[Harvesting of autologous bone graft for the mandible: from the hip or the jaw?] / Oogsten van autologe botgraft voor de mandibula: uit heup of kaak?

A 61-year-old edentulous patient presented with dental problems. Examination revealed a very narrow alveolar process in the symphysis area of the chin, with moderate vertical resorption. The decision was made for bone augmentation by means of harvesting an autologous bone graft from the alveolar process. This method can be carried out in an outpatient or day surgery unit and is much more cost effective and less invasive than harvesting an autologous bone graft from the hip area.

[Maxillomandibular advancement surgery as an optional therapy for patiens with severe obstructive sleep apnoea]. / Bimaxillaire osteotomie als mogelijke behandeling voor ernstig obstructieve slaapapneu.

Obstructive sleep apnoea (OSA) is a common chronic disorder which often requires lifelong treatment. Its prevalence in the Netherlands is estimated to be around 300.000 people. In this study 12 patients with severe OSA were treated with maxillomandibular advancement surgery between 2011 and 2012. The mean advancement during surgery was 8.7 mm and the mean postoperative admission was 4 days. All patients underwent polysomnography at 3 months. Three months after surgical treatment, the apnoea-hypopnea index had decreased with 74.9% (57.3 to 14.4). The subjective sleepiness of the patients had also decreased with a mean of 57.5%. The literature indicates comparable results in patients with severe OSAS, specifically a reduction of the apnoea-hypopnea index of 80-90%. Considering the successful results following maxillomandibular advancement surgery, this therapy is an appropriate alternative for patients who cannot cope with 'continuous positive airway pressure' or patients who want a permanent therapeutic solution. Further research is recommended to achieve higher levels ofevidence for maxillomandibular advancement surgery in patients with OSA.

[A rare complication during the surgical removal of an impacted maxillary third molar]. / Een zeldzame complicatie bij verwijdering van een geïmpacteerde derde molaar in de bovenkaak.

A 12-year-old boy was referred by his orthodontist due to the dysmorphic condition of the impacted teeth 18 and 28. Because teeth 17 and 27 were close related to the third molars, the decision was made to remove the impacted teeth under general anaesthesia. During luxation of tooth 28, it was accidentally displaced deeper into the socket. The tooth could still not be localized after the use of radiographs, an antrostomy, and surgical exploration. It was decided to leave the 28 in its place and to perform cone beam computertomography. This showed that tooth 28 was displaced into the infratemporal fossa. Since the patient was free of symptoms, a period of watchful waiting was initiated. A control visit and cone beam computertomography 9 months postoperatively revealed no signs or symptoms or changes in the position of the displaced tooth. It was therefore decided to leave the third molar in its displaced position. Displacement of a maxillary third molar into the infratemporal fossa is considered a rare complication.

Assessment of obstructive sleep apnoea treatment success or failure after maxillomandibular advancement.

Maxillomandibular advancement (MMA) is an alternative therapeutic option that is highly effective for treating obstructive sleep apnoea (OSA). MMA provides a solution for OSA patients that have difficulty accepting lifelong treatments with continuous positive airway pressure or mandibular advancement devices. The goal of this study was to investigate the different characteristics that determine OSA treatment success/failure after MMA. The apnoea-hypopnoea index (AHI) was used to determine the success or failure of OSA treatment after MMA. Sixty-two patients underwent MMA for moderate and severe OSA. A 71% success rate was observed with a mean AHI reduction of 69%. A statistically significant larger neck circumference was measured in patients with failed OSA treatments following MMA (P=0.008), and older patients had failed OSA treatments with MMA: 58 vs. 53 years respectively (P=0.037). Cephalometric analysis revealed no differences between successful and failed OSA treatment outcomes. There was no difference in maxillary and mandibular advancements between success and failed MMA-treated OSA patients. The complications most frequently reported following MMA were sensory disturbances in the inferior alveolar nerve (60%) and malocclusion (24%). The results suggest that age and neck girth may be important factors that could predict susceptibility to OSA treatment failures by MMA.

[A second generation of premolars in the mandible]. / Een tweede generatie premolaren in de onderkaak.

Two developing supernumerary bicuspids were noticed accidentally in the mandible of a 12 years old girl when evaluating an impacted 35 on a radiograph. The development of these teeth was followed, but at a later stage they were removed. In a 17 years old man multiple complete developed bicuspids were seen on a radiograph. The backgrounds and treatment concerning supernumerary bicuspids in the mandible are discussed.