Mandibular growth following implant restoration: does Wolff's law apply to residual ridge resorption?

This study measured bone height under a fixed detachable cantilever restoration supported by five or six endosseous implants in 60 consecutively treated patients. Panoramic films were made at surgery and 1, 2, 3, and 4 years postrestoration. A computer-enhanced method was used to measure mandibular height 5, 10, 15, and 20 mm distal to the last implant, which was used as a length. standard to correct for variation in film magnification. Implant restoration resulted in a significant growth of the mandible (baseline: 7.25 +/- 0.25 mm, 4 years: 8.18 +/- 0.18 mm; P = .05). The growth in dimension appears to occur during the first year of function.     

Mandibular sagittal split osteotomy: is a bicortical 2-screw osteosynthesis adequate?

The aim of this study was to prospectively evaluate the accuracy and reliability of the use of the Hunsuck/Epker–type mandibular split osteotomy together with osteosynthesis with placement of 2 bicortical positioning screws without the adjunctive use of a postoperative maxilla-mandibular fixation in the treatment of mandibular dentofacial deformities. We analyzed the clinical and radiologic data of 54 patients with dentofacial deformities. We recorded age and sex, status of healing, and complications. Postsurgical complications that were recorded as minor did not require surgical intervention, whereas major complications required further surgical intervention. Fifty-one patients (94.5%) had a successful treatment outcome without complications, 13 patients (24%) developed minor complications, and 3 patients (5.5%) developed screw loosening requiring hardware removal and reosteosynthesis. The present study has demonstrated that Hunsuck/Epker–type mandibular split osteotomy together with osteosynthesis with placement of 2 bicortical positioning screws without the adjunctive use of a postoperative maxilla-mandibular fixation in the treatment of mandibular dentofacial deformities results in a low rate of major complications with a high rate of success     

Mandibular greenstick fracture healing: A conservative approach

It is common that pediatric maxillofacial fractures develop after a traumatism. The lower calcification of pediatric bones allows them to be flexed in response to external forces, producing greenstick fractures. Many injuries that require surgical management in adults, could be conservatively managed in children due to anatomical, physiological and psychological factors. This is a case report of a six-year-old boy that presented a greenstick fracture of the mandibular body due to a vehicle accident. At clinical examination, it was observed an increase in mandibular left angle volume and intraoral lacerations. Radiographic exams confirmed an incomplete fracture line without displacement next to the permanent mandibular left first molar. The management was conservative: analgesic and anti-inflammatory therapy, soft diet, physical activities restriction and compliance with oral hygiene. The longitudinal follow-up during a year showed a good prognosis in mandible growth and development.     

Mandibular distraction osteogenesis for Pierre Robin sequence: what percentage of neonates need it?

Neonates with Pierre Robin sequence have respiratory distress caused by glossoptosis due to microretrognathia. Numerous therapeutic maneuvers have been used to stabilize the upper airway in these patients. The purpose of this study is to document the frequency with which each of these maneuvers is used, including the newest technique of mandibular distraction osteogenesis, in a single hospital with a large obstetrical service (22,646 deliveries between July 1, 2003, and June 30, 2006).The neonatal intensive care unit records for 3 consecutive years were reviewed retrospectively to identify all neonates with a diagnosis of respiratory distress (40%). Fifteen of these were classified as having Pierre Robin sequence, of whom, 9 did not have other craniofacial anomalies. The neonates with confounding additional congenital anomalies were excluded. The included neonates underwent airway and craniofacial evaluations by experienced pediatric otolaryngologists, craniofacial plastic surgeons and, occasionally, pediatric pulmonologists. Nonsurgical upper airway stabilization was attempted initially for all neonates. Four neonates with isolated Pierre Robin sequence could not be stabilized nonsurgically and underwent mandibular distraction in lieu of tracheotomy. Two of these subsequently required tracheotomy for reasons other than microretrognathia and glossoptosis. The remaining 5 Pierre Robin sequence neonates were stabilized without surgery and discharged home on room air.The treatment of neonatal upper airway obstruction due to Pierre Robin sequence includes both nonsurgical and surgical interventions. Use of a therapeutic algorithm can optimize nonsurgical management and minimize the need for tracheotomy. Mandibular distraction osteogenesis is an effective treatment to avoid tracheotomy in carefully selected Pierre Robin sequence neonates.     

Does clinical experience affect the reproducibility of cervical vertebrae maturation method?

Objective:To assess interobserver and intraobserver reproducibility of the cervical vertebrae maturation method (CVMM) among three panels of judges with different levels of orthodontic experience (OE).Materials and Methods:Fifty individual lateral cephalograms of good quality with complete visualization of cervical vertebrae 1 to 4 were selected. Thirty clinicians, divided according to their OE into three groups (junior group, JU, OE ≤ 1 year; postgraduate group, PG, 2 ≤ OE ≤ 4 years; specialist group, SP, OE ≥ 7 years), evaluated the cephalograms in two sessions (T₁ and T₂) at 3 weeks apart. Kendall''s W and weighted Cohen''s kappa (κ) coefficients were performed to assess interobserver and intraobserver agreement. The level of significance was set as P < .05. For both the interobserver and the intraobserver datasets, the percentage of perfect agreement (PPA) and the number of stages apart for each disagreement were calculated.Results:Kendall''s W at T₁ was SP  =  0.61, PG  =  0.70, and JU  =  0.87; at T₂ it was SP  =  0.78, PG  =  0.85, and JU  =  0.86. The percentage of total interobserver perfect agreement (Inter-PPA) was 42.3% at T₁ and 46.3% at T₂. The JU group had the highest Cohen''s κ coefficient at 0.78, while the PG and SP had coefficients of 0.64 each. The percentage of total intraobserver perfect agreement (Intra-PPA) was 54.2%.Conclusions:The reproducibility of the method was not improved by the level of orthodontic experience. The group with the lowest level of orthodontic experience had the best performance.