Immediate Loading of Palatal Implants in Stillgrowing Patients: a Prospective, Comparative, Clinical Pilot Study

OBJECTIVE: The objective of this prospective, comparative study was to evaluate the potential of allowing immediate (within 72 hours) loading of palatal implants used for maximum orthodontic anchorage. This is in contrast to the standard protocol calling for a healing period of 12 weeks. MATERIALS AND METHODS: Sixteen patients with a mean age of 14.22+/-1.37 years for whom orthodontic treatment with maximum anchorage was indicated were randomized into two groups. In the SB (immediate loading) group (n=8, mean age 14.15+/-1.2 years), the implants were employed to provide maximum anchorage for a 1.2 x 1.2 mm TPA wire in combination with a molar band within 72 hours of insertion. In the KB (conventional loading) group (n=8, mean age 14.30+/-1.57 years), the implants were not used for maximum anchorage until a 12-week healing period had elapsed. Patients in both groups with implants that were clinically unstable after insertion were excluded from the study. After conclusion of the treatment, the implants were explanted and embedded using the sawing-grinding technique after Donath. Bone-implant contact (KIK) was analyzed using Bioquant Osteo software version 7.10.10. RESULTS: The objective of the orthodontic treatment, to achieve maximum anchorage of the first molars, was achieved in both groups. In the SB group, the mean bone-implant contact was 55.0%+/-21.6. In the KB group, the mean bone-implant contact was 73.1%+/-19.8. With a p-value of 0.1661, the difference between the bone-implant contact values was not statistically significant. CONCLUSION: The results of our clinical study demonstrate that when implants are clinically stable following insertion, it seems that a 12-week healing phase during which the implants are not loaded leads to a non-statistically significant improvement in osseointegration.     

Bilateral bifid mandibular condyle: case report and literature review

Bifid mandibular condyle is an infrequent and normally asymptomatic morphological alteration of the mandibular condyle. Although the underlying cause is not clear, a number of theories have been proposed, including teratogenic effects in the embryo, vascular alterations during condyle development, and condylar remodeling following fracture. Since Schier first described this anomaly in 1948 in live individuals, further cases have been documented in the literature. We present a new case of bilateral bifid condyle. The disorder was asymptomatic and constituted a casual finding in a young male presenting for the surgical extraction of two impacted molars.     

Hämangioperizytom (extrapleuraler solitärer fibröser Tumor)

Background

Hemangiopericytoma was first mentioned in 1942. It is a very uncommon potentially malignant vascular tumour which can occur at every site of the body. According to the WHO, most of the tumours formerly diagnosed as hemangiopericytomas are considered to be extrapleural solitary fibrous tumours. The diagnosis of “hemangiopericytoma” is now only determined if a constant histological picture of hemangiopericytoma is present. The tumour can lead to lymphogenous or hematogenous metastasis. The major location of occurrence is the cutis and subcutis. It originates from the pericytes of the vascular wall. This is reflected in its vascular character and therefore the hemangiopericytoma might clinically be mistaken for a hemangioma.

Case reports

Patient 1: 60 years, female; diagnosis: malignant subocciptal hemangiopericytoma; size: 4.9×4.5×4.2 cm; pT1bNXMX L0 V0 Pn0; stage IA; grading G1; R0. Patient 2: 38 years, male; diagnosis: benigne hemangiopericytoma infraorbital left; size 1.5×1.5×1.5 cm

Discussion

Most often the hemangiopericytoma becomes clinically conspicuous as a slowly growing, painless swelling. The consistency ranges from soft to dense, and the color is greyish-blue. The slow and painless growth carries the danger of a clinically wrong diagnosis and thus delayed therapy. The histological diagnosis of hemangiopericytoma is determined by biopsy. Besides histology, MRI and angiography are methods that can be employed to diagnose hemangiopericytoma. The therapy of choice is the complete tumour-resection with a safety margin of 1 cm. In the case of an aggressive growth pattern, adjuvant postoperative radiotherapy is recommended. Until now there has been no documented specific therapy concept for managing incomplete resection and the occurrence of metastasis. There are reports about chemo- and radiotherapy either on their own or combined which evidence differing degrees of success. Lifelong monitoring is necessary because recrudescences and metastases can occur even decades later.     

Versorgung von Jochbeinfrakturen über einen transkonjunktivalen Zugang mit lateraler Kanthotomie unter Schonung des lateralen Lidbandes

Introduction

This study reports on a modified approach to treat zygomatic fracture. For the surgical approach, a transconjunctival incision and, instead of a lateral canthotomy, a superficial incision of the skin and subcutaneous tissue was used, preserving the lateral ligament. The results are compared with those of previous techniques, especially the subciliary incision.

Patients

In a prospective study, 30 patients (9 females and 21 males, mean age 32.1 years) with zygomatic fractures were operated using this approach. Mean follow-up time was 6 months after removal of the plates. Fractures were caused by trauma due to fighting, bicycle falls, or sport accidents. Follow-up radiographs were used to evaluate the position of the zygoma after reduction and rigid fixation.

Results

Reduction and rigid fixation of the fractures were possible to perform in all cases. The access to the orbital floor and the exposure of the inferior and lateral rim were satisfactory and an additional latero-orbital cut was not necessary. The disadvantage of the complete incision of the lateral ligament with the necessity of intraoperative refixation and possible ectropium of the eyelid could be avoided. Injuries or infections of the cornea or the bulbus did not occur. Postoperative complications such as scar formation resulting in entropium or ectropium were not seen.

Conclusion

These results show that the transconjunctival approach with lateral superficial incision preserving the lateral ligament for treatment of zygomatic fractures is satisfactory in all cases of rigid fixation of both inferior and lateral rims. Because of its esthetic and functional advantages this approach has become standard in our department.     

Differenzielle und gemeinsame Merkmale bei Patienten mit atypischem Gesichtsschmerz und kraniomandibularer Dysfunktion

Background

Craniomandibular disorders (CMD) and atypical facial pain (AFP) represent a clinical challenge. Whereas CMD patients respond to somatic approaches, somatization should be strictly avoided in AFP. The aim of this study was to establish prognostic criteria to identify an aggravated risk of a chronic course in CMD and AFP.

Method

A total of 124 consecutive patients with CMD (n=108) or AFP (n=16) were examined by two interdisciplinary academic pain centers. Psychometric evaluation was conducted with standardized questionnaires (SCL-90R, STAXI, modified SBAS-IV). All patients were clinically assessed by a maxillofacial surgeon or specialized dentist.

Results

The following variables proved to be significant: age (risk for AFP vs CMD increased by 6% p.a.), decreased dysfunction index (13% higher risk for AFP vs CMD), and low scores concerning outwardly directed anger (12% higher risk for AFP vs CMD). There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor (p<0.001) for patients presenting high initial pain with a marked discrepancy between somatic findings and subjective status.

Conclusions

CMD patients differ from AFP patients regarding age, psychosocial isolation, outwardly directed anger, and a decreased dysfunction index. Additionally, initial pain intensity in patients presenting indistinct CMD/AFP can be considered as a valid predictor for a chronic course in pain.     

Exfoliative cytology in clinical oral pathology

Exfoliative cytology is a rapid, non-invasive procedure for assessing dysplastic change within the oral epithelium. The indications for oral exfoliative cytology are reviewed and a technique for cell collection and smear examination is presented. The value of exfoliative cytology in oral cancer screening programmes as a public health measure is discussed.     

Sprach- und Sprechleistungen bei 417 Kindern mit Spaltbildungen

Zusammenfassung Spaltpatienten haben häufig Hör- und Sprachstörungen. Um ein effizientes Rehabilitations-programm zu erstellen, müssen Spätergebnisse der verschiedenen Behandlungsarten, einschließlich der Velopharyngoplastik und Sprachtherapie, vorliegen und ausgewertet werden.Im Rahmen dieser Nachuntersuchungen wurden 417 Spaltpatienten (außer Patienten mit isolierter Lippensplate) kieferchirurgisch, kieferorthopädisch, phoniatrisch-pädaudiologisch nachuntersucht. Es zeigte sich, daß 93% der Kinder sprachgestört waren. 80% der Kinder hatten Hörstörungen, im wesentlichen Tubenbelüftungsstörungen mit und ohne Paukenergüsse. Bei 58 Kindern (14%) mit offenem Näseln wurde eine Velopharyngoplastik mit kranial gestielter Schleimhaut nach Sanvenero-Rosselli durchgeführt. Die Untersuchung zeigte, daß die Sprachergebnisse nicht mit der Spaltart korrelierten. Bei 49% der Kinder war eine logopädische Sprachoder Sprechtherapie erforderlich. Bei 51% der Kinder war gar keine Sprachtherapie notwendig.Die Ergebnisse dieser Untersuchung zeigen, daß unser Behandlungsprogramm zur Rehabilitation der Spaltpatienten effizient ist.

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The speech and language skills of 417 children with cleft palate

Summary Children with cleft palate often suffer from hearing, speech, and language articulation disorders. In order to design an efficient rehabilitation program for children thus affected, it is mandatory to acquire knowledge of the long term results achieved by the various therapeutical strategies including velopharyngoplasty and speech therapy.In this follow-up study 417 children with cleft palate (excluding isolated cleft lip) were examined in an interdisciplinary approach by maxillofacial surgeons, orthodontists, otolaryngologists, audiologists, and speech and language pathologists. The examinations determined that 93% of the children had speech or language disorders and 80% of these children suffered from mild to severe conductive hearing loss with or without clinical signs of otitis media with effusion. In 58 children (14%) with rhinolalia aperta, which had not been improved after one year of speech therapy, velopharyngoplasty with a cranial based pharyngeal flap was performed.The study showed that language skills do not correlate to the type of cleft palate, but rather to the frequency and degree of hearing loss. Using an interdisciplinary approach in early detection and the prompt clinical correction of cleft palate disorders resulted in only 49% of the affected children having to undergo speech and language therapy. In 51% of the affected children no speech therapy was necessary at all. The results presented in this study lead to the conclusion that our program for managing the rehabilitation of children with cleft palate is efficient.

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Teilweise vorgetragen auf dem 6. Symposion des Interdisziplinären Arbeitskreises für LK-Spalten, Mainz, 19. und 20. 11. 1993.     

Neue Drähte und deren Kraftabgabe-Konsequenzen für die kieferorthopädische Therapie

Zusammenfassung Nivellierungsbögen aus verseilten Stahldrähten wurden mit Nickel-Titanium-Drähten der neuen Generation, ausgezeichnet durch Formgedächtnis, Superelastizität und exzellentes Rückstellvermögen, verglichen. Die im Biegeversuch ermittelten Werte wurden statistisch aufbereitet und ergaben eine lineare Kraftweg-Kennlinie der verseilten Stahldrähte. Die Nickel-Titanium-Drähte zeigten aber eine deutliche Abweichung von der Linearität mit kurviger Verlaufsform. Neben der atypischen Kraftweg-Kennlinie mit einer konstanten Kraftabgabe im Mittel der Kurve gaben diese Drähte, unabhängig vom Aktivierungsgrad (das heißt unabhängig davon, ob die Stufe zwischen den Brackets 1 oder 4 mm betrug), dieselbe Kraft ab. Je größer die Aktivierung zwischen den Brackets war, desto länger stellte sich der Bereich der konstanten Kraftabgabe-die Superelastizität-im Diagramm dar. Daher eignen sich die Drähe für große Niveauunterschiede oder Deflektionen. Bei geringer Aktivierung verläuft die Kennlinie sehr steil und annähernd linear. In diesen Fällen ist verseilten Stahldrähten aufgrund ihrer kleineren Federrate und Flexibilität der Vorzug zu geben.

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Summary Levelling arches made of stainless-steel wires were compared with nickel-titanium wires of the new generation which are distinguished by their shape memory, superelasticity and their excellent spring-back. The data received from a bending test have been analysed statistically and revealed a linear unloading curve of the twisted stainless-steel wires. The nickel-titanium wires, however, showed a clear deviation form the linearity with a curviform course. Besides the unusual unloading curve with a constant force mechanism in the middle range of deactivation the wires give off the same amount of force irrespective of the degree of activation (that is to say, regardless whether the level difference between the brackets amounts to 1 or to 4 mm). The diagram shows that the greater the activity between the brackets, the longer the period of superelasticity. Therefore the nickel-titanium wires are suited for large level differences or deflections. At a low activation rate the characteristic line takes a very steep and almost linear deactivation curve. In these cases twisted stainless steal wires should be preferred because of their lower load deflection rate and flexibility.

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Résumé Les arcs de nivelage de fils d'acier tressés ont été comparés avec les fils nickel-titane de la nouvelle génération, se distinguant par leur mémoire de forme, superélasticité et capacité excellente de rappel. Les valeurs relevées au cours de l'essai de pliage ont été enregistrées statistiquement et ont montré une caractéristique linéaire du tracé de force des fils d'acier tressés. Les fils nickel-titane ont cependant montré une déviation significative en présentant non une linéarité mais un tracé curviligne. A côté de leur caractéristique atypique de leur tracé de force avec un dégagement constant de force au centre de la courbe, ces fils ont produit la même force, indépendamment, du degré d'activation (c.-à-d., indépendamment du fait que l'espace entre les brackets fut de 1 ou 4 mm). Plus l'activation était grande entre les brackets, plus la zone du dégagement de la force constante-la superélasticité, paraissait longue sur le diagramme. C'est pourquoi ces fils sont indiqués pour de fortes différences de niveau ou déflexions importantes. En cas d'activation peu considérable, le tracé est très raide et presque linéaire. Dans ces cas, la préférence doit être accordée aux fils d'acier tressés, en raison de leur force élastique et flexibilité inférieures.