ABSTRACT
The aim of this case report is to describe the surgical technique and outcome using internal intraoral distraction devices in LeFort II distraction with zygomatic repositioning (LF2ZR). In Apert syndrome the midface is characterized by a complex hypoplasia, with the central part being more affected than the lateral orbito-zygomatic complex. In LF2ZR, the zygomas are repositioned and internally fixated, and the central midface is further advanced through a LeFort II distraction. In previous publications, the distraction has been performed using external halo-based devices. It seems that the LF2ZR procedure can be planned and performed with adequate accuracy using virtual surgical planning tools. Knowledge about the possibility of using internal intraoral distraction devices in LF2ZR is important, as the inconspicuous placement of intraoral devices can be advantageous for some patients.
Subject(s)
Acrocephalosyndactylia , Craniofacial Dysostosis , Osteogenesis, Distraction , Acrocephalosyndactylia/surgery , Craniofacial Dysostosis/surgery , Humans , Osteogenesis, Distraction/methods , Osteotomy, Le Fort/methods , Zygoma/surgeryABSTRACT
BACKGROUND: Patients with severe forms of chronic periodontitis present with varying degrees of decreased inflammatory reactivity. A previously reported algorithm for chronic periodontitis risk assessment and prognostication is based on the analysis of some 20 risk predictors. One of these predictors is a skin provocation test that assesses the individual patient's reactivity to a lipid A challenge. The aim of this report was to analyze results from validation data for the algorithm with respect to the contribution of results of the skin provocation test as a risk predictor for the progression of chronic periodontitis and to compare these results with the contribution from other predictors, namely smoking, angular bony destruction, furcation involvement, abutment teeth, and endodontic pathology. METHODS: Data from a previously reported clinical validation sample were used for the analysis, including the calculation of quality measures and explanatory values using different types of regression analysis and non-parametric testing. RESULTS: Smoking, endodontic pathology, abutment teeth, angular bony destruction, and furcation involvement presented with individual explanatory values for periodontitis progression between 4% and 13% and highly significant parameter estimates. Explanatory values for the results of the skin provocation test ranged between 2.6% and 5.1% depending on the disease severity group, with a positive predictive value of 82% for the identification of high-risk patients. CONCLUSION: The skin provocation test provided a clinically significant contribution to the quality of analysis with the periodontitis risk and prognostication algorithm, in particular in the selection of high-risk patients for in-depth individual tooth analysis.
Subject(s)
Algorithms , Chronic Periodontitis/immunology , Skin Tests , Adult , Aged , Alveolar Bone Loss/diagnostic imaging , Dental Abutments , Dental Pulp Diseases/pathology , Dental Restoration, Permanent , Disease Progression , Female , Furcation Defects/diagnostic imaging , Humans , Lipid A/immunology , Male , Middle Aged , Odds Ratio , Prognosis , Radiography , Regression Analysis , Risk Assessment/methods , Smoking , Statistics, NonparametricABSTRACT
BACKGROUND: The American Academy of Periodontology has recently stated that, "[risk assessment will become] increasingly important in periodontal treatment planning and should be part of every comprehensive dental and periodontal evaluation." (J Periodontol 2006;77:1608). Unaided risk assessment and prognostication show significant variability because chronic periodontitis is a multifactorial disease. This report summarizes the clinical validation of an algorithm for chronic periodontitis risk assessment and prognostication. The algorithm is a Web-based analytic tool that integrates some 20 risk predictors and calculates scores indicating levels of risk for chronic periodontitis for the dentition (Level I) and, if an elevated risk is found, prognosticates disease progression tooth by tooth (Level II). METHODS: An independent clinical validation sample was generated in an open, prospective clinical trial and analyzed in a predetermined validation plan. RESULTS: The analyses identified two threshold scores above which significant progression of periodontitis was found. Based on these scores, sufficiently high explanatory values with significant and increasing parameter estimates for increasing risk were established in Level I, justifying detailed analysis tooth by tooth in Level II. Subsequent prognostication of chronic periodontitis in Level II was found to be accompanied by clinically relevant measures of quality in relation to rates of disease progression. Three score intervals representing increasing levels of periodontitis progression were identified corresponding to increasing levels of significant annual marginal bone loss. CONCLUSIONS: The predictors included in the algorithm reflect a relevant selection for periodontitis risk assessment. Risk assessment and prognostication with the algorithm provides the clinician with a validated, reliable, consistent, and objective tool supporting treatment planning.
Subject(s)
Algorithms , Chronic Periodontitis/pathology , Models, Statistical , Adult , Aged , Alveolar Bone Loss/diagnostic imaging , Disease Progression , Female , Furcation Defects/diagnostic imaging , Humans , Linear Models , Male , Middle Aged , Prognosis , Radiography , Risk Assessment , Risk Factors , Sensitivity and Specificity , Severity of Illness Index , Statistics, NonparametricSubject(s)
Alendronate/adverse effects , Bone Density Conservation Agents/adverse effects , Bone Neoplasms/drug therapy , Diphosphonates/adverse effects , Imidazoles/adverse effects , Jaw Diseases/chemically induced , Osteonecrosis/chemically induced , Aged , Alendronate/administration & dosage , Bone Density Conservation Agents/administration & dosage , Diphosphonates/administration & dosage , Female , Humans , Imidazoles/administration & dosage , Injections, Intravenous , Jaw Diseases/diagnostic imaging , Jaw Diseases/pathology , Male , Middle Aged , Osteonecrosis/diagnostic imaging , Osteonecrosis/pathology , Pamidronate , Radiography , Risk Factors , Tooth Extraction/adverse effects , Zoledronic AcidABSTRACT
The purpose of the present study was to evaluate surface morphology and shear bond strength of All Bond 2 bonded to dentin surfaces, that were treated progressively to remove collagen fibers. For the study of surface morphology, fifteen teeth were divided in to five groups. Dentin surfaces in groups 1-4 were etched either with 24% EDTA for 30 seconds or 32% phosphoric acid for 15 seconds with and without subsequent treatment with 10% NaOCl for 60 seconds. Group 5 received no treatment and served as control. Evaluation was performed using scanning electron microscopy. Thirty teeth were used for the shear bond strength test. Two experimental surfaces were prepared on each tooth and cylindrical copper matrixes were attached to the surfaces. Experimental surfaces were divided into four groups and treated in the same way as group 1-4 in the morphology part of the study. Dentin was bonded with All Bond 2, after which a flowable composite was inserted and light cured. Shear strength test was performed at a crosshead speed of 1 mm/minute until the composite debonded. Results showed that etching followed by treatment with NaOCl removed all collagen fibers from the dentin surfaces, while treatment with EDTA alone denuded the fiber structures. Shear strength was significantly decreased when surfaces were treated with NaOCl. The highest shear strength values were obtained in the EDTA etched group. The results from the present study indicate that exposed dentin associated collagen fibers increases adhesion of All Bond 2 to dentin.
