Skeletal stability in orthognathic surgery with the surgery first approach: a systematic review.

The surgery first approach (SFA) is a therapeutic strategy used in orthognathic surgery that is constantly evolving. With this approach, the pre-surgical orthodontic treatment can be eliminated, the maxilla and the mandible are surgically repositioned into the desired position, and the therapy is ended with a short orthodontic phase. Several studies have reported that the SFA is an acceptable approach, but postoperative stability is unclear. In this study, a systematic review on the SFA was performed. The PubMed, Google Scholar, Scopus, LexisNexis, Web of Science, and Cochrane Library databases were accessed. Studies from which data could be extracted on skeletal stability based on specific cephalometric points were included. The search yielded 2766 publications. Application of the selection criteria resulted in a final group of 14 articles. Five hundred and sixty patients with class III malocclusion underwent orthognathic surgery, 339 with the SFA. Study parameters such as evaluation time points and reference planes varied, making it impossible to perform a meta-analysis. The studies suggest that surgery with the SFA is as stable as surgery with the conventional approach. However, all articles described stability using a penultimate time point of 'after surgery' and not 'after debonding'; hence orthodontic movements and consequent mandibular movements could have influenced cephalometric measurements. Thus, to verify the real stability of the SFA, further research with longer follow-up periods is required, with evaluation at the same time points.

Risks in surgery-first orthognathic approach: complications of segmental osteotomies of the jaws. A systematic review.

OBJECTIVE: To date, no systematic review has been undertaken to identify the complications of segmental osteotomies. The aim of the present systematic review was to analyze the type and incidence of complications of segmental osteotomies, as well as the time of subjective and/or clinical onset of the intra- and post-operative problems. MATERIALS AND METHODS: A search was conducted in two electronic databases (MEDLINE - Pubmed database and Scopus) for articles published in English between 1 January 2000 and 30 August 2015; only human studies were selected. Case report studies were excluded. Two independent researchers selected the studies and extracted the data. Two studies were selected, four additional publications were recovered from the bibliography search of the selected articles, and one additional article was added through a manual search. RESULTS: The results of this systematic review demonstrate a relatively low rate of complications in segmental osteotomies, suggesting this surgical approach is safe and reliable in routine orthognathic surgery. CONCLUSIONS: Due to the small number of studies included in this systematic review, the rate of complication related to surgery first approach may be slightly higher than those associated with traditional orthognathic surgery, since the rate of complications of segmental osteotomies must be added to the complication rate of basal osteotomies. A surgery-first approach could be considered riskier than a traditional one, but further studies that include a greater number of subjects should be conducted to confirm these findings.

Reconstruction of severe atrophic jaws with Fresh Frized Bone Allografts: clinical histologic and histomorphometric evaluation.

OBJECTIVES: Rehabilitation of maxillary edentulism with implant-supported prostheses has come into common clinical practice. Although autologous bone has osteoinductive, osteoconductive and osteogenetic properties, its use is subject to certain disadvantages such as: Increased morbidity Limited amount of bone harvested from each donor site. AIM: The aim of this study is to analyze clinical, histological and histomorphometric results of homologous bone for implantoprosthetic rehabilitation in severe atrophic jaws. PATIENTS AND METHODS: Twenty consecutive patients, 14 female and 6 males, were treated with homologous bone bank. Treatment protocol consist of: first surgycal step, trasversal and vertical volume restore, second surgycal step: screw remove, specimen biopsy and insert implant fixtures. RESULTS: Data show that Fresh Frozen Bone Allografts (FFBA) could be a valuable substitute for autologous bone, in as much as histological and histomorphometric results are widely overlapping. CONCLUSIONS: Homologous bone is a valuable option for its large availability with a low cost, good versatility, no morbidity at the donor site, shorter surgical time and hospital stay.

OSAS treatment with oral appliance: assessment of our experience through the use of a new device.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is defined as repeated episodes of obstruction of the upper airway and oxygen desaturation of the arterial hemoglobin. OSAS is associated with loud snoring, excessive daytime sleepiness, cardiovascular and neurocognitive disease, increase risk of road accidents. AIM: The aim of this study is to evaluate non-surgical therapy for OSAS using a mandibular advancement device (MAD) that provides for lower jaw protrusion and for an adequate vertical opening, that allows for greater airflow. MATERIALS AND METHODS: The device was assembled using the working principles of "Herbst-like" appliances and splints of neuromuscular deprogramming of the "Federici" type used for gnathologic treatments. We selected 17 males and 4 females, with an average age of 42 years, and an average BMI of 29. Eighteen patients were treated with our oral appliance, 1 patient was treated with the orthesis proposed by Schmidt-Nowara et al and 2 patients were treated with the oral appliance proposed by Johal and Battagel. All patients used the appliance for at least 6 months. RESULTS: After treatment with the oral appliance, the posterior airway space increased (p = 0.0002); no statistically significant difference for the improvement degree of OSAS severity (p = 0.1085) was shown; an improvement was found in: AHI (p = 0.0028); Nadir O2 (p = 0.0035); TO2 < 90% (p = 0.0140); 2 patients presented with temporomandibular joint (TMJ) discomfort. CONCLUSIONS: Our MAD has proved effective in improving the polysomnographic and radiographic parameters and assures good TMJ compliance.

Case report of oligodontia: long term stability of orthognatic surgery and prosthetic rehabilitation.

Oligodontia may compromise the harmonious development of the masticatory system. The quantity and quality of agenesis determines the type of approach and the complexity of rehabilitative therapy. We present a case of a patient affected by oligodontia and maxillo-mandibular skeletal alterations, corrected by orthodontic and orthognatic surgical treatment, assisted by prosthetic-presurgical rehabilitation of the lower arch. After surgery the occlusion was finally restored by a definitive prosthesis modeled on the presurgical one and supported by the same residual dental elements. Photographic and cephalometric analysis have shown the stability of the results at 20 years follow-up. The case presented shows that the final prosthesis on the residual teeth in patients affected by oligodontia may represent a possible alternative to implanto-prosthetic rehabilitation, presenting lower cost and requiring less time for definitive occlusal rehabilitation.

Tratamiento multidisciplinario de pacientes edéntulo con síndrome de Apert: reporte de un caso clínico / Multidisciplinary treatment of edentulous patients Apert syndrome: report of a case

Durante el abordaje terapéutico odontológico de los pacientes parcialmente edéntulos, resulta indispensable la obtención de una adecuada estabilidad esquelética, una buena dimensión vertical y una adecuada rehabilitación protésica; a tal fin, es necesaria una programación terapéutica así como la cooperación de las distintas especialidades odontológicas: prótesis, ortodoncia y cirugía. El presente artículo resume la programación y principales fases terapéuticas durante el abordaje de una paciente parcialmente edéntula, diagnosticada con Síndrome de Apert, quien fue sometida a un tratamiento ortodóntico-quirúrgico, además de realizársele una rehabilitación protésica con adecuada dimensión vertical, logrando un equilibrio neuromuscular y una estabilidad oclusal y esqueletal a largo plazo

A case of Apert´s Syndrome is reported as a contribution of better understanding of this disease. A literature review is done concluding that this disease has an important genetic component and belongs to those ones that present craneofacial deformities. The most important characteristics of this syndrome are the associated craneofacial and limb deformities. It´s treatment requires a team aproach with participation of diverses specialities of dentists, in order to give the patient a better treatment from the functional, esthetic and social standpoint

[Pseudo Class III: diagnosis and therapeutic planning]. / Pseudo III Classi: diagnosi e programmazione terapeutica.

In this study clinical diagnostic elements essential in pseudo-Class III malocclusion have been taken under consideration. First of all have been analysed the main etiopathogenetic factors which are the causes of an anomalous development of the Maxillo Facial Complex and peculiarly of mandibular pseudo prognathism. The clinical variants of the malocclusion have been pointed out and they are: the true prognathism, the occlusal or dental one, and the pseudo Class III malocclusion. The Authors therefore, describe principal procedures to treat the malocclusion with orthodontic and functional appliances. Two cases are presented for this kind of malocclusion treated with the various orthodontic techniques on the ground of the different kinds of clinical variants.