The ability of orthodontists and maxillofacial surgeons in predicting spontaneous eruption of mandibular third molar using panoramic serial radiographs

ABSTRACT Objective: To evaluate the skill of orthodontists and oral/maxillofacial surgeons (OMFS) in providing a prognosis of mandibular third molars spontaneously erupted, through follow-up panoramic analysis. Methods: 22 orthodontic patients treated without extraction, presenting spontaneously erupted mandibular third molars (n = 44) were analyzed through panoramic serial radiographs. The first panoramic radiograph was obtained just after orthodontic treatment (PR1), in patients aging from 13 to 19 years. A second panoramic radiograph (PR2), was obtained in average two years later. The radiographs were randomly analyzed by 54 specialists, 27 orthodontists and 27 OMFS, to obtain the opinion about the approach to be adopted to these teeth in PR1. Then, another opinion was collected by adding a serial radiograph (PR1+2). Results: The concordance of the answers was moderate for OMFS (Kappa 0.44; p< 0.0001) and significant for orthodontists (Kappa 0.39; p< 0.0001). In the analysis of the first radiograph (PR1) of the spontaneously erupted molars, OMFS indicated extraction in 44.5% of cases, while orthodontists indicated in 42%, with no difference between groups (p= 0.22). In PR1+2 analysis, orthodontists maintained the same level of extraction indication (45.6%, p= 0.08), while surgeons indicated more extractions (63.2%, p< 0.0001). Conclusions: Orthodontists and OMFS were not able to predict the eruption of the third molars that have erupted spontaneously. Both indicated extractions around half of the third molars. A follow-up analysis, including one more radiograph, did not improve the accuracy of prognosis among orthodontists and worsened for OMFS.

RESUMO Objetivo: Avaliar a habilidade de ortodontistas e cirurgiões bucomaxilofaciais (CBMF) em propor um prognóstico para terceiros molares inferiores. Métodos: Foram analisados 22 pacientes tratados ortodonticamente sem extração, cujos terceiros molares inferiores irrompidos espontaneamente (n= 44) foram avaliados por meio de radiografias panorâmicas seriadas. A primeira radiografia foi obtida logo após o tratamento ortodôntico (RX1), entre 13 e 19 anos de idade. A segunda radiografia (RX2) foi avaliada dois anos depois, em média. As radiografias foram analisadas aleatoriamente por 54 especialistas, 27 ortodontistas e 27 CBMFs, para obter sua opinião sobre a abordagem a ser adotada na RX1. Em seguida, outra opinião foi coletada adicionando-se a segunda radiografia seriada (RX1+2). Resultados: A concordância das respostas foi moderada para os CBMFs (Kappa = 0,44; p< 0,0001) e significativa para os ortodontistas (Kappa = 0,39; p< 0,0001). Após analisar apenas a primeira radiografia (RX1) dos molares antes deles irromperem espontaneamente, os CBMFs indicaram extração em 44,5% dos casos; enquanto os ortodontistas, em 42%, sem diferença entre os grupos (p= 0,22). Na análise de RX1+2, os ortodontistas mantiveram o mesmo nível de indicação de extração (45,6%, p= 0,08), enquanto os cirurgiões passaram a indicar mais extrações (63,2%, p< 0,0001). Conclusões: Ortodontistas e CBMFs não foram capazes de predizer a erupção de terceiros molares por meio da análise de uma única radiografia panorâmica, indicando extrações em cerca da metade dos terceiros molares examinados. Uma análise de acompanhamento, incluindo mais uma radiografia, não melhorou a precisão do prognóstico entre os ortodontistas, e piorou entre os CBMFs.

Hypoglossal nerve stimulation for treatment of obstructive sleep apnea (OSA): a primer for oral and maxillofacial surgeons / 대한악안면성형재건외과학회지

The prevalence of obstructive sleep apnea (OSA) is estimated to be 1–5% of the adult population world-wide, and in Korea, it is reported at 4.5% of men and 3.2% of women (Age 40 to 69 years old). Active treatment of OSA is associated with decrease in insulin resistance, cardiovascular disease, psychosocial problems, and mortality. Surgical treatment of OSA has evolved in the era of neuromodulation with the advent of hypoglossal nerve stimulation (HGNS). We share this review of HGNS with our maxillofacial surgical colleagues to expand the scope of surgical care for OSA.

The Role of Oral and Maxillofacial Surgeon in Dispatched Troops Oversea: Cases Report

Manejo multidisciplinario de la sedacion intravenosa en Cirugía Bucal

La sedación intravenosa se ha convertido en una de las técnicas más comúnmente empleadas para evitar traumas psicológicos a los pacientes que necesiten de algún tipo de cirugía bucal. Pues como todos sabemos el término Cirugía está asociado a miedo y ansiedad, y si se agrega la palabra Bucal que implica Odontología, para muchos es sinónimo de dolor y angustia. La necesidad de manejar el paciente que se somete a una cirugía bucal sin ansiedad, tensión, miedo, ni dolor, plantea la posibilidad de usar la sedación intravenosa como método para eliminar esas situaciones ante el procedimiento quirúrgico pero es muy importante la presencia del Anestesiólogo como integrante indispensable junto con el Cirujano para poder ser utilizada, además del ayudante del cirujano y el personal auxiliar. En el presente trabajo se revisarán las funciones de cada uno de los integrantes del equipo multidisciplinario que se necesita para que éste tipo de alternativa de tratamiento quirúrgico se aplique coordinada y eficazmente, permitiendo reducir al mínimo o evitando el riesgo que pudiera alguna vez ocasionar su aplicación, brindando al paciente la vigilancia de parámetros vitales y el suficiente confort antes, durante y después de la cirugía.

Intravenous sedation has become the most common procedure to avoid psychological trauma in the oral surgery patients. As we know the word Surgery is associated with fear and anxiety and if we add the word Oral that imply Dentistry for the majority of the people is synonymous of pain and suffer. The importance of management these feelings bring the possibility of use the intravenous sedation as a technique that controls and avoid those situations but it is very important to use an anesthesiologist as a indispensably member with the surgeon besides the surgical assistant and the hygienist. We are going to expose the specific functions of each member of the multidisciplinary team that is needed to apply this kind of surgical treatment efficiently and allowing to minimize or avoid the risks that in any case it should occur, taking good care of the patient before, during and after the surgery.