Erratum to: Nasal Profile Changes Following Anterior Maxillary Segmental Osteotomy: A Lateral Cephalometric Study

Purpose

Orthognathic surgery in reference to the maxilla attempts to correct underlying skeletal deformities and improve function. Consequently, it has the potential to significantly alter the central esthetic unit of the face, the nasolabial region. In order to evaluate the nasal morphological changes which would result following anterior maxillary segmental osteotomy (superior and posterior repositioning), four angles, namely nasolabial, nasal tip projection, columellar labial and supra tip break angle, were evaluated.

Method and Materials

In ten selected subjects who have undergone anterior maxillary segmental osteotomy with superior and posterior repositioning, preoperative (T1) and postoperative (T2) lateral cephalometric parameters pertaining to the four angles were analyzed using Wilcoxon’s signed-rank test.

Results

A significant increase in nasolabial angle and mild changes in nasal tip projection, columellar labial angle and supratip break angle were observed.

Conclusion

The results of this study emphasize the need for the presurgical evaluation of nasal morphology in every individual planned for anterior maxillary segmental osteotomy.

     

Surgical defect coverage in oral submucous fibrosis patients with single-stage extended nasolabial flap

Purpose

Long standing oral submucous fibrosis (OSMF) is associated with involvement of the oral submucosa and the muscles of mastication leading to difficulty in mouth opening. Various surgical modalities are mentioned for release but each has its own limitations. The aim of the study was to evaluate the postoperative mouth opening in patients of OSMF after excision of fibrous bands followed by coronoidotomy and surgical defect coverage by extended nasolabial flap.

Methods

We evaluated the use of extended nasolabial flaps and coronoidectomy in the management of 11 randomly selected patients with histologically confirmed oral submucous fibrosis. They all had interincisal opening of less than 25 mm and were treated by bilateral release of fibrous bands, coronoidectomy or coronoidotomy, and extended grafting with a nasolabial flap.

Result

Their interincisal opening improved significantly from a mean of 8.68±7 mm to a mean of 36.75±4.05 mm at 6-month follow-up.

Conclusion

The procedure was effective in the management of patients with oral submucous fibrosis, the main disadvantage being the extraoral scars.

     

Effect of Alveolar Segmental Sandwich Osteotomy on Alveolar Height: A Preliminary Study

Purpose

Bone loss following extraction is maximum in horizontal dimension. Height is also reduced which is pronounced on the buccal aspect. Various surgical procedures are available to correct the bone volume viz. GBR, onlay bone grafting, alveolar distraction and sandwich osteotomy. Sandwich osteotomy has been found to increase the vertical alveolar bone height successfully.

Objectives

The objective of the study was to assess the effect of alveolar segmental sandwich osteotomy on alveolar height and crestal width.

Materials and Methodology

A prospective study was undertaken from December 2012 to August 2014. Seven patients with 12 implant sites with a mean age of 36 years were recruited. All seven patients with 12 implant sites underwent alveolar segmental sandwich osteotomy and interpositional bone grafting. Alveolar bone height was assessed radiographically preoperatively, immediate post-op, and at 3 months post-op. Alveolar bone width was assessed radiographically preoperatively and at 3 months post-op. Statistical significance was inferred at p < 0.05.

Results

The mean vertical augmentation at immediate post-op was 6.58 mm (p = 0.001). The vertical augmentation that was achieved 3 months post-op was a mean of 3.75 mm which was statistically significant (p = 0.004). The change in alveolar height from immediate post-op to 3 month post-op was a mean 1.69 mm. The mean change in alveolar crestal width at 3 months was a mean of ?0.29 mm (p = 0.57).

Conclusion

Sandwich osteotomy can be used as an alternative technique to increase alveolar bone height prior to implant placement. Moderate alveolar deficiency can be predictably corrected by this technique.

     

Assessment of Alar Flare and Efficacy of Alar Cinch Suture in the Management of Alar Flare Following Le Fort 1 Superior Repositioning: A Comparative Study

Objectives

To prospectively analyze the amount of alar flare, factors contributing to alar flare and efficacy of cinch suture as an adjunctive procedure for alar flare reduction.

Study Design

Thirty adult patients with vertical maxillary excess, who underwent Le Fort 1 impaction, were divided into 2 groups of 15 each. Alar cinch was performed as an adjunct procedure in group 2 patients and results were compared to group 1 which was the control group. Measurements were made on the patients and on 1:1 standardized photographs.

Results

Group 2 showed a near pre-operative alar position compared to group 1. The alar flare resulting from every millimeter of impaction was significantly less in group 2 compared to group 1.

Conclusion

Alar cinch suture restores the normal alar width by preventing the lateral drift of the naso-labial muscle and thereby reducing the postoperative nasal flare significantly.

     

Complications of Midface Swing for Management of Juvenile Nasopharyngeal Angiofibroma

Introduction

Access osteotomies provide direct exposure to inaccessible areas of the deep part of craniofacial skeleton for treating pathologies involving vital structures. The use of maxillary swing approach for gaining wide access to the nasopharynx, infratemporal fossa, parapharyngeal space, middle fossa of skull base. Though the maxillary swing requires transfacial incision for wide exposure but with careful handling the scar is minimum and this approach can be used in young people.

Materials and Methods

Surgical resection is carried out following preoperative embolization of the involved feeder vessels. Total 16 cases were considered for this study.

Results

This article highlights cases successfully treated in our institution, the mention of complications associated with the cases along with management.

Conclusion

Maxillary swing is a good approach for getting access to the deep pathologies like JNA.

     

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.

     

Modified Le Fort III Osteotomy: Different Applications

Summary

Based on the new concepts of the modified Le Fort III osteotomy (MLFIIIO), Three variations of this technique are implemented: (A) the modified osteotomy Le Fort III Champy (1980) technique to be described with the use of surgical guides, and subciliary approach or an transconjunctival approach. Excellent technique for horizontal advancement no further to 6 mm, without requiring any type of graft.. (B) The modified Le Fort III osteotomy in “Z”: to solve horizontal (posterior anterior) problems of more than 6 mm without bone grafting. It is itself a modification of the technique described by Champy. (C) The modified Le Fort III osteotomy ascending: modified the original technique described by Bell and Epker with interpositional grafts, was modified by the called ascendant, making it higher in cases where the patient has an acceptable nasal bridge, but exorbitism the lateral wall of the orbit. Le Fort III osteotomy combined with a Le Fort I osteotomy and a front implant.

Method

As pointed out in Part I for the modified oblique Le Fort III osteotomy, methods for the design of the osteotomy Le Fort III property will depend on the requirements of individual patients, and this has led us to design specific techniques for the deformity.

Results

Patients have a right projection of the middle third, and protection of the eyeball.

Conclusions

The techniques presented for the advancement of the middle third have excellent results with the ability to be tailored to each patient deformity.

     

A Cost-Effective,In-House,Positioning and Cutting Guide System for Orthognathic Surgery

Introduction

Technological advances in 3D printing can dramatically improve orthognathic surgical planning workflow. Custom positioning and cutting guides enable intraoperative reproduction of pre-planned osteotomy cuts and can result in greater surgical accuracy and patient safety.

Objectives

This short paper describes the use of freeware (some with open-source) combined with in-house 3D printing facilities to produce reliable, affordable osteotomy cutting guides.

Methods

Open-source software (3D Slicer) is used to visualise and segment three-dimensional planning models from imported conventional computed tomography (CT) scans. Freeware (Autodesk Meshmixer ©) allows digital manipulation of maxillary and mandibular components to plan precise osteotomy cuts. Bespoke cutting guides allow exact intraoperative positioning. These are printed in polylactic acid (PLA) using a fused-filament fabrication 3D printer. Fixation of the osteotomised segments is achieved using plating templates and four pre-adapted plates with planned screw holes over the thickest bone. We print maxilla/ mandible models with desired movements incorporated to use as a plating template.

Results

A 3D printer capable of reproducing a complete skull can be procured for £1000, with material costs in the region of £10 per case. Our production of models and guides typically takes less than 24 hours of total print time. The entire production process is frequently less than three days. Externally sourced models and guides cost significantly more, frequently encountering costs totalling £1500–£2000 for models and guides for a bimaxillary osteotomy.

Conclusion

Three-dimensional guided surgical planning utilising custom cutting guides enables the surgeon to determine optimal orientation of osteotomy cuts and better predict the skeletal maxilla/mandible relationship following surgery. The learning curve to develop proficiency using planning software and printer settings is offset by increased surgical predictability and reduced theatre time, making this form of planning a worthy investment.

     

Evaluation of anatomical variations of the nasal cavity and ethmoidal complex on cone-beam computed tomography

Objectives

The purpose of this study was to evaluate the prevalence of anatomical variations of the nasal cavity and ethmoid complex on cone-beam computed tomography (CBCT) images.

Methods

The CBCT images of 322 patients were evaluated retrospectively. The anatomical variations of the bilateral nasal cavity and ethmoidal complex were evaluated in four categories, namely nasal septum, turbinates, ethmoid air cells, and crista galli.

Results

The patients comprised 134 males (41.6 %) and 188 females (58.4 %), with an age range of 18–83 years. One or more nasal septum variations were observed in 76.7 % of patients, while variations in the turbinate and ethmoid cell categories were present in 89.4 and 62.1 % of patients, respectively. Overall, 5 % of patients showed pneumatized crista galli.

Conclusions

The detailed radiographic examination of the nasal cavity and ethmoid complex is possible and successful on the CBCT images.

     

Efficacy of nasolabial flap in reconstruction of fibrotomy defect in surgical management of oral submucous fibrosis: a prospective study

Purpose

Various surgical modalities have been used in the surgical management of oral submucous fibrosis with variable results. This prospective study evaluates the efficacy of nasolabial flap in the reconstruction of fibrotomy defect in surgical treatment of oral submucous fibrosis in terms of functional and esthetic outcomes.

Material and method

In this prospective study, we treated 20 patients of oral submucous fibrosis surgically. The surgical protocol was consisting of bilateral fibrotomy, temporal myotomy, and coronoidotomy or coronoidectomy followed by reconstruction of fibrotomy defect with bilateral extended nasolabial flaps. All patients were prescribed with nutritional supplements and antioxidants. Vigorous mouth opening exercise was made compulsory for every patient. Preoperative and postoperative evaluation was done for interincisal mouth opening, function of mastication, and cosmetic results. Patient’s regular follow-up was done for 2 years.

Results

Postoperatively, we noted excellent increase in the interincisal mouth opening relieving trismus. Patient’s ability to chew solid food was increased significantly. Extraoral scar was minimal and well accepted by all the patients. There was no morbidity of the donor site. There was no injury to the facial nerve in all cases. The only drawback was intraoral hair growth which went on reducing with mucosalization of the graft tissue.

Conclusion

Random pattern nasolabial flap is a very good option for intraoral reconstruction of fibrotomy defect in surgical treatment of oral submucous fibrosis with excellent functional and cosmetic results with minimal complications.

     

Management of the premaxilla in the treatment of bilateral cleft of lip and palate: what can the literature tell us?

Objective

In the treatment of bilateral cleft lip and palate (BCLP) patients, there is discussion about the management of the position of the premaxilla. This literature analysis summarises the literature on managing this condition.

Materials and methods

A PubMed, Embase and Cochrane Library search was conducted resulting in 4465 articles which were screened on title and abstract.

Results

Seventy-one articles were available in full text, 16 of which were included in this literature analysis. We searched on keywords timing and technique, complications, growth of the maxilla and results after bone grafting the alveolar process. This literature analysis has shown that there are various ways to correct the position of the premaxilla. These can be divided into primary, early, late secondary and tertiary intervention before the age of 8 years, between the ages of 8 and 12 years and older than 12 years. Correction is done with surgery, orthodontics or a combination, with or without bone grafting.

Conclusions

An osteotomy of the premaxilla in combination with secondary alveolar bone grafting appears to be the most successful technique. Combining early secondary alveolar bone grafting with osteotomy creates more room to ensure a watertight closure of the nasal mucosa resulting in fewer postoperative complications. Before surgery, the orthodontist should try to optimise the position of the premaxilla for its surgical correction prior to bone grafting.

Clinical relevance

The treatment of BCLP patients is still based on experience and expert opinions. This literature analysis tries to give a summery on how to handle the protruded and displaced premaxilla.

     

Three-dimensional evaluation of angular,linear, and resorption features of maxillary impacted canines on cone-beam computed tomography

Objectives

The aim of this study was to evaluate the localization, angulation, and resorption features of maxillary impacted canines on cone-beam computed tomography (CBCT).

Methods

This retrospective study examined the CBCT scans of 140 maxillary impacted canines in 102 patients (43 males, 59 females; mean age: 16.25 ± 6.31 years). The following impacted canine-related parameters were analyzed on the CBCT images: impaction side; location; root resorption levels of adjacent teeth; occlusal plane and midline distances of impacted canines; and angulations of impacted canines to midline, lateral incisor, and occlusal plane.

Results

Bilateral canine impaction was found in 38 subjects, and unilateral canine impaction was present in 64 subjects. Severe resorption was found in 14 canines. There were no significant differences between the occlusal plane and midline distances to the impacted canine cusp tip and root apex (p > 0.05). The midline angulation of right maxillary impacted canines was significantly higher than that of left maxillary impacted canines (p < 0.05), while the occlusal plane angulation of left maxillary impacted canines was significantly higher than that of right maxillary impacted canines (p < 0.05).

Conclusions

Maxillary canine impaction was more frequently seen in female subjects than in male subjects. Lateral incisors were more frequently affected than first premolars, and slight resorption was more frequently seen in adjacent teeth. CBCT assessment of maxillary impacted canines can provide accurate measurements of angular, linear, and resorption parameters.

     

Facial Anthropometric Norms of the Young Iranian Population

Introduction

Facial anthropometric measurement is considered an essential concern of surgeons, orthodontists, artists and forensic scientists. The aim of this study is to investigate facial anthropometric norms of the young Iranian population.

Methods

The study participants consisted of 200 healthy Iranian students (100 males, 100 females) aged 18–25 years old. Twenty-three liner and four angular measurements were investigated twice by a dentist. Independent-samples t test was used to compare indices between males and females and also between countries. A p value less than 0.05 was considered statistically significant.

Results

It was found that the mean measurements of c’–sn’ of both sides, nasolabial angle, trichion–gnathion, tragion–tragion and gnathion–gnathion were statistically greater in Iranian males than in females (p < 0.05). Comparing Iranian anthropometric norms with North American Whites, Malays, Turkish and African American women demonstrated that there were statistically significant differences in most anthropometric measurements between Iranians and other populations (p < 0.05).

Conclusion

In Iranians, mean measurements of c’–sn’ of the right and left sides, nasolabial angle, trichion–gnathion, tragion–tragion and gnathion–gnathion were greater in men than in women. Comparing Iranian males and females with different ethnicities indicated several interracial differences, which should be taken into consideration when dealing with patients or also practitioners originated in this region.

     

Relationship between maxillary sinus pathologies and maxillary posterior tooth periapical pathologies

Objectives

To determine the prevalence of odontogenic maxillary sinus pathologies and their relationship with periapical pathologies in the maxillary posterior teeth using cone-beam computed tomography (CBCT).

Method

Maxillary posterior CBCT scans of consecutive patients aged 20–77 years were evaluated retrospectively. Patients with at least one maxillary posterior tooth were included. Patients with edentulous maxillae or having one or more maxillary implants were excluded. Finally, 461 CBCT images were evaluated. Demographic data, such as age and sex, and pathologic findings of the right and left maxillary sinuses and adjacent teeth were recorded. Statistical analyses were performed using the Chi square test and binary logistic regression.

Results

The prevalence of right and left odontogenic maxillary sinusitis was 59.5 and 64 %, respectively. Maxillary sinus pathology was more common in males, and there was no relationship with age. Regarding the maxillary sinus pathology, 64 % had mucosal thickening, 19 % had partial opacification, 5 % had total opacification, and 12 % had polypoidal mucosal thickening. Right and left maxillary sinus pathologies were approximately twice as prevalent in patients with periapical pathology in at least one maxillary posterior tooth. Periapical pathologies in the right maxillary first molar and left maxillary first and second molars significantly increased the risk of maxillary sinus pathology with odds ratios of 2.53, 1.83, and 3.12, respectively.

Conclusions

Odontogenic maxillary sinus pathologies were present in >50 % of the study population. Periapical pathologies in the maxillary first and second molar teeth significantly increased maxillary sinus pathologies.

     

Maxillary sinus mucocele: predisposing factors,clinical presentations,and treatment

Purpose

Maxillary sinus mucocele (MSM) is uncommon lesion and has many presenting features. The aim of this study was to detect the possible predisposing factors, clinical characteristics, and to assess the efficacy of trans-nasal endoscopic treatment of this lesion.

Methods

This retrospective multicenter study was conducted on 36 patients with MSM, the diagnosis of the disease was based on computed tomographic criteria. The patients’ history, presenting features, and surgical management were reviewed. All patients were followed up postoperatively for at least 3 years.

Results

Chronic sinusitis, previous surgery, allergic rhinitis, and nasal trauma may be implicated as predisposing factors for the disease. However, in some patients (56%) the cause may remain uncertain. MSM may present with unilateral cheek pain, heaviness, swelling, numbness, hemifacial pain, nasal obstruction, nasal discharge, and/or proptosis. All patients were treated with trans-nasal endoscopic marsupialization through the middle meatus, patients with large MSM showed bulged medial maxillary wall, and they needed to empty the fluid through inferior antrostomy to facilitate introduction of the instruments to the middle meatus. All patients reported resolution of their symptoms, and none required revision surgery through the follow-up period.

Conclusions

MSM has several predisposing factors such as chronic sinusitis, previous surgery, allergic rhinitis and nasal trauma. However, some patients have no identifiable cause. The disease can present with a variety of symptoms which are usually related to their expansion and subsequent pressure on the surrounding structures. Trans-nasal endoscopic approach is an effective and safe method for treatment of the lesion.

     

Comparison of digital dental images yielded by digital dental casts,cone-beam computed tomography,and multislice computed tomography for measurement of dental area

Objectives

We investigated and compared the errors generated by multislice computed tomography (MSCT), cone-beam computed tomography (CBCT), and digital dental casts when used to provide digital data about dental structures.

Methods

Ten A20 skull models were scanned with MSCT and CBCT, and dental plaster cast models were optically scanned in three dimensions. The maxillary dental area was then compared. The distance between the three-dimensional scan data of the skull and each set of digital dental data were measured. Reference data were then overlapped with the experimental digital model using surface-based registration. The distance of errors was measured with the shortest distance measurement function. The distances between each experimental digital model and the reference scan data were measured, and error values were determined for all maxillary teeth and each tooth surface area. Errors were measured for all teeth from the central incisors to the second molar on both the left and right sides. Errors were measured from the mesial, distal, and labial surfaces and the tooth cusp tip area for each tooth.

Results

The digital dental casts had the smallest error (p < 0.001). The error in the digital dental casts (mean ± standard deviation) was 0.10 ± 0.12 mm. The CBCT error was 0.34 ± 0.38 mm, which was significantly greater than the MSCT error (0.19 ± 0.16 mm) (p < 0.001).

Conclusions

We recommend the use of digital dental casts with digital dental imaging for three-dimensional measurement of the dental area because this technique had the smallest errors.

     

The Jugaad Technique for Jaw Reconstruction: Denture Based Inverse Planning

Aim

The aim of this clinical paper is to introduce a technique to plan for functional maxillofacial reconstructions.

Materials and Methods

Preoperative dental casts were made of the patient and mock surgery performed on the casts. A fibula analogue was then placed in an ideal functional reconstruction position. New dentures were fabricated on the fibula analogue and drill holes for the placement of implants were placed through the denture. This denture formed as a guide to position the fibula transplant during surgery.

Results

This technique was useful in producing functional and rehabilitative outcomes in cases of both maxillary and mandibular reconstructive surgeries.

Conclusion

The Jugaad technique—denture based inverse planning—is a cost effective method for planning and executing maxillofacial reconstructions using mock surgery on casts and interim dentures.

     

Prevalence of isolated maxillary lateral incisor agenesis in Syrian adolescents

Purpose

This research is designed to obtain a better understanding and provide more insight of this phenomenon through evaluating the prevalence of congenital absence of maxillary lateral incisors in a Syrian population.

Methods

The method involved clinical examination of 8000 school children with an equal number of males and females (age range 12–15 years) to identify students only affected by bilateral or unilateral congenital absence of maxillary lateral incisors. Agenesis was determined based on radiological evidence.

Results

The results of this study showed that the prevalence of isolated maxillary lateral incisors agenesis was 1.15%. In the sample studied, 66.3% of the patients were female and 33.7% were male (p < 0.05). Absence was bilateral in 47.8% of patients and unilateral in 52.2%. Of the unilateral cases, 48% occurred on the right side and 52% on the left side, and the contralateral maxillary incisor was found to be microdont in 43.75%, right lateral in 47.6%, and left lateral in 52.4%.

Conclusion

The results of this study allow the conclusion that the prevalence of isolated maxillary lateral incisors agenesis in a Syrian population is within the average range with regard to other populations. A significant familial component to the etiology of maxillary lateral incisors agenesis was found.

     

Craniofacial cephalometric morphologies in different cleft types: a retrospective cross-sectional study of 212 patients

Objective

The aim of this study was to evaluate and compare the craniofacial cephalometric morphologies among different cleft types in a Spanish population.

Methods

A retrospective cross-sectional study was carried out on 212 patients. The patients were subdivided into four groups according to their cleft types: unilateral cleft lip and palate; bilateral cleft lip and palate; cleft lip; and cleft palate. Angular and linear cephalometric measurements were taken on lateral radiographs.

Results

Unilateral cleft lip and palate was associated with a dolichofacial growth pattern, skeletal Class III with correct maxillary position, and lingual incisor inclination. Bilateral cleft lip and palate was associated with a mesofacial growth pattern, skeletal Class I with protruded maxillary position, and lingual incisor inclination. Cleft palate was associated with a mesofacial growth pattern, skeletal Class III with correct maxillary position, and lingual incisor inclination. Cleft lip was associated with a brachyfacial growth pattern, skeletal Class I with protruded maxillary position, lingual upper incisor inclination, and corrects lower incisor inclination. Significant correlations were observed between cleft types and their craniofacial cephalometric measurements.

Conclusions

The present information can be used for the determination of orthodontic treatment and even future orthognathic surgery planning, a requirement in most cleft patients.

     

Risk factors associated with oroantral perforation during surgical removal of maxillary third molar teeth

Purpose

The relationship between radiographic findings and the occurrence of oroantral perforation is controversial. Few studies have quantitatively analyzed the risk factors contributing to oroantral perforation, and no study has reported multivariate analysis of the relationship(s) between these various factors. This retrospective study aims to fill this void.

Methods

Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analysis. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) was assessed using panoramic radiography and classified as types 1–5. The relationship between the maxillary second and third molars was classified according to a modified version of the Archer classification. The relative depth of the maxillary third molar in the bone was classified as class A–C, and its angulation relative to the long axis of the second molar was also recorded.

Results

Performance of an incision (OR 5.16), mesioangular tooth angulation (OR 6.05), and type 3 RS classification (i.e., significant superimposition of the roots of all posterior maxillary teeth with the sinus floor; OR 10.18) were all identified as risk factors with significant association to an outcome of oroantral perforation.

Conclusion

To our knowledge, this is the first multivariate analysis of the risk factors for oroantral perforation during surgical extraction of the maxillary third molar. This RS classification may offer a new predictive parameter for estimating the risk of oroantral perforation.