Positional changes of maxillary central incisors following orthodontic treatment using single-crown implants as fixed reference markers.

OBJECTIVES: This follow-up study (1) compares tooth displacement of central incisors in patients with and without pre-implant orthodontic treatment and (2) investigates whether sex, age, or orthodontic retention have an effect on tooth displacement after the insertion of single-crown implants. MATERIALS AND METHODS: Fifty-seven patients - thirty-seven with (test group) and twenty without pre-implant orthodontic treatment (control group) - were rehabilitated with 89 single-crown implants in the upper maxilla. Clinical and radiographic data, clinical photographs, and dental casts were collected during baseline examinations after prosthetic rehabilitation and at the final follow-up examination at least 5 years later. A total of 114 dental casts were digitalized and aligned using a software program to measure changes in the positions of the central incisors. RESULTS: After a follow-up period of at least five years, 87% of the central incisors measured in the test group were displaced >0.25 mm vertically compared with 70% in the control group. Seventy-eight percent of the test group teeth had moved >0.25 mm horizontally compared with 55% in the control group. These differences were not significant, and there were no significant correlations with patient age or sex. CONCLUSION: The majority of patients had minor vertical (60%) or horizontal (67%) tooth displacement of the central incisors (0.25-0.75 mm) after a minimum follow-up period of 5 years. This study found no significant differences in tooth displacement comparing patients with and without pre-implant orthodontic treatment. No significant effect of sex, age, orthodontic retention, or implant location was observed on tooth displacement.

Treatment of severe hypodontia-oligodontia--an interdisciplinary concept.

The authors' experience with oral rehabilitation of patients suffering from oligodontia (i.e. six or more congenitally missing permanent teeth, third molars excluded) is reported. The concept is based on an interdisciplinary team approach involving pedodontists, orthodontists, maxillofacial surgeons and prosthodontists. A series of 112 consecutive patients suffering from oligodontia were referred from 1997 to 2001. Ten of the patients (8.9%) suffered from ectodermal dysplasia. The total number of missing teeth was 1126, with an average of 10 per patient. Ninety-two patients had either finished treatment or were on an active treatment schedule. Of these, 97% underwent some kind of orthodontic treatment. Of the 112 patients, 51 had finished treatment at the end of the follow-up period (mean 28 months, range 1-68). Of these, fixed implant-supported prosthetic restoration was used in 90% to replace missing teeth, often combined with alveolar ridge augmentations (73%), sinus floor augmentation (43%), inferior alveolar nerve transposition (18%) and orthognathic surgery (27%). Early diagnosis, and comprehensive treatment planning with good coordination and timing of the individual treatment phases are decisive for a successful treatment outcome. The therapeutic concept is presented with special emphasis on surgical aspects.

Deformation of the mandible due to neonatal moulding: a 10-year follow-up.

A 3-day-old infant with paralysis of the marginal mandibular branch of the facial nerve and asymmetry of the mandible due to neonatal moulding is presented. Ten years after the initial presentation, the asymmetry and paralysis was still present. Orthodontic treatment has been instituted because of malocclusion. Surgical correction of the mandibular asymmetry after adulthood seems not to be necessary.

[Surgical versus non-surgical treatment of unilateral dislocated fractures of the lower mandibular condyle]. / Kirurgisk versus ikkekirurgisk behandling af unilaterale dislocerede lave collum mandibulae-frakturer.

To compare open versus closed reduction of unilaterally dislocated low subcondylar fractures in adults, 101 consecutive patients were treated either by closed reduction with a median of four weeks of maxillomandibular fixation or by a median of six weeks of maxillomandibular fixation after surgical repositioning and transosseous wiring of the dislocated condylar fragment. No selection of patients was done for either treatment. Fifty-two patients were observed for a median of two years after treatment. Complications such as malocclusion, mandibular asymmetry, impaired masticatory function, and pain located to the affected joint or masticatory muscles were significantly more frequent in patients treated with closed reduction (39%) compared with those treated surgically (4%)(p = 0.005). Neither the degree of dislocation of the proximal fragment, concomitant mandibular fractures, nor the absence of posterior occlusal support seemed to influence the results.

Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar fractures: a clinical study of 52 cases.

To compare open versus closed reduction of unilaterally dislocated low subcondylar fractures in adults, 101 consecutive dentulous patients were treated either by closed reduction with a median of 4 weeks of maxillomandibular fixation, or with a median of 6 weeks of maxillomandibular fixation after surgical repositioning and transosseous wiring of the dislocated condylar fragment. No selection of patients was done for either treatment. Fifty-two patients were seen at a median of 2 years postoperatively. Complications such as malocclusion, mandibular asymmetry, impaired masticatory function, and pain located to the affected joint or masticatory muscles were seen significantly more frequent in patients treated with closed reduction compared with those treated surgically (P = .005). Neither the degree of dislocation of the proximal fragment, concomitant mandibular fractures, nor the absence of posterior occlusal support seemed to influence the results.

Long-term results after surgical reduction cheiloplasty in patients with Melkersson-Rosenthal syndrome and cheilitis granulomatosa.

Cheilitis granulomatosa in patients with Melkersson-Rosenthal syndrome has proven difficult to treat, and various forms of symptomatic treatment of orofacial swellings have been used with varying success. To evaluate long-term results after surgical reduction cheiloplasty in patients suffering from persistent lip swellings, a follow-up study was performed on 13 patients after 16 years (median). The operations were performed after unsuccessful conservative treatment and regardless of disease activity. Pre- and postoperative medical histories were updated and a clinical examination evaluated the following criteria for a good result: symmetry of the lip, a normalized anterior projection, dimensional harmony between upper and lower lip, no disfiguring cicatrices, and no sensory disturbances. In spite of postoperative disease activity in 6 patients, all 13 patients were satisfied with the long-term result. Clinically, the results in 12 patients were considered good. We therefore recommend lip resection as described when a stationary swelling becomes associated with permanent aesthetic deformity or functional disturbances and conservative measures are unsuccessful.

Suction drainage in the postsurgical treatment of jaw cysts.

Intraoral or extraoral closed suction drainage was used following the surgical enucleation of 42 jaw cysts. Primary healing was observed in 38 (90%) of the patients and complete osseous regeneration was achieved in 17 of 30 patients. In the remaining patients, a slight loss in width and height of the involved area occurred. No functional disturbances were caused by these bony reductions.

Changes in mandibular mineral content 3 years after residual ridge augmentation with porous hydroxyapatite: a clinical report.

Changes in the bone mineral content (BMC) of edentulous mandibles after augmentation with porous hydroxyapatite (HA), in blocks (B) in one side and in granules (G) in the opposite side, were measured in vivo by dual-photon absorptiometry. The BMC changes in each side at the 1-, 2-, and 3-year follow-up were expressed in percent of the 1-week postoperative BMC value. In unexposed augmentations new bone formation seems to occur during the first year in the HA-B sides, followed by the biologic age-related BMC loss; while the HA-G sides show pronounced resorption of hydroxyapatite and bone during the entire period. Although porous HA-B and HA-G are unsuitable for residual ridge augmentation, porous HA-B may be used for implantation in areas without risk for exposure of HA resulting from loading of covering soft tissues.

[Surgical treatment of temporomandibular joint ankylosis]. / Kirurgisk behandling af kaebeledsankylose.

Surgical treatment of temporo-mandibular joint (TMJ) ankylosis may be a particularly difficult procedure due to unfavourable anatomic configurations and the proximity of vital structures. Postoperatively, it is followed by an often long and painful period of physiotherapy. The results of treatment of eight patients with TMJ ankylosis are reported. Different methods were used according to age of the patient and the extent of the ankylotic changes. The importance of early treatment is emphasized. This results in less extensive surgery and reduces secondary growth anomalies of the jaws.

[Synovial chondromatosis of the temporomandibular joint]. / Synovial kondromatose i kaebeleddet.

Synovial chondromatosis of the temporomandibular joint is a rare, benign condition of unknown etiology. It is characterised by the presence of loose cartilage bodies in the joint space which gradually leads to increased functional disturbances. The clinical, radiological, histopathological and therapeutical aspects are presented together with a new case report.

[Use of porous hydroxyapatite in reconstructive maxillofacial surgery]. / Rekonstruktive kaebekirurgi med anvendelse af porøs hydroksylapatit.

The use of porous hydroxyapatite (HA) (Interpore 200) in blocks as well as in particulate form is presented based upon experience from 99 maxillofacial reconstructions. The indications have been local defects of the alveolar process after trauma and resections due to tumors, the edentulous atrophic alveolar ridge, secondary residual clefts, and bone defects associated with orthognathic surgery. Clinical, radiologic and histologic findings after a follow-up period up to 3 years showed that there is an indication for HA blocks and particulate HA in orthognathic surgery, and that relatively stable results with few complications can be achieved with particulate HA in reconstructions of local bone defects and the atrophic alveolar ridge. Bone ingrowth through the implant material is seen when HA blocks are used. With particulate HA a fibrous encapsulation of the granules is formed. To a certain extent HA may replace the use of autogenous bone, but with major maxillofacial reconstructions it seems that the use of autogenous bone is still mandatory.

Histologic response after implantation of porous hydroxylapatite ceramic in humans.

After periods of observation from 3 to 36 months, biopsies were obtained from 22 patients in whom porous block and particulate hydroxylapatite ceramic (Interpore 200) had been used for augmentation procedures and in two patients in whom nonporous particulate hydroxylapatite (Calcitite) had been used. Histologic examination of serial sections of decalcified specimens revealed vital bone formation in relation to the blocks, whereas the particulate was encapsulated in fibrous tissue. The differences in biological behavior are discussed.

Bone mineral content of the maxilla estimated by dual-photon absorptiometry after augmentation with bone or hydroxyapatite.

A new, precise, non-invasive method for measuring the bone mineral content (BMC) of the mandible in vivo by dual-photon absorptiometry has recently been introduced. The purpose of the present analysis was to examine the precision in vitro and in vivo and the accuracy in vivo for assessment of BMC in the maxilla. The precision was determined by repeated measurements in vitro on a cranium and in vivo on two test persons with and without a bone specimen fixed to a palatal plate. The accuracy in vivo was determined from the BMC measurements of the two test persons and of nine edentulous persons, scanned before and after augmentation of the maxillary alveolar ridge with hydroxyapatite. The analyses indicated that the precision for maxillary BMC assessments was high (0.9% in vitro and 2.0% in vivo) and the accuracy in vivo was 6.6%, corresponding to the accuracy in vitro for skeletal BMC measurements by dual-photon absorptiometry. The present method therefore seems to be well-suited for follow-up analyses of the BMC changes in the jaws after augmentation of the alveolar ridges with bone or hydroxyapatite.

A new type of human papillomavirus associated with oral focal epithelial hyperplasia.

Lesions from 10 patients suffering from focal epithelial hyperplasia (FEH) of the oral mucosa, including those of 4 Greenlandic Eskimos, were investigated for the presence of human papillomavirus (HPV) DNA sequences by blot hybridization experiments. Two distinct HPVs were detected in the DNA extracted from these lesions, and their genomes were molecularly cloned and characterized. One of these HPVs, detected in 4 patients, was found to be identical with HPV13, whose association with FEH was already known. The other one, detected in 6 patients, was only weakly related to HPV13 and to the other HPVs associated with lesions of the mucous membranes, and constituted a new HPV type, tentatively named HPV32. Lesions from other types of oral papillomas, obtained from 14 additional patients, were also analyzed. Human papillomavirus DNA sequences were detected in the DNA preparations extracted from 5 specimens: HPV6 DNA in a condyloma and in a papilloma, 2 as yet uncharacterized HPV DNAs in 2 papillomas, and HPV32 DNA in a papilloma which showed histologic similarities to FEH. Thus, it seems likely that FEH of the oral mucosa is a disease associated with 2 specific HPVs--HPV13 and HPV32.

Arterial embolisation in the treatment of central haemangiomas of the maxilla. Report of two cases.

The recent refinement of super-selective angiography and subsequent embolisation offer new promising possibilities in the treatment of central haemangiomas in the maxillo-facial area, either as a pre-operative measure allowing safer surgical removal, or as definitive therapy. Two cases of central haemangiomas of the maxilla are presented, both treated successfully by embolisation.

Tuberculous osteomyelitis of the mandible.

A rare case of tuberculous osteomyelitis of the mandible presenting as an aggressive, sequestrating lesion of the symphyseal area in a 26-year-old Eritrean woman is reported. The patient had disseminated tuberculosis, and all but the oral lesion responded well to chemotherapy. Upon sequestrectomy and decortication uneventful healing of the mandibular lesion took place.