Interdisciplinary management of Type 3 oligodontia: A retrospective case series.

STATEMENT OF PROBLEM: Type 3 oligodontia is the most dentoalveolar deficient manifestation of congenital tooth absence. There is a need to rehabilitate these children functionally and esthetically to improve quality of life. PURPOSE: The purpose of this retrospective case series was to evaluate the short- and intermediate-term outcomes of the dental treatment provided in a children's hospital and to develop a sequential interdisciplinary treatment planning protocol from infancy to the completion of jaw development. MATERIAL AND METHODS: A total of 10 patients were included in this retrospective longitudinal case series report. Different interventions had been carried out at times related to growth and development of the jaws. Implant-supported fixed dental prostheses were provided after the lateral growth of the anterior mandible had stabilized at around 12 years of age. Definitive mandibular prostheses were provided after the cessation of growth and following maxillary treatment. Treatment for the maxilla was more complex. Bone grafted and graftless implant-supported fixed prostheses were offered as alternatives to a complete denture. Implant stability and soft tissue response were evaluated at prosthesis removal. RESULTS: Seven patients received a 4-implant and 2 a 5-implant-supported immediately loaded fixed mandibular prosthesis. One patient elected to maintain the interim complete denture. Of the 38 implants, 2 failed and were satisfactorily replaced. In the maxilla, 4 patients elected to maintain a complete denture, and 6 received a maxillary implant-supported fixed prosthesis: 1 with bilateral sinus lift bone grafting and 6 regular implants; 1 with 6 regular implants; 1 with 4 regular implants; 2 with bilateral zygoma implants plus 2 regular anterior implants; and 1 with 4 zygoma implants. No implant failures were recorded in the maxilla. Follow-up for mandibular treatment ranged from 1 to 12 years and for maxillary treatment 1 to 9 years. All implants were classified as asymptomatic and surviving. CONCLUSIONS: The use of fixed implant-supported prostheses in selected individuals with Type 3 oligodontia can improve functional and esthetic outcomes as compared with the use of removable prostheses alone. Implant-supported prostheses require an interdisciplinary approach from early childhood until growth cessation.

Accuracy of mandibular repositioning surgery using new technology: Computer-aided design and manufacturing customized surgical cutting guides and fixation plates.

INTRODUCTION: Recent 3-dimensional technology advancements have resulted in new techniques to improve the accuracy of intraoperative transfer. This study aimed to validate the accuracy of computer-aided design and manufacturing (CAD-CAM) customized surgical cutting guides and fixation plates on mandibular repositioning surgery performed in isolation or combined with simultaneous maxillary repositioning surgery. METHODS: Sixty patients who underwent mandibular advancement surgery by the same surgeon were retrospectively evaluated by 3-dimensional surface-based superimposition. A 3-point coordinate system (x, y, z) was used to identify the linear and angular discrepancies between the planned movements and actual outcomes. Wilcoxon rank sum test was used to compare the outcomes between the mandible-only and the bimaxillary surgery groups with significance at P <0.05. Pearson correlation coefficient compared planned mandible advancement to the outcome from advancement planned. The centroid, which represents the mandible as a single unit, was computed from 3 landmarks, and the discrepancies were evaluated by the root mean square error (RMSE) for clinical significance set at 2 mm for linear discrepancies and 4° for angular discrepancies. RESULTS: There was no statistically significant difference between the planned and actual position of the mandible in either group when considering absolute values of the differences. When considering raw directional data, a statistically significant difference was identified in the y-axis suggesting a tendency for under-advancement of the mandible in the bimaxillary group. The largest translational RMSE for the centroid was 0.77 mm in the sagittal dimension for the bimaxillary surgery group. The largest rotational RMSE for the centroid was 1.25° in the transverse dimension for the bimaxillary surgery group. Our results show that the precision and clinical feasibility of CAD-CAM customized surgical cutting guides and fixation plates on mandibular repositioning surgery is well within clinically acceptable parameters. CONCLUSION: Mandibular repositioning surgery can be performed predictably and accurately with the aid of CAD-CAM customized surgical cutting guides and fixation plates with or without maxillary surgery.

Success rates of a skeletal anchorage system in orthodontics: A retrospective analysis.

OBJECTIVES: To evaluate the premise that skeletal anchorage with SAS miniplates are highly successful and predictable for a range of complex orthodontic movements. MATERIALS AND METHODS: This retrospective cross-sectional analysis consisted of 421 bone plates placed by one clinician in 163 patients (95 female, 68 male, mean age 29.4 years ± 12.02). Simple descriptive statistics were performed for a wide range of malocclusions and desired movements to obtain success, complication, and failure rates. RESULTS: The success rate of skeletal anchorage system miniplates was 98.6%, where approximately 40% of cases experienced mild complications. The most common complication was soft tissue inflammation, which was amenable to focused oral hygiene and antiseptic rinses. Infection occurred in approximately 15% of patients where there was a statistically significant correlation with poor oral hygiene. The most common movements were distalization and intrusion of teeth. More than a third of the cases involved complex movements in more than one plane of space. CONCLUSIONS: The success rate of skeletal anchorage system miniplates is high and predictable for a wide range of complex orthodontic movements.

The interdisciplinary management of a Class II division 1 malocclusion with an associated mandibular defect following surgical excision of fibromatosis: a clinical report.

Surgical excision of malignant or nonmalignant tumors of the maxillofacial region can result in significant anatomical loss/compromise. Correction of the residual defect can be complicated by the presence of an underlying malocclusion and can be a significant clinical challenge if large numbers of teeth have been lost in surgery. This clinical report discusses the interdisciplinary treatment to rehabilitate a patient with a history of surgical removal of fibromatosis. Treatment involved the use of osseointegrated implants to facilitate orthodontic correction of an underlying malocclusion. The implants were subsequently used in the prosthodontic rehabilitation of the residual surgical defect.