The efficacy of intra-articular injectable platelet-rich fibrin application in the management of Wilkes stage III temporomandibular joint internal derangement

The aim of this retrospective study was to compare the effectiveness of hyaluronic acid (HA) and injectable platelet-rich fibrin (i-PRF) in the management of Wilkes stage III internal derangement, and to evaluate the biosupplementation capacity of i-PRF. The records of all 54 relevant patients with Wilkes stage III internal derangement confirmed by magnetic resonance imaging and treated with arthrocentesis alone or in combination with HA or i-PRF were selected. The outcome variables were pain intensity at rest (VASr) and in function (VASf), evaluated with a visual analogue scale, and maximum mouth opening (MMO), evaluated in millimetres; assessments were made preoperatively, immediately after the procedure, and at 1 week, 1 month, and 3 months postoperatively. When compared to the HA and arthrocentesis groups, the i-PRF group showed significantly better improvements in MMO at 1 and 3 months (P = 0.024 and P = 0.006, respectively), VASr at 1 and 3 months (both P < 0.001), and VASf at 1 week (P = 0.019) and 1 and 3 months (both P < 0.001) postoperatively. In all groups, better MMO, VASr, and VASf values were observed compared to the preoperative status. The application of i-PRF after arthrocentesis is more effective than arthrocentesis alone or with HA in the short term. HA was found not to provide significant additional benefits over arthrocentesis alone.     

Efficiency of arthrocentesis treatment for different temporomandibular joint disorders

This study was performed to determine whether arthrocentesis therapy has different outcomes in three groups of patients with different temporomandibular disorders (TMDs). A clinical trial was conducted including 45 patients with 45 unilaterally affected joints divided into three groups (n = 15): osteoarthritis (OA), disc displacement with reduction (DDWR), and disc displacement without reduction (DDWoR). All patients underwent the same arthrocentesis treatment protocol. The outcome variables, including visual analogue scale evaluations and measurements of mandibular motion (in millimetres), were recorded at baseline and at 1 and 6 months postoperative. Inter-group assessments showed significant short-term differences in joint sounds (P = 0.016) and significant long-term differences in masticatory efficiency (P = 0.046) and protrusive movement (P = 0.048). The estimation of mean changes between baseline and long-term follow-up revealed significant differences in joint sounds (P < 0.001), disruption in daily activities (P = 0.002), maximum mouth opening (P = 0.008), and protrusive movement (P = 0.002) between the groups. Arthrocentesis therapy may be useful to improve clinical symptoms and range of mandibular movement in patients with all three types of TMD. However, the benefit of arthrocentesis may be greater for patients with DDWoR than for those in the other groups.     

Comparison of intraoperative outcomes with single and double puncture techniques of arthrocentesis of the temporomandibular joint

Evidence of differences in operator-related outcomes between single and double puncture arthrocentesis is limited. The purpose of this prospective study was to compare intraoperative outcomes with single puncture types 1 and 2, and double puncture, arthrocentesis. A total of 59 patients with 60 temporomandibular joints (TMJ) were treated sequentially by single puncture type 1 (n = 20), single puncture type 2 (n = 20), and double puncture arthrocentesis (n = 20). Total operating time, incidence of dislocation of the needle, preauricular swelling, and ease of operation were compared. Single puncture type 2 arthrocentesis took significantly less time than type 1 (p < 0.0001) or double puncture arthrocentesis (p < 0.0001), but there was no difference in operating time between single puncture type 1 and the double puncture technique (p = 0.25). There were significantly fewer dislocations of the needle with single puncture type 1 (p = 0.041) and single puncture type 2 (p = 0.033) than with double arthrocentesis. Single puncture type 2 arthrocentesis was easier than the single puncture type 1 (p = 0.001) or double puncture technique (p < 0.0001). Extravasation of fluid caused swelling in seven patients after double puncture, and in three patients each after single puncture types 1 and 2, arthrocentesis. Our results indicate that the single puncture type 2 technique is easiest and requires the least operating time. There was no difference between single puncture type 1 and double puncture arthrocentesis in terms of operating time or ease of the procedure. There were fewer operative dislocations of the needle with the single than with the double puncture technique.     

Does glucosamine,chondroitin sulfate,and methylsulfonylmethane supplementation improve the outcome of temporomandibular joint osteoarthritis management with arthrocentesis plus intraarticular hyaluronic acid injection. A randomized clinical trial

The purpose of this study was to compare clinical outcomes obtained with the use of glucosamine, chondroitin sulfate, and methylsulfonylmethane (GCM) supplementation after arthrocentesis plus intraarticular hyaluronic acid (HA) injection.A randomized clinical trial was implemented with adult participants with TMJ-OA who were referred to the author’s clinic between February 2014 and May 2015. The sample was entirely composed of patients with TMJ-OA who were treated randomly with a one-session arthrocentesis plus intraarticular HA injection only (control group), or an initial one-session arthrocentesis plus intraarticular HA injection followed by 3 months of GCM supplementation (study group). The predictor variable was management (treatment) technique. The outcome variables were visual analog scale evaluations (masticatory efficiency, pain complaint, joint sound) and mandibular mobility (maximal interincisal opening [MIO], and lateral and protrusive motions of the mandible). The outcome variables were recorded preoperatively and 12 months postoperatively.Thirty-one participants were enrolled in the study. Five were lost during follow-up. The final study sample consisted of 26 participants (age 28.35 ± 10.85 y): 14 in the control group (age 28.71 ± 10.94 y); and 12 in the study group (age 27.92 ± 11.20 y). Pain complaints (p < 0.001) and joint sounds (p = 0.030 for the control group; p = 0.023 for the study group) showed statistically significant decreases. Masticatory efficiency (p < 0.001 for the control group; p = 0.040 for the study group) and lateral mandibular motion (p = 0.040 for the control group; p = 0.004 for study group) showed statistically significant increases in both groups, whereas MIO and protrusive mandibular motion showed no significant changes in either group (p > 0.05). After estimating the differences between the follow-up and baseline outcomes, the mean changes in the primary outcome variables (VAS scores, MIO, and mandibular motion) showed no statistically significant differences between the two groups (p > 0.05).Progressions (reparative remodeling) of hard-tissue TMJ structures were observed on CBCT scans of some participants in both groups.These findings suggested that the use of GCM supplementation after arthrocentesis plus intraarticular HA injection produced no additional clinical benefits or improvements for patients with TMJ-OA compared with arthrocentesis plus intraarticular HA injection alone.     

Evaluation of the efficacy of celecoxib and ibuprofen on postoperative pain,swelling, and mouth opening after surgical removal of impacted third molars: a randomized,controlled clinical trial

The objective of this study was to compare the efficacy of celecoxib and ibuprofen in reducing postoperative sequelae following the surgical removal of impacted mandibular third molars. Ninety-eight subjects who needed surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly allocated to receive one of the following treatments twice a day for 5 days after surgery: placebo (n = 32), ibuprofen (n = 33), or celecoxib (n = 33). The primary outcome chosen was postoperative pain, which was evaluated using the visual analogue scale (VAS) score recorded by each patient. The secondary outcomes chosen were changes in postoperative swelling and maximum mouth opening values compared to preoperative ones. Compared to placebo, treatment with celecoxib and ibuprofen resulted in improvements in the primary outcome. Furthermore, when compared to the other groups, patients in the celecoxib group showed a significant reduction in postoperative pain scores at 6 h (P < 0.001), 12 h (P = 0.011), and 24 h (P = 0.041) after surgery. Regarding swelling and maximum mouth opening values, there were no significant differences between the groups at each follow-up session. This study demonstrated that treatment with celecoxib decreased the incidence and severity of postoperative pain following third molar surgery compared to ibuprofen and placebo.     

Airway changes and prevalence of obstructive sleep apnoea after bimaxillary orthognathic surgery with large mandibular setback

This study used three-dimensional computed tomography and polysomnography to evaluate the effect of a large mandibular setback on the postoperative pharyngeal airway space and obstructive sleep apnoea (OSA). Twelve patients who underwent bimaxillary surgery for a mandibular setback movement of >9 mm were included in this study. Changes in the pharyngeal airway space and polysomnography parameters based on the surgical movements were analyzed. The median mandibular setback movement was 11.08 mm. The total pharyngeal, oropharyngeal, and hypopharyngeal volumes, and the retroglossal cross-sectional area were significantly decreased postoperatively (P = 0.006; P = 0.005; P = 0.012; P = 0.005, respectively). The apnoea–hypopnoea index (AHI) increased significantly after surgery (P = 0.021). There were significant positive correlations between the preoperative inferiorly located hyoid bone and both AHI and respiratory disturbance index (RDI) postoperative (P = 0.008 and P = 0.027) and between the postoperative inferiorly dislocated retropalatal level and both AHI and RDI postoperative (P = 0.002 and P = 0.014). Four patients (33.3%) developed new onset OSA postoperatively. Large mandibular setback movements significantly reduced the pharyngeal airway space in the setting of bimaxillary surgery (P = 0.006).     

Clinical outcomes of lingual nerve repair

Lingual nerve injury, a well-described complication of third molar removal, may result in permanent lingual sensory deficit leading to symptoms including lost or altered sensation, inadvertent tongue biting, and the development of unpleasant neuropathic pain, with consequent impaired quality of life. We analysed outcomes of a prospective case series to determine whether direct anastomosis of the lingual nerve results in improved sensory recovery and reduced neuropathic pain, and whether delayed surgery is worthwhile. In 114 patients who underwent nerve repair at our nerve injury clinic following damage sustained during mandibular third molar removal, sensory deficit was assessed before and after surgery using a questionnaire and visual analogue scales (VAS) to assess pain, tingling, and discomfort. Neurosensory tests were utilised to evaluate light touch, pin-prick, and two-point discrimination thresholds. Subjectively, 94% patients felt their sensation had improved following nerve repair, with significant reductions in the incidence of tongue biting (p < 0.0001), impaired speech (p < 0.0001), and neuropathic pain (p = 0.0017). Quantitative neurosensory data showed highly significant improvements in light touch, pin-prick, and two-point discrimination (all p < 0.0001), and VAS scores for pain (p = 0.0145), tingling (p < 0.0025), and discomfort (p < 0.0001) were significantly reduced. Patients with high levels of pain preoperatively (VAS > 40) showed highly significant reductions in pain (p < 0.0001). No correlation was found between surgical outcome and patient’s age or delay until surgery. Lingual nerve repair results in good sensory outcomes and significant improvements in the incidence and degree of neuropathic pain, even when delayed.     

Bilateral sagittal split osteotomies versus mandibular distraction osteogenesis: a prospective clinical trial comparing inferior alveolar nerve function and complications

The aim of this study was to conduct a prospective clinical trial comparing the neurosensory function of the inferior alveolar nerve (IAN) after mandibular advancement surgery with either bilateral sagittal split osteotomies (BSSO) or mandibular distraction ostoegenesis (MDO). 23 Class II mandibular hypoplasia patients requiring mandibular advancement were randomized into two groups for either BSSO or MDO. Subjective and objective neurosensory evaluations were performed preoperatively and at the following postoperative times: 2 weeks (TBD1), 6 weeks (TBD2), 12 weeks (TBD3), 6 months (TBD4) and 12 months (TBD5). Subjective evaluation included the use of a visual analogue scale (VAS). Objective evaluation included the use of light touch (LT), two-point discrimination (2PD) and pain detection threshold (PD) tests. Intra-operative or postoperative complications were recorded. Using a mixed model, no significant differences were reported in subjective VAS scores and objective LT, 2PD and PD scores between the BSSO and MDO groups over 12 months (p > 0.05). Common postoperative complications included localized wound infection (BSSO = 2, MDO = 6) and condylar resorption (BSSO = 1, MDO = 1).     

Influence of low-level laser therapy on the healing process of autogenous bone block grafts in the jaws of systemically nicotine-modified rats: A histomorphometric study

ObjectiveTo analyze the influence of low-level laser therapy (LLLT) on the bone healing process of autogenous bone block grafts installed in nicotine systemically modified rats.MethodsSeventy-two rats (Wistar) were randomly assigned into 4 groups (n = 18). SS-BG: saline application + bone graft. SS-BG/LLLT: saline application + bone graft + LLLT. NIC-BG: nicotine application + bone graft. NIC-BG/LLLT: nicotine application + bone graft + LLLT. After 30 days of application of solutions, all animals received autogenous bone block graft in the jaw, with the donation from the parietal bone’s calvarial area. Treatment with LLLT was in bed-graft interface, after accommodation of the graft. The animals in each group were sacrificed at 7, 14, and 28 days after graft surgery.ResultsThe histologic analyses of NIC-BG group depicted a delay of osteogenic activity in the recipient bed-graft interface and the irradiation of tissue with LLLT provided better bone healing. The histometric analysis revealed that SS-BG/LLLT and NIC-BG/LLLT groups showed increased bone formation compared to BG-SS and NIC-BG groups, after 14 days (SS-BG 24.94% ± 13.06% versus SS-BG/LLLT 27.53% ± 19.07% and NIC-BG 14.27% ± 2.22% versus NIC-BG/LLLT 24.37% ± 11.93%) and 28 days (SS-BG 50.31% ± 2.69% versus SS-BG/LLLT 58 19% ± 12.32% and NIC-BG 36.89% ± 8.40% versus NIC-BG/LLLT 45.81% ± 6.03%).ConclusionNicotine harms bone formation in the bed-graft interface and LLLT action can mitigate this.     

Relationship between dental crowding,skeletal base lengths,and dentofacial measurements

ObjectivesThe objectives of this study were to study the correlation between dental crowding, skeletal base lengths, and dentofacial measurements.Materials and methodsPretreatment dental casts and lateral cephalograms of randomly selected 45 Class I orthodontic cases divided into two groups according to the severity of mandibular crowding were evaluated. Group 1 comprised 15 patients with mandibular crowding less than 3 mm while group 2 comprised 30 patients with mandibular crowding of 3 mm or more. Maxillary and mandibular dental crowding and dentofacial measurements were compared between the two groups. For correlations the whole sample was combined to a single group where crowding was used as a continuous variable.ResultsThe only significant difference (p = 0.000) between the two groups was in the amount of dental crowding in the lower arch. Direct moderate correlation (r = 0.45; p = 0.002) between maxillary crowding and mandibular crowding, direct high correlation (r = 0.68; p = 0.000) between maxillary base length (Co-A) and mandibular base length (Co-Gn) and also direct high correlation (r = 0.74; p = 0.000) between maxillary base position (SNA angle) and mandibular base position (SNB angle) were detected. Correlation between maxillary incisor position and facial vertical dimension measured by the MP to SN angle showed inverse moderate correlation. Correlation between mandibular incisor position and the anteroposterior jaw relationship measured by the ANB angle showed direct moderate correlation.ConclusionsResults showed the presence of correlation between the skeletal dimensions and the absence of correlation between dental crowding and the same measurements. Results suggest that dental crowding is independent of the skeletal measurements.     

Donor-site morbidity after fibula free flap transfer: a comparison of subjective evaluation using a visual analogue scale and point evaluation system

The aims of this study were: (1) to compare the visual analogue scale (VAS) with the point evaluation system (PES) in the subjective evaluation of donor-site morbidity after fibula free flap transfer; (2) to compare the functional outcomes of fibula free flap surgery between patients with a normal body mass index (BMI) and patients with a high BMI, and between skin paddle and non-skin paddle harvesting; and (3) to determine the correlation between functional outcomes and related factors. This study included 15 patients who underwent a vascularized fibula free flap transfer for oral and maxillofacial reconstruction. Demographic data, preoperative, intraoperative, and postoperative data were collected. Subjective self-evaluation of functional outcomes was done using a VAS followed by a PES. Comparison of the VAS and PES scores was assessed with Pearson's correlation coefficient. The statistical significance was set at P < 0.05. The VAS score was significantly correlated with the PES score (r = 0.63, P = 0.01). The tourniquet times for the skin paddle group were longer than for the non-skin paddle group (P = 0.02), while the satisfaction score of the non-skin paddle group was higher than that of the skin paddle group (P = 0.03). The VAS is a potential option for the subjective evaluation of donor-site morbidity after fibula free flap transfer.     

A cohort study of patients with juvenile idiopathic arthritis and arthritis of the temporomandibular joint: outcome of arthrocentesis with and without the use of steroids

The purpose of this study was to evaluate the effects of intra-articular temporomandibular joint (TMJ) treatment in patients with juvenile idiopathic arthritis (JIA). The inclusion criteria were met by 21 patients (38 joints). Joints were randomly selected for either arthrocentesis alone (n = 17) or arthrocentesis with the additional use of triamcinolone hexacetonide (n = 21) using a closed single-needle system. Measurements of pain and function were performed at baseline and at follow-up after 3 and 8 months. Pain on opening and lateral excursion improved significantly after injections. Pain decreased significantly from baseline to first and second control on a visual analogue scale (VAS) for overall pain (49–18–8) and overall function (41–19–4). Significant improvement was recorded for pain on palpation of muscles and joints. There was no statistically significant difference between the treatment modalities, with or without glucocorticoid injection. Arthrocentesis in the TMJ treatment of patients with JIA may be beneficial and steroids had no additional effect. Further studies are needed to evaluate the long-term effects on the TMJ structures and on condylar growth from arthrocentesis and intra-articular steroid injections.     

Effects of low-level laser therapy on the proliferation and apoptosis of gingival fibroblasts treated with zoledronic acid

Low-level laser therapy (LLLT) has been indicated as an adjuvant therapy for bisphosphonate-induced osteonecrosis. However, the effects of LLLT on bisphosphonate-treated cells are not yet clear. This study evaluated the effects of LLLT on the proliferation and apoptosis of gingival fibroblasts treated with zoledronic acid (ZA). Cells were exposed to ZA at 5 μM for 48 h. Irradiation was performed using a laser diode prototype (LaserTABLE, InGaAsP; 780 nm ± 3 nm, 25 mW) at 0.5 or 3 J/cm², three times every 24 h. Cell proliferation and apoptosis were evaluated by fluorescence microscopy. Data were analyzed by Mann–Whitney test at the 5% level of significance. ZA decreased cell proliferation to 47.62% (interquartile range (IQR) 23.80–57.14%; P = 0.007) and increased apoptosis of gingival fibroblasts to 27.7% (IQR 20.9–33.4%; P = 0.0001). LLLT increased cell proliferation compared with non-irradiated cells, at 0.5 J/cm² (57.14%, IQR 57.14–71.43%; P = 0.003) and at 3 J/cm² (76.19%, IQR 61.90–76.19%; P = 0.0001), but did not increase cell proliferation in ZA-treated cells. Irradiated fibroblasts presented lower apoptosis rates than the ZA-treated cells, but apoptosis was no different in ZA-treated cells compared to those that were ZA-treated and also irradiated.     

Irrigation fluid volume requirement for conventional arthrocentesis of the temporomandibular joint: a cadaver study

Temporomandibular joint (TMJ) arthrocentesis is considered an effective and minimally invasive procedure for certain conditions related to temporomandibular disorders. The ideal irrigation volume for arthrocentesis lavage has not yet been defined. Therefore, the aim of this study was to evaluate the efficacy of different saline solution volumes in removing methylene blue from the TMJ space of fresh human cadavers. Nineteen cadavers were selected and 1 ml of 10 μM methylene blue solution was injected into the upper joint space unilaterally. Conventional arthrocentesis was then conducted by infusion of 300 ml of 0.9% saline solution, collecting a 1-ml sample from the drained quantity for every 25 ml injected. Finally, the samples were assayed by measuring photo absorbance of the methylene blue solution. There was a statistically significant difference between the irrigation volumes regarding the removal of methylene blue solution from the joint space (P < 0.001), specifically between the first 25 ml and 200 ml (P = 0.014), 225 ml (P = 0.001), 250 ml (P < 0.001), and 275 ml (P = 0.001). Based on this ex vivo study, a 25-ml perfusion volume appears to be sufficient for joint lavage in conventional arthrocentesis of the TMJ.     

Long-term evaluation of single-puncture temporomandibular joint arthrocentesis in patients with unilateral temporomandibular disorders

The purpose of this study was to evaluate the long-term effects of the single-puncture arthrocentesis (SPA) technique. Forty-two patients with unilateral temporomandibular joint disorders (TMDs) were treated by SPA. Thirty-eight of these patients completed 1–24 months of follow-up (short-term group) and 21 completed 11 months or longer of follow-up (long-term group). The two groups were evaluated statistically for pain (visual analogue scale), maximum mouth opening, lateral excursion, and protrusion. Both follow-up duration groups showed significant improvements when compared to baseline levels for almost all of the outcome variables (P < 0.05). Single puncture temporomandibular joint arthrocentesis is an effective treatment method over both the short and long term.     

Cumulative effect of low-level laser therapy and low-intensity pulsed ultrasound on bone repair in rats

Many studies have assessed the effects of either low-level laser therapy (LLLT) or low-intensity pulsed ultrasound (LIPUS) on bone repair; however, an evaluation of the combination of these modalities (LLLT + LIPUS) has not yet been considered. The aim of this study was to demonstrate the effects of LLLT + LIPUS on bone repair. Male Wistar rats (n = 128; four groups of 32) were used; the animals underwent a partial tibial bone osteotomy. One group had the osteotomized limb treated with LLLT, the second group with LIPUS, and the third group with the combined treatment protocols of the LLLT and LIPUS groups; the fourth group received no further treatment (control). Each group was divided into two subgroups for assessment at two different time-points, 14 and 21 days. After the completion of treatment rats were sacrificed and the tibias submitted to a three-point bending test or to histomorphometric analysis. Histological evaluation showed increased bone trabeculae, increased vascularization, and decreased inflammation in the LLLT + LIPUS group. Mechanical evaluation revealed increased biomechanical properties including maximum force, maximum stress, and stiffness, in the LLLT + LIPUS group. Combined LLLT + LIPUS treatment enhanced bone healing both histologically and mechanically, shortening the length of the treatment period, when compared to treatment with LLLT or LIPUS alone.     

Biomechanical effect of asymmetric mandibular prognathism treated with BSSRO and USSRO on temporomandibular joints: a three-dimensional finite element analysis

Asymmetric mandibular prognathism is a clinically common skeletal dentomaxillofacial deformity. Unilateral sagittal split ramus osteotomy (USSRO) is an effective alternative procedure to bilateral sagittal split ramus osteotomy (BSSRO) for some patients. However, the biomechanical effect of temporomandibular joint (TMJ) of USSRO has not been fully studied. This study aims to evaluate the stress distribution changes in the TMJ of asymmetric mandibular prognathism treated with BSSRO/USSRO, to validate the clinical feasibility of USSRO. Nineteen patients with mandibular prognathism patients who were treated with BSSRO (n = 12) and USSRO (n = 7) had preoperative and postoperative computed tomographic scanning. Preoperative and postoperative 3-dimensional finite element analysis (FEA) of functional TMJ movements were made on one BSSRO patient and one USSRO patient. In all patients, the ANB angle and mandibular deviation were significantly improved postoperatively. There was no significant difference in the postoperative ANB angle and mandibular deviation between the BSSRO group and the USSRO group. In two preoperative FEA models, the maximum stresses of non-deviation side TMJ structures were greater than the deviation side during functional movements. The unbalanced stress distribution was corrected postoperatively in both BSSRO/USSRO FE models. Both BSSRO/USSRO can improve the ANB angle and mandibular deviation. The bilateral TMJ structure in patients with asymmetric mandibular prognathism had unbalanced stress, which could be significantly improved with the USSRO as effectively as BSSRO.     

Postoperative pulmonary complications following major head and neck cancer surgery

The primary aim of this observational study was to describe the incidence of postoperative pulmonary complications (PPCs) in 60 consecutive, surgically treated head and neck cancer patients requiring free flap reconstruction and tracheostomy, using both a prospective and a retrospective outcome measure. Secondary aims were to identify risk factors for PPC development, explore the effects of PPC on outcomes, and describe the provision of postoperative physiotherapy in this population. Postoperative pulmonary complications occurred in nine (15%) patients based on the Melbourne Group Scale and 27 (45%) patients based on Health Information Service coding data. The occurrence of a PPC was not statistically correlated with age, smoking history, comorbidities, operative time, or type of resection or free flap. Patients who developed a PPC, compared to those who did not, had a higher preoperative body mass index (P = 0.022) and were more likely to be sat out of bed earlier post-surgery (P = 0.038). Overall, patients required a median of 9.0 (interquartile range 7.0–11.0) physiotherapy sessions. Patients developing a PPC required significantly more physiotherapy sessions (P = 0.007) and additional days of supplemental oxygen (P = 0.022) as compared to those without a PPC, despite a similar hospital length of stay. In future, targeted physiotherapy interventions may reduce PPCs in this population.     

Treatment of mandibular angle fractures – Linea obliqua plate versus grid plate

ObjectivesTo compare treatment outcomes, handling and long term results between two osseo-fixation systems for mandibular angle fractures – the external oblique ridge (external oblique) plate and the grid plate.Material and methodsSixty patients with mandibular angle fracture were analyzed regarding their operative treatment: 30 patients were treated with an external oblique plate and compared to 30 patients treated with a grid plate on the vestibular cortex.The follow up period was at least 1 year for both groups and the following complications were noted: infection, abnormality in fracture healing, nonunion, pain, hypoaesthesia and dysocclusion.ResultsThe overall average operation time (from intubation to extubation) was 102.1 min (±44.1 min). Single sided fractures treated with the grid plate needed in average 81.07 min (±37.9 min) of operation time while single sided fractures treated with the external oblique plate needed 89.3 min (±42.2 min). In multiple mandibular fractures, no significant change in the operation time between either plating system was found (118.8 ± 35.2 min).After the follow up period fracture healing was considered clinically complete in all patients, but complications occurred significantly more often in the external oblique group (13.3%; N = 8) than in the grid plate group (0%; N = 0).ConclusionIsolated mandibular angle fractures can be more effectively treated using grid plates than using other osteosynthesis techniques. It is an easy to use alternative to conventional miniplate systems with good clinical outcome and fewer complications. An angulated burr and screwdriver has to be used to put on the plate laterally.     

The use of existing denture-satisfaction ratings for a diagnostic test to indicate prognosis with newly delivered complete dentures

PurposeThe study investigated the relation between subjective satisfaction ratings of existing dentures and outcomes of newly delivered dentures, and the ability of the diagnostic test, using existing ratings, to indicate prognosis with newly delivered dentures.MethodsConsecutive 165 edentulous patients were recruited from November 2001 to August 2006 at a university-affiliated hospital. Dentures were fabricated with an acrylic base with full-balanced occlusion using hard resin artificial teeth by multiple prosthodontists. At the baseline and 3-month after delivery, patients rate their overall, maxillary, and mandibular satisfaction for existing and replaced dentures on a 100-mm visual analogue scale (VAS). The association between baseline ratings and newly delivered dentures was analyzed by regression analysis. The test's performance was measured by constructing a two-by-two table; patients with the following cutoff values on the VAS (overall: ≤31; maxillary: ≤47; mandibular: ≤36) were considered unsatisfied with existing or new dentures. Relative validity of the diagnostic tests was assessed by means of sensitivity, specificity, and likelihood ratios.ResultsMandibular dentures showed a significant association between baseline and new dentures (coefficient = 0.27, p = 0.01). Results of test measures for overall, maxillary, and mandibular existing dentures were 71%, 38%, and 87% (sensitivity); 62%, 66%, and 49% (specificity); and 1.1, 1.9, and 1.7 (positive likelihood), and 0.5, 1.0, and 0.2 (negative likelihood).ConclusionsTest performance indicates that the negative (satisfied) result for mandibular existing dentures may be useful to rule out the unsatisfied patients with new mandibular dentures.