Surgically-assisted maxillary expansion

A combined surgical and orthodontic technique for management of transverse maxillary deficiencies in mature patients is described and discussed. Special references are made to the surgical release of several circummaxillary articulations to facilitate the use of a fixed expansion device, and to the authors' addition of an osteotomy below the nasal spine, to ensure that the nasal septum remains independent of the maxillary segments. Indications for the use of this surgically-assisted maxillary expansion technique, and its advantages when compared with segmented surgical expansion, are also presented.     

Obstructive sleep apnoea: The role of the oral and maxillofacial surgeon

Obstructive sleep apnoea is a relatively common sleep disorder that is popularly associated with snoring and excessive daytime sleepiness. It is a disorder with serious implications that has only in the last two decades received the attention of clinical specialists. The aim of this article is to review the role of the dental profession in the recognition and management of this disorder.     

A preliminary study into the dental health status of multiple sclerosis patients

Multiple sclerosis (MS) is an inflammatory disease of unknown etiology involving the central nervous system. Since MS affects the whole body, orofacial aspects of the disease must be expected, particularly since loss of muscular coordination may result in a diminished ability to maintain oral hygiene. This preliminary study examined the dental health status of 22 volunteer MS patients. A questionnaire collected data regarding medical and dental histories and socieo-demographic information. Extra- and intra-oral examinations were carried out on all subjects to determine the particular dental treatment needs of this special group. The DMFT and CPITN scores for this group did not indicate that MS patients were more susceptible to dental caries or periodontal disease. However, the prevalence of trigeminal neuralgia and symptoms of TMJ dysfunction in the group studied indicated that these conditions may be manifest in MS patients and warrant further investigations.     

Tooth discolouration: Staining effects of various sealers and medicaments

The aim of this investigation was to quantify the discolouration of tooth roots caused by various medicaments and sealers. The roots of extracted teeth were chemo‐mechanically prepared and the smear layer removed. The roots were filled with either Multi‐Cal (Pulpdent Corporation, Watertown, MA, USA), Ledermix (Lederle Laboratories, Wolfratshausen, Germany), 2% chlorhexadine acetate in polyethylene glycol (PEG), 5% clindamycin in PEG, PEG alone (as a vehicle control), sealers AH26 (De Trey Dentsply, Zurich, Switzerland), AH Plus (De Trey Dentsply), an experimental epoxy resin with zirconium dioxide (Millenium Chemicals, Rockingham, Western Australia) or Araldite (Selleys Pty Ltd, Sydney, Australia). The roots were maintained at 37°C in dark humid conditions and standardised images of the coronal surfaces recorded over 12 months. Ledermix caused the most darkening of the introduced medicaments, while calcium hydroxide and the materials in PEG did not cause darkening. AH26 caused more darkening than did the other sealers. It was concluded that the use of alternatives to Ledermix and AH26 should be considered when aesthetics are important.     

Malpositioned Osseointegrated Implants Relocated with Segmental Osteotomies: A Retrospective Analysis of a Multicenter Case Series with a 1‐ to 15‐Year Follow‐Up

Purpose: This multicenter case series evaluates retrospectively the clinical outcomes of malpositioned implants surgically relocated in a more convenient position by segmental osteotomies. Materials and Methods: Authors who published, on indexed journals or books, works about malpositioned implant correction by segmental osteotomies were contacted. Five centers, out of 11 selected, accepted to participate in this study. The dental records of patients who underwent implant relocation procedures were reviewed. Implant survival rates were analyzed and a blinded assessor examined clinical photos and periapical radiographs to evaluate esthetic outcome (pink esthetic score [PES]) and changes of marginal bone level over time. Patients were requested to fill a verbal rating scale form about discomfort, compliance, and satisfaction related to the procedure. Results: Fifteen malpositioned implants relocated by segmental osteotomies were followed for a period ranging from 1 to 15 years (mean 6.0 ± 3.9 years). The overall implant survival rate from baseline to the last follow‐up visit was 100%. The mean marginal bone loss was 0.36 mm at the 12‐month follow‐up visit and no relevant further changes were observed at the following examinations. Significant esthetic improvement was recorded at 1‐year examination with PES evaluation (p < .0001). Patients' feedback described this procedure as not excessively invasive and uncomfortable, reporting a high final satisfaction rate. Conclusions: The present study suggests that implant relocation with segmental osteotomies could be an effective alternative method to correct the position of unrestorable malpositioned implants in a single‐stage surgery.     

Bisphosphonate‐associated osteonecrosis of the jaw,with healing after teriparatide:a review of the literature and a case report

This paper reports the case history of a patient who had bisphosphonate‐associated osteonecrosis of the jaw (ONJ) in which adjunctive treatment with teriparatide was used. The patient was treated for 5 years with alendronate for osteoporosis and developed ONJ after extraction of maxillary teeth. An implant was placed at the site of the extracted teeth. The pathology report confirmed the clinical diagnosis of ONJ; treatment was changed from alendronate to teriparatide and the ONJ resolved. To our knowledge, this is the third case history reported in the literature in which teriparatide was successfully used as adjunct therapy in ONJ because it has an anabolic effect and presumed role in accelerating bone healing. ONJ is a serious but infrequent condition that has been recently associated with nitrogen‐containing bisphosphonate therapy. Teriparatide may be a useful adjunctive therapy when ONJ develops.     

The use of a simple functional appliance as an adjunct to fixed appliance orthodontic treatment

Three clinical case studies are presented to demonstrate the use of a simple functional appliance in orthodontic situations not covered by traditionally-accepted dental and skeletal indications. In each case, the appliance was used to reduce the severity of the malocclusion, before a routine fixed-appliance detailing phase.