Photobiomodulation using 940-nm laser as an adjuvant therapy on orthognathic surgery: A randomized clinical trial.

This study aimed to evaluate the effectiveness of photobiomodulation (PBM) therapy using 940-nm laser in patients undergoing orthognathic surgery. Twenty individuals were randomly distributed into laser (n = 10) and control (n = 10) groups. The PBM was conducted immediately after surgery, after 24 h, 48 h, and weekly for up to 4 weeks. All participants were evaluated for pain, edema, trismus and paresthesia. Data were compared by Fisher's and Mann-Whitney or chi-square tests (5%). The pain decreased from 24 h to 4 weeks, with the laser group reaching any pain after 3 weeks (p < 0.001). A significant difference was noticed for trismus on days 14 and 30 (p = 0.002; p = 0.019), without difference in paresthesia (p = 0.198). Edema was lower on the laser group compared to control, without a significant difference for most measurements. Data indicate that 940-nm PBM therapy decreased the occurrence of postoperative pain and significantly improved trismus.

Do the stages of orthodontic-surgical treatment affect patients' quality of life and self-esteem?

The orthodontic-surgical treatment comprises different stages from diagnosis to final soft tissue accommodation, but there are no data regarding the patient's perception during these phases. This study aimed to investigate the impact of these stages on quality of life and self-esteem of patients with dentofacial deformity. Patients were divided into 4 groups according to the treatment stage: initial orthodontic pre-treatment (1), one week before surgery (2), three months after surgery (3), and after the removal of the orthodontic appliance (4) (n = 20 / group). They filled the following questionnaires: Oral Health Impact Profile (OHIP-14), Orthognathic Quality of Life Questionnaire (OQLQ) and Rosenberg Self-Esteem Scale (RSES). Data were evaluated by Kruskal-Wallis test. Differences among groups were noticed in all evaluated scales (p = 0.001 for all). No statistically significant differences between patients in groups 1 and 2 (OHIP, OQLQ, and RSES, p >0.05 for all), while patients at group 4 presented different scores in all questionnaires compared to 1, 2, and 3 (p < 0.05 for all), irrespective of the type of dentofacial deformity (p > 0.05). The results indicate that dental decompensation stage did not negatively affect patient's confidence and well-being. Despite the improvement noticed few months after the orthognathic surgery, the main impact on patient's quality of life and self-esteem was evidenced after the removal of the orthodontic appliance. We highlight the important role of counselling patients to discuss all the treatment stages to clarify patients' subjective expectations before any intervention is carried out.

Longitudinal evaluation of the effects of low-power laser phototherapy on mandibular movements, pain, and edema after orthognathic surgery.

The aim of this study was to longitudinally evaluate mandibular movements, pain, and edema in patients who underwent low-power laser (LPL) phototherapy after bimaxillary orthognathic surgery. A double-blind, randomized, controlled clinical trial was conducted using 30 patients, who were divided into a study group (n = 15) and control group (n = 15). The former group received postoperative LPL (3 J/cm2, 808 nm, and 100 mW) and the latter group received placebo LPL phototherapy. Over a period of 60 days, these groups were evaluated for: mandibular movements - opening, laterality, and protrusion; pain - visual analogue scale; and edema - measured between cephalometric points. The study group showed significantly better jaw opening (p = 0.009), laterality (p = 0.036), and protrusion (p = 0.029) after 2 weeks in most comparisons. The study group showed significantly less postoperative pain (p < 0.001) in most comparisons, and they recovered from pain earlier than the control group. There was a reduction in edema, with no statistically significant difference for most measurements. As observed in most analyses, there were increases in values for all mandibular movements, no significant differences in the occurrence of edema, and decreases in the occurrence of pain.

Factors contributing to the surgical retreatment of mandibular fractures

The purpose of this retrospective study was to evaluate contributing factors in patients requiring surgical retreatment of mandibular fractures. Of all the patients with mandibular fractures who were treated using internal fixation at a trauma hospital over a seven-year period, 20 patients (4.7%) required a second surgery and thus composed the “reoperated” group. The control group comprised 42 consecutive patients with mandibular fractures who were treated at the same clinic and who healed without complications. Medical charts were reviewed for gender, age, substance abuse history, dental condition, etiology, location of fracture, degree of fragmentation, fracture exposure, teeth in the fracture line, associated facial fractures, polytrauma, time elapsed between trauma and initial treatment, surgical approach and fixation system. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0; descriptive statistics and the chi-squared test were used to determine differences between groups. Significant differences in substance abuse (p = 0.006), dental condition (p < 0.001), location of fracture (p = 0.010), degree of fragmentation (p = 0.003) and fracture exposure (p < 0.001) were found. With regard to age and time elapsed between trauma and initial treatment, older patients (31.4 years, SD = 11.1) and a delay in fracture repair (19.1 days, SD = 18.7) were more likely to be associated with reoperation. It was concluded that substance abuse, age, dental condition, location of fracture, degree of fragmentation, fracture exposure and the time between trauma and initial treatment should be considered contributing factors to the occurrence of complications that require surgical retreatment of mandibular fractures.

Factors contributing to the surgical retreatment of mandibular fractures.

The purpose of this retrospective study was to evaluate contributing factors in patients requiring surgical retreatment of mandibular fractures. Of all the patients with mandibular fractures who were treated using internal fixation at a trauma hospital over a seven-year period, 20 patients (4.7%) required a second surgery and thus composed the "reoperated" group. The control group comprised 42 consecutive patients with mandibular fractures who were treated at the same clinic and who healed without complications. Medical charts were reviewed for gender, age, substance abuse history, dental condition, etiology, location of fracture, degree of fragmentation, fracture exposure, teeth in the fracture line, associated facial fractures, polytrauma, time elapsed between trauma and initial treatment, surgical approach and fixation system. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0; descriptive statistics and the chi-squared test were used to determine differences between groups. Significant differences in substance abuse (p = 0.006), dental condition (p < 0.001), location of fracture (p = 0.010), degree of fragmentation (p = 0.003) and fracture exposure (p < 0.001) were found. With regard to age and time elapsed between trauma and initial treatment, older patients (31.4 years, SD = 11.1) and a delay in fracture repair (19.1 days, SD = 18.7) were more likely to be associated with reoperation. It was concluded that substance abuse, age, dental condition, location of fracture, degree of fragmentation, fracture exposure and the time between trauma and initial treatment should be considered contributing factors to the occurrence of complications that require surgical retreatment of mandibular fractures.

Evaluation of surgical retreatment of mandibular fractures.

INTRODUCTION: Mandibular fractures are frequent, and treatment for these fractures involves rigid fixation. Complications can occur after treatment and may require a new surgical procedure; however, there are limited studies evaluating surgical retreatment. AIM: The purpose of this retrospective study was to evaluate the characteristics and the types of treatment carried out in patients requiring surgical retreatment of mandibular fractures. MATERIALS AND METHODS: From all patients with mandibular fractures treated by rigid internal fixation at a trauma hospital during a 7-year-period, 20 patients (4.7% of the cases) required a second surgery. RESULTS: The most common complaints were pain, infection with the presence of fistula, and abnormal mobility. There was a predominance of Staphylococcus aureus in the bacterial culture. The most frequent radiographic images were diffuse bone resorption, loosening of screws, and a visible fracture line. The diagnoses were nonunion in 10 (50%) cases, soft tissue infection associated with screw loosening or plate exposure in 7 (35%) cases, osteomyelitis in 2 (10%) cases, and malunion in 1 (5%) case. Seven cases of nonunion presented with fistula, and four of these patients had bone sequestration. The required procedures included new fixation in 6 (30%) patients, removal of bone sequestration and new fixation in 4 (20%) patients, surgical exploration and removal of fixation material in 7 (35%) patients, removal of bone sequestration in 2 (10%) patients, and refracture in 1 (5%) patient. CONCLUSION: It was concluded that most cases requiring surgical retreatment of mandibular fractures comprised nonunion or soft tissue infection associated with screw loosening or plate exposure. Consequently, the main procedures needed were new fixation or surgical exploration with the removal of fixation material.

Fratura de mandíbula como complicação pós-operatória da instalação de implantes dentários / Mandibular fracture a postoperative complication after dental implant placement

A fratura espontânea da mandíbula é uma rara complicação pós-operatória da instalação de implantes dentários. O objetivo deste trabalho é relatar um caso de fratura da mandíbula ocorrida uma semana após a instalação de implantes osseointegrados por outra equipe e discutir os possíveis fatores predisponentes ligados à sua ocorrência. Não havia história prévia de trauma na região e o paciente relatava parestesia no lábio inferior e mento no lado esquerdo desde a instalação dos implantes. No exame clínico havia dor à palpação com discreta movimentação óssea na região de corpo mandibular esquerdo e foi observada oclusão dentária apenas na região anterior em decorrência de edentulismo mandibular posterior bilateral. Nos exames de imagens foram visualizados dois implantes longos que invadiam a região do canal mandibular e uma fratura completa da mandíbula na região de corpo esquerdo e associada ao implante mais posterior. O tratamento de escolha foi a remoção dos implantes seguida de redução aberta da fratura e imobilização com placa e parafusos de titânio. Com base nas características clínicas acima mencionadas, pôde-se especular que o padrão oclusal e as alterações proprioceptivas devido a parestesia parecem ser fatores importantes que contribuem para o aumento das tensões na região posterior da mandíbula e consequente fratura após instalação de implante dentário.

Spontaneous mandibular fracture is a rare postoperative complication after dental implant placement. The aim of this study was to report a case of mandibular fracture one week after placement of dental implants by another surgical team, and to discuss possible predisposing factors associated to it. There was no history of previous trauma and the patient reported paresthesia in the lower lip and chin on the left side since implant placement. On clinical examination, there was pain on palpation with discrete bone mobility and dental occlusion only in the anterior region as a result of bilateral, posterior mandibular edentulism. Two long implants impinging the mandibular canal were viewed on radiographs, and a complete mandibular fracture on the left mandibular body associated to the most posterior implant, as well. The treatment of choice was the removal of implants followed by open reduction of fracture and fixation with titanium plate and screws. Based on the aforementioned clinical characteristics, it can be speculated that occlusal patterns and proprioceptive changes due to paresthesia seem to be important factors contributing to the increase of stress in the posterior mandibular region and the accompanying fracture after dental implant placement.