Tunnel technique through three vertical buccal incisions to reduce nasolabial changes due to surgically assisted rapid palatal expansion.

The aim of this technical note is to present a minimally invasive approach to the maxilla for segmental Le Fort I osteotomy in surgically assisted rapid palatal expansion (SARPE). This approach reduces the nasolabial changes that occur with the traditional circumvestibular approach.

In vitro study of a modified sagittal split osteotomy fixation technique of the mandible: a mechanical test.

This study was performed to evaluate the compressive mechanical strength of rigid internal fixation (RIF) using 1.5-mm L-shaped plates fixed with monocortical screws in sagittal split osteotomy (SSO). Thirty synthetic hemimandibles, which had all undergone a 5-mm advancement, were divided into three groups: three 12-mm bicortical titanium screws were placed in an inverted L pattern in group A; one straight 2.0-mm system spaced titanium plate fixed with four 5-mm monocortical screws was used in group B; two 1.5-mm system L-shaped titanium plates, each fixed with four 5-mm monocortical screws, were used in group C. The models were subjected to compressive and progressive mechanical tests with forces applied in the area between the second premolar and first molar to verify resistance in Newtons (N). A displacement speed of 1mm/min was applied, with a maximum 10mm displacement of the distal segment or until disruption of the fixation. The deformity and/or eventual rupture of the plates were evaluated, and consequently their technical stability was determined. The results showed that the modified fixation technique tested in this study on synthetic mandibles resulted in adequate stability and superior mechanical behaviour compared to simulated osteosynthesis with the use of a straight 2.0-mm titanium plate.

How does mandibular bone atrophy influence the masticatory function, OHRQoL and satisfaction in overdenture wearers? Clinical results until 1-year post-loading.

This longitudinal clinical study investigated the differences in the masticatory function (MF), satisfaction and oral health-related quality of life (OHRQoL) between atrophic patients (AP) and non-atrophic patients (NAP) before and after rehabilitation with mandibular overdenture (MO). Twenty-six complete denture (CD) wearers were categorised into two groups, according to the mandibular bone atrophy (MBA) degree. MF was evaluated before and after 1, 3, 6 and 12 months of the MO loading via 2 standardised tests: (i) MP, masticatory performance (MP_X50, MPB, ME 5·6, ME 2·8) and (ii) ST, swallowing threshold (time, number of cycles, ST_X50, STB, ME 5·6, ME 2·8). The dental impact on daily living (DIDL) questionnaire measured changes in the satisfaction level and OHRQoL. MP comparisons showed significant difference only for ME 5·6 12 months after MO loading (AP=33·79 ± 23·6; NAP=17·58 ± 20·1). ST presented significant differences before MO loading for: ST_X50 (AP=5·48 ± 0·83; NAP=4·31 ± 1·44), ME 5·6 (AP=53·17 ± 24·71; NAP=29·83 ± 31·45) and ME 2·8 (AP=8·76 ± 6·91; NAP=18·61 ± 10·71). One month after MO loading, NAP performed the ST test 21% faster than AP. After 3 months, significant improvements in STB (AP=4·93 ± 4·82; NAP=2·73 ± 1·27) and ME 2·8 (AP=17·15 ± 10·00; NAP=24·69 ± 7·82) also were observed. DIDL evaluation showed significant differences in the oral comfort domain after 3 months (AP=0·66 ± 0·29; NAP=0·87 ± 0·16) and after 6 months (AP=0·79 ± 0·22; NAP=0·98 ± 0·08), with lower satisfaction levels in the AP. MBA negatively affects the MF mainly the ST. After 6 months, differences between AP and NAP disappeared and ST results were equalised. AP initially has lower satisfaction levels reaching similar levels of satisfaction as NAP after 1 year.

Success rate and complications associated with dental implants in the incisive canal region: a systematic review.

A systematic review was conducted to evaluate the success rate of dental implants placed in the incisive canal region and the complications related to this procedure. An electronic search was performed in the PubMed, Scopus, and Web of Science databases. Articles reporting the incisive canal deflation technique or neurovascular bundle lateralization technique, with or without concomitant dental implant installation and grafting procedures, were evaluated. Ten articles met the inclusion criteria; only one retrospective study and one longitudinal clinical trial were found. A total of 91 implants were installed in this region, and implant success ranged from 84.6% to 100%. With regard to complications, three articles reported temporary sensory loss. Permanent sensory loss in the palatal mucosa region was reported in one study applying neurovascular bundle lateralization. Five studies were assessed in the quality analysis: four were of moderate quality and one was of low quality. Although a high success rate was described in the selected studies, caution is recommended when dental implants are installed in the incisive canal region due to the low level of evidence available. Regarding complications, there are no parameters for predicting the occurrence of sensory disturbances or the extent of damage with the use of incisive canal deflation or neurovascular bundle lateralization.

Complications associated with the treatment of fractures of the dentate portion of the mandible in paediatric patients: a systematic review.

This study aimed to answer the following question: What is the best treatment option for fractures of the dentate portion of the mandible in paediatric patients when considering the occurrence of postoperative complications? A systematic literature review was done using the PubMed, Scopus, and Cochrane Library databases, and 1186 articles on the topic were found. Twelve of these articles were included in the final review after the full texts had been read. A sample of 178 paediatric patients was obtained. In the six cases in which treatment was surgery with titanium plate fixation, there were no postoperative complications, whereas in the 141 cases in which treatment was surgery with biodegradable plates, there were 12 postoperative complications, and in the 31 cases in which treatment was non-surgical, there were three postoperative complications. A connection between the best treatment and the number of postoperative complications in fractures of the dentate portion of the mandible in paediatric patients could not be established; however, the occurrence of postoperative complications was low for both surgical and non-surgical treatments.

Autogenous non-vascularized bone graft in segmental mandibular reconstruction: a systematic review.

The restoration of mandibular bone defects with non-vascularized bone grafts depends on the diagnosis, anatomical site, extent of the defect, and the patient's age, as well as the surgeon's experience. The aim of this study was to perform a systematic literature review on mandibular reconstruction for segmental mandibular bone defects using non-vascularized bone grafts to answer the following question: Is there scientific evidence to support the use of this technique? The initial literature search in PubMed, Scopus, and Cochrane databases identified 862 articles. Of these, 25 were included in the final review. These articles encompassed 926 procedures with non-vascularized bone grafts; 76.1% were from the iliac crest. Benign tumours were the major cause of these defects (56.8%), and 44.7% of defects were located in the lateral mandibular area. Although this technique showed a high occurrence of complications (290 in 873 patients, some with more than one complication), these did not account for treatment failure. The restoration of bone defects due to malignant tumours treated with radiation therapy had lower success rates, and these appear to be a contraindication for the technique. Although standardized randomized controlled clinical studies are needed to obtain better clinical evidence for treatment choices in general, the use of non-vascularized bone grafts for mandibular reconstruction showed an 87.6% success rate in this review.

Postoperative infection associated with mandibular angle fracture treatment in the presence of teeth on the fracture line: a systematic review and meta-analysis.

The aim of this review was to answer the question: Which is the best procedure to follow when there is tooth involvement in the line of mandibular angle fracture, taking into consideration the occurrence of postoperative infection? A systematic literature review using the PubMed (MEDLINE), Virtual Health Library (VHL), Cochrane Library, and Scopus databases was done, and a total of 1007 articles were found. Among these, 13 articles were included in the final review after the papers were read. A series of 1542 mandibular angle fractures with the presence of teeth in the fracture line was obtained. Of 788 cases where the tooth was removed, a postoperative infection occurred in 84 cases; of 754 cases where the tooth was retained, postoperative infection also occurred in 84 cases. Through this review it was observed that there was no significant statistical difference between removing or retaining the tooth in the line of fracture and the occurrence of postoperative infection.