A novel approach for horizontal augmentation with split box: A method that combines split bone block and ridge split techniques.

PURPOSE: The aim of this study was to investigate the effectiveness of the split-box technique, a novel technique that combines the ridge splitting and split bone block techniques. MATERIALS AND METHODS: In this retrospective study, alveolar ridge defects were grafted using the split-box technique and its modifications, reverse split box and sliding split box. To determine horizontal changes in the alveolar bone, thickness was measured at two levels: crest width (CW) and screw level width (SLW). Alveolar ridge height (ARH) was also measured to detect a possible loss of vertical dimension. Measurements were performed using cone-beam computed tomography taken before the operation (T0) and at five months after the operation (T1). RESULTS: Of a total of 41 patients included, 21 were females and 20 were males with a mean age of 44.5 ± 13.3 years. A total of 64 regions were augmented. Among the augmented regions, split-box technique was used in 31 regions, reverse split-box technique was used in 14 regions, and sliding split-box technique was used in 19 regions. The increase at the SLW, CW and the decrease in ARH from T0 to T1 was statistically significant (p < 0.005). A significant difference was found between split box and its modifications in terms of bone gain at the screw level, and the sliding box technique was associated with more bone gain than the other two methods (p < 0.05). CONCLUSIONS: Split-box technique provides a comparable net gain in the alveolar crest width with lower complication risk than ridge split technique and lower postoperative morbidity than split bone block technique.

The Predictive Value of Cold Pack Test for Pain After Third Molar Surgery.

BACKGROUND: Early identification of patients who are prone to postoperative pain may provide individualization of postoperative analgesia strategies. PURPOSE: The aim of the study was to investigate whether the cold pack test is associated with postoperative pain levels after mandibular third molar surgery. STUDY DESIGN, SETTING, SAMPLE: This prospective cohort study included healthy male patients admitted to Department of Oral and Maxillofacial Surgery of a tertiary health-care center between June 2022 and December 2022 and scheduled for lower third molar extraction. Those who had used any analgesic within the past 10 days or had a history of intolerance/allergy to analgesics were excluded. PREDICTOR VARIABLE: The primary predictor variable was pain tolerance, measured using the endurance test score. Subjects were grouped into two categories, low tolerance test score (withdrew the hand from the cold pack in <240 seconds) and high tolerance test score (maintained the hand on the cold pack for 240 seconds). MAIN OUTCOME VARIABLES: The primary outcome variable was pain measured by the patients from 0 to 10 with the visual analog scale, and the secondary outcome variables were the amount of ibuprofen and paracetamol consumed in the postoperative period. Pain measurements and ibuprofen consumption were recorded at 0-2, 8, 16, 24, 32, 40, 48, 56, 64, 72, 80, 88, and 96 hours (0-2 interval of the first 2 hours immediately after surgery). COVARIATES: Age, classification and position of mandibular third molar were utilized as covariates. ANALYSES: The relationship between pain tolerance and postoperative pain was analyzed using the Mann-Whitney U test and the Fisher exact test. Statistical analysis was performed using the SPSS version 28.0 software. RESULTS: A total of 30 male patients with a mean age of 22.5 ± 4.8 years were included in our study. In the group with low pain tolerance, the pain scores at the first 2 hours, 32, and 48 hours after the operation (4.55 ± 3.59, 2.91 ± 2.59, 2.91 ± 2.43, respectively) were found to be significantly higher than the group with high pain tolerance (2.00 ± 2.67, 0.95 ± 1.68, 0.95 ± 1.39, respectively) (P < .05). In the first 2 hours after the operation, the amount of ibuprofen consumed was also significantly higher in the group with low pain tolerance compared to the other group, and 81.8% of this group felt the need to consume ibuprofen (P < .05). CONCLUSIONS AND RELEVANCE: The cold pack test, a more practical version of quantitative sensory testing, is useful in identifying male patients at risk of developing greater pain after third molar surgery. It can be helpful to provide effective analgesia in male patients with different pain tolerance thresholds.

Nasal Airway Function After Prophylactic Intranasal Surgery for Excessive Maxillary Superior Repositioning: A Retrospective Cohort Study Using the Nasal Obstruction Symptom Evaluation Scale.

PURPOSE: The purpose of this study is to evaluate the degree of nasal airway function after simultaneous intranasal corrective surgery and bimaxillary surgery in patients with excessive superior maxillary repositioning. MATERIALS AND METHODS: A retrospective cohort study was conducted on consecutive LeFort I superior repositioning patients who also underwent simultaneous intranasal surgery to prevent airway obstruction between 2015 and 2019. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to all participants before the operation and after 1 year. RESULTS: Fifteen patients (n=12 females; n=3 males) among 440 bimaxillary orthognathic surgery patients were enrolled with inclusion criteria of maxillary impaction between 8 and 12 mm. All subjects underwent at least LeFort I osteotomy, septoplasty, bilateral inferior turbinectomy, and bilateral sagittal split osteotomy. Two patients received custom-made total joint prosthesis. The primary outcome variable investigated was nasal function. The mean preop Nasal Obstruction Symptom Evaluation score was 24.33 and the mean postop score was 5. CONCLUSIONS: Intranasal procedures performed simultaneously with 8 mm or more maxillary impaction improves postoperative functional outcome in terms of nasal airway patency and breathing. Partial inferior turbinectomies and septoplasty should be performed consistently to avoid nasal obstruction if the impaction of upper jaw exceeds 8 mm.

Retrospective examination of complications observed in orthognathic surgical surgery in 85 patients.

BACKGROUND: The aim of our study is to examine the possible complications, risk factors, and solutions encountered in orthog-nathic surgery in the light of the cases; we performed in our clinic. METHODS: This study includes a retrospective analysis of the records of 85 patients who underwent orthognathic surgery between 2015 and 2020 in Istanbul Pendik District Hospital Oral and Maxillofacial Surgery Service. The types of complications encountered during the operations were recorded in the study. Independent variables such as gender, age, number of operations, surgical site, and type of osteotomy were evaluated. Complications were evaluated according to the Clavien-Dindo classification. The data were pre-sented for statistical analysis with a significance level of 0.05. RESULTS: Of the 85 patients included in the study, 40 were male and 45 were female. Of these patients, 65 had double chin operation and 20 had single chin operation. A total of 150 jaw osteotomies were performed, 78 of them in the maxilla and 72 in the mandible. While the maxilla was operated in 13 of the cases, in which single jaw operation was performed, only the mandible was treated in 7 of them. Complications were observed in 24 (10.57%) of a total of 227 osteotomies. Among the complications encountered, bleeding (8), nerve damage (7), malocclusion (3), infection (2), TMJ problems (2), bad split (1), and deviation at the tip of the nose (1) stand out, while complications were observed equally in men and women, complications were observed more frequently in cases with longer operative time (p<0.05). Complications were observed more frequently in bilateral sagittal split osteotomies (p<0.001) compared to Le Fort 1 osteotomies. Clavien-Dindo grade I complications were most common (72.04%) depending on the treatment. According to the Clavien-Dindo classification, there was no relationship between gender, age, duration of surgery, length of hospital stay, or surgical site, and the degree of complications (p≥0.05). CONCLUSION: Post-operative malocclusion, bleeding, inferior alveolar nerve injury, infection, poor division, and infection are the most common complications in orthognathic surgery. It can be associated with factors such as the duration of the operation, the number of operations, the site of the operation, and the type of osteotomy which performed. It is thought that positive contributions can be made to the success of the surgery by considering these factors in the treatment planning, during the operation and in the post-operative follow-up part.

Comparison of bicortical, miniplate and hybrid fixation techniques in mandibular advancement and counterclockwise rotation: A finite element analysis study.

OBJECTIVE: This study aims to evaluate biomechanical stability and stress distribution of five different fixation types with finite element analysis using 10-mm advancement with or without counterclockwise rotation of the mandible. MATERIALS AND METHODS: After sagittal split osteotomy, 10-mm advancement was performed in the first group and 10-mm advancement and 10-degree counterclockwise rotation were performed in the second group. One miniplate (M-1), two-miniplate (M-2), one miniplate and a bicortical screw (H), l-shaped bicortical screw (B-1), and inverted l-shaped bicortical screw (B-2) systems were placed. Totally, 120 N force was applied to the models at a 45-degree angle from the lower edge of the symphysis. RESULTS: The highest values on fixation were seen with miniplate, while the mean values were obtained with bicortical screw system. The highest values on bone were achieved using bicortical screws. One miniplate (M-1) showed both the highest and mean displacement. The highest values in counterclockwise-rotated models increased in all parameters, compared to non-rotated models. CONCLUSION: In cases in which passive alignment between segments and adequate bone contact are ensured, inverted l-shaped bicortical screw, two-miniplate, or hybrid systems are recommended.

Retrospective Analysis of Zygomatic Implants for Maxillary Prosthetic Rehabilitation.

PURPOSE: The aim of this study was to evaluate 141 zygomatic implants for the reconstruction of severely atrophic maxillae. MATERIALS AND METHODS: In this retrospective case series study, zygomatic implants were placed under general anesthesia. Inclusion criteria were as follows: ASA I or ASA II, age older than 18 years, inadequate bone for restoration with conventional implants, alternative augmentation procedures considered either inappropriate or contraindicated, absence of a medical condition related to implant failure, and providing written consent. Zygomatic implants used in the study consisted of three different brands: NobelZygoma, Southern Implants System, and Implantswiss. RESULTS: The study included 45 patients, in whom 141 zygomatic implants were placed. The mean age of the patients was 51.76 (range: 23 to 72) years. Three patients were rehabilitated with removable prostheses, 19 patients with fixed prostheses, and 23 patients with hybrid prostheses. The overall complication rate was 5.67% (two zygomatic implants developed infection [1.4%], one zygomatic implant developed peri-implantitis [0.7%], three zygomatic implants developed sinusitis [2.1%], and two zygomatic implants showed unsuccessful prosthetic rehabilitation [1.4%]). The follow-up period ranged from 6 to 36 months. CONCLUSION: Clinical complications of zygomatic implants are acceptable, and their survival rates are similar to those of endosteal implants. Zygomatic implants can contribute to prosthetic rehabilitation.