Plasma protein changes in chronic osteomyelitis of the jaws

In the present study, quantification of different serum proteins known as inflammatory reactans was performed during different stages of chronic osteomyelitis of the jaws, to find a suitable tool for evaluation of treatment. In all 46 sera from 17 osteomyelitis patients and 6 healthy subjects were analyzed. Repeated measurements of alfa-1-antitrypsin, orosomucoid and haptoglobin could be recommended for following-up the effect of treatment, although too extensive conclusions should not be drawn from single measurements. The serum levels of these proteins seemed to co-vary with the clinical activity of the disease. Since the synthesis of the immunoglobulins only indirectly reflects the inflammatory activity, they are not considered to be suitable markers of inflammation, although their concentration in serum varied with the clinical activity. A certain "mass of inflammation" seemed to be necessary before raised values of C-reactive protein were detected. No information was gained from albumin concentration.     

Hard and soft tissue changes after crestal and subcrestal immediate implant placement

Background: The purpose of this study is to assess the influence of the placement level of implants with a laser‐microtextured collar design on the outcomes of crestal bone and soft tissue levels. In addition, we assessed the vertical and horizontal defect fill and identified factors that influenced clinical outcomes of immediate implant placement. Methods: Twenty‐four patients, each with a hopeless tooth (anterior or premolar region), were recruited to receive dental implants. Patients were randomly assigned to have the implant placed at the palatal crest or 1 mm subcrestally. Clinical parameters including the keratinized gingival (KG) width, KG thickness, horizontal defect depth (HDD), facial and interproximal marginal bone levels (MBLs), facial threads exposed, tissue–implant horizontal distance, gingival index (GI), and plaque index (PI) were assessed at baseline and 4 months after surgery. In addition, soft tissue profile measurements including the papilla index, papilla height (PH), and gingival level (GL) were assessed after crown placement at 6 and 12 months post‐surgery. Results: The overall 4‐month implant success rate was 95.8% (one implant failed). A total of 20 of 24 patients completed the study. At baseline, there were no significant differences between crestal and subcrestal groups in all clinical parameters except for the facial MBL (P = 0.035). At 4 months, the subcrestal group had significantly more tissue thickness gain (keratinized tissue) than the crestal group compared to baseline. Other clinical parameters (papilla index, PH, GL, PI, and GI) showed no significant differences between groups at any time. A facial plate thickness ≤1.5 mm and HDD ≥2 mm were strongly correlated with the facial marginal bone loss. A facial plate thickness ≤2 mm and HDD ≥3 were strongly correlated with horizontal dimensional changes. Conclusions: The use of immediate implants was a predictable surgical approach (96% survival rate), and the level of placement did not influence horizontal and vertical bone and soft tissue changes. This study suggests that a thick facial plate, small gaps, and premolar sites were more favorable for successful implant clinical outcomes in immediate implant placement.     

Chronic osteomyelitis of the jaws

The incidence of osteomyelitis has been greatly reduced since the advent of antibiotics. In many 3rd World countries, however, numerous cases of severe advanced osteomyelitis still present annually. A case of subacute osteomyelitis is reported and the pathology and clinical features of chronic osteomyelitis are reviewed.     

Alveolar osteitis and osteomyelitis of the jaws

Postoperative bone healing after oral surgical procedures occurs uneventfully in most cases. However, in certain patients, the normal process of healing can be delayed and, in some cases, often because of multiple coexisting factors, the sites can become infected, with extension of the infection into medullary bone. This process is termed osteomyelitis. This article outlines the pathogenesis, microbiology, and surgical and medical therapies of this condition and specifically addresses osteomyelitis cases related to patients with no documented history of radiation or bisphosphonate exposure and in whom the principal factor in the development of the condition is infection by pyogenic microorganisms.     

Hard and soft tissue predictability with advancement genioplasties

Variability in soft tissue response to genial advancements has been noted in the literature. Although many factors may influence the results, little attention has been paid to bony vertical movement in conjunction with the bony horizontal movement of the chin and its effect on horizontal soft tissue movement. Eighteen patients who underwent isolated genial advancements were studied preoperatively and for at least 6 months after surgery. It was noted that the further the chin was advanced the less the soft tissue followed the advancement. In addition, vertical movement of the chin greatly influenced the overall result. The more the bony chin is shortened, the thicker the soft tissue chin becomes; the reverse is true when it is lengthened. Finally, horizontal resorption/stability appears to be influenced by the amount of dissection rather than the amount of advancement.     

Bionator矫治器矫治Ⅱ类1分类错(牙合)的软硬组织变化

目的：研究Bionator矫治器治疗安氏Ⅱ类1分类下颌后缩骨性错[牙合]的效果。方法：对12例患儿矫治前后软硬组织变化行x线头影测量分析。结果：①Bionator矫治器对上颌骨生长无明显的抑制作用；②使用Bionator矫治器可使下颌体及下颌升支长度明显增长，使下颌生长方向有利于软硬组织侧貌面型的改善；③Bionator矫治器可减少安氏Ⅱ类1分类骨性错[牙合]患者的上前牙唇向倾斜，上下前后牙槽高度均增加。结论：Bionator矫治器对安氏Ⅱ类1分类下颌后缩的骨性错[牙合]有较好的治疗效果。     

Twin-block矫治器治疗安氏Ⅱ类1分类错的软硬组织变化

目的探索安氏Ⅱ类1分类错畸形在应用Twin-block矫治器治疗后软硬组织侧貌的变化。方法将50例处于生长发育高峰前期或高峰期的安氏Ⅱ类1分类错患者分为2组,治疗组（27例）接受Twin-block矫治器治疗,对照组（23例）不进行治疗,随访观察。对2组治疗（观察）前后的X线头影测量数据进行统计学分析。结果软组织指标中治疗组Ls-E、Li-E、U1-Stms、Stms-Stmi、NsLs-FH、LsNsLi、LsNsPg’、H角减小;Sn-Stms、Stmi-Me’、Ns-Me’、Sn-Me’、NsLi-FH、NsPg’-FH、A’Ls-FH、B’Li-FH、LiB’Pg’、CmSnLs、GSnPg’、Z角增大,与对照组比较有统计学差异（P<0.05）。硬组织指标中治疗组SNB、L1-NB、IMPA增大;ANB、U1-SN、U1-NA、FMIA减小,与对照组比较有统计学差异（P<0.05）。结论Twin-block矫治器可显著改善下颌后缩患者上下颌骨的矢状关系,促进面下1/3高度的生长,使软组织侧貌趋于直面型。     

Radiological and histological study of osteomyelitis of the jaws

Fifty-six patients with maxillary and mandibular osteomyelitis were investigated radiologically and histopathologically. The radiographic changes were classified into 5 patterns: osteolytic, mixed, sclerosing, sequestrum and irregular trabeculation patterns. Osteomyelitis was classified into 3 histological types, based on the amount of bony trabeculae present. Type I bone consisted of severely sclerotic bone, type II bone had coarse trabeculae with fibrotic marrow spaces. In contrast, type III bone had thin trabeculae with occasional osteoblastemata. The correlations between the radiographic and histological patterns and differences between acute and chronic cases were examined. Acute cases were often of the osteolytic or sequestrum patterns, and had type I or II bone. Type II bone was the most common, and was found in all radiographic types. Type III bone was frequently seen in cases with an osteolytic or mixed radiographic pattern. It seemed that severely sclerotic bone with narrowed or occluded Haversian canals (type I bone) tended to develop following acute infection. A possible explanation of the relationship of 5 radiographic types is also discussed.     

Hard and soft tissue changes and long-term stability after vertical height reduction genioplasty using biodegradable fixation

The aim of this work was to analyse the stability of vertical height reduction genioplasty using biodegradable material, as well as to determine vertical changes of hard and soft tissues during this procedure.Forty patients underwent vertical height reduction genioplasty using two types of biodegradable fixation (Biosorb FX^® or OSTEOTRANS-MX^®), combined with mandibular setback surgery. We assessed lateral cephalographs over time (pre-operation; immediately post-operation; 3 months, 6 months and 12 months post-operation).We found a mean vertical difference of 0.22 mm (standard deviation (SD) = 0.49 mm) at the menton point immediately post-operation, compared with 12 months post-operation. And there was no statistical significance(P > 0.05). The chin hard tissue remained stable from the immediate post-operation period to 1 year post-operation, and the chin soft tissue remained stable from 3 months to 1 year post-operation. The regression equation describing the replacement of hard tissue with soft tissue change, between pre-operation and 12 months post-operation is y = 0.590x + 0.885 (R² = 0.300, P < 0.001).We confirm that the use of biodegradable fixation is a stable method, in terms of skeletal tissues, and a relatively stable method, in terms of soft tissues. In vertical height reduction genioplasty, soft tissue does not reflect 100% of the vertical tissue reduction in hard tissues. This data may influence establishment of surgical treatment objectives.     

Hard and soft tissue considerations at mini-implant insertion sites

Abstract

Various factors influence where orthodontic mini-implants will be placed. This article highlights the pertinent variables that should find consideration when planning the placement of orthodontic mini-implants.     

Infectious foci in chronic osteomyelitis of the jaws

Chronic osteomyelitis of the jaws has a varied clinical appearance and an unclear etiology. In a retrospective study based on case histories and histological material from 24 patients with chronic osteomyelitis, no specific correlation could be found between clinical symptoms and morphological changes in bone. In 10 patients, bacteria were found in certain foci such as osteocytic lacunae of necrotic bone and dentinal tubules of embedded tooth fragments. In these foci, the bacteria probably escaped the immunological response as well as the antibiotic treatment. From these foci, the bacteria might maintain an inflammatory reaction in the surrounding bone. In some patients, the mandibular canal seemed to be a pathway for the spreading of the inflammatory process.