Clinical and Cephalometric Changes in Long-face Patients With Retrogenia Following the Novel B-genioplasty Technique.

BACKGROUND: The chin plays a fundamental role in facial attractiveness. Accordingly, several surgical procedures have been proposed for chin contouring. This study aimed to introduce "B-genioplasty" as a novel genioplasty technique and assess the clinical and cephalometric changes in long-face patients with retrognathia following the novel B-genioplasty. METHODS: This is a cross-sectional study. Subjects with class I occlusion increased lower facial height and retrognathia underwent B-genioplasty in this prospective experimental study. Soft and hard tissue cephalometric measurements were made, and the depth of the notch in the lower border of the mandible was measured on lateral cephalograms at 6 months postoperatively and compared with baseline. Patient satisfaction with the outcome was also assessed. RESULTS: Seventeen subjects were studied. Ten (58%) patients underwent rhinoplasty plus genioplasty. All patients were satisfied with the outcome. The step/notch in the lower border of the mandible was not detected in clinical examination in any patient. The mean notch depth was 0.5±0.83 mm on lateral cephalograms. The change in all soft and hard tissue cephalometric parameters was significant at 6 months postoperatively compared with baseline (P<0.001 for all). CONCLUSION: B-genioplasty caused satisfactory clinical and cephalometric changes in long-face patients with retrognathia, including prevention of step/notch in the inferior border of the mandible, significant reduction of gonial angle, correction of the mandibular plane, and reduction of lower facial height.

What Are the Incidence and Factors Associated With Implant Fracture?

PURPOSE: Implant fracture is a serious complication, which leads to treatment failure. The purpose of this study is to estimate the incidence of implant fractures and identify factors associated with them. MATERIALS AND METHODS: In this retrospective cohort study, the sample was derived from 2 implant centers. The predictors were grouped into the following categories: demographic, location of implant, physical characteristic of implant, implant-abutment connection, type of prosthesis, type of retention, and outcome variable (time to implant fracture). The Kaplan-Meier test was used to estimate implant survival. A Cox regression model was applied to evaluate the time-to-event effect of variables on implant fracture. RESULTS: Of 18,700 implants, 37 (0.002%) had fractures. The 1- and 5-year risk of implant fracture was 0.38 per 1,000 and 1.46 per 1,000, respectively. Implant fractures more often occurred in the premolar and molar area (94.6%) than in the anterior of the jaws. The Pearson correlation test did not show any correlation between age, implant diameter, or implant length and time of fracture (P > .05). Analysis of the data by the log-rank test showed a significant difference for survival between cemented and screw-retained crowns (P = .001). The Cox regression model showed a hazard ratio of 0.23 for tapered implants versus cylindrical fixtures and for screw-retained crowns (hazard ratio, 296.54) versus cemented crowns. CONCLUSIONS: According to this study, conical implants and screw-retained prostheses may have lower survival rates due to implant fracture.

Bipolar Disorder: Review of Orthodontic and Orthognathic Surgical Considerations.

An increasing number of patients with psychological conditions with or without drug regimens are seeking orthodontic treatment and orthognathic surgery to address jaws dysmorphology. Depression and bipolar affective disorders are relatively common. These disorders may interfere with the presurgical orthodontics, surgical intervention and postsurgical treatments and thus requires careful considerations. The aim of this article is to report of a case with bipolar disorder and review the orthodontics and orthognathic surgery considerations of patients with bipolar disorder.

Oro-facial characteristics and the surgical correction of patients affected by beta-thalassaemia: a review of the literature and report of a case.

Despite the fact that recent medical advances have improved the quality of life and increased the life expectancy of patients suffering from thalassaemia, no standard strategy or clinical guidelines are available for the correction of the presenting craniofacial anomalies. The aim of the present study is to review the craniofacial features of affected patients, and to discuss the orthodontic and orthognathic surgical treatment options available to manage the associated and characteristic facial deformity.

Comprehensive treatment and rehabilitation of a patient with maxillary arteriovenous malformation.

Arteriovenous malformations (AVMs) of the maxilla are rare and potentially life-threatening conditions that can pose a therapeutic dilemma. We reported the first case of maxillary AVM in a 15-year-old girl who was treated by marginal hemimaxillectomy including overlying palatal mucosa and immediate replantation of the segment after removing the AVM tissues and teeth and covering by a full-thickness pedicled temporal muscle flap rotated into the mouth. Then, this preserved bone underwent distraction osteogenesis and dental implant rehabilitation successfully. This method was previously used for the definitive treatment of mandibular AVMs, and in this case, we applied this method for the first time in maxillary AVMs. In conclusion, this surgical method may be considered as a safe, convenient, and effective treatment and reconstructive modality for such vascular malformations in the maxilla and restores function and symmetry of the jaws while obviating the need for bone harvesting and future major reconstructive operations.

Stabilization of premaxilla repositioned during secondary bone grafting in complete bilateral cleft lip and palate patients.

Secondary bone grafting simultaneous to premaxillary repositioning is a well-recognized surgical procedure for the management of bilateral cleft lip and palate patients. Proper stabilization of the repositioned premaxilla is considered as a key factor for the success of secondary bone grafting because the mobility of the premaxillary segment jeopardizes graft integration. This case series reports a reliable method of premaxillary stabilization that incorporated the intrasurgical application of resin bone cement to cover and reinforce the arch bars or orthodontic brackets applied on the maxillary teeth. Occlusal loads were reduced by application of posterior bite blocks on the mandibular teeth. The stabilization method was performed on 7 patients (5 women and 2 men) with a mean age of 12.4 years. During postsurgery follow-ups, the repositioned premaxillary segments did not show mobility in any of the patients. The palatal fistulae were completely closed. Panoramic radiographies taken 2 months after surgery demonstrated acceptable graft integration. The patients have now been followed up to 5 years. No evidence of relapse has been observed. This technique seemed to be undemanding, included minimal laboratory procedure, and maintained the labial mucosa overlying the repositioned segment intact.

Thickness of labial alveolar bone overlying healthy maxillary and mandibular anterior teeth.

AIM: This study aimed to measure the thickness of labial bone overlying maxillary and mandibular anterior teeth and the distance between cementoenamel junction and bone crest in a Persian population. MATERIALS & METHODS: Two calibrated examiners evaluated tomographic data of 152 maxillary and 200 mandibular anterior teeth. Labial bone width was assessed at levels 1.0 to 5.0 mm apical to bone crest. Moreover, the distance between cementoenamel junction and bone crest was measured for both maxillary and mandibular teeth and its potential effect on the amount of labial bone thickness was assessed. RESULTS: One hundred-twenty nine maxillary central incisors, 77 lateral incisors, 70 canines, 105 mandibular central incisors, 103 lateral incisors and 81 canines were included for measurements. In maxilla, width of bone averaged 1.08mm, 1.11mm, and 1.3mm for central incisors, lateral incisors, and canines, respectively. Corresponding numbers for mandibular central incisors, lateral incisors, and canines were 0.74mm, 0.66mm and 0.40mm. High variation of cementoenamel junction to bone crest distance (range 0.5 to 5.15 mm) was detected. The mean amount of labial bone width was not statistically different in patients with different distances between cementoenamel junction and bone crest; except for mandibular lateral incisors. CONCLUSION: The mean thickness of the labial alveolar bone overlying maxillary anterior teeth was found to be between 1 to 1.2 mm and between 0.5 to 0.8 mm for mandibular anterior teeth at the first 5 mm from bone crest in a Persian population.

Multidisciplinary reconstruction of a palatomaxillary defect with nonvascularized fibula bone graft and distraction osteogenesis.

Reconstruction of extensive palatomaxillary defects with oronasal/antral communication represents a challenge to surgeons. Bone-containing microvascular flaps have been suggested as a promising option for rehabilitation of function and esthetics. These types of flaps, however, might be associated with high morbidity. A combination of less complicated treatments might also provide acceptable results while diminishing potential donor site complications. This clinical report presents a bilateral maxillary defect with oronasal communication due to resection of malignant melanoma of the palate. The lost alveolar bone was initially reconstructed with a nonvascularized fibula bone graft. After 6 months, the alveolar segment was subjected to vertical distraction osteogenesis to increase bone height. After a 3-month consolidation period, the patient received 10 dental implants and an implant-supported fixed prosthesis. To preclude graft harvesting morbidity for reconstructing the oronasal fistula, the frame of the prosthesis was designed to include 3 ball attachments on which a palatal obturator, merely covering the palate, could be stabilized. The removable implant-retained obturator restored function perfectly. During the 5-year follow-up, no complication regarding bone graft, the dental implants, and the obturator has been observed.

Healing of extraction sockets and augmented alveolar defects following 1-year treatment with bisphosphonate.

To assess the effect of bisphosphonates on healing of extraction sockets and augmented alveolar defects, 12 adult female mongrel dogs were assigned to 2 experimental groups and a control group. The experimental groups received oral alendronate (ALN, 3.5 mg/kg/wk) or IV pamidronate (PAM, 1 mg/kg/wk) for 12 months. Animals were randomly tested for serum C-terminal telopeptide of collagen I (CTx). The right first and second premolars were extracted. After 8 weeks, extraction sites were evaluated for healing. Subsequently, 3-wall defects were created in ridges and filled with human mineralized cortical particulate bone. Two months post-augmentation, animals were sacrificed and mandibles were collected for cone-beam computed tomography (CBCT) and histomorphometric appraisal. The obtained data were compared using 1-way ANOVA test. CTx test results in both experimental groups were comparable (<10 pg/mL) but lower than that of the control group (minimum 159.2 pg/mL). Two months post-extraction, bone sequestra were noticed in extraction sites in BP-treated groups, involving the entire alveolar bone in the PAM group and the upper rim of the alveoli in the ALN group. Histologically, bone sequestra from the PAM group demonstrated empty osteocyte lacunae, while in the ALN group areas of necrotic bone along with evidence of active bone remodeling was distinguished. Eight weeks post-augmentation, the experimental groups showed no evidence of bone formation in the augmented area, while bone formation ratio was measured to be 18.32% in the control group. The mean amount of pixel intensity calculated from the CBCT images of the ALN, PAM, and control group was 113.69 ± 11.04, 124.94 ± 4.72, and 113.69 ± 6.63, respectively. Pixel intensity in PAM-treated group was significantly higher than both other groups. This study demonstrated that 1-year treatment with ALN/PAM was associated with impairment of post-extraction and post-augmentation bone healing in dogs.

Clinical importance of recipient site characteristics for vertical ridge augmentation: a systematic review of literature and proposal of a classification.

This review evaluated the characteristics of vertical alveolar defects that were augmented via onlay bone grafting or guided bone regeneration. Information regarding the anatomic site, type of edentulism, and defects' dimensions were extracted. The experiments differed vastly in the description of the defects' features. Aiming to mitigate the confounding effect of recipient site's morphology in future experiments, a classification of vertically deficient recipient sites is proposed.

Vertical bone augmentation with simultaneous implant placement using particulate mineralized bone and mesenchymal stem cells: a preliminary study in rabbit.

This study aimed to assess vertical bone augmentation with simultaneous implant placement in rabbit tibiae using particulate mineralized bone/fibrin glue/mesenchymal stem cell. Bone marrow was aspirated from tibiae of five 10-week-old New Zealand White male rabbits. Right and left tibiae of each rabbit were prepared, and a 3-mm protruding implant from tibial bone was placed in each side. Particulate allogenic bone/fibrin glue/mesenchymal stem cell combination was placed around test implants and particulate bone graft/fibrin glue around controls. Two months postoperatively, the animals were euthanized, and sections were prepared for histological analysis. The mean amount of vertical bone length was higher in the experimental group than the control group (2.09 mm vs 1.03 mm; P < .05). New supracrestal trabecular bone formation was also significantly higher in the test group (28.5 ± 4.5% vs 4.3 ± 1.8%; P < .05). Mesenchymal stem cell/particulate allograft/fibrin glue appears to be a promising combination for vertical bone augmentation around simultaneously inserted implants in rabbit tibia.

Lefort 1 osteotomy in a beta-thalassemia major patient--a case report.

Maxillary setback of patients with protruded maxilla is a complex procedure. This complexity is aggravated when combined with thalassemia. The Aim of this case report was to treat a beta-thalassemia major girl with severe maxillary protrusion. A 16 year-old beta-thalassemia major girl presented with excessive maxilla, incompetent lips and an everted upper lip was referred for treatment. She had her spleen removed at the age of 9 and her blood transfusion was stopped 3 month before referral. After leveling and aligning with 018 standard edgewise system the patient was sent for Lefort 1 osteotomy. Segmental osteotomy was denied due to excessive bleeding in the procedure. The results showed that the thalassemic patient was effectively treated with presurgical orthodontics, Lefort 1 osteotomy followed by post surgical orthodontics. Very satisfactory esthetic results were obtained in the patient after 4.5 years of active treatment.

Does leucocyte- and platelet-rich fibrin enhance neurosensory recovery after genioplasty? A double-blind, split-mouth, randomised clinical trial.

Neurosensory disturbances (NSD) are common after genioplasty. In this study we aimed to assess the recovery of NSDs with or without leukocyte- and platelet-rich fibrin (L-PRF) following genioplasty. In this double-blind, split-mouth, randomised clinical trial, L-PRF was applied around the mental nerve at the osteotomy site in genioplasty (treatment side). The contralateral side was considered the control side. Two-point discrimination (TPD) test, brush test, and self-reported NSDs (SR-NSD) were used to determine NSD at one, four, and 12 months after genioplasty. Twenty patients were studied. At one and four months after osteotomy, the mean scores of TPD and SR-NSDs were significantly different between the treatment and control sides (p = 0.04, p = 0.01, respectively). The mean of TPD and SR-NSDs was not statistically different on both sides 12 months after operation (p = 0.05, p = 0.71, respectively). The application of L-PRF may enhance the speed of NSD recovery four months after genioplasty.

Current trends in mesenchymal stem cell application in bone augmentation: a review of the literature.

PURPOSE: The literature regarding mesenchymal stem cell (MSC)-based bone reconstruction techniques are sparse and no comprehensive review of current methods has been performed. The aim of this article was to provide a discussion of clinical and experimental reports of MSC application in the reconstruction of bony defects in live models. MATERIALS AND METHODS: This search was executed using the PubMed database with various combinations of related keywords. Currently published English-language studies that had applied MSCs as a part of their treatment protocol for reconstruction of bony defects in rat, rabbit, dog, and human models were reviewed. The included studies had reported substantiation that the applied cells were of MSC origin as a part of the study design. Publications inclusive to February 1, 2010 were evaluated. Of review of 187 found abstracts and full texts, 25 articles met the inclusion criteria. RESULT: Based on this review, tremendous differences exist among investigators for the application of MSCs in bone augmentation procedures. These differences include not only species uniqueness but also a plethora of other variances, such as stem cell source, defect sites and sizes, carriers and constructs, use of additional growth factors, measured parameters, and methods of data collection. CONCLUSION: Because of the multitude of protocols, range of parameters, and data in the current English-language literature, this review did not reach any significant conclusion as to the "most predictable" model in stem cell reconstruction. However, it does "shed light" on the need for additional collaborated studies using similar homogenous designs and data analysis in advancing the science of bone reconstruction using MSCs.

What factors affect the attachment of the inferior alveolar nerve to the buccal plate following sagittal split osteotomy?

PURPOSE: This study aimed to assess the factors that can possibly affect the positioning of the inferior alveolar nerve (IAN) in the proximal or distal segment following sagittal split osteotomy (SSO). MATERIALS AND METHODS: This was a prospective cohort study. The patients were assigned according to the position of the IAN: the IAN was attached to the buccal plate in group 1 (27 SSOs), while it was in the distal segment in group 2 (83 SSOs). RESULTS: The mean of the buccolingual thickness of the proximal segment at the vertical cut of the osteotomy (BLTP) was 5.0 ± 0.62 mm in group 1 and 4.16 ± 0.72 mm in group 2. The mean of the distance between the IAN and the external cortical bone at the distal of the second molar before the osteotomy (IANB) was 0.5 ± 0.24 mm in group 1 and 1.24 ± 0.45 mm in group 2. There were significant differences for the mean BLTP and IANB between the two groups (P = 0.001). CONCLUSION: It seems that the thickness of the buccal plate of the proximal segment, the distance from the IAN to the external cortical bone, the osteotomy technique, and the presence or absence of impacted third molars may be associated with the positioning of the IAN following SSO.

Comprehensive reconstruction of the maxilla after a failed premaxillary osteotomy: a case report with long-term follow-up.

Major complications after maxillary orthognathic surgery are fortunately uncommon when executed properly. However, segmental necrosis has been reported. When this occurs, comprehensive reconstruction of the maxilla becomes difficult because both hard and soft tissues are lost. Use of a free flap such as the fibula for this purpose is difficult because it is bulky. We report a 40-year-old woman who presented with a defect of the anterior maxilla that occurred after necrosis of the premaxilla, which we treated with a modified prefabricated osteocutaneous free fibula flap and dental implants with long-term follow-up. The modified prefabricated free fibula flap is suitable for maxillary reconstruction.

Treatment of an Adult Skeletal Class III Patient with Surgically Assisted Rapid Palatal Expansion and Facemask.

This case report presents the treatment of a 21-year-old male patient with class III skeletal malocclusion, an open bite, and vertical growth pattern. He was managed with surgically assisted rapid palatal expansion (SARPE) along with an orthopedic facemask. The duration of treatment was 16 months. Significant improvement and favourable outcome were observed concerning both facial appearance and paraclinical parameters after completion of treatment.

Experience with the prefabricated free fibula flap for reconstruction of maxillary and mandibular defects.

PURPOSE: We report our 11-year experience with a new technique to prefabricate the osteocutaneous free fibula flap to reconstruct defects of the maxilla and mandible not amenable to conventional methods of treatment. MATERIAL AND METHODS: We treated 11 patients aged 17 to 47 years with jaw defects using prefabricated free fibula grafts from 1994 to 2005. We prepared the fibula on the leg with a 6- to 8-mm muscle cuff; next we transferred the bone flap to the surface of the leg without severing the pedicle, and then covered the muscle almost circumferentially by partial thickness skin graft. The bone flap was left in place with its pedicle intact for 2 to 3 months, after which the skin graft had taken and the flap was free of inflammation. The fibula flap was then transferred to the face, fixed in place with plates, and microvascular anastomosis was performed. Implant placement was completed 4 to 6 months after transfer of the flap to the oral cavity. RESULTS: Graft take was unremarkable in all cases. There were no cases of infection and only minor complications. Edema of the flap may be encountered, which subsides with time. If the mandible is not edentulous the mandibular teeth may bite into the flap, but these wounds heal by the time the patient is ready for implant insertion (3 to 6 months). Implants placed in the fibula were successful during the follow-up period (2 to 13 years). CONCLUSION: The prefabricated fibula with a "banking time" on the leg for flap maturation seems to be a better choice compared with other methods of using the fibula for reconstruction and has passed the test of time. We hereby report this new technique to add to the armamentarium of jaw reconstruction surgery.

Treatment of arteriovenous malformations: assessment of 2 techniques--transmandibular curettage versus resection and immediate replantation.

PURPOSE: This study evaluates 2 surgical methods used at our center for the treatment of mandibular arteriovenous malformations (AVMs): resection with immediate replantation and curettage via proximal transmandibular osteotomy. PATIENTS AND METHODS: Patients with AVMs of the mandible who were treated during a 17-year period between 1992 and 2008 at our department were assessed. Two surgical techniques were used for treatment: 1) resection of the segment, curettage of the intrabony lesion, extraction of involved teeth, and immediate replantation and 2) proximal osteotomy curettage of the lesion within the bone and extraction of involved teeth. In the replantation group the resected segment of the mandible was replanted after the contents were scraped out and the involved teeth removed. In contrast, in the proximal osteotomy group this was done without removal of the bone segment. In both techniques the cortical bone of the mandible was maintained. However, in the transmandibular curettage group the periosteum was not entirely stripped off because curettage was done via proximal osteotomy without removal of the segment. The entire intrabony lesion and a margin of cancellous bone related to the lesion were excised in both groups. The bone was fixed with titanium plates in all cases. All patients were followed up annually for a period of 1 to 17 years (mean, 9.5 years). RESULTS: We treated 12 patients with mandibular AVMs (2 male and 10 female patients). Their ages ranged from 7 to 17 years. Preoperative angiography showed high-flow central vascular lesions in all patients. Of the lesions, 7 (58%) were treated via resection with immediate replantation and 5 (42%) were treated via transmandibular curettage. Embolization was performed in 4 cases 48 hours before surgery. However, blood loss was not significantly decreased by embolization. The lesions were categorized as multilocular (58.3%) or unicystic (41.7%) based on the radiographic findings and were located in the mandibular body (66.7%) or ramus (33.3%). Blood loss averaged 1.60 L in the group undergoing resection and immediate replantation and 1.30 L in the transmandibular curettage group. During the follow-up period, no recurrences were encountered in either group via clinical, radiographic, or computed tomography scan assessment, and none of the patients had facial deformities develop. CONCLUSIONS: The results suggest that transmandibular curettage via proximal osteotomy without complete resection is an effective less invasive method with which to treat AVMs of the mandible provided that the lesion is small, is confined within the bone, and has not invaded the soft tissues. Less blood loss, preservation of the bone, more favorable postoperative esthetics, and better function are among the advantages of this technique. In more extensive cases and those involving both hard and soft tissues, resection with immediate replantation is recommended. Both techniques obviated the need for bone graft reconstruction. This technique is better than resection and discarding of the segment.

The effect of autologous leukocyte platelet rich fibrin on the rate of orthodontic tooth movement: A prospective randomized clinical trial.

OBJECTIVE: The aim of this study was to evaluate the effect of LPRF, placed in extraction sockets, on orthodontic tooth movement (OTM). MATERIALS AND METHODS: Thirty extraction sockets from eight patients (five males, three females, with a mean age of 17.37 years; range 12-25 years) requiring extraction of first premolars based on their orthodontic treatment plan participated in this split-mouth clinical trial. In one randomly selected quadrant of each jaw, the extraction socket was preserved as the experimental group by immediate placement of LPRF in the extraction socket. The other quadrant served as the control group for secondary healing. Immediately, the teeth adjacent to the defects were pulled together by a NiTi closed-coil spring with constant force. A piece of 0.016 × 0.022-inch stainless steel wire was used as the main arch wire. The amount of OTM was measured on the study casts at eight time points with 2-week intervals for 3 months. Analysis of random effect model was performed for the purpose of comparison between the experimental and control groups. RESULTS: According to the random effect model, a statistically significant difference was found between the experimental and control group in rate of OTM (P = 0.006). CONCLUSION: According to the results, application of LPRF, as an interdisciplinary approach combining orthodontics and surgery, may accelerate OTM, particularly in extraction cases.