Pre-autotransplantation alveolar process augmentation and premolar autotransplantation as a treatment method for single tooth replacement in adolescents.

The treatment of young patients with missing teeth and an atrophied alveolar process after trauma or agenesis of a tooth can be challenging. The aim of this study was to evaluate autotransplantation of a premolar after pre-autotransplantation alveolar process augmentation (PAPA) as a treatment option for these patients. A retrospective cohort study was implemented to analyse the PAPA procedure and subsequent autotransplantation procedure. Alveolar process augmentation was performed using different types of autologous bone grafts. Subsequent autotransplantation of one or more premolars was performed approximately 4 months later. Nine patients with a mean age of 12 years were included. Twelve premolars were transplanted after a PAPA procedure: seven in the maxillary incisor region, four in the mandibular premolar region, and one in the mandibular incisor region. Initially all transplanted teeth functioned well. However, one mandibular premolar that was transplanted in the maxillary incisor region was lost because of resorption after 6 years of follow-up. The other 11 transplanted teeth functioned well. The mean follow-up was 6 years (range 3-13 years). The results showed that autotransplantation can be facilitated by PAPA with a high chance of success. It can therefore be a valuable addition to other existing treatment options.

[Psychological aspects of orthognathic surgery]. / Psychologische aspecten van een kaakstandcorrectie.

Corrective jaw surgery, for patients with malocclusion and dysgnathia, is primarily performed to rehabilitate oral functions. However, the patients' motivation for orthognathic surgery often seems to be influenced as well by the desire for aesthetic correction of a facial anomaly. Preoperative screening for psychiatric problems such as body dysmorphic disorder is requisite. The majority of orthognathic patients experience a negative influence of their appearance on their psychosocial well-being. In addition, the hope for aesthetic improvement is not seldom an important incentive for visiting an oral and maxillofacial surgeon. In the literature, in addition to a positive effect of corrective jaw surgery on the patient's perceived appearance, an associated improvement in quality of life is described. Correction of a disharmonious face is at least as important to patients as oral function recovery.

Autotransplantation of two maxillary premolars in a free vascularized fibula reconstructed mandible.

A 10-year-old female patient with a fibula transplant in her left hemimandible due to ameloblastoma treatment was referred for combined orthodontic and surgical planning and treatment to observe and prevent expected asymmetric facial development and malocclusion, because the premolars and molars on the left side of the mandible were missing. The patient had an Angle Class II malocclusion and arch length discrepancy in the upper jaw. The two second premolars in the maxilla were transplanted into the neomandible to create occlusion on the left side and retention for orthodontic treatment. Clinical and radiological examination 3 months postoperatively showed good integration of both premolars without pocket formation. After 4 months, active orthodontic treatment with fixed appliances was started to create sufficient arch space in the upper jaw for both canines to erupt and to extrude and for the transplanted premolars in the lower jaw to rotate and align into the planned positions. This case report demonstrates that autotransplantation of premolars into a fibula transplant can be a successful dental rehabilitation procedure.

[Interdisciplinary cooperation in dentistry]. / Interdisciplinaire samenwerking in de tandheelkunde.

The treatment of complex dental problems often requires the involvement of different disciplines in dentistry. Referral of the patient from one dentist or dental-specialist to the other in these cases is not uncommon. It is known as multidisciplinary treatment. In dentistry today treatment planning and treatment of complex dental problems are done as a team, working together, as an interdisciplinary team.

The value of long-term follow-up of mandibular advancement surgery in patients with a low to normal mandibular plane angle.

The objective of this study was to evaluate retrospectively the stability of mandibular advancement via bilateral sagittal split osteotomies. Two fixation methods were compared: intermaxillary fixation (IMF) and rigid internal fixation (RIF). The hypothesis was that, in patients with a low to normal mandibular plane angle (MPA) in retrognathia, the bilateral sagittal split osteotomy (BSSO) to advance the mandible is a predictable and stable procedure and that no significant changes occur after 1 year. Twelve patients with mandibular deficiency with a low to normal MPA (mean 24.7 degrees, range 20.3 degrees-30.7 degrees) underwent BSSO with IMF. The follow-up period was at least 5 years (mean 6.3, range 5-9.1 years). Cephalometric analysis using a commercial software package was performed on radiographs that were taken immediately preoperatively (T0), within 6 weeks postoperatively (T1), 1 year postoperatively (T2), and at least 5 years postoperatively (T3). The average advancement at B point was 4.7 mm (range: 3-7 mm). The assessment of B point in regard to relapse showed no significant change. One patient showed a relapse due to condylar resorption. Forty-five consecutive patients were treated with RIF. Radiographs were taken preoperatively (T0), 6 weeks postoperatively (T1), and 1 year postoperatively (T2). This group had a mean MPA of 26.2 degrees, range 10 degrees-32 degrees. The average B-point advancement was 4.4 mm (range 1-10 mm). No patient showed a clinically significant relapse at T2.