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1.
Sridhar Reddy Kanubaddy Sathya Kumar Devireddy Kishore Kumar Rayadurgam Rajsekhar Gali Mallikarjun Rao Dasari Sivaganesh Pampana 《Journal of maxillofacial and oral surgery》2016,15(4):535-541
Purpose
This prospective study was conducted to evaluate the efficacy of stainless steel single linear miniplate with rectangular grid plate in the treatment of mandibular angle fractures.Methods
This study included 30 patients who were allocated randomly into two groups of each. Group 1 patients were treated with single 2 mm × 4 hole linear stainless steel miniplate and group 2 patients with 2 mm × 4 hole rectangular grid plate. Patients were evaluated for fracture stability, occlusion, mouth opening, and complications at 1st week, 1 and 3 months post operatively.Results
There were no significant differences between the two groups with respective variables statistically. In group 1 20 % (n = 3) had mild occlussal derangement 6.66 % (n = 1) patient had deranged occlusion at 1 week post operatively and 13.3 % (n = 2) had mild derangement at 1 month post operatively. In group 2 6.66 % (n = 1) had mild derangement at 1 week postoperatively. 20 % (n = 3) had limited mouth opening at 1 week in group 1 and 13.3 % (n = 2) in group 2. All patients in both groups achieved adequate mouth opening by the end of 3 month. None of the patients in both groups had plate fracture, screw loosening, non union or mal-union.Conclusion
Within the limits of the study, use of rectangular grid plates for fixation of mandibular angle fractures was reliable with low complication rates, easy adaptation and an effective alternative to conventional miniplates. Further clinical studies with larger sample size can derive a more comprehensive conclusion.2.
Juliana de Souza Vieira Felipe Rychuv Santos Jessica Vavassori de Freitas Flares Baratto-Filho Carla Castiglia Gonzaga Melissa Rodrigues de Araujo 《Oral and maxillofacial surgery》2016,20(2):157-160
Introduction
Bone graft is a very common procedure that is performed when bone volume needs to be increased before a dental implant. Screws and miniplates are the clinical standards for osteosynthesis. However, some disadvantages for this method have been reported, including artifacts on radiological images, infection, screw loosening, and the need to remove screws that interfere with the dental implants. Bone adhesives are a promising alternative for bone graft surgery.Purpose
The aim of this study was to compare the shear bond strength of two cyanoacrylate-based adhesives and titanium screws for bone graft fixation.Methods
Pig jaw samples were cut into rectangular bars (2 × 6 × 20 mm) and bonded with a 5-mm overlap of N-butyl cyanoacrylate and ethyl cyanoacrylate, and 1.5-mm titanium screws were inserted into the center of the contact area. The blocks were fixed on a shear bond strength device that was coupled to a universal testing machine. The maximum force (N) was recorded on a computer and divided by the bonded area (in mm2) in order to calculate the bond strength (MPa). The data were statistically analyzed with ANOVA and Tukey’s test (α = 0.05).Results
The shear bond strengths of the screws were significantly higher than both cyanoacrylate adhesives, which presented statistically similar bond strength means, and have the biomechanical potential to be used for bone fixation.Conclusions
Ethyl cyanoacrylate is an inexpensive adhesive that has multiple purposes and can be considered as an alternative for bone fixation.3.
Yashmeet Kaur Sandhu Sarfaraz Padda Tejinder Kaur Amit Dhawan Sarika Kapila Jasmine Kaur 《Journal of maxillofacial and oral surgery》2018,17(2):211-217
Introduction
Maxillomandibular fixation is required in nearly all cases of facial fractures which can be achieved by conventional dental wiring techniques or newer methods using transalveolar screws.Material and Methods
A prospective randomized clinical study divided into two groups with thirty adult patients each with mandibular fractures was undertaken comparing the Maxillomandibular fixation technique using transalveolar screws and Erichs arch bar. Total time taken, rate of glove perforation, intraoperative and postoperative complications were noted in both the groups.Results
The time taken for maxillomandibular fixation in minutes and rate of glove perforation was found to be statistically significantly less for transalveolar group compared to arch bar group (p < 0.05). However, there was no significant difference found in the oral hygiene and gingival status using the Glass index and Gingival index. The rate of screw breakage (04.67%), wire breakage (05.12%), non-vitality due to iatrogenic dental damage (01.66%), soft tissue injury and tooth loss were some of the noted complications during the study.Conclusion
We found that transalveolar group offered advantages like less time taken with a definite decreased risk of percutaneous injury, while the iatrogenic complications like dental damage can be reduced by taking adequate precautions.4.
Rubens Camino Junior Rogério Bonfante Moraes Constantin Landes João Gualberto C. Luz 《Oral and maxillofacial surgery》2017,21(3):327-334
Purpose
A comparative study of the use of the 2.0-mm locking fixation system with conventional systems in the treatment of mandibular fractures was performed.Methods
For this study, 87 consecutive patients with 112 mandibular fractures were randomized to receive either 2.0-mm locking plates (n = 45) or conventional 2.0- or 2.4-mm plates (n = 42) and had a minimum follow-up of 6 months. Fractures were classified based on the degree of displacement and complexity. Statistical analyses were used to verify possible differences between the groups when separately compared unfavourable and favourable cases (p ≤ 0.050).Results
Despite randomization, systemic diseases were more frequent in the 2.0-mm locking group in favourable cases. Substance abuse occurred predominantly in the 2.0-mm locking group, in unfavourable and favourable fractures. There were more cases of complex fractures in the conventional group in unfavourable cases. One case involving a major postoperative complication occurred in the locking group (2.2%) and three cases occurred in the conventional group (7.1%) but with no significant difference between groups. In this study, there were no major differences between conventional and locking 2.0-mm locking systems with regard to the outcome of treated mandibular fractures, showing that both are adequate as long as the criteria of their indication and requirements for installation are met.Conclusions
It was concluded that the 2.0-mm locking fixation system can replace conventional systems in the treatment of mandibular fractures; in addition, this approach was effective in the treatment of unfavourable fractures that typically require the 2.4-mm conventional system.5.
Fadekemi Olufunmilayo Oginni Taoreed Oladejo Dayo Paul Alake Jolaiya Olufunke Oguntoba Olawande Funmilola Adebayo 《Journal of maxillofacial and oral surgery》2016,15(2):184-190
Aims
Traumatic injuries remain a major cause of morbidity, mortality and economic loss worldwide. An audit of maxillofacial injuries presenting and managed at any facility is key to understanding the trends, strategies for prevention and improving outcome of care. We sought to study the pattern and treatment of facial bone fractures managed at the Department of Maxillofacial Surgery, Obafemi Awolowo University Teaching Hospital, Ile-Ife, between 2005 and 2013. Also, to compare these with the pattern in the preceding 29 years.Methods
Data on patients’ socio-demographics, dates of injury and presentation, interval before presentation, agent of injury, type of crash, patient’s status, type(s) of fracture, extent of injury, treatment offered and outcome were collected and analyzed.Results
311 patients aged 5–72 years were reviewed. A male preponderance was observed. Peak age incidence was 21–30 years and 86.1 % of injuries resulted from road traffic crashes (RTC) most (67.5 %) of which were motorcycle related injuries. 215 patients sustained mandibular fractures in 311 sites while 141 patients sustained 225 midface fractures. Of the 242 patients managed definitively, only 11.2 % had open reduction and internal fixation.Conclusion
Motorcycle related RTC remains the major cause of facial bone fractures. Management with osteosynthesis is gradually emerging, although demonstrating fewer complications, it is unaffordable for a majority.6.
Yogesh Mittal K. George Varghese S. Mohan N. Jayakumar Somil Chhag 《Journal of maxillofacial and oral surgery》2016,15(1):93-98
Introduction
Three dimensional titanium plating system was developed by Farmand in 1995 to meet the requirements of semi rigid fixation with lesser complication. The purpose of this in vivo prospective study was to evaluate and compare the clinical effectiveness of three dimensional and two dimensional Titanium miniplates for open reduction and fixation of mandibular parasymphysis fracture.Materials and Methods
Thirty patients with non-comminuted mandibular parasymphysis fractures were divided randomly into two equal groups and were treated with 2 mm 3D and 2D miniplate system respectively. All patients were systematically monitored at 1st, 2nd, 3rd, 6th week, 3rd and 6th month postoperatively. The outcome parameters recorded were severity of pain, infection, mobility, occlusion derangement, paresthesia and implant failure. The data so collected was analyzed using independent t test and Chi square test (α = .05).Results
The results showed that one patient in each group had post-operative infection, occlusion derangement and mobility (p > .05). In Group A, one patient had paresthesia while in Group B, two patients had paresthesia (p > .05). None of the patients in both the groups had implant failure. There was no statistically significant difference between 3D and 2D miniplate system in all the recorded parameters at all the follow-ups (p > .05).Conclusion
3D miniplates were found to be better than 2D miniplates in terms of cost, ease of surgery and operative time. However, 3D miniplates were unfavorable for cases where fracture line was oblique and in close proximity to mental foramen, where they were difficult to adapt and more chances for tooth-root damage and inadvertent injury to the mental nerve due to traction.7.
Mrinal Satpathy M. K. Gupta Ajay Kumar Pillai Sunderraman Prabhu Saba Tiwari Neha Jain 《Journal of maxillofacial and oral surgery》2016,15(1):25-31
Purpose
To ascertain the pattern, incidence, causes, age and sex distribution, types, condition and treatment of maxillofacial fractures and their interwoven relationship being practiced in Bhopal.Materials and Methods
Retrospectively 3 year records of patients with maxillofacial fractures from 12 selected centres in Bhopal were reviewed. The following data were extracted from the medical records: age; gender; site of the fracture(s); other associated injury(ies); cause of the trauma and method of treatment(s).Result
In 1268 patients, a total of 2613 fractures were found of which 44.58 % patients had mandibular fractures. Parasymphysis was the most common site of fracture overall. Most patients were in the 21–30 year old age group, and the male: female ratio was 3.3:1. Road traffic accident accounted for 858 cases (67.67 %). Head injury was the highest occurring associated injury. Open surgical modalities was the most employed treatment modality in 52.60 % of cases.Conclusion
Preference for open surgical treatment along with increasing trend of supplemental intermaxillary fixation was found, which prompts us to check for the underlying reason behind this, which could be the increasing number of displaced and comminuted fracture cases or the decreasing efficiency of open reduction treatment rendered. Latter reason prompts to re-evaluate the existing surgical techniques and expertise of the practicing surgeons.8.
Sakshi Aggarwal Manpreet Singh Palash Modi Esha Walia Rachit Aggarwal 《Oral and maxillofacial surgery》2017,21(4):383-390
Introduction
This study was performed to evaluate the efficacy and post-operative complication of 3-dimensional (3D) titanium miniplate and locking plate in mandibular fractures (parasymphysis, symphysis, body, and angle).Materials and methods
Forty patients, with non-comminuted mandibular fractures treated with open reduction and internal fixation using 3D titanium miniplate system or locking plate system through an intra-oral approach, were included in this study. All patients were systematically monitored up to 2 months post-operatively. Parameters recorded were infection, occlusal discrepancies, hardware failure, wound dehiscence, sensory disturbance of the inferior alveolar nerve, and stability of fractured segments.Results
Forty patients with mandibular fracture were divided into two groups randomly without any bias. The fractures of all 40 patients were found to be adequately fixed when checked intra-operatively after fixation. One patient (2.5%) of the 3D plate group developed an infection on the first and second post-operative visit and was treated by antibiotic coverage. One patient in the locking plate group (2.5%) reported wound dehiscence after the first week follow-up.Conclusion
Both 3D titanium miniplates and locking plate are effective in the treatment of mandibular fractures, and overall complication rates are lesser. However, the 3D plating system uses less hardware in cases of parasymphysis and symphysis fractures and more hardware in cases of body and angle fractures.9.
Objective
The aim of this study was to assess the results of open reduction and internal fixation (OR/IF) of isolated mandibular fracture under regional anesthesia using mandibular nerve block.Patients and methods
This prospective study was carried out on 44 patients who had isolated traumatic parasymphyseal mandibular fractures. All patients were managed by OR/IF by two titanium miniplates using manual maxillomandibular fixation (MMF). All patients were sedated by (0.05 mg/kg) midazolam and (2 μg/kg) fentanyl. The patients were randomly classified into two groups: the control group (22 patients) treated under general anesthesia (GA) and the study group (22 patients) repaired under regional anesthesia. The results were assessed as regards dental occlusion, average intrinsic vertical mouth opening, actual operative time, complication, tolerance and patient’s satisfaction, and postoperative hospital stay time.Results
Both groups were matched for age and sex. There were no statistically significant differences of the postoperative complication, dental occlusion, and mouth opening between both groups. Duration for anesthesia induction, intubation, and anesthesia recovery was not needed in regional anesthesia. Regional anesthesia was tolerable and highly satisfactory in all patients with no intraoperative or postoperative anesthesia-related problems and no reported complications.Conclusion
Regional anesthesia can effectively replace GA in selected cases of mandibular fracture obviating the risks of GA.10.
Ritesh Rajan Dinesh Kumar Verma R. M. Borle Abhilasha Yadav 《Oral and maxillofacial surgery》2016,20(2):191-194
Purpose
The purpose of the present study was to find, if there exists, a co-relation between presence of unerupted mandibular third molar and fracture of mandibular condyle.Methods
A retrospective, multicenter study was done collecting the data of all mandibular condyle fractures treated from November 2006 till August 2015. Data was collected from the patient’s records and radiographs for the following information: age, sex, etiology of fracture, presence and state of lower third molars, and associated fracture. The results were subjected to statistical analysis.Results
Out of 180 patients of condylar fracture, unerupted third molars were present in 35 (19.44 %) cases compared to 145 (80.55 %) cases of condylar fracture where the unerupted third molars were not present. The difference was statistically significant (p < 0.05). In the unerupted third molar present group, isolated bilateral condylar fracture was seen in 4 (11.4 %) cases, bilateral condylar fracture associated with other mandibular fractures in 9 (25.7 %) cases, isolated unilateral condylar fracture in 0 (0.0 %) cases, and unilateral condylar fracture associated with other mandibular fractures in 17 (48.5 %) cases and condylar fracture associated with mid face fractures in 5 (14.2 %) cases. In the unerupted third molar absent group, isolated bilateral condylar fracture was seen in 5 (3.4 %) cases, bilateral condylar fracture associated with other mandibular fractures in 30 (20.6 %) cases, isolated unilateral condylar fracture in 24 (16.5 %) cases, unilateral condylar fracture associated with other mandibular fractures in 73 (50.34 %) cases, and condylar fracture associated with mid face fractures in 13(8.96 %) cases. The difference between the groups was statistically significant (p = 0.032).Conclusion
This study suggests that the fractures of mandibular condylar region have a significantly higher incidence in patients without an unerupted mandibular third molar.11.
Purpose
The purpose of this study was to compare the efficacy of single versus two non-compression miniplates in the management of unfavourable angle fracture of mandible.Materials and methods
A total of 28 patients who required open reduction of mandibular angle fracture were included in the study. The patients were randomly divided into two groups. Group I comprised of patients treated with two miniplates and those in group II were treated with single non-compression miniplate. The parameters of assessment were malocclusion, surgical site infection, need for implant removal, duration of surgery, inter-incisal mouth opening and cost of implants used, in both the groups. Statistical analysis was carried out to compare all the parameters.Results
Out of 14 patients in group II, inadequate reduction was noticed in three patients, whereas screw loosening had occurred in two cases. Screw loosening was always associated with chronic infection. In these cases, hardware removal was deemed necessary. Plate bending was observed in two cases resulting in malocclusion and difficulty in eating. Non-union of fracture occurred in one patient treated in group II. In group I, no plate bending, screw loosening, surgical site infection, non-union or malocclusion was observed. No patient had to undergo implant removal in group I.Conclusion
In the management of unfavourable mandibular angle fracture, two miniplates must be preferred over the use of single miniplate as using two miniplates results in better results with minimal complications.12.
Aim
Aim of the study is to compare the primary and secondary healing after surgical removal of impacted mandibular third molars, in terms of swelling, severity of pain, trismus, and periodontal healing between two types of closure.Materials and methods
A total of 60 patients, divided into two groups randomly: group A, with 30 patients in which primary closure was done; group B, with 30 patients in which secondary closure was done. A comparison between two groups was done in terms of postoperative pain, swelling, trismus at first, third, and seventh postoperative days, and periodontal healing near adjacent second molar after 6 months.Results
The swelling and pain in group A were greater than that in group B, with a statistically significant difference (p <?0.05). Mouth opening is greater in group B compared to group A. There is no significant difference in periodontal healing in between two groups after 6 months. Complication like alveolar osteitis was noted in 1 patient (3.3%) in group B.Conclusion
We conclude that secondary closure was better than primary closure in terms of postoperative pain, swelling, and trismus. Irrespective of any closure technique, there is no difference in terms of periodontal healing.13.
Introduction
The purpose/aim of the study conducted was to compare the efficiency between two principles of plating system, 3D non locking mini plates versus 3D locking mini plates.Materials and Methods
A total of 20 adult patients were selected according to the inclusion criteria and divided into two groups of locking plates/screws and non-locking plates/screws of ten each. All patients were treated with 2.0 mm 3D locking and non locking mini plates and screw system. Comparison of ease of use, functional stability, operator’s comfort were tabulated.Results
A total of 27 fractures in 20 patients were treated. Each group contained ten patients. Fracture reduction was good in all the cases. At the follow up of 3 months, all fractures had healed, only one patient had a occlusal discrepancy.Conclusion
There was no difference in the stability in both the groups. Intra operatively locking group consumed more time in fixation as it demands precision in making a hole exactly in the centre of plate necessitating the use of drill guide. Clinical and radiographic healing was good in both the groups.14.
Auday M. AL-Anee Ahmed Fadhel Al-Quisi Hassanien A. Al-jumaily 《Oral and maxillofacial surgery》2018,22(3):303-307
Purpose
Is to compare the patterns, severity, and management of the high- and low-velocity mandibular war injuries managed at Al Shaheed Gazi Al-Hariri Hospital in Baghdad Medical City, Iraq, during a 2-year period.Methods
Forty-one patients with a history of mandibular war injuries treated by our maxillofacial team were reviewed during a period of 2 years (2015–2017). All patients were treated in the Maxillofacial Unit of the Hospital of Specialized Surgeries in Baghdad Medical City.Results
A 2-year retrospective study evaluated 41 patients with mandibular war injuries with a total of 94 fractures (comminution represents 79.06% of the bullet injuries, while it is only 62.74% with IED injuries). Management of these injuries was varied according to the severity of the injuries and resources available. Close reduction was used in 72.72% of the linear fracture cases, whereas open technique was used in 56.6% of the comminuted fractures.Conclusions
Bullet injuries were associated with a higher number of mandibular comminuted fractures, in addition to more extensive bone loss. While shell injuries of IED (improvised explosive devices), on the other hand, were associated with higher infection rate and more postoperative complication.15.
Satoshi Wanifuchi Masaya Akashi Yasuo Ejima Hirotaka Shinomiya Tsutomu Minamikawa Shungo Furudoi Naoki Otsuki Ryohei Sasaki Ken-ichi Nibu Takahide Komori 《Oral and maxillofacial surgery》2016,20(4):337-342
Purpose
This retrospective study aimed to analyze the relationship between tooth extraction and osteoradionecrosis (ORN) occurrence. The irradiation field, dose, and time interval between radiotherapy (RT) and ORN were reviewed. We also discuss appropriate guidelines for prophylactic tooth extraction.Methods
A total of 33 patients treated for grade ≥2 (clinical) ORN in our department from 2002 to 2014 were enrolled. The following epidemiological data were retrospectively gathered: age, sex, histological diagnosis, primary tumor sites, radiation dose, chemotherapy, site of ORN, relationship between tooth extraction and ORN occurrence, and time interval between tooth extraction and the initiation or end of RT.Results
Twenty-one percent of ORN cases resulted from tooth extraction. The most common site of ORN (82 %) was the mandibular molar region. About half of ORN cases (49 %) occurred within 2 years after RT. All patients who received tooth extraction after RT developed ORN (100 %) independently of time interval between tooth extraction and the end of RT (median interval, 37.5 months; range, 27–120 months). In contrast, only 50 % of patients who received tooth extraction before RT developed ORN. There may have been an association between the irradiation field and the site of ORN developmentConclusions
ORN occurrence due to tooth extraction was 21 %. Occurrence timing of ORN did not depend on time interval between tooth extraction and the end of RT. The irradiation field is certainly related to the site of ORN; therefore, prophylactic tooth extraction should be performed in consideration of the proposed radiation field and dose.16.
Aims of this Study
(1) To highlight the role of intraoral submerged device in distraction osteogenesis (DO) of patients requiring two jaw surgeries for the correction of severe developmental maxillary hypoplasia (MH) and mandibular prognathism (MP) (2) To analyse the hard and soft tissue changes following maxillary DO and mandibular setback with bilateral sagittal split osteotomy (BSSO) in patients with severe MH and MP requiring two jaw surgeries.Materials and Methods
During the period Jan 2004 to Dec 2006, five patients with severe developmental MH along with MP were treated. In 1st stage maxillary distraction was done. Distraction started on 6th postoperative day, 1 mm distraction was carried out for 10–15 days on either side. Serial radiographs were taken immediate postoperative period for baseline comparison, post-distraction and at the end of distraction. After a period of 3–4 months of distraction 2nd stage was done. In 2nd stage, mandibular setback was done with BSSO and distractors were removed under general anesthesia. Radiographs were taken immediately and at 4 months post-operatively. Cephalometric tracings were carried out preoperatively, post DO and finally after mandibular setback with BSSO.Results
The mean horizontal movement of maxilla was 11.4 mm at ANS and 9.6 mm at A point. Upper incisor edge was advanced by 8.8 mms. SNA increased by 8.4° and SNB decreased by 4.6°. Nasal projection advanced by 4°. Nasolabial angle normalized in all patients, mean change achieved was 10.8°. Upper lip moved forward by 5.4 mm. Lower lip moved backward by 5.4 mm. Mandible positioned backward by 4 mm at B point. No vertical change occurred in the position of A, ANS and upper incisor edges. Mean increase in skeletal angle of convexity was 26.4°. Concave profile was significantly changed to convex in all patients.Conclusion
Maxillary DO and mandibular setback with BSSO was associated with improved facial balance and esthetics.17.
18.
Ruben Muñoz Golaszewski Gajos Jose Bladimir Diaz Carvajal Alvaro Luis Grace Del Valle Speranza 《Oral and maxillofacial surgery》2018,22(1):39-44
Introduction
This study describes a modified protocol using transmandibular zygomatic implants with immediate occlusal loading for the comprehensive dental rehabilitation of previously reconstructed mandibular defects and reports preliminary results of this modified protocol.Materials and methods
Fifteen patients (6 female and 9 male), with a mean of age 40.26 years (range 12 to 68 years), had previously undergone immediate mandibular reconstruction using either autologous bone grafting, bone transport, or microvascular free-flap reconstruction for a variety of diagnoses. Transmandibular zygomatic implants were subsequently placed, depending on the type of defect. Implant stability was evaluated by insertion torque, percussion testing, and the implant stability quotient (ISQ). The patients were rehabilitated with an immediate provisional prosthesis. All patients’ records included pre and postoperative clinical examination, radiographs, CT scan, and photographic analysis. All patients were followed for a minimum of 36 months.Results
All patients were dentally rehabilitated immediately with functional and esthetic hybrid dentures based on either acrylic or porcelain on a metal framework. Among all cases of transmandibular zygomatic implants, the ISQ was greater than 75, which allowed immediate prosthetic loading. The zygomatic implants were considered to be successful if they were asymptomatic with no clinical mobility and no sign of infection. We have also added new indications for placement of transmandibular implants in cases of sequelae of gunshot trauma, dentoalveolar defects, and complications of orthognathic surgery, partially edentulous and/or failure of prior mandibular reconstruction.Conclusions
The zygomatic implant is an excellent immediate loading option for mandibular dental rehabilitation among patients with mandibular defects. According to our observation, immediate occlusal loading of transmandibular zygomatic implants has a very good potential for success.19.
Objectives
The aim of this study was to examine different central bearing point methods in patients with and without temporomandibular disorders (TMD) by an experienced and unexperienced examiner.Material and methods
The 20 fully dentulous subjects were screened for TMD based on the Research Diagnostic Criteria for TMD and distinguished into functional impaired and functional healthy groups. The mandibular relationship was recorded by an electronic central bearing tracing device (IPR-System, IPR GmbH, Oldenburg, Germany) with an integrated pressure sensor. Three bite registration methods were performed using this device: initial neuromuscular position, final neuromuscular position after dynamic sequences with the intraoral pin (=neuromuscular deprogramming), and centric relation guided manually by an experienced and an unexperienced examiner.Results
The neuromuscular positions before and after neuromuscular deprogramming were not significantly different (paired t test as a group comparison test: transverse: p = 0.369; sagittal: p = 0.486). Both positions were significantly anterior in comparison to the manually guided centric relation (paired t test as a group comparison test: p < 0.0001). The neuromuscular positions before and after deprogramming tend to have high scattering values.Conclusion
By means of the central bearing point method, the manually guided centric relation is the one which is sufficiently reproducible. It seems doubtful to take the significant anterior neuromuscular position for a definite reconstruction.Clinical relevance
Using the central bearing point method, the manually guided centric relation should be preferred, whereas the neuromuscular position should not be used for definite reconstructions.20.