Esthetic perception of changes in facial profile resulting from orthodontic treatment with extraction of premolars: A systematic review

Background

The authors conducted a systematic review to assess changes in patients’ facial profiles resulting from orthodontic treatment with and without extraction of 4 premolars and to identify cephalometric parameters that can assist decision making in borderline cases.

Risultati clinici e istologici delle preparazioni subgengivali a lama di coltello. Casi clinici

Objectives

This article evaluates the correlation between clinical and histological results in teeth prepared for fixed prosthodontics using the Biologically Oriented Preparation Technique (BOPT).

Materials and methods

Clinical cases are presented to illustrate the main steps in the BOPT procedure and the clinical results. Six anterior teeth regarded as “hopeless” were used for histological analysis. Three were prepared according to the BOPT (test), and the other three were prepared with a rounded juxtagingival shoulder (control). Temporary acrylic resin restorations were immediately placed. The teeth were extracted after five weeks.

Results

The junctional epithelium (JE) measured 2.5 ± 0.4 mm (test) and 1.7 ± 0.3 mm (control) (p < 0.001). The area of connective tissue infiltrated by inflammatory cells was 2.7 ± 0.7 mm² (test) and 1.5 ± 0.3 mm² (control) (p < 0.001).

Conclusions

The BOPT appears to favor the formation of a long JE and inflammatory-cell infiltration of the connective tissue, so it should not be used on periodontically sound teeth.     

Corone singole su impianti ottenuti per fabbricazione diretta tramite laser. Studio prospettico e multicentrico con follow-up a un anno

Objectives

This prospective study evaluated the survival rate and the implant-crown success of single-tooth titanium dental implants produced with direct laser metal forming (DLMF) after 1-year of functional loading.

Materials and methods

110 maxillary (N = 65) and mandibular (n = 45) implants (TixOs^®, Leader Novaxa, Milan, Italy) were placed in 82 patients (44 males, 38 females; age range 26-67 years) in 7 different clinical centers. The prosthetic restorations included 110 single crowns (SCs) (32 anterior, 78 posterior). The scheduled 1-year follow-up examination focused on several clinical, radiographic, and prosthetic parameters. Implant success was defined as the absence of pain, sensitivity, suppuration, and exudation; absence of clinically detectable implant mobility; absence of peri-implant radiolucency; distance between the implant shoulder and the first visible bone contact (DIB) < 1.5 mm; absence of prosthetic complications at the implant abutment interface.

Results

After 1-year of functional loading, the overall implant survival rate was 99.1% (98.4% maxilla, 100% mandible). The mean DIB was 0.60 mm (± 0.32). All but 3 of the 109 surviving implants fulfilled the implant-crown success criteria (implant-crown success 97.2%).

Conclusions

Titanium dental implants produced with DLMF seem to represent a valid treatment option for single-tooth restorations in the maxilla and in the mandible. Further studies are needed to evaluate the long-term performance of these implants.     

Tecnica osteotomica piezoelettrica e rotante nella chirurgia dei terzi molari inferiori inclusi: comparazione delle sequele postoperatorie

Objectives

The aim of this study was to compare the outcomes of surgery for impaction of mandibular third molars performed with piezoelectric or high-speed rotatory osteotomy technique.

Materials and methods

One hundred fifty patients with impacted mandibular third molars were included in the study. Seventy-five were treated with a piezoelectric osteotomy technique (group A) and 75 patients were treated with high-speed rotatory osteotomy (group B). The treatment protocol was the same for both groups. Twenty-four hours after surgery, facial swelling and trismus were evaluated in both groups.

Results

Mean procedure duration was 22.65 minutes in group A and 17.56 minutes in group B. Mean facial swelling was 4.44 mm in group A and 6.67 mm in group B; trismus was 12.28 mm in group A and 17.28 mm in group B. Statistical analysis revealed significant reductions (p < 0.001) in postoperative facial swelling and trismus in group A, but the duration of the surgical procedure in this group was also significantly increased (p < 0.001 vs group A).

Conclusions

Compared with high-speed rotatory osteotomy, piezoelectric osteotomy produces less facial swelling and trismus 24 hours after surgery, but it also increases the duration of surgery.     

Soft tissue outcome after mandibular advancement—an anthropometric evaluation of 171 consecutive patients

Objectives

There is an ongoing discussion in the literature about preoperative planning and postoperative evaluation of orthognathic surgery and its impact on facial appearance and aesthetics.

Materials and Methods

We present an anthropometric and cephalometric evaluation of orthognathic surgery results based on reference anthropometric data. In 171 Class II patients, mandibular advancement by bilateral sagittal split osteotomy was performed. Preoperative as well as 3 and 9 months postoperative standardized frontal view and profile photographs and lateral cephalograms were evaluated in a standardized manner by use of 21 anthropometric indices. In cephalograms, SNA and SNB angle as well as Wits appraisal were investigated. Results of anthropometric and cephalometric measurements were correlated.

Results

Lower vermilion contour, vermilion and cutaneous total lower lip height, nose–lower face height, nose–face height, upper face–face height, upper lip– and chin–mandible height index showed significant pre- to postoperative changes as well as SNB angle and Wits appraisal. Furthermore, medial–lateral cutaneous upper lip height, vermilion and cutaneous total lower lip height and philtrum–mouth width index presented significant correlations to cephalometric measurements.

Conclusions

The investigated anthropometric indices and cephalometric measurements presented reproducible results related to surgery. The correlation of cephalometric to anthropometric measurements has been proven useful for preoperative planning and postoperative evaluation of orthognathic surgery patients.

Clinical relevance

The presented anthropometric measurements and their observed correlation to cephalometric measurements could lead to a better prediction and optimized planning of the soft tissue result in orthognathic surgery patients and thereby improve the aesthetic outcome.     

Aumento verticale nelle atrofie mandibolari: evidenze scientifiche

Objectives

The aim of this article is to evaluate the most effective reconstructive-regenerative and/or implant techniques available for increasing the vertical bone height of atrophic mandibles, according to the biological material used.

Materials and methods

We analyzed data from 14 randomized clinical trials that met the criteria for inclusion in Cochrane reviews.

Results and conclusions

Vertical bone regeneration can be achieved in the atrophic posterior mandible, but complications are frequent. Furthermore, it is not clear which technique is the best. When the atrophic mandible is totally edentulous, the best approach seems to be intraforaminal placement of short implants (8-11 mm). It is a relatively easy procedure that can be done on an outpatient basis and is associated with lower morbidity.     

Les répercussions craniofaciales dans l’agénésie des incisives latérales maxillaires

Objectives

Assessment of the influence of maxillary lateral incisor agenesis (MLIA) on the facial morphogenesis.

Methods

Evaluation of the skeletal dimensions of the upper maxilla and its incisor region. Analysis was performed among three groups: individuals with MLIA, its relatives and the normal population. Among these a comparison between adults and growing individuals was performed.

Results

MLIA may interfere with the maxillary length and the anterosuperior facial height, negatively conditioning on its potential growth. MLIA was not correlated with changes of the palatine plane inclination, maxillary height nor with adjustment of the anterior nasal spine dimensions related to the Frankfurt plan or to the posterior nasal spine–Frankfurt plan during the observed development stage; the backward angle of the incisors in children with bilateral agenesis of lateral incisors appear to have been corrected in adulthood.

Conclusions

MLIA is associated with an upper maxilla shortening, and appear to interfere significantly with the anterior facial height, reducing its potential size.     

Trigemino-Cardiac Reflex: A Phenomenon Neglected in Maxillofacial Surgery?

Background

Trigemino-cardiac reflex is a physiologic response of the body to pressure effects in the region of distribution of the trigeminal nerve. Oral and maxillofacial surgical procedures can induce the development of this reflex, which leads to significant changes in the heart rate and sinus rhythms. This study intends to evaluate the effects of this reflex in patients with facial fractures and its subsequent management.

Patients and Methods

A total of thirty-seven patients with facial fractures who reported to the Department of Oral and Maxillofacial Surgery at Basaveswar Teaching and General Hospital, Gulbarga during a period from July 2015–March 2016 were considered for the study.

Results

A male preponderance is observed with the most susceptible age group being 21–30 years. Twenty-three patients sustained mid-facial fractures alone, nine patients had isolated mandible fractures and five patients had fractures of both the mid-face and mandible. A relative bradycardia was observed in the patients with mid-facial trauma, both at the time of presentation and also during the surgical reduction of midfacial fractures which improved after completion of procedure in most of the patients. However, in two patients, the bradycardia progressed to a cardiac asystole during midface manipulation which required immediate halt of the procedure and intravenous administration of atropine.

Conclusion

Trigeminocardiac reflex though physiologic, which usually tends to subside without complications is not to be neglected in the surgeries of the maxillofacial skeleton. A propensity for unforeseen complications due to this reflex has to be avoided by meticulous monitoring of the ECG.

     

Solidarizzazione elettronica su impianti a carico immediato: un caso clinico in chirurgia flapless

Objectives

The author presents a case of rehabilitation using flapless surgery, immediate-load implants, and electronic soldering of the implants as a support for implant osseointegration.

Materials and methods

The surgical and prosthetic techniques are described along with the method used for implant soldering. Implants were inserted and the interim prostheses manufactured on the same day; the procedures lasted about 1 hour.

Results

There were no complications, and all implant were intact at the 18-month follow-up visit. The patient maintains good oral hygiene and is satisfied with the functional and esthetic results of the intervention. There is no radiological evidence of peri-implant bone loss.

Conclusions

In the case described here, this technique proved to be an effective aid for immediately loaded implant osseointegration.     

Anatomical relation between nasal septum deviation and oropharynx volume in different facial patterns evaluated through cone beam computed tomography

Introduction

The objective of this study was to establish the anatomical relation between nasal septum deviation (NSD) and oropharynx volume in different facial patterns using cone beam computed tomography (CBCT).

Methods

Ninety CBCT examinations were analyzed. InVivoDental software was used to evaluate cephalometric image reconstructions in terms of facial type, determined from cephalometric measurements indicative of growth direction; the presence of NSD was also evaluated. ITK-SNAP software was employed for delimitation of the oropharynx. Intra-examiner error methods were recorded. The results were subjected to parametric and non-parametric tests using Bioestat 5.0.

Results

A comparison of facial types revealed a significantly lower prevalence of NSD in the dolichofacial group compared with the brachyfacial and mesofacial groups (P = 0.0101 and 0.0149, respectively). In the total sample, there was a very strong positive relation between the presence of NSD and oropharynx space volume (P = 0.0162). The oropharynx volume was larger in all facial patterns in the presence of NSD.

Conclusion

The presence of NSD was not associated with facial type, although the oropharynx volume in patients with NSD increased. Therefore, deviation of the septum influences oropharynx volume.

     

Sodium hyaluronate accelerates the healing process in tooth sockets of rats

Objective

In this study we evaluated the effects of sodium hyaluronate (HY) in the healing process of tooth sockets of rats.

Design

Immediately after the extraction of the upper first molars of male Holtzman rats, right sockets were treated with 1% HY gel (∼0.1 ml), while left sockets were used as control (blood clot). The animals were sacrificed at 2, 7, and 21 days after tooth extraction and upper maxillaries processed for histological and morphometric analysis of the apical and medium thirds of the sockets. Carbopol, an inert gel, was used to evaluate the mechanical effect of gel injection into sockets. Expression of bone morphogenetic protein-2 (BMP-2) and osteopontin (OPN) was determined by immunohistochemistry at 1, 2, 3, 4, 5, and 7 days after tooth extraction.

Results

Histological analysis showed that HY treatment induced earlier trabecular bone deposition resulting in a bone matrix more organized at 7 and 21 days after tooth extraction. Also, HY elicited significant increase in the amount of bone trabeculaes at 7 and 21 days after tooth extraction (percentage of trabecular bone area at 7 days: 13.21 ± 4.66% vs. 2.58 ± 1.36% in the apical third of control sockets) and in the vessels counting at 7 days. Conversely, the number of cell nuclei was decreased in HY-treated sockets. Additionally, expression of BMP-2 and OPN was enhanced in HY-treated sockets compared with control sockets.

Conclusions

These findings suggest that HY accelerates the healing process in tooth sockets of rats stimulating the expression of osteogenic proteins.     

Subjective image quality assessment of cross sectional imaging methods for the symphyseal region of the mandible prior to dental implant placement

Objectives

A three dimensional appreciation of the form of the anterior mandible is required to place dental implants safely in the region. This study compared the subjective image quality of four available methods of cross sectional imaging of the symphyseal region, the lateral cephalometric view, cone beam computed tomography (CBCT), spiral tomography and the transymphyseal X-ray view.

Methods

An experimental water phantom was developed to reproduce human soft tissue around the mandible. Images were taken of four mandibles by the four X-ray techniques. Three different CBCT machines were included.The source of each image was disguised by displaying all images in the same format on the same computer screen. A protocol was developed to process the images for viewing whilst preserving their image quality.A panel of observers of ten dentists viewed the images and rated their image quality by recording their agreement with six statements on a five point Likert scale.

Results

The results showed a statistically significant difference in image quality between imaging methods. There were clear differences in the ratings between the three cone beam computed tomography machines. Small volume, high resolution CBCT provided images with the highest scores for subjective image quality.

Conclusions

Within the limitations of this study, significant differences in subjective image quality were found between imaging systems used for cross sectional imaging for the symphyseal region of the mandible prior to dental implant placement.     

Versatility of uniplanar prearthoplastic distraction osteogenesis in the correction of post-ankylosis facial deformities—a report of five different cases

Purpose

Unilateral or bilateral ankylosis can lead to severe micrognathia and facial deformity that requires multiple, often, staged surgical corrections. To date, there is no ideal treatment modality that satisfactorily corrects the complex anatomy, restores the ramal height, and corrects the micrognathia and microgenia. Distraction osteogenesis has been acclaimed as a successful modality for the treatment of such deformities. It is a cost-effective approach with low morbidity and less relapse thus providing better functional and esthetic outcomes. It allows the surgeon to correct the deformity in various planes by using various devices by changing osteotomy designs and vectors, with simultaneous hard tissue and soft tissue reconstruction.

Patients and methods

Here, we present a series of five cases where different types of distraction osteogenesis were combined with various other procedures to correct post-ankylotic facial asymmetry. In one case, simultaneous maxillo-mandibular distraction [Molina’s technique] was used.

Results

All patients showed significant improvement in function and esthetics. Outcome assessment was made using clinical photographs and radiographs.

Conclusion

Pre-arthroplastic distraction osteogenesis is a versatile cost effective approach that can be customized for every patient based on their needs.

     

Analisi in vivo del rilascio di bisfenolo A da un sigillante

Objectives

The aim of this work was to measure the amount of bisphenol A (BPA), a substance with low estrogenic activity, present in the saliva before and after (1 min) the application of a commercial dental sealant.

Materials and methods

We recruited 15 healthy subjects (8 men and 7 women, 21-48 years of age). Saliva specimens (4-5 mL) were collected from each immediately before (baseline) and one minute after application and polymerization of the sealant (test). The amount of BPA was measured in all specimens with gas chromatography-mass spectrometry (GC-MS).

Results

BPA was detected in all post-sealant saliva specimens with a mean level of 54.3 ± 74 ng/mL. BPA levels exhibited significant inverse correlation with salivary pH values.

Conclusions

Our results confirm that the sealant releases BPA into the saliva but the concentrations found are lower than those reported to produce estrogen-like biological effects in vivo.     

Scelta ragionata dei dispositivi ortopedico-ortodontici nella malocclusione di Classe II

Objectives

Functional treatment of Class II malocclusion has been advocated to control and modify the direction of growth of the maxillary teeth and to reduce the need for treatment involving the permanent teeth.

Materials and methods

Many studies demonstrate the effectiveness of functional appliances in the treatment of Class II malocclusion caused by mandibular retrognathism in growing patients. A wide range of functional/orthopedic appliances are available for the correction of this problem. The aim of all these appliances is to stimulate mandibular growth by forward posturing of the mandible.

Results

A systematic review of the literature reveals substantial variability in the reported outcomes of functional jaw orthopedics in Class II malocclusion. These differences depend mainly on the type of appliance used and the timing of intervention. The growth peak that occurs during puberty is the most suitable period for undertaking this type of treatment.

Conclusions

Subjects with habits that interfere with proper maxillary and mandibular development benefit from early treatment of Class II malocclusion that guarantees proper mandibular growth.     

Valutazione multidisciplinare e trattamento delle agenesie degli incisivi laterali mascellari. Revisione della letteratura

Objectives

The purpose of this work was to identify the most effective treatment plan for missing maxillary lateral incisors by means of a review of the relevant literature published on this topic during the last 10 years.

Material and methods

Using the PubMed and Cochrane Library search engines, we selected articles published between 1999 and 2009 with the following Keywords: “congenitally missing lateral incisors”; “treatment option”; “long term clinical results”; “soft tissue aspects”; and “bone level”. Fifty articles were selected: 20 were eliminated; and 30 articles were considered relevant. Ultimately; only 11 articles proved useful for identification of the best treatment option for patients with missing maxillary lateral incisors.

Results

Our review confirms that the most frequently used approach in patients with missing maxillary lateral incisors is the multidisciplinary plan (orthodontics, implantology, prosthetics), but the current trend is to use orthodontic space closure alone whenever possible.

Conclusions

Treatment options for patients with missing maxillary lateral incisors include space closure or space reopening, and insertion of implants. Both options can be considered effective from both the functional and esthetic points of view.     

Relationship between cranial base and jaw base in different skeletal patterns

Purpose

To determine the relationship between the cranial base and both jaw bases in different skeletal patterns.

Utilizzo di un nuovo vetropolimero nella protesi metal-free

Objectives

The aim of this study was to examine the use in different clinical settings of a new composite system for creating metal-free prostheses.

Materials and methods

The system consists of a basic mass, DEI^® Clever Fibre Composite; an esthetic mass, DEI^® Experience; and, for fixed partial prostheses, DEI^® Experience Multi Fibre Bridge.

Results and conclusions

On the basis of our clinical experience, which includes six years of follow-up, we feel that the use of these new composite materials, in association with multidirectional fibers, is a valid approach for the realization of metal-free crowns and relatively short-span partial fixed prostheses, and it could represent an alternative to the use of traditional metal ceramic prostheses.     

Masseter muscle thickness three years after surgical correction of class III dentofacial deformity

Objective

To analyse the effect of integrated orthodontic treatment, orthognathic surgery and orofacial myofunctional therapy on masseter muscle thickness in patients with class III dentofacial deformity three years after orthognathic surgery.

Design

A longitudinal study was conducted on 13 patients with class III dentofacial deformities, denoted here as group P1 (before surgery) and group P3 (same patients 3 years to 3 years and 8 months after surgery). Fifteen individuals with no changes in facial morphology or dental occlusion were assigned to the control group (CG). Masseter muscle ultrasonography was performed in the resting and biting situations in the three groups. Data were analysed statistically by a mixed-effects linear model considering a level of significance of P < 0.05.

Results

Significantly higher values (P < 0.01) of masseter muscle thickness (cm) were detected in group P3 (right rest: 0.82 ± 0.16, left rest: 0.87 ± 0.21, right bite: 1 ± 0.22, left bite: 1.04 ± 0.28) compared to group P1 (right rest: 0.63 ± 0.19, left rest: 0.64 ± 0.15, right bite: 0.87 ± 0.16, left bite: 0.88 ± 0.14). Between P3 and CG (right rest: 1.02 ± 0.19, left rest: 1 ± 0.19, right bite: 1.18 ± 0.22, left bite: 1.16 ± 0.22) there was a significant difference on the right side of the muscle (P < 0.05) in both situations and on the left side at rest.

Conclusion

The proposed treatment resulted in improved masseter muscle thickness in patients with class III dentofacial deformity.     

Brown tumor of secondary hyperparathyroidism: surgical approach and clinical outcome

Background

Secondary hyperparathyroidism is a frequent complication of chronic renal failure. The brown tumor is an unusual presentation of fibrous osteitis that represents a serious complication of renal osteodystrophy, affecting predominantly the hands, feet, skull, and facial bones.

Case report

The aim of this paper is to describe the case of a 53-year-old female patient, with renal failure who has been on dialysis for 6 years and developed severe secondary hyperparathyroidism and brown tumor of the maxilla and mandible, confirmed by incisional biopsy. Parathyroidectomy was indicated as a result of rapid growth of the tumor and the maintenance of laboratory findings. Despite the normalization of serum parathyroid hormone and alkaline phosphatase, tumor regression was slow and patient’s important functional and esthetic deficits persisted. Excision of the mandible tumor was conservative. Osteoplasty was recommended because during a 5-year follow-up there was regression of the lesion, decreased pain, bleeding, and tooth mobility.