Three-dimensional evaluation of the pharyngeal airway using cone-beam computed tomography following bimaxillary orthognathic surgery in skeletal class III patients

Objective

The study aims to evaluate the pharyngeal airway space (PAS) following bimaxillary surgery in skeletal class III patients and to compare the changes in PAS between genders using cone-beam computed tomography (CBCT).

Materials and methods

In all, 38 patients (16 male and 22 female) with skeletal class III malocclusion underwent bimaxillary surgery. CBCT scans were acquired approximately 1 month before surgery, 3 months after surgery, and 6 months after surgery. The oropharyngeal volume and the minimum cross-sectional area (CSA) were characterized using the InVivoDental imaging software package at each time point.

Results

The volume and minimum CSA decreased significantly postoperatively, which was maintained until 6 months postoperatively (p < 0.01). The location of the minimum CSA tended to move into the retropalatal and retroglossal areas postoperatively. A strong correlation between volume and minimum CSA was found. The amount of mandibular setback was not correlated with the change in the airway. By gender, significant decreases in both the volume and minimum CSA were found in females (p < 0.05) but not in males.

Conclusion

Bimaxillary surgery significantly affects PAS. Gender differences should also be considered when considering changes in PAS.

Clinical relevance

An awareness of the effects of bimaxillary setback surgery on the airway should be considered when implementing an orthognathic treatment plan.

     

Mechanical and microstructural properties of fixation systems used in oral and maxillofacial surgery

Objectives

This paper aims to evaluate in vitro the mechanical and microstructural properties of internal fixation systems used in oral and maxillofacial surgeries.

Materials and methods

Four brands of internal fixation systems (screws and 4-hole straight plates) were selected and assigned to four groups: G1 Leibinger®, G2 Tóride®, G3 Engimplan®, and G4 Medartis®. The systems were submitted to Vickers hardness testing, metallographic and interstitial elements chemical composition analyses. Data were submitted to ANOVA and Tukey’s test for statistical analysis.

Results

Plates in groups 1, 2, and 3 showed similar microstructure and mechanical properties, different from those in G4 revealing larger grains. In all groups, the screws showed similar microstructure, with uniform arrangement and size of grains; the screws showed higher hardness values than those observed for the plates.

Conclusions

The results indicate that all materials tested are adequate for use in oral maxillofacial surgeries.

     

Prevalence of the systemic inflammatory response syndrome in patients who underwent orthognathic surgery

Purpose

The systemic inflammatory response syndrome (SIRS) is the body’s response to an insult, such as infection, trauma, burn, and surgical stress linked to several factors deemed potential for multiple organ failure if left untreated. Thus, the aim of this paper was a prospective study to examine the incidence of SIRS in postoperative patients who underwent orthognathic surgery from June/2013 to July/2016.

Methods

The sample consisted of 80 patients who underwent bimaxillary orthognathic surgery, with data on vital signs and white blood cell count collected preoperatively, and the same data collected in the immediate postoperative period, in addition to CO₂ pressure in arterial blood by blood gas analysis. The data were tabulated and cases of SIRS (2 or more signs out of four pre-set signs) were identified within 24 h after surgery.

Results

From the sample of 80 patients, 26 (32.5% of total) patients had SIRS with higher incidence in females who are 40 years old.

Conclusion

The incidence of patients who develop SIRS after orthognathic surgery is relatively high and we should pay attention to the possible complications that these cases can evolve.

     

Postural assessment in class III patients before and after orthognathic surgery

Purpose

This study aimed to assess body posture before and after bimaxillary orthognathic surgery by photogrammetry in skeletal class III patients.

Methods

Thirty-one patients with skeletal class III dentofacial deformities (14 men, 17 women) who underwent orthodontic preparation for surgery were included in this non-randomized controlled trial. Of these, 15 who did not undergo orthognathic surgery during the period of this study served as controls. Postural assessment was performed by photogrammetry using SAPO® (Postural Assessment Software) based on anterior-, posterior-, and lateral-view images taken 1 month before and 4 months after bimaxillary orthognathic surgery with internal rigid fixation (or 4 months after the initial assessment, for the control group). The study was approved by PUCRS Research Ethics Committee, and written informed consent was obtained from all individual participants prior to their inclusion in the study.

Results

There was no significant difference between groups for age, gender, and GAP. In the intervention group, the right leg/hindfoot angle, which initially indicated a valgus deformity, normalized after intervention (P?<?0.048). Posterior displacement of the head (P?<?0.005) and trunk (P?<?0.004) were observed after intervention.

Conclusions

These results suggest that correction of class III dentofacial deformities by bimaxillary orthognathic surgery can produce systemic postural adjustments, especially posterior displacement of the head and trunk and knee and ankle valgus.

     

Assessment of hematologic parameters before and after bimaxillary orthognathic surgery

Purpose

The purpose of the study was to evaluate changes of hematologic parameters in bimaxillary surgery.

Methods

Fifty-three patients were prospectively evaluated and divided into groups based on the surgical procedure and sex (predictor variables). Hemoglobin, red blood cells, hematocrit, and platelet were the primary outcome variables, operation time the secondary outcome, and the patients’ age and weight the other variables. Trial registration: NCT02364765 (U.S. National Institutes of Health, clinicaltrials.gov).

Results

There was statistically significant difference between all hematologic parameters before and after surgery, for both men and women, and for all surgical groups. There was a positive correlation between operative time and the decrease (in %) of the hematologic parameters. Linear regression analysis suggested that the Hb values decrease 0.083 % for every minute increase in the operation time, and 0.066, 0.066, and 0.010 % for RBC, Hct, and platelet count, respectively. There was a negative correlation between weight and all hematologic parameters. Correlations between age and hematologic parameters were not statistically significant. Almost all correlations between age, weight, sex, and the surgery group and the hematologic parameters were considered as very weak. Only one patient was transfused.

Conclusions

It is suggested that operation time and patient’s weight play a bigger role than patient’s age and sex in the decrease of hematologic parameters after bimaxillary surgery.

     

Cementoblastic lineage formation in the cross-talk between stem cells of human exfoliated deciduous teeth and epithelial rests of Malassez cells

Objectives

The purpose of this study was to evaluate the synergistic effect of epithelial rests of Malassez cells (ERM) and transforming growth factor-β₁ (TGF-β₁) on proliferation, cementogenic and osteogenic differentiation of stem cells derived from human exfoliated deciduous teeth (SHED).

Materials and methods

SHED were co-cultured with ERM with/without TGF-β₁. Then, SHED proliferation, morphological appearance, alkaline phosphatase (ALP) activity, mineralization behaviour and gene/protein expression of cemento/osteoblastic phenotype were evaluated.

Results

TGF-β₁ enhanced SHED proliferation when either cultured alone or co-cultured with ERM. ERM induced the cementoblastic differentiation of SHED which was significantly accelerated when treated with TGF-β₁. This activity was demonstrated by high ALP activity, strong mineral deposition and upregulation of cementum/bone-related gene and protein expressions (i.e. ALP, collagen type I, bone sialoprotein, osteocalcin and cementum attachment protein).

Conclusions

ERM were able to induce SHED differentiation along the cemento/osteoblastic lineage that was triggered in the presence of TGF-β₁.

Clinical relevance

The cemento/osteoblastic differentiation capability of SHED possesses a therapeutic potential in endodontic and periodontal tissue engineering.

     

Evaluation of the oropharynx in class I and II skeletal patterns by CBCT

Purpose

This study aimed to evaluate the dimensions of the oropharynx and its shape in the minimum cross-sectional area, in individuals with Class I and Class II skeletal patterns, using three-dimensional CBCT images.

Methods

Forty-two cone-beam computed tomography images of grown individuals were evaluated. The images were divided according to the patient’s skeletal patterns. The dimensions of the oropharyngeal airway space were determined using the Dolphin Imaging software.

Results

The volume and the minimum cross-sectional area were greater in patients with a Class I skeletal pattern, with a median difference of 5379 mm³ and 86.8 mm², respectively. The anteroposterior and lateral diameters in the minimum cross-sectional area were also higher in Class I individuals (2.3 and 6.0 mm, respectively), but the ratio between them was not different.

Conclusions

The volume and the minimum cross-sectional area of the oropharynx, as well as the anteroposterior and lateral diameters, are lower in individuals with a class II skeletal pattern than in individuals with a class I skeletal pattern. There was no difference in the shape of the oropharynx in healthy individuals with different skeletal patterns.

     

In vitro comparison of new bisphosphonic acids and zoledronate effects on human gingival fibroblasts viability,inflammation and matrix turnover

Objectives

Bisphosphonates (BPs) are drugs clinically used in resorptive diseases. It was already proved that some clinically relevant BPs can inhibit a class of enzymes called matrix metalloproteinases (MMPs), required during tissue remodelling. Combining the arylsulfonamide function with the bisphosphonic group, several compounds were synthesized to obtain selective inhibitors of MMPs. The aim of the present study was to compare the effect of zoledronic acid (ZA), the most potent bisphosphonate available as therapy, with new sulfonamide containing BPs in an in vitro model of human gingival fibroblasts (HGFs).

Materials and methods

Western blot was used to measure procollagen I, β1 integrin MMP-8 and MMP-9, phase contrast and MTT for cell viability; L-lactate-dehydrogenase (LDH) measurement was performed for toxicity evaluation and ELISA for prostaglandin E₂ (PGE₂) secretion assessment.

Results

When compared with ZA, the treatment with the newly synthesized compounds shows increasing viability, procollagen I expression and decreased expression of β1 integrin in HGFs. Higher levels of released LDH, PGE₂ and MMP-9 expression are recorded in ZA-treated HGFs. Increased levels of MMP-8 are recorded in newly synthesized compounds-treated samples.

Conclusions

These findings allowed to conclude that new tested BPs did not affect HGFs viability and adhesion, did not induce cellular toxicity, were not responsible for inflammatory event induction and could preserve the physiological matrix turnover.

Clinical Relevance

It could be hypothesized that the new molecules were better tolerated by soft tissues, resulting in lesser side effects.

     

Long-Term Effect of Maxillary Distraction Osteogenesis (DO) on Nasal Index in Adult Patients with Cleft Lip and Palate Deformities

Purpose

To test the hypothesis that there is no immediate and long-term effects of maxillary distraction osteogenesis (DO) on nasal index among adult subjects with cleft lip and palate deformities.

Materials and Methods

Twelve adult subjects in the age range of 17–20 years with complete unilateral cleft lip and palate underwent advancement of maxilla by DO. The immediate and long-term effects of maxillary DO on nasal index were evaluated from extra-oral full face frontal photographs recorded prior to DO (T₀), at the end of active DO (T₁) and at least 2-years after the DO (T₂). The ANOVA, Post Hoc test (Bonferroni) and Pearson correlation coefficients were used. The probability value (P value) 0.05 was considered as statistically significant.

Results

SNM angle and Ptm-M distance increased significantly by DO (P < 0.001). The nasal index increased significantly (P < 0.01) by 13.85 % from T₀ value of 85.15 ± 4.49 to 99.02 ± 11.16 % at the end of active distraction (T₁) and by 12.69 to 97.84 ± 9.14 % at the end of long-term follow-up (T₂). The correlation between sagittal maxillary advancement and nasal index was statistically significant (P < 0.001). For each millimeter of maxillary advancement, the nasal index increased by 1.38 % and 1.8 % at the end of active distraction and long-term follow-up respectively.

Conclusion

The advancement of maxilla by distraction osteogenesis among subjects with cleft lip and palate deformities increased nasal index significantly.

     

IL-17A and IL-17F polymorphisms in rheumatoid arthritis and Sjögren’s syndrome

Objective

The aim of this study was to evaluate the influence of Th17 polymorphisms on the susceptibility or severity of rheumatoid arthritis (RA) and Sjögren’s syndrome (SS).

Materials and methods

The study sample comprised 206 individuals of both genders divided into three groups: exclusive rheumatoid arthritis (RA—100 patients), rheumatoid arthritis and Sjögren’s syndrome (RA/SS—31 patients), and healthy controls (C—75 individuals). All the individuals were submitted to clinical evaluation, unstimulated sialometry, and Schirmer test; some patients with RA were also submitted to minor salivary gland biopsy for definition of SS diagnosis. Saliva samples were collected for isolation of DNA and genotyping of Th17 genes; IL-17A (-197G/A) and IL-17F (7488T/C).

Results

IL-17A (-197G/A) and IL-17F (7488T/C) SNPs were not associated with susceptibility to RA or secondary SS (sSS, p > 0.05 for both SNPs). In addition, they did not influence RA activity or clinical markers of SS.

Conclusion

IL-17A (-197G/A) and IL-17F (7488T/C) polymorphisms are not associated with the susceptibility nor to the severity of RA and sSS in the studied population.

Clinical relevance

A better understanding of the pathogenesis of SS is demanded to an adequate treatment as well as to the development of new management strategies.

     

Recent Advances in Face Lift to Achieve Facial Balance

Introduction

Facial balance is achieved by correction of facial proportions and the facial contour. Ageing affects this balance in addition to other factors. We have strived to inform all the recent advances in providing this balance.

Method

The anatomy of ageing including various changed in clinical features are described. The procedures are explained on the basis of the upper, middle and lower face.

Results

Different face lift, neck lift procedures with innovative techniques are demonstrated.

Conclusion

The aim is to provide an unoperated balanced facial proportion with zero complication.

     

Bone regeneration with recombinant human bone morphogenetic protein 2: a systematic review

Aim

The aim of this work was to perform a systematic literature review on the clinical application of rhBMP-2 in bone reconstruction prior to placing implants.

Materials and Methods

A PUBMED search was made about the subject and nine clinical trials were selected according to strict inclusion criteria.

Results

Overall success rates of bone regeneration with rhBMP-2 was 81.4% and success of implants placed was 87.4%. Most frequent adverse events were pain, edema and erythema.

Conclusion

It was concluded that the treatment with rhBMP-2 foi satisfactory in most cases and the placement of dental implants in the bone regenerated with rhBMP-2 is feasible.

     

Plasma rich in growth factors (PRGF) for the promotion of bone cell proliferation and tissue regeneration

Objectives

Over the past few years, studies about growth factors have been increasingly developed and the knowledge of their role in stimulating cell proliferation and differentiation used for therapeutic purposes. This study aims to compare a platelets concentrate, the plasma rich in growth factors (PRGF) to a control, consisting of cellulose membranes, to evaluate in vitro the cellular adhesion and migration of human osteoblasts (hOb) and understand if the use of platelets concentrates could be an advantage in view of bone tissue regeneration.

Study design

Twenty-seven human donors provided 27 blood samples used to make 54 samples: 27 for PRGF and 27 for the control group. PRGFs and controls were incubated for 48 h in sterility in 1 ml of culture with 10⁵ hOb and hOb in the scaffolds were then quantified.

Results

In PRGF samples, hObs were more numerous than in controls. (T?=?6.6964, p?<?0.0001).

Conclusions

Human osteoblasts are driven to colonize PRGFs with a greater efficacy than negative controls, probably due to the presence of chemokines and growth factors in PRGFs.

     

Facial fractures caused by less-lethal rubber bullet weapons: case series report and literature review

Purpose

The present study aims to describe three cases of patients inflicted by rubber bullets with severe facial fractures.

Methods

In addition, a review of English-language literature involving facial fractures by rubber bullets from 1975 to 2016 was performed.

Results

This current study demonstrated that the use of the LLRBW is unsafety even when applied by police enforcements exclusively.

Conclusions

Management of facial fractures caused by LLRBW is done in a usual manner with closed or open reduction associated with bone mini-plates or reconstruction plates when indicated. Special initial wound care should be done to avoid secondary infection and additional procedures.

     

Pre-arthroplastic mandibular distraction osteogenesis for the correction of OSA in TMJ ankylosis: a prospective observational study of 25 cases

Introduction

In severe TMJ ankylosis cases, the lack of growth of the mandible creates an anatomically narrow airway with a reduced pharyngeal airway space [PAS] which predisposes these patients towards obstructive apnoea [OSA]. There is evidence in the literature that such patients experience severe discomfort during physiotherapy if such airway abnormalities are not corrected prior to ankylosis release. This eventually leads to non-compliance towards physiotherapy and increases the risk of re-ankylosis.

Objective

In our study, pre-arthroplastic mandibular distraction osteogenesis [DO] was used to increase the PAS and resolve the underlying OSA prior to releasing the ankylosis.

Materials and methods

Twenty-five cases of TMJ ankylosis with micrognathia and OSA were included in this prospective observational sleep study. They were further divided into a paediatric group [14 subjects] and an adult group [11 subjects]. All cases presented with a history of onset of ankylosis during childhood [before the completion of craniofacial growth] as result of which there was a lack of forward growth of the mandible. Subjects included in our study underwent initial DO of the mandible followed by a second procedure for distractor removal and ankylosis release. Questionnaires, lateral cephalograms and sleep studies were taken pre-operatively (T0), immediate post-distraction to the desired length (T1) and 12 months post the distractor removal and ankylosis release (T2). The parameters studied were PAS width, apnoea hypopnea index [AHI], O₂ saturation, mouth opening and mandibular advancement.

Results

The paediatric group variables were as follows: mean PAS width which increased from 3.5 mm [T0] to 9 mm [T2], mean AHI which decreased from 48.04 [T0] to 3.60 [T2], mouth opening which increased from 4.5 mm [T0] to 34 mm [T2] and mean O₂ saturation which increased from 89.86% [T1] to 96.88% [T2]. The adult group variables were as follows: mean PAS width which increased from 5 mm [T0] to 11 mm [T2], mean AHI which decreased from 31.45 [T0] to 1.43 [T2], mouth opening which increased from 5 mm [T0] to 34 mm [T2] and mean O₂ saturation which increased from 92.01% [T0] to 96.84% [T2]. Statistical analysis revealed that DO of the mandible significantly improved OSA by increasing the PAS which was evident by the lower AHI score. Mouth opening was also significantly improved post ankylosis release and maintained at the T2 interval. Ten subjects followed up beyond the T2 interval [mean 28 months post ankylosis release] and their data also revealed positive compliance towards physiotherapy, adequate mouth opening and maintenance of normal AHI.

Conclusion

Pre-arthroplastic mandibular DO has proved to be a successful modality for treatment of OSA in TMJ ankylosis patients with stable results at 12 months. By resolving the narrow airway and OSA, compliance towards physiotherapy was improved thus reducing the risk of re-ankylosis in the long term.

     

Comparison of implant versus tooth-supported zirconia-based single crowns in a split-mouth design: a 4-year clinical follow-up study

Objectives

This study aims to evaluate the 4-year clinical performance of tooth versus implant-supported single-unit zirconia crowns (LAVA?) placed on posterior region.

Materials and methods

Twenty-four patients (10 men and 14 women) who had received 48 single crowns (24 implant-supported and 24 tooth-supported) from January 2007 to December 2009, were included. California Dental Association (CDA) quality assessment system, plaque and gingival index scores were used to evaluate the performance of the crowns at baseline and at all follow-up examinations.

Results

During the follow-up period, no fracture of zirconia coping has occurred. Major complication was chipping in three patients that required a new crown fabrication. Except for the failure ones, all crowns in both groups were rated as satisfactory at the follow-up examinations based on the CDA quality assessment criteria. There were no statistically significant differences between tooth and implant-supported crowns in terms of periodontal parameters.

Conclusions

The present 4-year follow-up clinical study demonstrates that single-unit tooth- and implant-supported zirconia crowns have similar prosthetic and periodontal outcomes.

Clinical relevance

Single-unit implant or tooth-supported zirconia crowns may be considered acceptable treatment modalities for restoration of either missing or compromised posterior teeth

     

Reconstruction of orbital floor defects assisted by transantral endoscopy

Purpose

The goal of orbital reconstruction is to restore anatomy, volume, and function. In extensive orbital floor defects, the visualization of the posterior area is limited through inferior eyelid incisions. The use of endoscope may improve the treatment; however, it is a high-sensitivity technique. The aim of this case series is to describe the combination of inferior eyelid incision with transantral endoscopy for treatment of extensive orbital floor defects.

Methods

Three patients were submitted to orbital reconstruction, and the postoperative CT scans were evaluated to analyze the orbital volume and anteroposterior globe position. Surgical treatment was performed using subciliary inferior palpebral approach to explore the orbital floor and placement of the titanium mesh and an intraoral antrostomy for endoscopy to magnification of the surgical field and adaptation of the mesh.

Results

Postoperative CT scan analysis shows that all treatments restored orbital volume and globe position without compression or damage of the optical nerve.

Conclusion

The use of endoscope allowed the precise visualization of the posterior region of the orbit and adaptation of the titanium mesh.

     

An experimental study on the comparison of the effects of triester glycerol oxide on wound repair

Aim

The aim of this study is to assess the effects of triester glycerol oxide (TGO) on cutaneous wound epithelization process.

Material and methods

Fifty-four male Wistar rats were divided into 2 groups of 27 rats each: control(C) and TGO (PX). The groups have been divided into three subgroups which included nine rats each regarding the wound excision on the 3rd, 7th, and 10th days, respectively. The specimens were evaluated according to histological properties and hydroxyproline levels.

Results

Seventh day examination showed that PX and control groups present the same score. HP levels in the control group were significantly lower compared to PX groups.

Conclusion

TGO have positive effects on wound epithelization process by increased collagen synthesis.

     

A Protocol for Management of the Hairs Problem in Oral Cavity Reconstruction by Submental Flap

Background

Submental flap is a useful aid in maxillofacial reconstruction. For intraoral usage the hairs in male patients will create some problems.

Materials and Methods

In a retrospective study, patients in whom submental flap had been used for reconstruction of orofacial region between 2007 and 2013, in the Mashhad University, Ghaem Hospital, were included. The ways in which the problem of hairs was solved in male patients were evaluated.

Results

There were 42 patients in whom submental flap was used for orofacial reconstruction. Sixty percent were males. Three ways had been used for management of intraoral hairs: radiotherapy (9 patients), second surgery (2 patients) and flap de-epithelialization (13 patients).

Conclusion

Deepithelialized variant of submental flap is the best option when submental flap is used for oral cavity reconstruction in male patients. Flap thickness, age, race and postoperative radiotherapy can have strong influence on this strategy.