A Comparative Study of Canine Retraction by Distraction of the Periodontal Ligament and Dentoalveolar Distraction Methods

Introduction

Canine distraction was introduced as an alternative treatment to retract the canines in minimum possible period of 3 weeks. It involved rapid canine retraction through distraction of the periodontal ligament. Another technique for rapid canine distalization involved osteotomies surrounding the canines to achieve rapid movement of the canines in the dentoalveolar segment known as dentoalveolar distraction. The present study is intended to assess and evaluate canine retraction by the above two mentioned methods of distraction osteogenesis.

Materials and Methods

Eight orthodontic patients who required first premolar extractions were selected and 16 canines were distracted into the extraction space, using a distraction screw.

Results

The distraction procedure was completed in 15.38 ± 1.51 days on the side of periodontal ligament distraction while it took 14.50 ± 2.45 days on the side of dentoalveolar distraction. No significant anchorage loss was seen in both the sides. The distal displacement of the canines was 6.63 ± 0.90 mm on the periodontal distraction side at the rate of 0.43 ± 0.05 mm/day and 6.91 ± 1.16 mm on the side of dentoalveolar distraction at the rate of 0.48 ± 0.08 mm/day. An angulation change of 14.94° ± 7.58° was observed in canine inclination in periodontal distraction side while change of 14.88° ± 3.15° was seen in the dentoalveolar distraction side.

Conclusion

No significant differences in the various parameters were found between both the techniques of canine retraction by distraction osteogenesis, while reducing orthodontic treatment duration by 6–9 months without any unfavorable short-term effects on the periodontium.

     

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.

     

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.

     

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.

     

Submental-Cervical Angle: Perceived Attractiveness and Threshold Values of Desire for Surgery

Aim

The submental-cervical angle may alter as a result of mandibular orthognathic surgery and/or the ageing process and is therefore an important facial aesthetic parameter for comparative diagnosis and treatment planning. The purpose of this study was to undertake a quantitative evaluation of the influence of the submental-cervical angle on perceived attractiveness and threshold values of desire for surgery.

Study Design

The submental-cervical angle of an idealized profile silhouette image was altered incrementally between 90° and 130°. The images were rated on a seven-point Likert scale by pre-treatment orthognathic patients (n = 75), laypeople (n = 75), and clinicians (n = 35).

Results

A submental-cervical angle of 90°–105° was deemed acceptable. Angles up to 120° were deemed slightly unattractive by the lay and clinician groups, but very unattractive by the patient group. By 125°–130° all groups perceived the angle as very unattractive. The threshold value of desire for surgery was 110° for patients, 115° for lay people and 125° for clinicians. Patients appear to be more critical than lay and clinician groups.

Conclusions

These ranges of normal variability of the submental-cervical angle and threshold values of desire for surgery, in terms of observer acceptance, should be considered by clinicians in planning mandibular orthognathic surgery and aesthetic surgical procedures of the submental-cervical region.

     

Where to position osteotomies in genioglossal advancement surgery based on locations of the mental foramen,canine, lateral incisor,central incisor,and genial tubercle

Purpose

The study aimed to provide precise measurements of anterior mandibular structural anatomy and to explore potential osteotomies for genioglossal advancement.

Methods

Cone beam computed tomography was used to analyze 33 randomly selected patients undergoing surgery for obstructive sleep apnea (OSA) between 2014 and 2016 at an academic surgical hospital. The locations of relevant mandibular structures were measured and statistical modeling was performed.

Results

Mean horizontal distances from midline to the mental foramina and the roots of the canine, lateral incisor, and central incisor were 22.11 ± 1.92, 13.56 ± 3.01, 6.19 ± 1.58, and 2.04 ± 0.87 mm, respectively. Mean vertical distances from the inferior border of the mandible were 15.15 ± 1.77, 17.11 ± 3.28, 20.48 ± 3.10, and 21.81 ± 3.49 mm, respectively. The superior border of the genial tubercle was 15.63 ± 2.75 mm, and the inferior border was 6.87 ± 3.29, from the inferior border of the mandible. The angle of decline of the best-fit line through the important structures was about 18° from the occlusion plane at the midline.

Conclusions

A straight line estimating the mental foramen, canine, lateral incisor, and central incisor tooth roots crosses at a mean of 22.3–22.6 mm above the inferior border of the mandible at the midline and has an angle of decline of about 18°. Potential osteotomies made parallel to and below this line result in tradeoffs between maximizing capture of the genioglossus muscle attachment and risk of dental/neurovascular injury.

     

A comparative study of intermaxillary fixation screws and noncompression miniplates in the treatment of mandibular fractures: a prospective clinical study

Background

The main goal of treatment of mandibular fractures is to restore normal dental occlusion and promote appropriate bone healing and a normal mouth opening. Recently, there has been a resurgent interest in the use of screws for intermaxillary fixation of mandibular fractures. This study was therefore designed to determine how the clinical outcomes of the use of screws for intermaxillary fixation compare with the use of miniplates in the treatment of mandibular fractures in Nigeria.

Objectives

The objectives of this study are as follows:

1. 1.
   To compare the clinical outcomes of the use of 2.0 mm × 9.0 mm screws for intermaxillary fixation with 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures in Lagos, Nigeria
    
2. 2.
   To determine the clinical outcomes in the use of 2.0 mm × 9.0 mm screws for intermaxillary fixation (IMF) and 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures
    
3. 3.
   To compare the complications associated with the use of 2.0 mm × 9.0 mm screws for IMF and 2.0 mm noncompression miniplates in the treatment of mandibular fractures
    

Methodology

This randomized controlled clinical study was carried out at the Department of Oral and Maxillofacial Surgery of the study institution. Subjects with simple unilateral mandibular fractures who met the inclusion criteria were randomly allocated into the study (intermaxillary fixation screw) and control (miniplate) groups through balloting. Factors assessed and compared during and after the procedures included intraoperative pain, postoperative nerve impairment, postoperative occlusion, limitation of mouth opening, incidence of hardware failure, incidence of infection and non-union. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 20.

Results

A total of 56 subjects participated in the study, with 28 subjects in each group. Majority (91%) of the subjects were male. Road traffic crash was the highest aetiological factor while sport was the least (3.6%). A higher proportion (25.0%) of subjects in the miniplate group had major complications compared with 14.3% in the IMF screw group. There was no statistically significant association between site of mandibular fracture, time elapsed before treatment and complications (p < 0.05). All cases of mandibular fractures healed successfully at 6 weeks.

Conclusion

The use of screws for IMF is as effective as 2.0 mm noncompression miniplates in the treatment of simple unilateral mandibular fractures.

     

Radiographic evaluation of condylar positioning in patients undergoing orthognathic surgery

Objective

The aim of this study was to evaluate alterations in condylar positioning through submentovertex projection (Hirtz Radiographic Technique) in patients who underwent orthognathic surgery for maxillary advancement and mandibular setback with stable internal fixation.

Methods

A prospective longitudinal clinical study of 40 surgical patients presenting dentofacial deformity admitted in the Oral and Maxillofacial Surgery Department of Federal University of Paraná (UFPR) in the period between March 2013 and December 2015. We performed two submentovertex digital radiographs, one 7 days before surgery and the other one 30 days after the procedure. Cephalometric tracings were made using Radiocef® Studio 2 Software and measured the intercondylar and condylar angles (right and left).

Results

There was a decrease in the intercondylar angle (p < 0.001) and an increase in condylar angles both the right and the left side (p < 0.001) when compared with the pre and postoperative period. There was a larger increase in condylar angle on the right side in males (p = 0.007).

Conclusion

There is a tendency of decreasing of the intercondylar angle after orthognathic surgery, regardless of the alteration in the condylar angles, creating a new position of the condyle in the glenoid fossa. Patients with asymmetry may present greater alterations in the positioning of the opposite condylar to the deviation of the mandibular midline.

     

Distraction Osteogenesis for Management of Severe OSA in Pierre Robin Sequence: An Approach to Elude Tracheostomy in Infants

Background

Severe obstructive sleep apnoea (OSA) is a life threatening condition associated with Pierre Robin sequence (PRS) due to mandibular micrognathia and glossoptosis. Often these patients require tracheostomy at an early age which has high morbidity. Distraction osteogenesis (DO) is an accepted method of treatment for patients with hypoplastic mandible to achieve mandibular lengthening without need for a bone graft. It has also been used in respiratory distressed neonates and infants to avoid tracheostomy.

Case report

An eight month old baby, a diagnosed case of PRS with severe OSA and recurrent episodes of aspiration pneumonia and on nasogastric tube feeding since birth was referred to us for evaluation and possibility of therapeutic augmentation of the mandible by DO. After a thorough clinico-radiological assessment the child was operated for bilateral extraoral placement of horizontal corpus distractor. A total distraction of 12 mm was carried out and consolidation of callus was monitored by USG. Postoperatively the patient was followed up for 12 months. Presently she has normal respiratory and feeding function without any episode of aspiration pneumonia.

Conclusion

Mandibular corpus DO is a safe and effective technique that can be applied to predictably relieve severe upper airway obstruction in selected PRS cases. In order to avoid the limitations of alternative surgical procedures and the tracheostomy-associated morbidity, DO should be considered among the routine treatment modalities.

     

Successful Treatment of Postoperative Mouth Opening Limitation Following Le Fort III Distraction with Bilateral Coronoidectomies

Introduction

Distraction osteogenesis is a powerful tool in craniomaxillofacial surgery, allowing for large advancements of osteotomized segments in the setting of a restrictive soft tissue envelope. Despite its benefits, distraction can have negative functional consequences. We present a case of a patient with Crouzon syndrome who developed reduced mouth opening capability after a Le Fort III midfacial advancement with rigid external distraction.

Technique

Radiographic evaluation revealed that the coronoid process was restricting the normal excursion of the mandible by contacting the posterior zygoma. The patient was subsequently treated with a bilateral coronoidectomy via an intraoral approach, which improved his interincisal opening. Maximum interincisal distance was improved from 18 mm to 33 mm following bilateral cornoid resection.

Conclusion

We report coronoid impingement as a potential complication after Le Fort III distraction. Such a finding suggests the need for a detailed vector analysis in cases undergoing midface advancement with distraction. Post-distraction coronoidectomy is a useful surgical procedure to treat mouth opening limitation due to coronoid impingement against the zygoma after midfacial advancement.

     

Condylar surface CT value in sagittal plane before and after sagittal split ramus osteotomy

Purpose

The purpose of this study was to evaluate the relationship between computed tomography (CT) values of the condylar surface and temporomandibular joint (TMJ) disc position in the sagittal plane before and after sagittal split ramus osteotomy (SSRO) setback surgery, retrospectively.

Materials and methods

The subjects were 75 patients (150 condyles) who underwent bilateral SSRO setback surgery. They were divided into two groups (42 symmetric patients and 33 asymmetric patients). Maximum CT values (pixel values) of five points of the condylar surface and condylar height, length, fossa height, fossa length, and ramus angle in the sagittal plane were measured preoperatively and 1 year postoperatively. Disc position was classified as anterior disc displacement, anterior type, fully covered type, and posterior type, both pre- and postoperatively, using magnetic resonance imaging (MRI).

Results

Postoperative value was significantly higher than preoperative one in CT value of 135° (P = 0.0199) and 180° (0.0363), in the non-deviation side in the asymmetry group. The anterior disc displacement group was significantly larger than those of some other areas pre- and postoperatively in the CT value of 0° point (P < 0.05).

Conclusions

This study suggested that CT value of the posterior site of the condylar surface could change in the non-deviation side in the asymmetry group after 1 year SSRO, and the condyle with anterior displacement showed high CT value at the anterior site of the condyle before and after surgery.

     

A new approach to treat bone gaps after midfacial and zygomatic fractures with a collagen membrane

Purpose

The aim of the study was to analyze the eligibility of resorbable collagen membrane in the treatment of midfacial fractures to prevent gap formation and subsequent cheek tissue retraction.

Material and methods

We included nine patients (six males, three females; mean age 51; range 20–73 years; mean bone gap size 8.03 × 13.12 mm) in a retrospective study design. The defect size was assessed by ultrasound.

Results

After a healing period of 4 to 55 weeks, treatment resulted in a significant reduction of gap size (residual mean bone gap size 6.14 × 7.32 mm).

Conclusions

Native resorbable collagen membrane is a promising tool to reduce the size of bony gap in midfacial defects.

     

Minimizing Relapse in Mandibular Asymmetry Correction by BSSRO with Intentional Osteotomy of Distal Segment: A Prospective Study

Introduction

Surgical correction of the patients with mandibular asymmetry by bilateral sagittal split ramus osteotomy (BSSRO) creats remarkable results in the immediate post operative period, but it carries a high risk of relapse by powerful muscle forces and the osteotomized segments. To minimize this risk, literatures highlight the procedure of an intentional osteotomy and stripping of muscles. A prospective study was conducted in Government Dental College, Kottayam, Kerala, to assess the effect of intentional osteotomy of posterior part of distal segment and stripping of medial pterygoid muscle on the proximal segment on affected side in mandibular asymmetry patients treated with BSSRO.

Materials and Methods

20 patients above 18 years with mandibular asymmetry underwent surgical correction by BSSRO setback and rotation. Clinical evaluation and postero anterior cephalogram (PA Ceph) were used to assess relapse. PA cephalogram taken post operatively at 2 weeks, 6 months and 1year were compared using cephalometric parameters by Grummons analysis to assess relapse. Paired t test and Chi-square test was used to analyse quantitative and qualitative parameters respectively with statistical significance of p < 0.05.

Results

Barring Methodological errors which is inevitable, the amount of relapse was not statistically significant with respect to dental midline, chin midline and frontal photograph.

Conclusion

Intentional osteotomy of posterior part of distal segment and stripping of medial pterygoid muscle on the affected side can prevent relapse in patients who underwent surgical correction of mandibular asymmetry by BSSRO set back and rotation.

     

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.

     

Hypoesthesia associated with mandibular movement after sagittal split ramus osteotomy

Purpose

This retrospective study investigated the relationship between the degree of neurosensory disturbance (NSD) and mandibular movement distance after sagittal split ramus osteotomy (SSRO) and assessed sensory recovery.

Methods

Lower lip hypoesthesia was evaluated at 1 week, 1 month, and 2 months after SSRO in 38 patients categorized according to the distance of mandibular movement: S group (0–7 mm; n = 17, 4 males and 13 females) and L group (7–14 mm; n = 21, 7 males, 14 females). Symptoms were evaluated by visual analog scale (VAS), tactile-threshold (SW) test, static 2-point discrimination (s-2PD) test, and current perception threshold (CPT) test.

Results

The two groups did not differ significantly in gender and age. The Aβ fiber results of the CPT test differed significantly between the groups at 1 week and 1 month postsurgery (P < 0.05). There were no significant differences between the groups throughout the period in terms of VAS, SW, s-2PD, Aδ fiber, and C fiber of CPT.

Conclusions

Post-SSRO, the incidence of NSD in terms of tactile sensation may be greater in the L group early postoperatively. This may assist surgeons in explaining postoperative hypoesthesia to patients preoperatively.

     

Anesthetic Efficacy of 4 % Articaine During Extraction of the Mandibular Posterior Teeth by Using Inferior Alveolar Nerve Block and Buccal Infiltration Techniques

Introduction

The study was designed to evaluate the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine (A100) in infiltration and inferior alveolar nerve block (IANB) anesthetic techniques for the pain control during extraction of the mandibular posterior teeth.

Methods

This prospective randomized single-blind clinical trial included 100 patients needing extraction of at least two mandibular molars. Patients received either infiltration in the buccal vestibule opposite to the first molar supplemented with lingual infiltration or standard IANB with A100. For assessment of depth of anesthesia obtained by the two anaethetic techniques, presence or absence of pain during the extraction were rated using the visual analog scale.

Results

Fifty patients received infiltration anesthesia and fifty patients were anesthetized by IANB. The success rate of pain-free extraction after buccal infiltration was 94 %, whereas by using IANB with the same anesthetic it was 92 %. No statistical differences were detected in the success rates between the two anesthetic techniques (P = 0.15).

Conclusions

Buccal Infiltration can be considered a good option during extraction of the mandibular molar and premolar teeth of course, with supplemental lingual anesthesia.

     

Therapeutic accuracy of the completely customized lingual appliance WIN

Objective

The aim of this retrospective cohort study was to assess the accuracy of the completely customized lingual appliance WIN (DW Lingual Systems, Bad Essen, Germany) employing a three-dimensional (3D) comparison between the setup and the final result.

Materials and methods

The setup and final models of 20 consecutively debonded patients (40 jaws; 7 males, 13 females; mean age 15.76 ± 4.45 years) with various malocclusions of a private practice specialized in orthodontics were digitalized using a 3D scanner. The 3D models of the setup and the final model of each jaw were then digitally matched using the best fit algorithm and segmented into single teeth. After placing individual coordinate systems, the homologous teeth of the setup and the final model were matched to be able to calculate the exact deviations of all rotational and translational components. The t test for unpaired samples, Kruskal–Wallis tests, U tests, and ANOVA with Duncan post hoc test were applied statistically.

Results

Regarding the incisors, the angle discrepancies between the setup and the final result appeared to be less than 3° (torque 2.96°; tip 2.04°; rotation 2.00°). The translations showed mean values less than 0.3 mm (mesiodistal 0.16 mm; buccolingual 0.15 mm; vertical 0.29 mm). Slightly higher values could be measured in the lateral segments regarding rotations (torque 5.18°; tip 3.10°; rotation 3.70°) as well as regarding translations (mesiodistal 0.26 mm; buccolingual 0.64 mm; vertical 0.36 mm).

Conclusions

Using the completely customized lingual appliance WIN, it is possible to achieve the final result predicted by the setup with a high accuracy.

     

A Giant Plunging Sublingual Dermoid Cyst Excised by Intraoral Approach

Objective

Dermoid and epidermoid cysts are rare cysts of the head and neck region, which should be considered in differential diagnosis of sublingual mass, constituting 0.01 % of all oral cavity cysts. There are suspected theories regarding the basis of the pathology.

Case Report

30-year-old male referred to our clinic with a chief complaint of sublingual mass which had been present for many years but the lesion enlarged over the past 3 years. MRI examination revealed a giant cystic mass which was 3.6 × 3.9 mm in diameter and medially located at sublingual region.

Treatment and Prognosis

Intraoral approach was preferred for surgery and no recurrence or complaints were detected during follow-up period.

Conclusion

When a cystic mass is detected on the floor of oral cavity, we must consider dermoid cysts for differential diagnosis. Surgery is the only treatment. If possible, intraoral approach should be preferred because of its perfect cosmetic results.

     

Malocclusion in the primary dentition in children with and without deformational plagiocephaly

Objectives

Asymmetries of the jaw and orthodontic abnormalities are suspected as long-term consequences of positional cranial deformity. But only few data exist on this issue. As plagiocephaly is a common problem in infancy, potential functional impairments should be investigated to initiate appropriate measures if necessary. The aim of our study was to compare the orthodontic situation in primary dentition of children with positional plagiocephaly and children without cranial deformities.

Material and methods

Fifty children treated by helmet therapy for plagiocephaly and 50 non-affected children (age 1.98–5.69 years) were examined in a cross-sectional study. Orthodontic parameters of all dimensions were assessed and analyzed.

Results

Children of the plagiocephalic group showed more often orthodontic alterations compared to the others. Especially the frequencies of a class II malocclusion (36 vs. 14 %), an edge-to edge bite (28 vs. 12 %), and deviations of the midline (38 vs. 16 %) were conspicuous. However, none of the differences was significant (p > 0.003). Of all observed mandibular asymmetries, 69 % appeared as a shift to the contralateral side of the former flattened occipital region.

Conclusion

Positional head deformity might be associated in some cases with a higher prevalence of occlusal abnormalities in primary dentition.

Clinical relevance

Positional plagiocephaly interfaces medicine and dentistry. As it is a common disorder, this etiology has to be considered in the prevention and therapy of malocclusion.

     

Pre-Emptive Analgesia with Ketamine for Relief of Postoperative Pain After Surgical Removal of Impacted Mandibular Third Molars

Purpose

In this study we assessed the clinical efficacy of sub-mucosal injection of ketamine at sub-anesthetic dose of 0.5 mg/kg on post-operative pain, swelling and trismus following surgical extraction of impacted mandibular third molars.

Methods

Forty bilaterally symmetrical impacted mandibular third molars in 20 patients who required surgical removal were included in the study. Within the same individual, one of the sites received a test medication whereas the other site was used as control. All patients received nerve blocks with local anesthetic (2 % lignocaine hydrochloride with 1:80,000 adrenaline); the Test group received sub-mucosal infiltration of 0.5 mg/kg of ketamine hydrochloride (without preservative) around the impacted mandibular third molar and along the incision line, while the Placebo group received normal saline infiltration, 10 min before placement of the incision.

Results

The pain scores on VAS at 30 min, 1, 4, 12 h and 1 day post-operatively was significantly lower in the Test group than in the Placebo group (p < .05). With respect to facial swelling and mouth opening the Test group and Placebo group showed overall no statistically significant difference (p > .05) on the 1st, 3rd and 7th post-operative days.

Conclusion

The sub-mucosal injection of 0.5 mg/kg ketamine administered before surgical removal of impacted mandibular third molars was found to be effective in significantly reducing post-operative pain for the first 24 h.