Body mass index and weight loss in patients submitted to orthognathic surgery: a prospective study.

OBJECTIVE: To compare the body mass index (BMI) and the weight loss (WL) in patients with dentofacial deformities who underwent monomaxillary versus bimaxillary orthognathic surgery. MATERIALS AND METHODS: This prospective longitudinal study included 69 patients with dentofacial deformities who underwent surgical orthodontic treatment. Patients were divided into two groups according to the type of orthognathic surgery: monomaxillary or bimaxillary. A preoperative nutritional assessment based on BMI was performed; the percentage of involuntary WL between the preoperative and postoperative periods was also calculated. Data were collected at preoperative and 10, 40, and 90 days postoperative (PO). Statistical analysis was performed using SPSS 17.0 (IBM Corp., Armonk, NY, USA), and data are reported with 95% confidence interval. RESULTS: According to BMI, patients who underwent monomaxillary surgery presented: underweight = 2.6%, normal weight = 51.3%, overweight = 35.9%, and obese = 10.3%. The subjects who underwent bimaxillary surgery presented: normal weight = 43.3%, overweight = 36.7%, and obese = 20%. BMI was similar between the groups at all time points (preoperative, p= 0.237; 10 days PO, p= 0.325; 40 days PO, p= 0.430; and 90 days PO, p= 0.609). All patients lost weight postoperatively, and WL was similar among the PO measurements (p= 0.163). CONCLUSIONS: Although both monomaxillary and bimaxillary orthognathic surgeries resulted in WL and lower BMI, there was no statistically significant difference in these metrics between the two types of surgery.

Polymorphisms in hormonal-related genes might be associated with variations in permanent tooth crown size.

BACKGROUND: The variability in tooth crown size (TCS) is influenced by genetic factors and might be regulated by the difference in hormonal response. MATERIALS AND METHODS: This study aimed to evaluate the association between variations in TCS of permanent teeth with associated factors and genetic polymorphisms in hormonal-related genes (ESR1, ESR2 and PTH). This cross-sectional study involved dental casts from 86 individuals of both sexes. Dental casts were used to determine the maximum TCS of all fully erupted permanent teeth (except third molars) in the mesiodistal (MD) and buccolingual (BL) dimensions. Data such as sex, ethnicity, dental group (incisor, canine, premolar and molar), dental arch (upper and lower) and genetic polymorphisms of hormonal-related genes were used. The DNA from each patient was collected to evaluate the genetic polymorphisms in ESR1 (rs2234693 and rs9340799), ESR2 (rs1256049 and rs4986938) and PTH (rs694, rs6256 and rs307247) through real-time PCR. The data were submitted to statistical analysis with a significance level of 0.05. RESULTS: In the MD dimension, the sex, dental group and dental arch were associated with variation in TCS (P < .05). In the BL dimension, the sex, dental group, dental arch and polymorphism in rs694 and rs307247 were associated with variation in TCS. CONCLUSIONS: In short, this study suggests that genetic polymorphisms of PTH are associated with variations in the BL TCS of permanent human teeth.

Genetic Polymorphisms of Estrogen Receptors α and ß are Associated with Craniofacial Measurements in Patients With Dentofacial Deformity.

Dentofacial deformities are characterized by abnormalities in craniofacial development that affects the individual's skeletal and occlusion, often causing functional and esthetic problems. In literature, there is an involvement of polymorphisms in estrogen receptor 1 (ESR1) and estrogen receptor 2 (ESR2) genes in craniofacial measurements. The aim of this study was to evaluate a possible association between polymorphisms in ESR1 (rs2234693 and rs9340799) and ESR2 (rs1256049 and rs4986938) genes with cephalometric measurements in individuals with dentofacial deformities. This cross-sectional study was performed with 158 individuals in the preoperative period of orthognathic surgery. The cephalometric measurements obtained through lateral cephalogram using Dolphin Imaging software. For genetic analysis, the DNA extracted from epithelial cells of the oral mucosa and were genotyped using the real-time polymerase chain reaction. The data found submitted to statistical analysis, through the Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis tests, using the IBM SPSS software version 24.0. Considered a significance level of 0.05. We found association between polymorphisms and cephalometric measurements just in the female sex. The polymorphisms ESR1/rs9340799 ( P= 0.003), ESR1/rs2234693 ( P= 0.026), and ESR2/rs1256049 ( P= 0.046) were associated with the upper gonial angle (Ar-Go-N). The polymorphism ESR2/rs1256049 was also associated with the facial axis-rickets (NBa-PtGn) ( P= 0.004), anterior cranial base (SN) ( P= 0.036), and Y-axis (SGn-SN) ( P= 0.031).

Body mass index and weight loss in patients submitted to orthognathic surgery: a prospective study

ABSTRACT Objective: To compare the body mass index (BMI) and the weight loss (WL) in patients with dentofacial deformities who underwent monomaxillary versus bimaxillary orthognathic surgery. Materials and Methods: This prospective longitudinal study included 69 patients with dentofacial deformities who underwent surgical orthodontic treatment. Patients were divided into two groups according to the type of orthognathic surgery: monomaxillary or bimaxillary. A preoperative nutritional assessment based on BMI was performed; the percentage of involuntary WL between the preoperative and postoperative periods was also calculated. Data were collected at preoperative and 10, 40, and 90 days postoperative (PO). Statistical analysis was performed using SPSS 17.0 (IBM Corp., Armonk, NY, USA), and data are reported with 95% confidence interval. Results: According to BMI, patients who underwent monomaxillary surgery presented: underweight = 2.6%, normal weight = 51.3%, overweight = 35.9%, and obese = 10.3%. The subjects who underwent bimaxillary surgery presented: normal weight = 43.3%, overweight = 36.7%, and obese = 20%. BMI was similar between the groups at all time points (preoperative, p= 0.237; 10 days PO, p= 0.325; 40 days PO, p= 0.430; and 90 days PO, p= 0.609). All patients lost weight postoperatively, and WL was similar among the PO measurements (p= 0.163). Conclusions: Although both monomaxillary and bimaxillary orthognathic surgeries resulted in WL and lower BMI, there was no statistically significant difference in these metrics between the two types of surgery.

RESUMO Objetivo: Comparar o Índice de Massa Corporal (IMC) e a perda de peso (PP) de pacientes com deformidades dentofaciais após cirurgia ortognática monomaxilar e bimaxilar. Material e Métodos: Foi realizado um estudo longitudinal prospectivo em 69 pacientes com deformidade dentofacial submetidos a tratamento cirúrgico-ortodôntico. Os pacientes foram divididos em dois grupos: cirurgia ortognática monomaxilar e bimaxilar. Foi realizada avaliação nutricional pré-operatória de acordo com o IMC. Foi calculada a porcentagem de PP involuntária entre o pré e o pós-operatório (PO). A coleta de dados foi realizada no pré-operatório e aos 10, 40 e 90 dias PO. A análise estatística foi realizada no software SPSS v. 17.0, com intervalo de confiança de 95%. Resultados: De acordo com o IMC, os indivíduos submetidos à cirurgia monomaxilar apresentaram: baixo peso = 2,6%, peso normal = 51,3%, sobrepeso = 35,9% e obesidade = 10,3%. Entre os indivíduos submetidos à cirurgia bimaxilar, 43,3% estavam com peso normal, 36,7% estavam com sobrepeso e 20% eram obesos. O IMC foi semelhante em todos os períodos (pré-operatório, p= 0,237; 10 dias PO, p= 0,325; 40 dias PO, p= 0,430; e 90 dias PO, p= 0,609). Todos os pacientes perderam peso no pós-operatório. A PP foi semelhante entre os tempos de PO (p= 0,163). Conclusões: A cirurgia ortognática monomaxilar ou bimaxilar pode causar redução do peso corporal e diminuição no IMC, mas não há diferença estatisticamente significativa entre esses dois tipos de cirurgia em relação à PP e ao IMC.

Mutations in the osteoprotegerin-encoding gene are associated with temporomandibular joint ankylosis.

OBJECTIVE: This study aimed to investigate genetic variations in the osteoprotegerin-encoding gene (TNFRSF11B) in patients with temporomandibular joint ankylosis (TMJA). STUDY DESIGN: The sample comprised 17 patients diagnosed with TMJA, of both sexes with ages ranging from 6 to 57 years old. TNFRSF11B mutational analysis was performed using the Sanger sequencing method with DNA extracted from oral cells, and the functional impact prediction of the variants was assessed using bioinformatic analysis. RESULTS: Sequencing analysis identified 15 (88.23%) patients that presented at least 1 genetic variant in TNFRSF11B. The mutation rs202090603 (p.E33K) was found in 6 individuals, and rs140782326 (p.V281M), rs11573942 (p.L295), and rs1375250340 (p.I389T) were identified in 1 subject each. According to the pathogenicity potential of mutations, 3 variants were considered of low impact (rs2073618, rs202090603, and rs2228568) and 3 as disease causing (rs140782326, rs11573942, and rs1375250340). The variant rs202090603 (p.E33K) was found in the first cysteine domain with differences in the loop positions of p.E33K mutated the 3D structure of osteoprotegerin. CONCLUSION: Two polymorphisms (rs2073618 and rs2228568) and the mutations rs202090603 (p.E33K), rs140782326 (p.V281M), rs11573942 (p.L295), and rs1375250340 (p.I389T) in the TNFRSF11B gene may be associated with TMJA.

Single nucleotide polymorphisms in dopamine receptor D2 are associated with bruxism and its circadian phenotypes in children.

Objective: To evaluate the association of bruxism phenotypes with single nucleotide polymorphisms in FKBP5, DRD2, ANKK1, and COMT.Methods: Clinical oral examination was performed to diagnose bruxism phenotypes in 150 children. DNA was collected from saliva. Logistic univariate regression, Chi-square, and Fisher's exact tests were performed (p < 0.05).Results: Bruxism was associated with DRD2 (p = 0.02). Tooth grinding while awake was associated with ANKK1 (p < 0.001), and tooth grinding while asleep was associated with DRD2 in the additive (p = 0.030) and dominant (p = 0.008) model. Tooth clenching while awake was associated with ANKK1 in the additive (p = 0.005) and dominant (p = 0.008) models, whereas tooth clenching while asleep was associated with ANKK1 (p < 0.001) and with COMT in the additive (p = 0.001) and dominant (p = 0.003) models.Discussion: Polymorphisms in DRD2, ANKK1, and COMT are associated with bruxism phenotypes.

Quality of Life and Temporomandibular Disorders in Patients With Skeletal Class III Malocclusion With Cleft Lip and Palate.

OBJECTIVE: The aim of the study was to assess the quality of life (QOL), oral health-related QOL (OHRQOL), temporomandibular disorders (TMDs), and psychological factors in patients with skeletal Class III malocclusion with cleft lip and palate (CLP) and without CLP. DESIGN: Case-control. SETTING: Primary care, institutional practice. PATIENTS: One hundred thirty-six patients with skeletal Class III malocclusion with CLP (n = 68) and without CLP (n = 68). MAIN OUTCOME MEASURES: QOL and OHRQOL were assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire and the Oral Health Impact Profile-14 questionnaire, respectively. TMDs and psychological factors were assessed using the Research Diagnostic Criteria for TMD (RDC/TMD). RESULTS: No differences in QOL were found between the groups (P > 0.05). Patients with CLP reported a better OHRQOL (P = 0.025) in the physical pain, physical disability, and psychological disability domains (P < 0.05). Patients with CLP presented with less myofascial pain (OR, 0.28; 95% CI, 0.11-0.71] and other articular conditions (OR 0.24; 95% CI 0.06-0.90]. More patients with CLP reported no chronic pain (P = 0.012). The QOL of patients with CLP with no depression or with no nonspecific physical symptoms including pain (NSPSIP) was better than that of patients without CLP. The OHRQOL of patients with CLP without TMDs or no psychological factors was better than that of patients without CLP. CONCLUSIONS: Patients with skeletal Class III malocclusion who require orthognathic surgery with CLP have better OHRQOL and present with fewer TMDs than those patients without CLP.

Knowledge of Dentists and Dental Undergraduates Related to COVID-19

Abstract Objective: To assess the knowledge of Brazilian dentists and final-year dental undergraduates concerning COVID-19. Material and Methods: We conducted a self-administered online questionnaire about the symptoms, incubation period, and transmission routes of COVID-19. In total, there were three questions addressing these topics and 15 correct answers, so each participant could score from 0 to 15 points. Besides that, data such as sex, age, education level, years of work experience and place of work were collected. All data were submitted to statistical analysis with a 5% significance level. Results: 476 participants were recruited. Regarding the respondents' perception of the most common symptoms of COVID-19, 99.4% responded fever, 95.2% cough, and 99.2% dyspnea. About the incubation period, 56.3% answered from 1 to 14 days. About the transmission routes, 98.3% recognized transmission through droplets, 80.3% through direct contact with infected persons, and 70.4% through indirect routes. The median knowledge score was 10 (4 - 14). Regarding the socio-demographic variables, participants aged 30 years or more had a higher score than those aged up to 29 years old (p=0.004). For education level, specialist dentists presented a higher score than undergraduates (p=0.006), general dentists (p=0.048) and Ph.D. (p=0.016). Participants with 15 years or more of work experience had a higher score than undergraduates (p=0.003). Concerning the workplace, participants working in the public sector had a higher score than those working in the private sector or universities (p=0.015). Conclusion: Participants recognized the main symptoms, incubation period, and transmission routes of the COVID-19 virus; however, the knowledge level of specialist dentists, older dentists, more experienced dentists, and dentists working in the public sector was higher than the other participants (AU).

Effect of different factors on patient perception of surgical discomfort in third molar surgery

Abstract: The aim of this study was to evaluate patient perception of surgical discomfort in third molar surgery and the association with clinical variables and polymorphisms associated with the FKBP5, SLC6A4, and COMT genes. This cross-sectional observational study was carried out on 196 participants aged between 18 and 64 years at the Federal University of Paraná in 11 months. The intensity of surgical discomfort was assessed using the QCirDental questionnaire. Data on surgical and individual procedures were also cataloged. The oral health related quality of life was assessed by the Oral Health Impact Profile questionnaire (OHIP-14). The DNA sample was obtained from cells of the oral mucosa. Five markers of the FKBP5, SLC6A4, and COMT genes were genotyped. The data were submitted to statistical analysis with a significance level of 5%. Women reported greater intensity of discomfort associated with third molar surgery compared to men (p = 0.001). In the recessive model, the AA genotype of the rs3800373 marker was associated with greater surgical discomfort (p = 0.026). Therefore, women and individuals of the AA genotype for the rs3800373 marker in the FKBP5 gene reported greater surgical discomfort associated with third molar surgery.

Effect of different factors on patient perception of surgical discomfort in third molar surgery.

The aim of this study was to evaluate patient perception of surgical discomfort in third molar surgery and the association with clinical variables and polymorphisms associated with the FKBP5, SLC6A4, and COMT genes. This cross-sectional observational study was carried out on 196 participants aged between 18 and 64 years at the Federal University of Paraná in 11 months. The intensity of surgical discomfort was assessed using the QCirDental questionnaire. Data on surgical and individual procedures were also cataloged. The oral health related quality of life was assessed by the Oral Health Impact Profile questionnaire (OHIP-14). The DNA sample was obtained from cells of the oral mucosa. Five markers of the FKBP5, SLC6A4, and COMT genes were genotyped. The data were submitted to statistical analysis with a significance level of 5%. Women reported greater intensity of discomfort associated with third molar surgery compared to men (p = 0.001). In the recessive model, the AA genotype of the rs3800373 marker was associated with greater surgical discomfort (p = 0.026). Therefore, women and individuals of the AA genotype for the rs3800373 marker in the FKBP5 gene reported greater surgical discomfort associated with third molar surgery.

Depression, temporomandibular disorders, and genetic polymorphisms in IL6 impact on oral health-related quality of life in patients requiring orthognathic surgery.

PURPOSE: To assess oral health-related quality of life (OHRQoL) in patients requiring orthognathic surgery, and evaluate if depression, temporomandibular disorders (TMD), and genetic polymorphisms in interleukin-6 (IL6) influence their OHRQoL. METHODS: A total of 132 individuals included in three different groups. Two groups were composed by patients with dentofacial deformity (DFD) Class II (n = 44) or Class III (n = 44) malocclusions, requiring orthognathic surgery. The control group (n = 44) included individuals without DFD. Patients from all groups were evaluated in preoperative appointments to assessOHRQoL, TMD, and genetic polymorphisms in IL6. OHRQoL was assessed using the 14-item Oral Health Impact Profile (OHIP-14). TMD and depression were assessed using Research Diagnostic Criteria for Temporomandibular Disorders protocol. The genetic polymorphisms rs1800795 and rs1800796 in IL6 were assessed through genomic DNA using real-time polymerase chain reaction. RESULTS: OHIP-14 scores were increased in patients with depression, myofascial pain, and inflammatory temporomandibular joint alterations in the right side, regardless of sex and DFD group. Individual homozygous CC in rs1800795 had increased values in domains "social disability" and "handicap" of the OHIP-14 compared with those who were homozygous GG. Individual heterozygous CG in the rs1800796 demonstrated increased values in domain "psychological discomfort" compared with those homozygous for CC and GG. CONCLUSION: In individuals requiring orthognathic surgery, depression, TMD, and genetic polymorphisms in IL6 contribute to negative impact on OHRQoL. These physical and emotional conditions, together with biological pathways, should receive more attention in treatment plans, in order to improve the patients' quality of life.

Eminectomia para tratamento de luxação recidivante da ATM / Eminectomy for treatment of recurrent TMJ dislocation

Introdução: A luxação da articulação temporomandibular ocorre quando a cabeça da mandíbula se movimenta para fora da fossa articular, fazendo com que a superfície posterior da cabeça da mandíbula fique à frente da eminência articular. Quando ocorrem episódios frequentes, essa condição é referida como luxação recidivante. Embora existam diferentes tratamentos, a eminectomia apresenta-se como uma opção cirúrgica com resultados satisfatórios e prognóstico favorável. Relato de caso: Este trabalho relata o caso de uma paciente com quadro severo de luxações recidivantes associadas à distonia muscular, tratada cirurgicamente por eminectomia. A paciente apresenta acompanhamento de 36 meses, estável, sem sintomatologia ou novos episódios de luxação. A abordagem multidisciplinar apresenta um alto índice de sucesso, e procedimentos cirúrgicos devem ser considerados quando procedimentos clínicos falham. Considerações finais: A eminectomia mostra bons resultados no tratamento da luxação recidivante de ATM, com chances mínimas de recidiva ou danos articulares. Após a cirurgia, os pacientes mostram uma boa função articular... (AU)

Introduction: Dislocation of the temporomandibular joint occurs when the jaw head moves out of the joint fossa causing the posterior surface of the jaw head to be ahead of the joint eminence. When they occur in frequent episodes, this condition is referred like relapsing dislocation. Although there are different treatments, eminectomy presents as a surgical option with satisfactory results and favorable prognosis. Case report: This paper reports the case of a patient with severe recurrent dislocations associated with muscular dystonia, treated through surgical treatment of eminectomy associated with a clinical treatment protocol. The patient has a 36-month followup, stable, without symptoms or new episodes of dislocation. The multidisciplinary approach has a high success rate and surgical procedures should be considered when clinical procedures fail. Final considerations: Eminectomy shows good results in the treatment of recurrent TMJ dislocation, with minimal chances of recurrence or joint damage. After surgery, patients show good joint function... (AU)

Complications associated with orthognathic surgery: A retrospective study of 485 cases.

PURPOSE: To identify the most prevalent types of complications associated with orthognathic surgery and its possible risk factors. METHODS: This study was a retrospective investigation of records of 485 patients who underwent orthognathic surgery between 2008 and 2014 at the Oral and Maxillofacial Surgery Service at the Federal University of Paraná, Curitiba, Brazil. Types of complications were recorded. Independent variables such as sex, age, duration of surgery and hospitalization, number of surgeries, surgical site, and types of osteotomy performed were evaluated. Complications were also evaluated based on the treatment according to the Clavien-Dindo Classification. Data were submitted to statistical analysis with a significance level of 0.05. RESULTS: A total of 93 complications were reported (19.2%), including postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split, and infection. Complications were more common in men (p = 0.029). The number of complications was higher in surgeries that took more time to perform (p < 0.05) when the entire sample was taken into consideration. The prevalence of complications was related to a higher number of procedures per surgery (p = 0.019). Complications were more frequent in mandibular procedures (p = 0.010), particularly in bilateral sagittal split osteotomies (p < 0.001). Related to treatment, Clavien-Dindo grade I complications were the most frequent (72.04%). There was no association between sex, age, surgery duration, length of hospitalization, or surgical site with complication grades according to the Clavien-Dindo classification (p ≥ 0.05). CONCLUSION: Postoperative malocclusion, hemorrhage, inferior alveolar nerve injury, bad split and infection are the most prevalent complication in orthognathic surgery. They seem to be related to sex, duration of surgery, number of surgeries, surgical site, and the type of osteotomy performed. With these in mind, it is possible to explain to the patient the different levels of severity of complications related to the surgery.

Large Anterior Oronasal Fistula Repair Using Pedicled Buccal Fat Pad and Fibroepithelial Tissue.

Oronasal fistula (ONF) is the most common complication after palatoplasty in patients with cleft lip and palate (CLP). When left untreated, it may negatively affect the quality of life, leading to development of other comorbidities. This study reports for the first time, the use of a portion of a hyperplasic tissue associated with pedicled buccal fat pad flap to repair a large anterior ONF in a 60-year-old man. The hyperplasic tissue may have developed due to the combination of a loose fitting upper denture and long-term use of dihydropyridine calcium channel blocker (amlodipine besylate). There is controversy in the literature about use of pedicled buccal fat pad flap in the anterior region. However, in this study, we report successful repair of a large anterior ONF using a portion of a fibroepithelial hyperplasic tissue associated with pedicled buccal fat pad flap.

Intranasal Ectopic Tooth in Adult and Pediatric Patients: A Report of Two Cases.

The aim of this study was to report two rare cases of ectopic tooth into the nasal cavity. The first case reports a 32-year-old female patient with the main complaint of having a tooth inside her nose. According to her, this condition causes pain and sporadic nosebleed. The patient had a facial trauma when she was 6 years old. The second case refers to an 8-year-old girl with left incomplete unilateral cleft lip and palate. The main complaint was left-sided nasal obstruction by a white hard mass. The treatment for both cases was surgical removal of the ectopic erupted tooth under general anesthesia. In conclusion, we can state that the surgical removal of intranasal tooth is a safe procedure and improves patient's quality of life.

Evaluation of different stable internal fixation in unfavorable mandible fractures under finite element analysis.

INTRODUCTION: The mandibular angle fracture is the most common fracture between this type of injury in jaw bone and also is the type of fracture treatment that presents a larger number of complications, and a series different osteosynthesis types have been studied over the years by the world literature. The finite element method is a form of mathematical analysis, which is based on dividing a structure into a finite number of small areas. It has the ability tomathematically model structures, making it possible to apply forces anywhere. MATERIAL AND METHODS: For this study, a three-dimensional mandible with an unfavorable angle fracture was simulated. Five different types of fixations were evaluated: group 1, Champy technique with one 4-holes miniplate, 2.0 system; group 2, technique with two parallel 4-holes conventional miniplates, 2.0 system; group 3, technique with two parallel 4-holes locking miniplates, 2.0 system; group 4, technique with one reconstruction 6-holes plate, 2.8 system in base jaw; and group 5, technique with one reconstruction 6-holes plates, 2.8 system in jaw body + one parallel 4-holes conventional miniplate, 2.0 system. RESULTS: The results showed that strains are better distributed through the locking miniplate and screws system and presented less stress concentration when compared with the conventional ones. The Champy technique had the worst results about of all groups. The use of the locking system shows less stress compared to the non-locking system, and the presence of a reconstruction plate associated with a mini plate does not lead to increased stability compared with an isolated reconstruction plate.

Atypical Mandibular Angle Fracture.

The mandibular fracture takes the second position among facial bones fractures, with significant increase of cases in the last years. The aim of this paper is to report a clinical case of a patient with facial trauma due to an automotive accident, resulting in an atypical fracture in a unilateral mandibular angle. In the image examinations an atypical favorable fracture in the right mandibular angle region involving the apex of the erupted 48 tooth was found. The fracture line started in the posterior region of mandibular ramus, below mandibular condyle, and spread out until inferior border of the mandible in premolar region. Despite the atypical design of the mandibular angle fracture described in this paper, the treatment showed satisfactory results, without any aesthetic or functional changes for the patient.

Total Mandibular Subapical Alveolar Osteotomy to Correct Class II Division I Dentofacial Deformity.

INTRODUCTION: Class II division I malocclusions are the most common dentofacial deformities seen in clinical practice. Severe cases or cases in which growth has ceased may require full correction combining orthodontic and surgical treatment. We report a case of a total mandibular subapical alveolar osteotomy, performed to correct a class II division I dentofacial deformity. CASE REPORT: A 19-year-old female patient was referred to the oral and maxillofacial surgery department at the Federal University of Paraná with chin aesthetic complaints as well as class II malocclusion. The proposed treatment was total mandibular subapical alveolar osteotomy, retaining the chin position and eliminating the need for genioplasty, since, although the patient presented with a class II dentofacial deformity, the chin was well positioned. Under general anesthesia, a "V-shaped" incision was conducted from the right retromolar region to the left retromolar region. A ring of cortical bone was removed around the mental foramen, with the aim to create a space around the mental nerve. Fixation was conducted with plates and screws of the 2.0 system. The patient on six-year follow-up showed osteotomy stability, a better overall occlusion, and outcome satisfaction.

Comparison of the Stability of Mandibular Sagittal Osteotomy Fixation between Two Types of Titanium Miniplates: A Biomechanical Study in Sheep Mandibles.

This study aimed to compare the biomechanical stability of the fixation of mandibular sagittal split osteotomy of the ramus by two types of titanium miniplates in sheep mandibles. Seven preserved sheep mandibles with similar weight and size were selected, dissected with complete removal of soft-tissue structures, and sectioned in their midline. After performing sagittal split osteotomy, 5 mm of advancement was standardized and samples were divided into two groups according to the type of titanium miniplate (GI = seven hemimandibles were fixed with straight titanium miniplate, GII = seven hemimandibles were fixed with L-shaped titanium miniplates), and then subjected to compressive load. The means (standard deviation) of the compressive load and extension values were 70.68 N (22.26) and 63.36 mm (15.60) to straight miniplates, and 78.80 N (32.54) and 70.55 mm (5.42) to L-shaped miniplates. After comparison and statistical analysis, the results showed no significant difference between the two types of titanium miniplates.

Does orthognathic surgery improve myofacial pain in individuals with skeletal class III? One-year follow-up.

OBJECTIVE: The objective of the study was to evaluate the effect of orthognathic surgery on temporomandibular disorder (TMD) in patients with skeletal class III malocclusion. STUDY DESIGN: Forty-seven patients undergoing surgery were evaluated by a trained examiner using Axis I of the Research Diagnostic Criteria/TMD index, consecutively, at 3 different periods: 1 week before operation (T0), 6 months after operation (T1), and 1 year after operation (T2). Bivariate analyses were performed to compare the evaluation periods (P < .05). RESULTS: The prevalence of TMD in the sampled patients from T0 to T1 decreased from 30 (63.8%) to 22 (46.8%) (P = .021). Even in T2, the prevalence of TMD remained lower than that in T0, at 21 (44.7%) diagnosed patients (P = .049). The reported frequencies of myofascial pain and headache were lower in T1 and T2 than in T0 (P < .001). Decrease in the frequency of joint pain and joint sounds was observed only from T0 to T1 (P = .039 and P = .021, respectively). The mean maximum of mouth opening decreased from T0 to T1 (P < .001) and increased again at T2 (P < .001). CONCLUSIONS: Orthognathic surgery promoted reduction in the frequencies of myofascial pain and headache reported by patients with skeletal class III malocclusion.