The Dissociation of Edta and Edta-Sodium Salts

Abstract

Objective. This is a questionnaire study aimed to collect information from Turkish dentists and oral and maxillofacial surgeons concerning common occupation-related health problems, their knowledge about these problems and the precautions they commonly took. Study design. This study involved a postal questionnaire survey of oral and maxillofacial surgeons and other dentists working in various regions of Turkey in both public and private dental institutions in 2010. Results. A total of 608 dentists (337 female, 271 male) were included in the study group and evaluated for musculoskeletal complaints. The mean age of participant was 27.63 ± 9.5, ranging from 22–63 years old. Working position is very important for development of pain. This study exhibited that a significant proportion of dentists with pain worked in standing or sitting alternately working positions (p < 0.001). This study found that 39% of dentists worked in standing position with loading on the right foot, 14.6% loading on left foot and 46.4% loading on both the right and left foot alternately to balance their body weights. It was found that 57% of respondents had worked with a dental assistant and 43% had not. Conclusion. In this study, it was found that musculoskeletal complaints were most frequently seen at dentists and oral and maxillofacial surgeons who have long working hours per day, working in sitting or standing positions alternately and intermittent working designs.     

The role of prosthetic,orthodontic and implant-supported rehabilitation in the management of secondary malocclusion to maxillofacial trauma- A systematic review

PurposeDifferent approaches have been proposed to treat malocclusion secondary to the treatment of maxillofacial trauma. This study aimed to investigate the efficacy of prosthodontic treatment, orthodontic treatment, and implant-supported rehabilitation for the management of secondary malocclusion after maxillofacial trauma.Study selectionWe searched five electronic databases and hand searched eight journals. The types of studies included were randomized controlled trials, cohorts, case–controls, and case series with at least eight patients with maxillofacial trauma and postoperative malocclusion. These studies used prosthetic treatment and implant-supported rehabilitation for secondary malocclusion after maxillofacial trauma. Risk of bias of eligible studies to be included in the final analysis was assessed independently by two authors using a tool for methodological quality assessment and synthesis of case series and case reports.ResultsAfter initial screening and identification of titles and abstracts, full text of 44 articles were found and evaluated against inclusion criteria. Of these 42 articles were excluded and remaining two were included in the review. Both the studies were case series with moderate to high risk of bias.ConclusionsBoth prosthetic treatment and implant-supported rehabilitation have the potential to restore secondary malocclusion after maxillofacial trauma. However, because less number of well-designed studies with high risk of bias were included in this systematic review, the findings should be interpreted with caution. Well-designed high-quality studies are required to draw definitive conclusions.     

Patterns and etiology of maxillofacial fractures in Riyadh City,Saudi Arabia

ObjectiveThe aim of the present study was to study the etiologies and patterns of maxillofacial fractures in patients treated in Riyadh City, Saudi Arabia, between 2007 and 2011.Patients and methodsData were obtained through a retrospective review of 237 patients admitted to the King Saud Medical City Dental Department with a diagnosis of maxillofacial trauma. After excluding patient files with incomplete or unclear records, and cases in which computed tomography showed no evidence of fracture, the files of 200 patients with a diagnosis of maxillofacial fracture were included in the study. For each case, patient’s sex and age, pattern of facial fractures, and cause of injury were recorded on a data sheet. The data were transferred to an SPSS (ver. 16.0; SPSS Inc., Chicago, IL, USA) spreadsheet for statistical analysis. The chi-square test was used to test the association between two categorical variables or factors (age group, cause) with p value set at p<0.05, and t-test value at <0.05 and independent.ResultsMotor vehicle accidents were the most common cause of maxillofacial fractures in most age groups, especially in males. Within the study sample, mandibular fractures were significantly more common than middle-third facial fractures (56.4% vs. 43.6%; p=0.006). Among mandibular fractures, parasymphyseal fractures were most common (47%), followed by condylar fractures (35.3%). Most (77.2%) middle-third facial fractures involved the zygomatic complex, and the incidence of such fractures differed significantly between male and female patients. p=0.72, not significant.ConclusionMales were more prone to maxillofacial fractures, perhaps as a result of the conservative nature of Saudi society, as the rules of Saudi Arabia do not allow the females to drive. Motor vehicle accidents were the most common cause of maxillofacial fractures in patients aged 10–29 years, indicating the high demand for the application of stricter traffic rules to reduce the rate of such accidents.     

Surgical management of odontogenic cysts involving the maxillary sinus- a retrospective study

ObjectiveTo describe our strategy for the management of odontogenic cysts involving the maxillary sinus, and to define the role of transnasal endoscopic sinus surgery in the treatment algorithm.MethodsA retrospective study was conducted. Included were all consecutive patients with odontogenic cysts involving the maxillary sinus who were treated in a single medical center between 2011 and 2019. Their medical records were reviewed for demographic data, preoperative presentation, surgical approach, final pathology, and postoperative course. Odontogenic cysts were classified as small or large according to maxillary sinus extension within or beyond the alveolar recess, respectively.ResultsA total of 30 patients with odontogenic cysts involving the maxillary sinus were treated by a team of maxillofacial and endoscopic sinus surgeons during the study period. There were 11 cases of dentigerous cysts, 11 radicular cysts, seven odontogenic keratocysts (OKCs), and one glandular cyst. Sixteen cases were managed by transnasal endoscopic sinus surgery alone and 14 were managed by a combined intraoral and endoscopic sinus surgery approach. A total of 22 patients had large cysts and total resection was achieved in 20 of them. There was one case of OKC recurrence during an average follow-up of 31 months. No major complications were recorded.ConclusionsThe endoscopic approach can serve as an alternative to the transalveolar or lateral window approach. The endoscopic approach is associated with low morbidity and low recurrence rates.     

Blood spatter in oral surgery: Prevalence and risk factors

BackgroundOral surgeons are exposed to blood spatter. The authors evaluated the prevalence of and risk factors for blood spatter in facial masks during oral surgery procedures.MethodsThe authors evaluated facial masks and caps of oral surgeons and assistants for blood spatter using the Kastle-Meyer test after different oral surgery procedures. The authors correlated the presence of blood spatter to the clinician, type of surgery, surgery time, and self-awareness of blood spatter, using χ² and t tests.ResultsThe authors analyzed a total of 202 samples and detected blood particles in 46% of the samples in both operators and assistants. The authors observed blood contamination in all types of procedures, and in 4% of the cases, the internal part of the visor was also affected. Clinicians were unaware of the presence of blood spatter in 40% of the cases.ConclusionsThe risk of clinician contamination with blood during tooth extraction and implant placement was 46%. The risk increased with the use of high-speed instruments and longer surgery time.Practical ImplicationsThe use of facial protective devices should be mandatory during oral surgery procedures to avoid blood contamination, especially when rotary devices are used. In many cases, imperceptible blood spatter is present.     

Perception of oral and maxillofacial surgeons,orthodontists and laypersons in relation to the harmony of the smile

ObjectiveHarmony is one of the main objectives in surgical and orthodontic treatment and this harmony must be present in the smile, as well as in the face. The aim of the present study was to assess the perceptions of professionals and laypersons in relation to the harmony of the smile of patients with or without vertical maxillary alterations.Materials and methodsSixty observers (oral and maxillofacial surgeons, orthodontists and laypersons) reported the degree of harmony of six smiles using an objective questionnaire and the participants indicated if there was a need for corrective surgery or not. The classification of observers was recorded on a Likert scale from 1 to 5. Mixed regression was used to determine differences between the three groups.ResultsStatistically significant differences were found only for the harmony of the smile between the oral and maxillofacial surgeons and laypersons, with laypersons being more critical when assessing the smile. There was no statistical difference between the other groups for the harmony of the smile or the indication of corrective surgery. The patterns of greater or lesser harmony determined by observers during the smile were similar to those found in the literature as the ideal standard in relation to vertical maxillary positioning.ConclusionsLaypersons had a tendency to be more critical in relation to facial harmony than surgeons, although no statistical differences were found in the other groups in relation to the harmony of the smile or indication for the corrective surgery. In addition, the patterns of greater or lesser harmony of the smile determined by the participants were similar to those found in the literature as the ideal standard in relation to vertical maxillary positioning. Overall, the present study demonstrates that adequate interaction between surgeons, orthodontists and laypersons is essential in order to achieve facial harmony with orthodontic and/or surgical treatment.Clinical relevanceOpinion of specialists and laypersons about the smile in relation to the vertical positioning of the maxilla.     

Displacement of lower third molar into floor of mouth: a single institutional experience

Purpose

The displacement of the tooth/tooth fragment into the floor of mouth sometimes happens during the lower third molar surgery and the patients are usually referred to oral and maxillofacial surgeons. To date, however, there is no consensus how to manage the displaced tooth due to the lack of available data.

Methods

In this study, we have retrospectively analyzed the management of the displaced lower third molar into the floor of mouth. Our institute experienced seven cases during 2010 to 2020.

Results

Incidence rate of the lingual nerve injury caused by displacement of the lower third molar was 1/7. Six patients out of seven underwent surgical removal of the displaced fragment. The direct approach was used when the fragment was palpable superficially and the fragment was horizontally located away from the lingual plate (2 cases), while when the fragment was not palpable, or was palpable and adjacent to the lingual plate, the lingual mucoperiosteal flap was selected (4 cases).

Conclusion

We conclude that the palpation and preoperative diagnosis with computed tomographic images are significantly important to decide a better and most effective surgical approach.

     

Evaluation of Wound Healing Following Surgical Extractions Using the IPR Scale

ObjectiveTo monitor wound healing following surgical extraction of wisdom teeth using the novel Inflammatory Proliferative Remodeling (IPR) Scale.MethodsA prospective study design was used. Participants included 94 otherwise healthy adult patients undergoing surgical extraction of a wisdom tooth at a tertiary medical centre from June 2018 to June 2019. The IPR Scale was completed by two resident surgeons in oral and maxillofacial surgery at three time points after the procedure, corresponding to the three phases of wound healing. Mean subscale and total scores were calculated. Patients graded their preoperative anxiety, intraoperative pain, and pain during follow-up on a 10 cm visual analog scale, and the findings were correlated with the IPR Scale scores.ResultsMean IPR total score (range 0–16) was excellent (14.43 ± 1.45). Mean scores by healing phase were as follows: inflammatory 6.35 ± 1.34 (range 0–8); proliferation, 4.56 ± 0.8 (range 0–5); remodeling, 2.83 ± 0.51 (range 0–3). There was a positive correlation between mean preoperative anxiety level (5.9 ± 3.6) and intraoperative pain perception (2.4 ± 2.4; P = 0.65) and a negative correlation between mean preoperative anxiety level and IPR Scale scores for each healing phase. Two cases were complicated by abscesses which resolved with treatment.ConclusionThe IPR Scale is a promising tool for the effective evaluation of the wound healing process following wisdom tooth extractions. Relaxation methods and behavioural adaptation might help to lower patient anxiety and thereby improve oral wound healing.     

The use of patient specific polyetheretherketone implants for reconstruction of maxillofacial deformities

PurposeThe aim of this study was to evaluate polyetheretherketone (PEEK) as a patient-specific implant (PSI) material in maxillofacial reconstructive surgery.Materials and methodsThe retrospective study included a cohort of 24 patients who underwent maxillofacial surgery using PEEK PSIs. Each patient underwent preoperative multislice computed tomography (CT) with 0° tilt of gantry. Based on the CT scan, the PEEK PSIs were planned and manufactured using three-dimensional (3D) modeling and computer-aided design/computer-aided manufacturing (CAD/CAM) techniques. All procedures were performed under general anesthesia. Implants were placed intraorally, extraorally or through subciliary, transconjuctival or coronal incisions.ResultsIn 22 of 24 cases, the PEEK PSI fit well without adjustments. Although the fit to the surrounding bone was perfect in almost all of the cases, the outer contour of the PSI was modified in nine cases before fixation. However, intraoperative implant modification did not affect the infection rate. In two cases, postoperative wound dehiscence and infection needed additional treatment and healed without removal of the implants.ConclusionThe follow-up data in this study showed good outcomes with reliable results for PSI made of PEEK in the maxillofacial region.     

Social factors as career obstacles for female oral and maxillofacial surgeons in three Middle Eastern countries

Despite the feminization of dentistry in many areas of the world, female representation in the field of oral and maxillofacial surgery (OMFS) is poor. The purpose of this study was to identify factors perceived by female oral and maxillofacial surgeons in Egypt, Jordan, and Saudi Arabia as being obstacles to their career progression and to compare them to factors identified by their male colleagues. This was a cross-sectional questionnaire-based study. A Google Forms questionnaire was designed to collect data on socio-demographics and perceived career obstacles in OMFS. This was distributed to oral and maxillofacial surgeons in Egypt, Jordan, and Saudi Arabia. Statistically significant differences between the genders were evident in terms of marital status (P = 0.001), spouse’s education (P = 0.005), and spouse’s occupation (P < 0.001). When compared to male surgeons, female surgeons more often considered that their spouse’s occupation hindered their career progression (P < 0.001). Female surgeons, but not male surgeons, perceived sexism and social factors such as marriage, children, and the attitudes of society to be major career obstacles (P < 0.005). In conclusion, female maxillofacial surgeons in some Middle Eastern countries were found to have different socio-demographic characteristics compared to their male colleagues and they considered sexism, marriage, children, and the attitudes of society to be major career obstacles.     

Evaluation of soft tissue prediction accuracy for orthognathic surgery with skeletal class III malocclusion using maxillofacial regional aesthetic units

Objectives

This study aimed to evaluate the soft tissue prediction accuracy of patients undergoing orthognathic surgery to correct skeletal class III malocclusion using maxillofacial regional aesthetic units.

Materials and methods

Pre- and postoperative cone-beam computed tomography (CBCT) and 3D facial scans were taken for 58 patients who had undergone orthognathic surgery. The preoperative 3D facial scan was integrated with the preoperative CBCT using ProPlan CMF software. The software simulated the surgery and generated postoperative soft tissue prediction. The simulated 3D facial scan was then compared with the actual 3D facial scan obtained at least 6 months after the surgery by the maxillofacial regional aesthetic units and the facial soft tissue landmark points.

Results

The anatomical regions of the upper lip, lower lip, chin, right external buccal and left external buccal prediction were above 2.0 mm. As for the soft tissue landmarks, at chl, chr, ls, stm and li, the position of predicted scan was higher than that of the actual postoperative scan.

Conclusions

The accuracy of 3D soft tissue predictions using ProPlan CMF software in Skeletal III patients was clinically satisfactory according to maxillofacial regional aesthetic units combined with facial soft tissue landmark points. However, the accuracy of prediction still needed improvement in some areas.

Clinical relevance

The accuracy of soft tissue prediction can be analyzed more clearly through maxillofacial regional aesthetic units so that clinicians have a deeper understanding of the use of the software to predict soft tissue change after orthognathic surgery.

     

Quality of life following maxillofacial trauma in the elderly: a multicenter,prospective study

Background/aims

When facial trauma involves elderly patients, the possible presence of frailty and comorbidities in victims of trauma may worsen the posttraumatic symptoms and decrease quality of life. The aim of this multicenter study was to assess the quality of life following surgical or non-operative management of maxillofacial trauma in elderly patients.

Materials and methods

This cohort study was based on the administration of validated self-administered questionnaires to all the geriatric patients (70 years or more) with facial fractures from the involved maxillofacial surgical units across Europe, since 1st January 2019 to 31st June 2019. The following questionnaires were administered: SF36 questionnaire; the VFQ-25 questionnaire; the Oral Health Impact Profile – 14 (OHIP14). Outcome variables were VFQ-25 and OHIP-14 results.

Results

A total of 37 patients (14 male and 23 female patients) met the inclusion criteria and were included in the study. Elderly patients had an improvement in almost all the categories examined by the SF-36 questionnaire 6 months after trauma, with the only exception of a worsening as for role limitations due to physical health. An improvement was observed in almost all the categories at SF-36 test. A worsening of scores of OHIP-14 for all the considered dimensions in the whole study population was observed too.

Conclusions

Elderly patients following facial trauma experience significant emotional, social, and functional disturbances. We observed that emotional problems, energy/fatigue, social functioning, and generally social limitations played a great role in the decrease of QoL in elderly patients following maxillofacial trauma.

     

Virtual surgery simulation in orbital wall reconstruction: Integration of surgical navigation and stereolithographic models

PurposeCorrection of post traumatic orbital and zygomatic deformity is a challenge for maxillofacial surgeons. Integration of different technologies, such as software planning, surgical navigation and stereolithographic models, opens new horizons in terms of the surgeons' ability to tailor reconstruction to individual patients. The purpose of this study was to analyze surgical results, in order to verify the suitability, effectiveness and reproducibility of this new protocol.MethodsEleven patients were included in the study. Inclusion criteria were: unilateral orbital pathology; associated diplopia and enophthalmos or exophthalmos, and zygomatic deformities. Syndromic patients were excluded. Pre-surgical planning was performed with iPlan 3.0 CMF software and we used Vector Vision II (BrainLab, Feldkirchen, Germany) for surgical navigation. We used 1:1 skull stereolithographic models for all the patients. Orbital reconstructions were performed with a titanium orbital mesh. The results refer to: correction of the deformities, exophthalmos, enophthalmos and diplopia; correspondence between reconstruction mesh positioning and preoperative planning mirroring; and the difference between the reconstructed orbital volume and the healthy orbital volume.ResultsCorrespondence between the post-operative reconstruction mesh position and the presurgical virtual planning has an average margin of error of less than 1.3 mm. In terms of en- and exophthalmos corrections, we have always had an adequate clinical outcome with a significant change in the projection of the eyeball. In all cases treated, there was a complete resolution of diplopia. The calculation of orbital volume highlighted that the volume of the reconstructed orbit, in most cases, was equal to the healthy orbital volume, with a positive or negative variation of less than 1 cm³.ConclusionThe proposed protocol incorporates all the latest technologies to plan the virtual reconstruction surgery in detail. The results obtained from our experience are very encouraging and lead us to pursue this path.     

Impact of cone-beam computed tomography for the identification and management of an oral portal of entry in patients with infective endocarditis. A Delphi study

Background Infective endocarditis (IE) is a rare and life-threatening disease. Cutaneous portal of entry (POE) is predominant for IE, but an oral POE is the second most frequent source. Thus looking for and treating an oral POE in IE patients is of critical importance in order to reduce the risk of IE relapse or recurrence. The objectives of this study were: 1) To reach a consensus on decision-making following the detection of an oral POE on cone-beam computed tomography (CBCT) while they were not identified using the current recommended approach in IE patients (oral examination and orthopantomogram: OPT). 2) To determine whether this consensus differs when regarding the microbiology of IE.Material and Methods Twenty oral or maxillofacial surgeons participated to this Delphi study. The questionnaire was based on five radiological cases (OPT and matching CBCT) with two scenarios according to the objectives of detecting oral POE in an IE patient (curative in case of oral causative microorganism, and preventive if not) and different therapeutic approaches (surgical or conservative treatment, no treatment) for each of them. Consensus was defined as an agreement rate of ≥75%.Results The response rate was≥85%. After four rounds, consensus was achieved for all proposals. CBCT changed the decision-making of experts in four cases. In one case, the decision was influenced by the IE microbiology toward a more radical approach in case of oral causative microorganism.Conclusions In IE patients, CBCT changed markedly the decision-making of experts by eradicating more oral POE than when using OPT. This could reduce the risk of IE relapse and recurrence. Key words:Cone beam computed tomography, orthopantomogram, clinical decision-making, oral infectious foci, infective endocarditis, Delphi study.     

Cervical Spine Injuries and Maxillofacial Trauma: A Systematic Review

ObjectivesIdentify specific maxillofacial trauma patterns associated with cervical spine injuries.MethodsThe protocol was developed according to (PRISMA-P) and was admitted to PROSPERO under accreditation code #CRD42020177816. Furthermore, the reporting of the present SR was conducted based on the PRISMA checklist.ResultsOf the 1,407,750 patients recorded, a total of 115,997 patients (12.13%) had MFF with an associated CSI with a gender proportion (M:F) of 3.63:1 respectively. Motor vehicle accident was the most common cause of the combined Maxillofacial Trauma (MFT) and CSI. The most common CSI location was at the C2, followed by the C5 cervical spines. The most common location of a maxillofacial fracture resulting in a CSI was the mandible.ConclusionThe incidence of the association of CSIs with MFT has been low (12.13%). Nevertheless, in cases of an isolated mandibular trauma due to a severe blow presenting with a low Glasgow Coma Scale, maxillofacial surgeons should be at a high alert of an associated CSI.     

Maxillofacial Injuries as an Occupational Hazard of Farming in Rural and Semi-urban Population: A 3-Year Retrospective Epidemiological Study

PurposeThe aim of the retrospective study is to conduct an epidemiological evaluation of farm-based/farm-related maxillofacial injuries to assess the pattern and severity of maxillofacial injuries sustained and to formulate prevention strategies.Materials & MethodIn this analytical retrospective study, records/case sheets of patients presenting with trauma sustained in farm-based settings in a government hospital catering to rural and semi-urban population from January 2014 to Dec 2017 were analyzed to assess the incidence, pattern, etiology and trauma configurations of maxillofacial injuries sustained.ResultsOut of a total of 11,736 trauma cases, 2484 patients suffered injuries in farm-based settings. Out of these, 334 patients had maxillofacial injuries. Mandibular condylar fracture along with parasymphysis fracture was the most common fracture configuration. Injuries while working with non-motorized machinery followed by working around farm livestock were the most common etiological factors in farm-related trauma.ConclusionMaxillofacial injuries account for a significant percentage of injuries suffered in a farm-related environment. Through this study, we have identified the patterns of maxillofacial injuries occurring in such an environment, and the data thus obtained can be used to develop various ergonomic and safety interventions in terms of machinery design and handling along with implementation of training programs and enforcing strict safety guidelines to minimize maxillofacial trauma in farm-based settings.     

Career perceptions of young academic oral and maxillofacial surgeons.

PURPOSE: To evaluate the perceptions and motivation of young full-time academic oral and maxillofacial surgeons who chose a career in academia and their experiences as faculty members. MATERIALS AND METHODS: An 11-item questionnaire was sent to the chairman of all nonmilitary American Dental Association-accredited oral and maxillofacial surgery training programs (total of 90 training programs), requesting that this questionnaire be completed by all full-time faculty who completed surgical residency between 1997 and 2003. RESULTS: Forty-eight completed surveys were included in this study. CONCLUSIONS: The primary motivation to pursue a career in academic oral and maxillofacial surgery was the opportunity to perform major maxillofacial surgery, closely followed by a desire to teach dental students and surgical residents. Most respondents noted that they had the opportunity to pursue a faculty practice, and most believed that they worked in a supportive environment. However, several noted that they did not have faculty practice opportunities, and most did not have protected time to carry out research, administrative, or other scholarly activities.     

Importance of anatomy in dental implant surgery

BackgroundThe knowledge of nerves and vessels in the maxillofacial region, particularly the anatomical structures in the maxilla, mandible, tongue muscles, and salivary glands, is essential for dental surgeons. In addition, the structures in the mandibular canal, palate, and maxillary sinus should be understood well.HighlightThe arteries and nerves in the maxillofacial region were observed in this study. Some variations in the origin of the inferior alveolar artery were found. Notably, the variations in the origin of the inferior alveolar artery from that of the external carotid artery and a double origin of the inferior alveolar artery were observed. Thus, the maxillary artery may originate from the external carotid and stapedial arteries. The following points are important. (1)The greater palatine artery is always located deeper than the greater palatine nerve. (2)The posterior superior alveolar artery often runs through the compact bone of the maxilla. Using CT scans, the canal of the artery can be observed. (3)Variations in origins of the inferior alveolar artery have been observed. The origin of the inferior alveolar nerve may differ depending on the course of the maxillary artery.ConclusionsDental practitioners should, therefore, have a comprehensive knowledge of the anatomy of the maxillofacial region and its variations. Without this knowledge, they should not operate on patients.