = 0.71, respectively). The application of L-PRF may enhance the speed of NSD recovery four months after genioplasty.

What factors affect the attachment of the inferior alveolar nerve to the buccal plate following sagittal split osteotomy?

PURPOSE: This study aimed to assess the factors that can possibly affect the positioning of the inferior alveolar nerve (IAN) in the proximal or distal segment following sagittal split osteotomy (SSO). MATERIALS AND METHODS: This was a prospective cohort study. The patients were assigned according to the position of the IAN: the IAN was attached to the buccal plate in group 1 (27 SSOs), while it was in the distal segment in group 2 (83 SSOs). RESULTS: The mean of the buccolingual thickness of the proximal segment at the vertical cut of the osteotomy (BLTP) was 5.0 ± 0.62 mm in group 1 and 4.16 ± 0.72 mm in group 2. The mean of the distance between the IAN and the external cortical bone at the distal of the second molar before the osteotomy (IANB) was 0.5 ± 0.24 mm in group 1 and 1.24 ± 0.45 mm in group 2. There were significant differences for the mean BLTP and IANB between the two groups (P = 0.001). CONCLUSION: It seems that the thickness of the buccal plate of the proximal segment, the distance from the IAN to the external cortical bone, the osteotomy technique, and the presence or absence of impacted third molars may be associated with the positioning of the IAN following SSO.

Treatment of an Adult Skeletal Class III Patient with Surgically Assisted Rapid Palatal Expansion and Facemask.

This case report presents the treatment of a 21-year-old male patient with class III skeletal malocclusion, an open bite, and vertical growth pattern. He was managed with surgically assisted rapid palatal expansion (SARPE) along with an orthopedic facemask. The duration of treatment was 16 months. Significant improvement and favourable outcome were observed concerning both facial appearance and paraclinical parameters after completion of treatment.

The effect of autologous leukocyte platelet rich fibrin on the rate of orthodontic tooth movement: A prospective randomized clinical trial.

OBJECTIVE: The aim of this study was to evaluate the effect of LPRF, placed in extraction sockets, on orthodontic tooth movement (OTM). MATERIALS AND METHODS: Thirty extraction sockets from eight patients (five males, three females, with a mean age of 17.37 years; range 12-25 years) requiring extraction of first premolars based on their orthodontic treatment plan participated in this split-mouth clinical trial. In one randomly selected quadrant of each jaw, the extraction socket was preserved as the experimental group by immediate placement of LPRF in the extraction socket. The other quadrant served as the control group for secondary healing. Immediately, the teeth adjacent to the defects were pulled together by a NiTi closed-coil spring with constant force. A piece of 0.016 × 0.022-inch stainless steel wire was used as the main arch wire. The amount of OTM was measured on the study casts at eight time points with 2-week intervals for 3 months. Analysis of random effect model was performed for the purpose of comparison between the experimental and control groups. RESULTS: According to the random effect model, a statistically significant difference was found between the experimental and control group in rate of OTM (P = 0.006). CONCLUSION: According to the results, application of LPRF, as an interdisciplinary approach combining orthodontics and surgery, may accelerate OTM, particularly in extraction cases.

What Are the Incidence and Factors Associated With Implant Fracture?

PURPOSE: Implant fracture is a serious complication, which leads to treatment failure. The purpose of this study is to estimate the incidence of implant fractures and identify factors associated with them. MATERIALS AND METHODS: In this retrospective cohort study, the sample was derived from 2 implant centers. The predictors were grouped into the following categories: demographic, location of implant, physical characteristic of implant, implant-abutment connection, type of prosthesis, type of retention, and outcome variable (time to implant fracture). The Kaplan-Meier test was used to estimate implant survival. A Cox regression model was applied to evaluate the time-to-event effect of variables on implant fracture. RESULTS: Of 18,700 implants, 37 (0.002%) had fractures. The 1- and 5-year risk of implant fracture was 0.38 per 1,000 and 1.46 per 1,000, respectively. Implant fractures more often occurred in the premolar and molar area (94.6%) than in the anterior of the jaws. The Pearson correlation test did not show any correlation between age, implant diameter, or implant length and time of fracture (P > .05). Analysis of the data by the log-rank test showed a significant difference for survival between cemented and screw-retained crowns (P = .001). The Cox regression model showed a hazard ratio of 0.23 for tapered implants versus cylindrical fixtures and for screw-retained crowns (hazard ratio, 296.54) versus cemented crowns. CONCLUSIONS: According to this study, conical implants and screw-retained prostheses may have lower survival rates due to implant fracture.

Lateral Ramus Cortical Bone Plate in Alveolar Cleft Osteoplasty with Concomitant Use of Buccal Fat Pad Derived Cells and Autogenous Bone: Phase I Clinical Trial.

Tissue regeneration has become a promising treatment for craniomaxillofacial bone defects such as alveolar clefts. This study sought to assess the efficacy of lateral ramus cortical plate with buccal fat pad derived mesenchymal stem cells (BFSCs) in treatment of human alveolar cleft defects. Ten patients with unilateral anterior maxillary cleft met the inclusion criteria and were assigned to three treatment groups. First group was treated with anterior iliac crest (AIC) bone and a collagen membrane (AIC group), the second group was treated with lateral ramus cortical bone plate (LRCP) with BFSCs mounted on a natural bovine bone mineral (LRCP+BFSC), and the third group was treated with AIC bone, BFSCs cultured on natural bovine bone mineral, and a collagen membrane (AIC+BFSC). The amount of regenerated bone was measured using cone beam computed tomography 6 months postoperatively. AIC group showed the least amount of new bone formation (70 ± 10.40%). LRCP+BFSC group demonstrated defect closure and higher amounts of new bone formation (75 ± 3.5%) but less than AIC+BFSC (82.5 ± 6.45%), suggesting that use of BFSCs within LRCP cage and AIC may enhance bone regeneration in alveolar cleft bone defects; however, the differences were not statistically significant. This clinical trial was registered at clinicaltrial.gov with NCT02859025 identifier.

Multidisciplinary management of a patient with van der Woude syndrome: A case report.

INTRODUCTION: Van der Woude syndrome (VWS) is the most frequent form of syndromic cleft lip and palate (SCLP) accounting for 2% of all patients with CLP. CASE PRESENTATION: We describe the orthodontic treatment of a girl diagnosed with VWS referred by her family dentist for her cosmetic concerns. DISCUSSION: Comprehensive orthodontic treatment, secondary bone graft, distraction osteogenesis (for a deficient maxilla), secondary palatoplasty and excision of lower lip pits, as well as orthodontic and prosthetic procedures may provide a satisfactory outcome. Genetic testing showed a known putative splice site mutation (c.174+1G/A) as the prime cause of VWS in our patient and her family. CONCLUSION: SCLP has significant effects on facial aesthetics and the psychosocial status. Parents should be assessed and counseled appropriately. This condition is treatable in the absence of life threatening systemic anomalies. An interdisciplinary team approach is advocated.

Accuracy and reliability of cone beam computed tomographic measurements of the bone labial and palatal to the maxillary anterior teeth.

PURPOSE: The aim of this study was to measure the thickness of bone labial and palatal to maxillary anterior teeth on cone beam computed tomographic (CBCT) images and to compare these measurements with direct clinical measurements to determine the reliability and accuracy of CBCT. MATERIALS AND METHODS: Eighteen healthy subjects were randomly selected from among candidates for immediate implant placement in the anterior maxilla. After extraction, labial bone thickness was measured at 1, 4, and 8 mm from the bone crest. Palatal bone thickness was also measured at 1 and 4 mm from the bone crest. The same measurements were performed on presurgical CBCT images. The CBCT measurements were compared to the direct measurements, and their accuracy and reliability were assessed by Pearson correlation coefficients and intraclass correlation coefficients, respectively. RESULTS: The mean width of labial bone was 0.50 ± 0.32 mm and 0.76 ± 0.37 mm for direct and CBCT measurements, respectively. Average thickness of the palatal bone was 1.16 ± 0.53 mm and 1.41 ± 0.51 mm for direct and CBCT measurements, respectively. The mean absolute error and mean relative error of CBCT measurements compared to direct measurements were 0.28 ± 0.29 mm and 0.60 ± 0.84 mm, respectively. The Pearson correlation between CBCT and direct measurements was 0.795 (P < .001) and the intraclass correlation coefficient between direct and CBCT measurements was 0.840. The correlation between the measurement series increased significantly when the measured bone was more than 1 mm thick. CONCLUSION: CBCT measurements of labial bone mostly overestimated bone thickness. CBCT has relatively good accuracy and reliability for measurement of labial bone thickness when the alveolar bone is thicker than 1 mm. However, most subjects have labial bone thinner than 1 mm; therefore, CBCT could result in large errors in many patients.

Oro-facial characteristics and the surgical correction of patients affected by beta-thalassaemia: a review of the literature and report of a case.

Despite the fact that recent medical advances have improved the quality of life and increased the life expectancy of patients suffering from thalassaemia, no standard strategy or clinical guidelines are available for the correction of the presenting craniofacial anomalies. The aim of the present study is to review the craniofacial features of affected patients, and to discuss the orthodontic and orthognathic surgical treatment options available to manage the associated and characteristic facial deformity.

Bipolar Disorder: Review of Orthodontic and Orthognathic Surgical Considerations.

An increasing number of patients with psychological conditions with or without drug regimens are seeking orthodontic treatment and orthognathic surgery to address jaws dysmorphology. Depression and bipolar affective disorders are relatively common. These disorders may interfere with the presurgical orthodontics, surgical intervention and postsurgical treatments and thus requires careful considerations. The aim of this article is to report of a case with bipolar disorder and review the orthodontics and orthognathic surgery considerations of patients with bipolar disorder.

Cutaneous Metaplastic Synovial Cyst: A Case Report and Literature Review.

INTRODUCTION: Cutaneous metaplastic synovial cyst (CMSC) is a rare cutaneous lesion characterized by a tender subcutaneous nodule, which usually occurs at the site of previous surgical or local trauma. Histologically, the lesion includes a cystic structure with villous-like projections and a lining mimicking hyperplastic synovium. CASE PRESENTATION: We reported the first case of CMSC which developed at the surgical incision site of treatment of a maxillofacial fracture. In addition, we reviewed English literature to evaluate all previously reported CMSC cases and discussed its clinical and histopathological features and etiology. From 1987 to now, reviewing the English literature about CMSC includes 17 studies that described 28 cases, and our presented case was the 29th. There was no sex predilection and age of patients ranged from 7 to 82 years, but most of them were over 40 years. We can see this lesion in any site of the body and hand/arm is the most prevalent involved region (28% cases). Most of the patients had a history of previous local trauma or operation in the involved area. CONCLUSIONS: Although the actual etiology of CMSC remains unclear, trauma, as the most probable etiologic factor, plays a role in development of CMSC. Surgical excision of the lesion is the preferable treatment choice and rate of recurrence is low.

Thickness of labial alveolar bone overlying healthy maxillary and mandibular anterior teeth.

AIM: This study aimed to measure the thickness of labial bone overlying maxillary and mandibular anterior teeth and the distance between cementoenamel junction and bone crest in a Persian population. MATERIALS & METHODS: Two calibrated examiners evaluated tomographic data of 152 maxillary and 200 mandibular anterior teeth. Labial bone width was assessed at levels 1.0 to 5.0 mm apical to bone crest. Moreover, the distance between cementoenamel junction and bone crest was measured for both maxillary and mandibular teeth and its potential effect on the amount of labial bone thickness was assessed. RESULTS: One hundred-twenty nine maxillary central incisors, 77 lateral incisors, 70 canines, 105 mandibular central incisors, 103 lateral incisors and 81 canines were included for measurements. In maxilla, width of bone averaged 1.08mm, 1.11mm, and 1.3mm for central incisors, lateral incisors, and canines, respectively. Corresponding numbers for mandibular central incisors, lateral incisors, and canines were 0.74mm, 0.66mm and 0.40mm. High variation of cementoenamel junction to bone crest distance (range 0.5 to 5.15 mm) was detected. The mean amount of labial bone width was not statistically different in patients with different distances between cementoenamel junction and bone crest; except for mandibular lateral incisors. CONCLUSION: The mean thickness of the labial alveolar bone overlying maxillary anterior teeth was found to be between 1 to 1.2 mm and between 0.5 to 0.8 mm for mandibular anterior teeth at the first 5 mm from bone crest in a Persian population.

Comprehensive treatment and rehabilitation of a patient with maxillary arteriovenous malformation.

Arteriovenous malformations (AVMs) of the maxilla are rare and potentially life-threatening conditions that can pose a therapeutic dilemma. We reported the first case of maxillary AVM in a 15-year-old girl who was treated by marginal hemimaxillectomy including overlying palatal mucosa and immediate replantation of the segment after removing the AVM tissues and teeth and covering by a full-thickness pedicled temporal muscle flap rotated into the mouth. Then, this preserved bone underwent distraction osteogenesis and dental implant rehabilitation successfully. This method was previously used for the definitive treatment of mandibular AVMs, and in this case, we applied this method for the first time in maxillary AVMs. In conclusion, this surgical method may be considered as a safe, convenient, and effective treatment and reconstructive modality for such vascular malformations in the maxilla and restores function and symmetry of the jaws while obviating the need for bone harvesting and future major reconstructive operations.

Stabilization of premaxilla repositioned during secondary bone grafting in complete bilateral cleft lip and palate patients.

Secondary bone grafting simultaneous to premaxillary repositioning is a well-recognized surgical procedure for the management of bilateral cleft lip and palate patients. Proper stabilization of the repositioned premaxilla is considered as a key factor for the success of secondary bone grafting because the mobility of the premaxillary segment jeopardizes graft integration. This case series reports a reliable method of premaxillary stabilization that incorporated the intrasurgical application of resin bone cement to cover and reinforce the arch bars or orthodontic brackets applied on the maxillary teeth. Occlusal loads were reduced by application of posterior bite blocks on the mandibular teeth. The stabilization method was performed on 7 patients (5 women and 2 men) with a mean age of 12.4 years. During postsurgery follow-ups, the repositioned premaxillary segments did not show mobility in any of the patients. The palatal fistulae were completely closed. Panoramic radiographies taken 2 months after surgery demonstrated acceptable graft integration. The patients have now been followed up to 5 years. No evidence of relapse has been observed. This technique seemed to be undemanding, included minimal laboratory procedure, and maintained the labial mucosa overlying the repositioned segment intact.

The osteoregenerative effects of platelet-derived growth factor BB cotransplanted with mesenchymal stem cells, loaded on freeze-dried mineral bone block: a pilot study in dog mandible.

Due to shortcomings associated with autogenous bone graft, the gold standard of craniofacial grafting, investigators seek alternatives that are accessible, efficient, and affordable. Accordingly, in the present pilot study, bone regeneration was induced using bone marrow-derived mesenchymal stem cells (BMSCs) loaded onto freeze-dried mineral bone block (FDMBB) in the presence or absence of recombinant platelet-derived growth factor-BB (rh PDGF-BB). Eight weeks after the bilateral extraction of premolars of four mongrel dogs, 25 × 10 mm defects were created at both sides of the mandible. The right mandible received autogenous-BMSC loaded on FDMBB (MSC group), whereas the left mandible received cellular blocks impregnated with rhPDGF-BB (MSC + PDGF Group). Animals were euthanized 8 weeks after grafting. Micro-computed tomography (micro-CT) and histomorphometric analysis demonstrated higher levels of bone formation for the test group (10.34% ± 0.20 and 26.63% ± 3.14, respectively) when compared to the control group (8.20% ± 0.20 and 21.38% ± 5.11). The differences were not statistically significant (P > 0.05). According to the performed micro-CT and histomorphometric analysis, adding 0.5 mg rhPDGF-BB (0.3 mg/mL) to the combination of BMSC/FDMBB did not significantly increase bone formation in supracrestal defect in dog mandible.

Rapid, conservative, multidisciplinary miniscrew-assisted approach for treatment of mandibular fractures following plane crash.

Mandibular fractures are among the most common facial injuries. This case report demonstrates the efficacy of simultaneous usage of miniscrews and direct bonding techniques without open reduction in an extensive traumatized patient. A 25-year-old girl with multiple injuries in the head and facial region 1 month after a plane crash accident was referred to manage the mandibular fractures. Due to the presence of multiple injuries, a conservative treatment of symphysiseal fracture was performed. In order to keep the fractured fragments of the mandible close together, the anterior teeth of the lower arch were tied by means of the orthodontic wire. Ten miniscrews were used to improve the anchorage units and also, settling the occlusion by means of light intermaxillary elastics. Following the active treatment, clinical and radiographic analysis showed satisfactory healing without any periodontal involvement of the teeth in the fracture line.

Osteoblastic differentiation of human stem cells derived from bone marrow and periodontal ligament under the effect of enamel matrix derivative and transforming growth factor-beta.

PURPOSE: To increase the understanding of the applicability of biomaterials and growth factors in enhancing stem cell-based bone regeneration modalities, this study evaluated the effects of enamel matrix derivative (EMD) and recombinant human transforming growth factor-beta (rhTGF-ß) on osteoblastic differentiation of human bone marrow mesenchymal stem cells (hBMSCs) as well as human periodontal ligament stem cells (hPDLSCs). MATERIALS AND METHODS: hBMSCs and hPDLSCs were obtained, and identification of stem cell surface markers was performed according to the criteria of the International Society for Cellular Therapy. Each group of stem cells was separately treated with a serial dilution of EMD (10, 50, and 100 µg/mL) or rhTGF-ß (10 ng/mL). Osteoblastic differentiation was examined through in vitro matrix mineralization by alizarin red staining, and mRNA expression of osteopontin and osteonectin was determined by quantitative reverse-transcriptase polymerase chain reaction. hPDLSCs were further assessed for osteocalcin mRNA expression. Stem cells cultured in osteogenic medium were employed as a standard positive control group. RESULTS: In none of the experimental groups were bone-related mRNAs detected subsequent to treatment with EMD for 5, 10, and 15 days. Alizarin red staining on day 21 was negative in EMD-treated BMSC and PDLSC cultures. In rhTGF-ß-supplemented BMSC culture, expression of osteonectin mRNA was demonstrated on day 15, which was statistically comparable to the positive control group. Nevertheless, extracellular matrix mineralization was inhibited in both groups of stem cells. CONCLUSIONS: Within the limitations of this study, it could be concluded that EMD with a concentration of 10, 50, or 100 µg/mL has no appreciable effect on osteoblastic differentiation of BMSCs and PDLSCs. Application of rhTGF-ß increased osteonectin mRNA expression in BMSCs. This finding corroborates the hypothesis that TGF-ß might be involved in early osteoblastic maturation.

Lefort 1 osteotomy in a beta-thalassemia major patient--a case report.

Maxillary setback of patients with protruded maxilla is a complex procedure. This complexity is aggravated when combined with thalassemia. The Aim of this case report was to treat a beta-thalassemia major girl with severe maxillary protrusion. A 16 year-old beta-thalassemia major girl presented with excessive maxilla, incompetent lips and an everted upper lip was referred for treatment. She had her spleen removed at the age of 9 and her blood transfusion was stopped 3 month before referral. After leveling and aligning with 018 standard edgewise system the patient was sent for Lefort 1 osteotomy. Segmental osteotomy was denied due to excessive bleeding in the procedure. The results showed that the thalassemic patient was effectively treated with presurgical orthodontics, Lefort 1 osteotomy followed by post surgical orthodontics. Very satisfactory esthetic results were obtained in the patient after 4.5 years of active treatment.

Clinical importance of recipient site characteristics for vertical ridge augmentation: a systematic review of literature and proposal of a classification.

This review evaluated the characteristics of vertical alveolar defects that were augmented via onlay bone grafting or guided bone regeneration. Information regarding the anatomic site, type of edentulism, and defects' dimensions were extracted. The experiments differed vastly in the description of the defects' features. Aiming to mitigate the confounding effect of recipient site's morphology in future experiments, a classification of vertically deficient recipient sites is proposed.