Reproducibility of a three-dimensional skeletal-based craniofacial orientation method for virtual surgical planning.

Inadequate craniofacial orientation of computed tomography (CT) scans can have significant implications in all three planes of space. The purpose of this study was to present the reproducibility of a 3-dimensional skeletal-based method of craniofacial orientation for virtual surgical planning. The protocol was defined by landmarks commonly used for cephalometry, and required identification of basion, nasion, right porion, and right orbitale, and navigation in all CT views (coronal, sagittal, and axial) for correction of yaw, roll, and pitch. Reproducibility of the method was assessed using eight CT scans that were randomly selected and anonymised. The observer group consisted of six oral and maxillofacial surgeons with varying levels of experience (resident or faculty) who performed craniofacial orientation according to the proposed method. Results were expected to be below 2° of variation, when overall accuracy as well as the influence of the academic level of the observers and symmetry of the evaluated anatomy, were considered as independent variables. Overall accuracy for all cases and for yaw, roll, and pitch were always below 2° of variation, without influence of level of experience and symmetry. Interobserver assessment was categorised as excellent in all instances, and intraobserver evaluation demonstrated consistency in the orientation of all axes. The proposed craniofacial orientation protocol presented in this study is easy to learn, applicable to computer-aided surgical planning, and can be performed by the non-technical clinician, resulting in excellent reproducibility and consistency.

Rehabilitation of severely resorbed edentulous mandible using the modified visor osteotomy technique.

The prosthetic rehabilitation of an atrophic mandible is usually unsatisfactory due to the lack of support tissues, mainly bone and keratinized mucosa for treatment with osseointegrated implants or even conventional prosthesis. The prosthetic instability leads to social and functional limitations and chronic physical trauma decreasing the patient's quality of life. A 53-year-old female patient sought care at our surgical service complaining of impairment of her masticatory function associated with the instability of the lower total prosthetic denture. The clinical and complementary exams revealed edentulism in both arches, while the mandibular arch presented severe reabsorption resulting in denture instability and chronic trauma to the oral mucosa. The proposed treatment plan consisted in the mandibular rehabilitation with osseointegrated implants and fixed Brånemark's protocol prosthesis after mandibular reconstruction applying the modified visor osteotomy technique. The proposed technique offered predictable results for reconstruction of the severely resorbed edentulous mandible and posterior rehabilitation with osseointegrated implants.

Histological and histomorphometric analysis of the bone-screw interface in the mandibular body after using a 2.0-mm miniplate system: an experimental study in dogs.

PURPOSE: To evaluate the bone-screw interface in a 2.0-mm miniplate system used for rigid internal fixation (RIF). MATERIALS AND METHODS: Nine adult mongrel dogs were subjected to unilateral continuous defect through an osteotomy between the lower third and fourth premolars. The control contralateral side remained untreated. Two 4-hole miniplates were placed bilaterally according to the Arbeitgeimeinschaft für Osteosynthesefragen manual. Miniplates adapted to the alveolar processes were fixed monocortically with 6.0-mm-long titanium alloy screws, whereas miniplates placed near the mandible base were fixed bicortically. At 2, 6, and 12 weeks, mandible segments enclosing the RIF were removed, fixed in formalin, ground-sectioned, and stained with toluidine blue. Under conventional light microscopy, proportions of bone-to-screw contact (BSC) were determined, and data were compared by analysis of variance. RESULTS: At 2 weeks, for both groups, the area between threads exhibited necrotic bone with multiple cracks and absence of bone cells and blood vessels. At 6 and 12 weeks, new Haversian systems progressively replaced necrotic bone. At each time point, no significant differences were seen between screws placed in the same miniplate or between groups. The proportions of BSC were statistically similar at 2 and 6 weeks and lower at 12 weeks. CONCLUSION: The results suggested that in this model, osteotomy did not significantly alter bone repair adjacent to the screw surface.