Patients' evaluation of the final result of sagittal split osteotomy: is it influenced by impaired sensitivity of the lower lip and chin?

The purpose of this article was to evaluate whether neurosensory disturbances such as impaired sensitivity of the lower lip and chin influence patients' final evaluation of the treatment result. Information about the patients' degree of satisfaction and about lip and chin sensitivity were obtained from final follow-up documents of 215 patients. All patients had undergone sagittal split ramus osteotomy for mandibular advancement. In patients with normal sensitivity on both sides of the lower lip and chin, the degree of satisfaction was equally distributed at a very high level through all age groups. Among those with some degree of numbness on either or both sides of the lower lip and chin, patients in the younger quarter and middle half of the group were as satisfied as those with normal sensitivity, while those in the oldest quarter with impaired sensitivity demonstrated a lower degree of satisfaction than the rest of the patients. Although the difference was not statistically significant, the finding strongly indicates that older patients seem to suffer more from neurosensory disturbances than do younger patients with similar conditions.

Five-year prospective follow-up report of the Astra Tech Dental Implant System in the treatment of edentulous mandibles.

This report of the 1st 2 prospective studies using the Astra Tech Implant System and fixed detachable bridges for rehabilitation of mandibular edentulism, presents clinical and radiographic data at the 5-year follow-up. The original material comprised 109 subjects, 56 of whom had been included in the original study, using the 1st generation Astra Tech Implant. Two subjects were excluded and the 3-year follow-up report was based on the remaining 54 subjects and 310 fixtures. After some minor changes to the fixture and the abutment, the 2nd generation Astra Tech Implant was used in 53 subjects and 308 fixtures. In all 16 subjects were lost to follow-up and the 5-year results are based on the remaining 91 subjects with 517 fixtures in function: 5 fixtures were lost due to mobility at abutment installation and during the 1st year, 2 fixtures were removed due to pain, and after 4 years in situ 1 fixture failed. As no clinical or radiographic differences were obvious in the annual registrations of the 2 studies the results have been combined. The fixed bridges were removed at 3 and 5 years to test each fixture and none was mobile. The cumulative fixture survival rate at 5 years was 98.7% and the bridge survival rate was 100%. Of the sites 82% were plaque free, and 96.8% showed no signs of inflammation. Over the 5-year period after bridge insertion, i.e. from baseline registration, there was only minor deterioration in marginal bone levels as measured on standardized intraoral radiographs: the mean differences in mm and standard deviations (SD) were -0.09 (0.27) in the 1st year, -0.20 (0.40) in the 3rd year, and -0.26 (0.53) in the 5th year. According to the stringent clinical and radiographic criteria by Albrektsson and co-workers, the successful treatment outcome and the survival rate in 91 subject over 5 years, indicates that the Astra Tech Dental Implant System with fixed detachable bridges is an appropriate method for rehabilitation of mandibular edentulism.

Inferior alveolar nerve function after mandibular osteotomies.

A total of 1034 patients who had undergone orthognathic surgery were examined after 2 years; 818 had been treated with varying types of mandibular osteotomy such as vertical ramus osteotomy, sagittal split ramus osteotomy, and genioplasty. Neurosensory function in the mental nerve region was assessed by evaluating light touch perception. The incidence of neurosensory deficiency was 216/548 (39%) after sagittal split ramus osteotomy, 26/140 (19%) after extraoral vertical ramus osteotomy, 9/78 (12%) after genioplasty and 60/650 (9%) after intraoral vertical ramus osteotomy. Additional genioplasty increased both the incidence and severity of neurosensory disturbance after intraoral vertical ramus osteotomy but did not significantly influence the neurosensory function after sagittal split ramus osteotomy. The incidences of neurosensory disturbance after mandibular osteotomies in this report correspond well with those previously reported, but the incidence of almost 40% after sagittal split ramus osteotomy must be considered a disquieting drawback of the procedure.

Inferior alveolar nerve function after sagittal split osteotomy of the mandible: correlation with degree of intraoperative nerve encounter and other variables in 496 operations.

Dysfunction of the inferior alveolar nerve indicated by various degrees of numbness of the lower lip and chin is one of the few drawbacks of sagittal split osteotomy (SSO) of the mandible. Although it has been recorded throughout the history of this technique its true aetiology is poorly understood. In this study of 496 SSOs, we have evaluated possible correlations between neurosensory dysfunction and several variables that have been implicated, such as the age of the patient, mandibular movement, type of split technique and osteosynthesis, degree of intraoperative nerve encounter, and surgical skill. Nerve dysfunction developed after 200/496 SSOs (40%). The patient's age had a significant influence on the recovery of the neurosensory function. Intraoperative nerve encounter such as nerve manipulation correlated with dysfunction to a much lesser degree than expected. Surgical skill seemed to influence the recovery of neurosensory function after SSO, which is often referred to as a technique-sensitive procedure. We suggest that the dissection of the soft tissue on the medial aspect of the mandibular ramus might be partly responsible for nerve dysfunction of the lower lip and chin after SSO of the mandible.

Pre- and perioperative suggestion in maxillofacial surgery: effects on blood loss and recovery.

The basic assumption underlying the present study was that emotional factors may influence not only recovery but also blood loss and blood pressure in maxillofacial surgery patients, where the surgery was performed under general anesthesia. Eighteen patients were administered a hypnosis tape containing preoperative therapeutic suggestions, 18 patients were administered hypnosis tapes containing pre- and perioperative suggestions, and 24 patients were administered a hypnosis tape containing perioperative suggestions only. The patients who received taped suggestions were compared to a group of matched control patients. The patients who received preoperative suggestions exhibited a 30% reduction in blood loss. A 26% reduction in blood loss was shown in the group of patients receiving pre- and perioperative suggestions, and the group of patients receiving perioperative suggestions only showed a 9% reduction in blood loss. Lower blood pressure was found in the groups that received pre- and perioperative and perioperative suggestions only. Rehabilitation was facilitated in the group of patients receiving perioperative suggestions only.

A histomorphometric evaluation of bone-to-implant contact on machine-prepared and roughened titanium dental implants. A pilot study in the dog.

This investigation was performed to assess the bone-to-implant surface contact at fixtures of titanium that either had a standard machine prepared or a TiO2-blasted surface. Five beagle dogs were used in the experiment. Extractions of the premolars were performed in the maxilla. After 4 months of healing, 5 standard machine-prepared fixtures and 5 prepared according to the TioBlast technique were inserted. Two months later another 5 "standard" and 5 TioBlast-prepared implants were inserted. Four months after the first fixture installation, the animals were killed and ground sections prepared from each implant site. Of the 20 implants installed, 19 were successfully incorporated. The mean bone-to-implant surface for "standard" fixtures was about 40% both at the 2 and 4 months observation interval. The corresponding figures for the TioBlast-prepared fixtures were similar during the first 2 months of observation, while subsequently the TioBlast-prepared fixture surface seemed to stimulate to a more close bone-to-implant contact (65%) than the "standard" one.

A 3-year clinical study of Astra dental implants in the treatment of edentulous mandibles.

A prospective study for the treatment of mandibular edentulism using the new Astra dental implant system was conducted on 54 patients. The clinical performance of 310 implants was monitored over 3 years. The survival rate was 100% for the prostheses and 98.1% for individual implants. Four implants failed during the first 3 months after placement, one was retained as a "sleeper," and two more were removed because of persistent discomfort. Both resorption and deposition of mandibular marginal bone were observed. Bone changes from baseline to the end of the first year ranged from -0.4 to +1.0 mm (median 0.00), from the first to the third year from -0.8 to +0.6 mm (median 0.04), and over the 3 years ranged from -1.1 to +1.0 mm (median 0.01). No marked mean bone resorption was observed during the first year compared to the two following years. A significant gain in marginal bone level was recorded in males, but in females the level was unchanged. There were no serious inflammatory reactions in the surrounding soft tissues during the 3-year follow-up period.

Nasolabial morphology after Le Fort I osteotomies. Effect of alar base suture.

This paper describes the effect of an alar base suture in an attempt to gain control of the alar base flaring associated with maxillary advancement and/or maxillary impaction. The suture did reduce alar flaring but it also increased the nasolabial angle. The suture did not significantly influence nasal tip projection.

Histometric and ultrastructural studies of tissues surrounding Astra dental implants in dogs.

Twenty-four Astra titanium dental implants were inserted bilaterally, three on each side, into the mandibles of four dogs to study mucosal and bone-implant junctions. After a healing period of 6 months, the dogs were sacrificed and bone sections with implants were removed and processed for histologic evaluation. All implants were stable, and radiographs disclosed complete bone healing. The surrounding mucosa closely resembled that surrounding natural teeth. Histometric analysis of the alveolar bone revealed that, on average, 61.3% of the implant surface interface was integrated in the bone at the light-microscopic level.

Changes after correction of maxillary retrusion by Le Fort I osteotomy. A comparison of 2 methods of skeletal fixation.

2 methods of skeletal fixation are compared in 24 patients with maxillary retrusion treated with Le Fort I osteotomy only: group I, intraosseous fixation only (10 patients); group II, enhanced fixation, intraosseous and suspension wires (14 patients). Follow-up checks on the patients were carried out using lateral cephalograms. The changes of the maxillary position in relation to the anterior cranial base were analyzed via a technique of superimposition in a computer system without using conventional landmarks. Vertical and horizontal changes and rotations were studied. The method error was small. In the vertical direction, there was a significant difference between the groups. In group I, the vertical relapse during the early postoperative period was 55%, while in group II, it was only 15%. The conclusion is that a rigid vertical fixation is needed.

Ecological effects of penicillin prophylaxis in orthognatic surgery.

A study was conducted to evaluate 2 prophylactic penicillin regimens in 18 patients undergoing orthognathic surgery. The effects on the oral microflora were also studied. All patients received 3 g benzyl-penicillin as infusion from the beginning of operation and then 3 g every 6th hour during 24 h. One group of 9 patients then received 1 g phenoxymethylpenicillin as oral suspension twice daily for 6 days postoperatively. The second group of 9 patients received no further penicillin. One infection occurred in this second group, but the patient was cured with metronidazole. 7 of the 9 patients who received penicillin for 1 week, showed pronounced decreases in the number of streptococci and micrococci. In the 9 other patients who received only benzylpenicillin for one day, much smaller changes in the aerobic microflora were observed. Colonization with different enterococci, enterobacteria or yeasts was greater in the group receiving 1-week treatment. No major differences between the 2 groups of patients, concerning the impact on the anaerobic microflora were observed. The results indicate that benzylpenicillin is still a suitable prophylactic antibiotic in maxillofacial surgery. Extension of the antibiotic coverage to 1 week is doubtful because of the increased ecological risks. The clinical significance of anaerobes was obvious, as one postoperative infection occurred caused by an anaerobic micro-organism.

Necrotizing sialometaplasia--a malignancy simulating oral lesion.

A case of necrotizing sialometaplasia is reported in a 63-year-old white male. The lesion appeared as an ulcerated and painful lesion inside the left ramus mandibulae. An incisional biopsy was performed and reported as well-differentiated squamous cell carcinoma. A few days after the initial biopsy was taken the necrotizing tissue disappeared and the ulcer started to heal. A new, excisional biopsy was performed. The initial diagnosis was revised and the lesion reported as necrotizing sialometaplasia. Two weeks after the excisional biopsy complete healing was obtained. The clinical and histological findings are discussed in relation to the different stages through which a necrotizing sialometaplasia might develop. From a differential diagnostic point of view it is important for both the clinician and pathologist to be aware of the lesion's behaviour during the different stages of development.

Effect of methylprednisolone on complications after removal of impacted mandibular third molars.

Bilateral impacted mandibular third molars were surgically removed in 20 healthy patients. The effects of methylprednisolone on postoperative healing was investigated in a double-blind, cross-over study. Some decrease in postoperative discomfort (swelling and trismus) was noted in the methylprednisolone group. No statistically significant difference was noted, however in comparison with a placebo group.

Prophylaxis with tinidazole in oral surgery. Tissue penetration and effect on the oral microflora.

10 patients with odontogenic cysts were given 500 mg tinidazole orally every 12 h for infection prophylaxis before cystectomy. The administration started 48 h before operation and lasted for 7 days. Samples for assay of tinidazole were collected from blood plasma and cystic fluid during surgery. Saliva samples for microbiological studies of the normal flora were obtained before, during and after the antibiotic administration period. Mean concentrations of tinidazole in plasma and cystic fluid were 10.7 mg/l and 10.0 mg/l, respectively. The anaerobic flora was suppressed in all patients and two patients were colonized with enterobacteria, and two with fungi. No anaerobic bacterial strains resistant to tinidazole emerged during the treatment period. It is concluded that tinidazole can be administered prophylactically 48 h before oral surgery, in order to obtain maximal tissue concentration, without risk of the emergence of resistant bacterial strains or severe ecological disturbances of the oral microflora.

Long-term evaluation of autotransplanted maxillary canines with completed root formation.

Autotransplantation of 33 maxillary canines was followed up in 29 patients with an average age of 27.5 years. The mean follow-up period was 6.0 years. Endodontic treatment was performed in 23 teeth. Signs of root resorption were found in an increasing number of canines during the follow-up period. At the last examination eight canines showed no signs of resorption. External and internal resorption of inflammatory type were the most frequent forms of resorption and were also found to be the most hazardous factors for the prognosis of the transplanted tooth. Extraction of the transplant was necessary in four cases because of root resorption or poor bone regeneration.

Concentration of phenoximethylpenicillin, clindamycin and tinidazole in dental cysts.

In the treatment of bacterial infections, adequate antibiotic concentrations must be realised at the site of infection. Levels of 3 antibiotics--phenoximethylpenicillin, clindamycin and tinidazole - were measured in serum and fluid of periapical odontogenic cysts in 30 patients undergoing enucleation of periapical cysts. After a single dose of 500 mg tinidazole, the concentration of tinidazole in the cystic fluid was 4.3 micrograms/ml, which was about 1/3 of the concentration in the serum. No measurable levels were achieved in the cystic fluid with phenoximethylpenicillin or clindamycin.