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.

Evaluation of an oral appliance in patients with mild to moderate obstructive sleep apnea syndrome intolerant to continuous positive airway pressure use: Preliminary results.

Obstructive sleep apnea syndrome (OSAS) is a phenomenon of repeated, episodic reduction, or cessation of airflow (hypopnea/apnea) as a result of upper airways obstruction. First-line treatment in younger children is adenotonsillectomy, although other available treatment options in middle-aged adults include continuous positive airways pressure (CPAP) and airway adjuncts. Oral appliances (OA) are a viable treatment alternative in patients with OSAS.The objective of this study was to assess, in a 1-year follow-up study, an OA in OSAS patients. The participants were subjected to polysomnographic examination with a validated device (MicroMESAM). Eight participants were fitted with a Thornton Adjustable Positioner (TAP). The participants were asked to wear the test appliance for 7 nights, and in case of compliance, for 6 months. The selected patients record their usage of the appliance and any adverse effects in a treatment journal. The research focused on the following outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea index) and the effect of oral appliances on daytime function.In conclusion, the results suggest that OA have a definite role in the treatment of snoring and sleep apnea.

Three-dimensional morphological condylar and mandibular changes in a patient with juvenile idiopathic arthritis: interdisciplinary treatment.

Temporomandibular joint (TMJ) involvement is common but usually delayed in patients with juvenile idiopathic arthritis (JIA). We describe the case of a JIA patient with bilateral TMJ involvement, mandibular retrognathia, bone erosion, and severely restricted mouth opening. The use of cone beam computed tomography and a 3D diagnostic protocol in young patients with JIA provides reliable, accurate and precise quantitative data and images of the condylar structures and their dimensional relationships. Analgesics and conventional disease modifying antirheumatic drugs were ineffective, but interdisciplinary treatment with etanercept and a Herbst functional appliance improved functional TMJ movement and bone resorption.

Qualitative and quantitative assessment of plaque bacteria in pediatric patients, patients undergoing orthodontic treatment, combined orthdontic-surgical treatment and implant-prosthetic rehabilitation.

AIM: The aim of this paper was to describe the qualitative and quantitative changes occurring within the oral bacterial flora of several groups of patients following oral prevention protocols during the stages of the dental treatment they required. METHODS: Three hundred patients were enrolled in the study. The selected patients were categorized into different groups to receive preventive strategies according to their needs and treatment required. Plaque samples from each patient were collected at different intervals according to the treatment they were undergoing. These were then assessed under a microscope to carry out a quantitative and qualitative assessment of the plaque. RESULTS: The Mean Plaque Index Score of most patients generally decreased during the various treatment phases and hence the overall bacterial count. However, we noticed a slight increase in the plaque index in patients undergoing orthodontic surgery after placement of the orthodontic appliance and patients undergoing combined orthodontic-surgical treatment during the intermaxillary fixation phase. We generally found that the coccoidal bacterial form was the most prevalent. CONCLUSION: Patients who were adequately instructed and motivated through oral hygiene prevention strategies, showed a significant decrease in the plaque levels and in the overall bacterial components between the first visit and the successive sample taking. Even though we noticed a slight increase in the plaque index in patients undergoing the intermaxillary fixation phase, this decreased immediately once the phase ended and the patients managed to return to the routine oral hygiene care. This highlights the importance of constant motivation and oral hygiene instruction reinforcement.

Change in condylar and mandibular morphology in juvenile idiopathic arthritis: Cone Beam volumetric imaging.

AIM: The aim of this study was to show the importance of Cone Beam Computerized Tomography (CBCT) to volumetrically quantify temporomandibular joint (TMJ) damage in patients with juvenile idiopathic arthritis (JIA), measuring condylar and mandibular real volumes. Methods. Thirty-four children with temporomandibular involvement by JIA were observed by CBCT. Four were excluded because of several imaging noises. The mandible was isolated from others craniofacial structures; the whole mandibular volume and its components' volumes (condyle, ramus, emibody, emisymphysis on right side and on left side) has been calculated by a 3D volume rendering technique. Results. The results show a highly significant statistical difference between affected side volumetric values versus normal side volumetric values, above all on condyle region (P<0.01), while there was no statistical difference between right versus left side. Conclusion. The CBCT represents a huge improvement in understanding of the condyle and mandibular morphological changes, even in the early stages of the JIA. In children the JIA can lead to TMJ damage with facial development and growth alterations.

The use of silicon elastomer in maxillofacial rehabilitation as a substitute for or in conjunction with resins.

Maxillofacial prosthetic rehabilitation aims to restore anatomic function when serious tissue defects are present, as a result of congenital factors, trauma, or surgery. The aims are both aesthetic and functional, and results are obtained using devices that contain, reconstruct, and fill. This study introduces a technique using methods and materials that are acceptable to the patient in that they satisfy chewing, phonetic, and aesthetic functions, while respecting bone structure and restoring function to the soft tissues without causing trauma to them. Our techniques do not use innovative materials, but ones that are structurally different and that, until now, have not been connected with attachment systems. Acrylic resin, acetylic resin, and silicon are used, each in such a way as to take maximum advantage of each material's characteristics and thus give the best results.

Immunological patterns during regular intensive training in athletes: quantification and evaluation of a preventive pharmacological approach.

The effects of regular intensive exercise training on immune system homeostasis and the potential value of treatment with an immunostimulating agent were assessed in this randomized, double-blind, placebo-controlled, parallel-group study. A total of 60 athletes were studied over a 3-month period of regular intensive physical activity. After 1 and 3 months there were significant decreases in the immunoglobulin levels in the whole athlete population compared with baseline values. Specifically there were significant decreases in immunoglobulin M and immunoglobulin G (G1 and G2 subclasses). There was also a significant decrease in natural killer cells and a slight but significant increase in B and T lymphocytes. In the thymomodulin-treated group, unlike the placebo group, there was no significant decrease in the immunoglobulin G2 subclass and there was a significant increase in the T-helper cell subpopulation. The clinical relevance of these immunological findings should be evaluated in larger clinical and epidemiological studies.

Aspirin does not affect exercise performance.

A single-blind, cross-over study was carried out to evaluate the effects of acetylsalicylic acid (ASA) on cardiorespiratory performance during exercise. Eighteen young men, 9 athletes and 9 untrained but active subjects, performed a progressive maximal exercise test on a cycle ergometer (30 watt, 3 min steps, starting at 60 watt) on three different occasions, after a single administration of plain aspirin (1000mg of ASA), chewable buffered aspirin (1000mg of ASA and 600 mg of calcium carbonate) and placebo. Continuous measurement of breath-by-breath ventilation, oxygen consumption, carbon dioxide output, respiratory frequency and heart rate was carried-out at rest and during the exercise test. Blood lactate concentration was measured just before the start of exercise and at the third minute of each step in order to detect the anaerobic threshold. The pharmacokinetics of aspirin during exercise was also investigated in ten of the eighteen participants. The analysis of all investigated variables did not show any statistically significant difference between treatments, suggesting that a single dose of 1000mg of aspirin does not affect physical performance during submaximal and maximal exercise.

Telethermography and Raynaud's phenomenon.

A Raynaud's Phenomenon reported by a young female athlete in concomitance with a traumatic injury occurred during her gymnastic performance is described. Discussion is carried out taking into account the recent acquisitions about the pathophysiology of this syndrome.

Pharmacokinetic study of a new oral buffered acetylsalicylic acid (ASA) formulation in comparison with plain ASA in healthy volunteers.

A single-blind, randomized, crossover pharmacokinetic study was carried out to investigate the bioavailability of a new oral buffered 325 mg acetylsalicylic acid (ASA) formulation (ASPIRINA 03) in comparison with a 325 mg plain tablet. Twelve healthy volunteers of both sexes, aged between 20 and 37 years, received buffered or plain ASA on two separate occasions with a wash-out interval of at least two weeks. ASA and salicylic acid (SA) plasma levels were determined by a chromatographic method. The results showed no difference between the area under concentration time curve (AUC0-infinity) ASA values of both formulations (p = 0.19), and buffered ASA relative bioavailability was 102.49% (= bioequivalence). A significant difference was found between the AUC0-30 min ASA values: 90.5 micrograms. min/ml with buffered and 67.7 micrograms. min/ml with the plain tablet (p less than 0.05). The buffered ASA time of maximum concentration was shorter (28 +/- 8 min) than the plain one (38 +/- 19 min, p less than 0.05). The plasma concentrations and pharmacokinetic parameters of SA were not significantly different after the administration of the two ASA formulations. The plain ASA tablet had a significantly lower (p less than 0.05) dissolution rate than buffered ASA tablet. Moreover, the buffered ASA tablet significantly (p less than 0.01) increased the pH by 0.5 units. In conclusion, the bioavailability of the new oral buffered ASA was equivalent to that of plain ASA, but the plasma concentration peak was reached in a shorter time.

Use of telethermography in the management of sports injuries.

Telethermography can contribute to the diagnostic process in the management of sports injuries by clearly demonstrating thermal alterations in the tissues involved. Although there are no typical images, in general hyperthermic images are found when inflammatory reactions prevail, and hypothermic pictures when compression or degenerative processes are present. Telethermography is not only an aid to diagnosis, it also appears to be an ideal tool in controlling the injury evolution and treatment efficacy. In fact this objective method of evaluation is noninvasive, innocuous and repeatable, and well-related to the clinical and functional status.

Pirprofen in the treatment of sports injuries.

Patients with sports injuries were treated with pirprofen, a non-steroidal anti-inflammatory drug, in two separate studies. In the single centre study, 39 athletes were treated with 1000 mg/day pirprofen for 2 weeks. In the multicentre study, a further 80 athletes were treated with a variable dosage (600-1200 mg/day) until the disappearance of symptoms, but for no longer than 2 weeks. Efficacy was considered excellent or good in 99/119 (83%) of the patients treated. The clinical variables of pain and mobility significantly (P less than 0.05) improved after 1 week of treatment. Tolerability was satisfactory, the main side-effects involving the gastro-intestinal tract.

Telethermographic evaluation of NSAIDs in the treatment of sports injuries.

In a multicenter double-blind clinical trial, forty-five athletes, 39 males and 6 females, mean age 20.87 yr (SD 4.48), affected by sports injuries were treated with diclofenac, suprofen, or placebo, orally administered for a period of 1 wk. An objective examination like telethermography was performed with the clinical evaluations (pain on movement or at pressure, motility, and swelling) before and after the treatment period, in all patients. Moreover, at the end of the trial both investigator and patient gave their global judgement of efficacy. The statistical analysis showed a significant superiority of diclofenac sodium versus suprofen and placebo both in patients' and in investigators' global evaluations (P less than 0.05--Kruskal-Wallis tests). This superiority appeared particularly clear in the telethermographic evaluation (P less than 0.05), which is more objective than the clinical one, attesting to the usefulness of the early administration of anti-inflammatory drugs in management of sports injuries. Furthermore, a correlation analysis showed that telethermography is a good technique in controlling the recovery process.

Pirprofen in the treatment of migraine and episodic headache attacks: a placebo-controlled crossover clinical trial.

A double-blind, within patient, randomized study to compare the efficacy and tolerability of acute rectal administration of 600 mg pirprofen capsules with matched placebo was carried out in 40 out-patients. They were divided into two groups of 20 patients each according to diagnosis of episodic headache or common or classic migraine. Treatment was given once during each of two consecutive attacks according to a crossover design. None of the patients was withdrawn after randomization. There was a statistically significant difference in favour of pirprofen as regards the preferences expressed by patients at the end of the trial: 34 patients preferred pirprofen, two preferred placebo and four patients had no preference. Pirprofen significantly reduced the duration of headache attack and associated symptoms, but not the peak of pain intensity. Tolerability of the drug was good.

Iontophoretic administration of pirprofen or lysine soluble aspirin in the treatment of rheumatic diseases.

A double-blind study was designed to compare the efficacy and tolerability of pirprofen and lysine soluble aspirin administered by iontophoresis to 80 patients with various painful rheumatic diseases. Treatment lasted two weeks, with five administrations a week, each lasting 20 minutes (direct current; mean intensity, 2.3 mA). After five administrations, patients showed significant improvement in pain at rest and on movement, with no significant differences between pirprofen and aspirin. Final results were excellent or good in about 75% of the patients treated and functional improvement was satisfactory in about 80%. There were no side effects.

Intramuscular treatment of migraine attacks using diclofenac sodium: a crossover clinical trial.

This was a double-blind clinical trial, with a crossover design, to compare the efficacy of a non-steroidal anti-inflammatory drug, diclofenac sodium, intramuscularly administered, and placebo in the treatment of migraine attacks. The drug was administered to 40 patients once a day in three consecutive migraine attacks. If pain still remained after 6 h following administration the patient was given a 100 mg diclofenac sodium suppository, in open condition. Evaluation was by a complete medical examination performed by the physician and by the patient completing a specially designed self-assessment card. A total of eight patients dropped out of the trial (all during placebo administration): three due to poor compliance, four for refusal to continue and one because no further migraine attacks developed. Results were analysed after having checked the absence of both period and carry-over effects. In all cases diclofenac sodium was more effective than placebo (P less than 0.01). This was also confirmed by data obtained from the patient self-assessment cards (P less than 0.001) and by preferences expressed by patients at the end of the trial (P less than 0.001). Tolerance to the drug was similar to that of placebo.