Safety and Stability of Postponed Maxillomandibular Fixation After Intraoral Vertical Ramus Osteotomy.

The purpose of this study was to evaluate the postoperative safety and long-term stability of bimaxillary orthognathic patients with postponed maxillomandibular fixation (MMF) after intraoral vertical ramus osteotomy.A total of 61 patients (21 male and 40 female patients; average age [SD], 21.7 [4.7]) were enrolled. All patients underwent maxillary LeFort I osteotomy and bilateral intraoral vertical ramus osteotomy for mandibular prognathism. During the hospital stay, postoperative airway compromise was observed and patients underwent MMF with wire at the second postoperative day. Stability was evaluated by measuring the position at each period: preoperative (T0), 2-day postoperative (T1), and 1-year postoperative.Postoperative dyspnea and respiratory distress were absent in all patients. The mean number of refixations in physiotherapy was 0.62 (0.86) and the mean duration of physiotherapy was 11.6 (5.5) days. The mean amount of mandibular setback was 12.56 (5.76) mm and menton movement 0.98 (2.36) mm superiorly (T1). The mean mandibular relapse at Pog was 0.87 (1.96) mm anteriorly. Menton showed 1.11 (1.41) mm superiorly movement 1-year postoperatively (T2).Despite its many advantages, intraoral vertical ramus osteotomy requires a period of MMF which can lead to early discomfort and airway-related emergency. In this study, the physiotherapy procedure and postoperative long-term stability in the postponed MMF group were not different from those of an immediate MMF group studied previously. It therefore constitutes a viable option for oral breathers and other compromised patients.

Occlusal stability after Herbst treatment of patients with retrognathic and prognathic facial types : A pilot study.

OBJECTIVES: The purpose of this study was to assess and compare occlusal changes induced by Herbst treatment and the stability of these changes in patients with retrognathic and prognathic facial types. PATIENTS AND METHODS: The sample comprised 11 retrognathic (SNA ≤76°, SNB ≤72°, ML/NSL ≥36°) and 10 prognathic (SNA ≥83°, SNB ≥80°, ML/NSL ≤32°) patients with Class II molar relationships of ≥0.5 cusp widths bilaterally or ≥1.0 cusp width unilaterally. Both groups involved similar distributions of skeletal maturity before treatment. Study parameters were assessed on casts reflecting the situations before treatment (T0), after Herbst treatment (T1), after multibracket treatment immediately following Herbst treatment (T2), and after a mean of 31.1 months of retention (T3). RESULTS: Sagittal molar relationships improved by 0.8 cusp widths in the retrognathic and by 0.7 cusp widths in the prognathic group during active treatment (T0-T2). Insignificant changes of ≤0,2 cusp widths were seen in both groups during retention (T2-T3). Overjet decreased by 8.6 mm in the retrognathic and by 5.5 mm in the prognathic group during T0-T2, and both groups showed clinically irrelevant amounts of relapse by 0.7 mm during T2-T3. Overbite improved by 1.2 mm in the retrognathic and by 2.5 mm in the prognathic group during T0-T2, reaching mean values of 1.0 mm or 1.4 mm by T2, which was followed by 0.2 mm or 1.1 mm of relapse during T2-T3. CONCLUSION: Treatment with a Herbst appliance seems to offer stable correction of the sagittal occlusal relationships in Class II patients with retrognathic or prognathic facial types, with the vertical changes being more pronounced in the prognathic cases.

El retropropulsor y estimulador de Buño: su uso en los prognatismos mandibulares, cambios cefalométricos / The retropropulsor and Buño stimulator: use in mandibular prognathism, cephalometric changes

El problema de los prognatismos mandibulares es motivo de interés permanente para genetistas, antropólogos, ortopedistas, ortodoncistas, pediatras, cirujanos y psiquiatras. Se realizó un estudio prospectivo con el uso del retropropulsor y timulador del profesor Indalecio Buño en 24 pacientes con prognatismos mandibulares en dentición mixta. Conocer los cambios cefalométricos durante el uso del retropropulsor y estimulador.Se les realizaron telerradiografías de perfil, antes y doce meses después, comparando los cambios cefalométricos obtenidos como resultado de cambios esqueletales y dentoalveolares logrados, teniendo en cuenta el sexo también.Estadísticamente se encontró aumento del ángulo SNA y reducción del ángulo SNB muy significativos, lo que representó un cambio muy significativo del ángulo ANB.En relación con el sexo, hubo cambios muy significativos en el ángulo SNA en los varones y en el ángulo SNB en las hembras, además de una variación muy significativa en las hembras, del ángulo 1 SNB. Estos cambios ayudaron en la mejoría del perfil, cóncavo, así como a descruzar las mordidas anteriores que caracterizan a los pacientes con prognatismos mandibulares en el síndrome de clase III(AU)

A prospective study was conducted with the use of the retropropulsor and stimulator of Professor Indalecio Buño in 24 patients with mandibular prognathism in mixed dentition.The objective to know the cephalometric changes during the use of the retropupulsor and stimulator.Patients underwent lateral radiographs before and twelve months after, comparing cephalometric changes obtained as a result of skeletal and dentoalveolar changes achieved, taking into account sex too.The results statistically increase of SNA angle and very significant reduction in SNB angle were found, which represented a significant change of the ANB angle.The conclusions: regarding sex, there were significant changes in the SNA angle in males and in females in SNB angle, in addition to a significant variation in females of 1 SNB angle. These changes helped in improving the profile, concave, and to uncross previous bites that characterize patients with class III mandibular prognathism syndrome.

Recovery pattern of mandibular movement by active physical therapy after bilateral transoral vertical ramus osteotomy.

PURPOSE: The purpose of the present study was to evaluate the effect of an active physical therapy (PT) protocol after transoral vertical ramus osteotomy and to investigate the rehabilitation patterns of mandibular movement. MATERIALS AND METHODS: The study included 187 patients diagnosed with mandibular prognathism with or without facial asymmetry who had undergone bilateral transoral vertical ramus osteotomy from 2001 to 2009. The subjects were evaluated preoperatively and 1, 3, 6, 12, 18, and 24 months postoperatively in terms of the periods of PT and range of mandibular movement. The data were analyzed using 1-way analysis of variance (significance level, P < .05). RESULTS: Of the 187 patients, 108 (57.8%) did not receive repeat intermaxillary fixation (IMF) during the PT period, 58 (31.0%) received it once, 15 (8.0%) twice, and 6 patients more than 3 times. The average PT period for all was 10.9 days (range 5 to 45). The mean maximal mouth opening was 50.7 mm before surgery, decreasing to 33.9 mm at 1 month postoperatively. This was followed by an increase to 46.3 mm at 6 months postoperatively, with the maximal mouth opening thereafter showing 93.9% to 95.7% recovery compared with the preoperative state. CONCLUSIONS: About 88% of the patients with transoral vertical ramus osteotomy responded well to the reduced IMF duration and active PT protocols, receiving repeat IMF less than twice. It required about 6 months to recover 90% of the preoperative maximal mouth opening and 12 months to recover near preoperative levels statistically. The benefits of reduced IMF duration and the PT protocols seem to promote rehabilitation of the masticatory muscles and prevention of mandibular hypomobility.

[The functional mandibular prognathism]. / Le proglissement mandibulaire.

The functional mandibular prognathism belong to the class III malocclusion according to the terminology of Angle. Its origins are multiple, from the abnormality of eruption of deciduous or definitive incisors to lingual dysfunction (low position of the tongue). In spite of its weak prevalence, it must be prematurely detected and treated (mixed or temporary teeth) to prevent a functional anomaly to become a skeletal anomaly. It is important at this stage to proceed to the unique gesture which allows making the differential diagnosis: it is the De Névrezé procedure; it allows obtaining a more retrusive position of the mandible to minimize the dental relations. In case of true mandibular prognathism, the maneuver does not succeed; there is no modification of the dental reports. An interceptive therapeutic phase allows finding quickly a previous correct guide and to rehabilitate the growth of jaws.

Rehabilitation of a hemophiliac with implants: a medical perspective and case report.

A patient suffering from classical hemophilia had previous surgery for ankylosis of the right temporomandibular joint. This was replaced by a costochondral graft and an overlay of temporalis muscle. A bilateral sagittal split was performed for a micrognathic mandible and a sleep apnea problem. That procedure solved the sleep apnea; however, it resulted in a prognathic mandible and an anterior open bite. The lower anterior teeth were periodontally involved with impaired alveolar support. The restricted opening of the oral cavity of 18 mm between maxillary and mandibular centrals and the potential danger of bleeding complicated the surgical and restorative procedures. The patient was prepared medically on each of 4 occasions with factor VIII replacement concentrate, and oral antifibrinolytic therapy (tranexamic acid). The treatment of choice was the extraction of the remaining lower incisors and their replacement with an implant-supported temporarily cemented retrievable fixed prosthesis. Serial extractions and chairside temporization provided the surgeon with precise guides for implant placement, and enabled the patient to enjoy unimpaired function through periods of healing and osseointegration.

Prosthetic treatment of a patient with facioscapulohumeral muscular dystrophy: a clinical report.

Facioscapulohumeral muscular dystrophy syndrome (FSHD) is a rare hereditary myopathy characterized by muscle atrophy and weakness, particularly in the face and upper arms. Patients may also exhibit dental malocclusions. This article presents the prosthodontic treatment for an 18-year old male with FSHD.

[Use of an overdenture in the prosthetic correction in a patient with cleft palate]. / Keményszájpad-hasadékos beteg protetikai ellátása "overdenture" típusú fogpótlással.

A fourty-year old male patient with cleft palate had been operated on four times in his childhood in order to close the defect. The shrinked dental arch and the pseudoprogenia, remaining after the operation, caused problems in the mastication and esthetic defects to the patient. With the help of an overdenture a new dental arch was created, in this way the pseudoprogenia could be eliminated, the facial harmony and the mastication could be restored.

[Orthognathic surgery: a team effort]. / Chirurgie orthognathique: un travail d'équipe.

Patients in daily practice can be asking us about the problems they experience with their occlusal relationship, facial esthetics and joint dysfunction. If this dysfunction is present in a harmonious facial balance, the treatment plan should be classically dental (building-up plate to free the joint, occlusal equilibration, amalgam reconstructions, crown and bridgework, orthodontics). If the dentist observe a facial imbalance, whether it is antero-posterior, vertical or transversal, the treatment should be in cooperation with an orthognathic team (orthodontist and maxillo-facial surgeon). If the clinical problem is exclusively esthetic, without any relation with dental malocclusion and/or joint dysfunction, the treatment planning can be plastic surgery only.