[Minimally invasive approach for Le Fort I osteotomy].

Orthognathic surgeries in which mobilization of the maxilla is required, are common procedures in the treatment of skeletal and developmental facial abnormalities. The Le fort I osteotomy is currently a safe, reliable and predictable procedure granting the surgeon good visualization and approach. However, these surgeries often involve substantial post operative swelling and pain, mostly due to the relatively extensive size of the mucoperiosteal approach flap. Several techniques have been previously reported in the literature, describing alternative approaches and novel instruments in an effort to reduce the intraoperative and postoperative challenges and complications of current surgical modalities. In this article we present a brief review of past and present maxillary osteotomy surgeries and describe our experience with a modified minimally invasive surgery in which approach to the maxilla is obtained through a smaller flap above the incisors, enabling sufficient osteotomy access, while limiting the extent of required surgical incisions and related post-operative complications.

[Obstructive Sleep Apnea: review and a case presentation].

Obstructive sleep apnea may be a life threatening situation if does not get proper attention. Risk factors are easy to find, therefore general dental surgeons should be aware of them and refer if needed. This literature review clearly explains how obstructive sleep apnea is diagnosed and treated. We present a case of a patient with severe obstructive sleep apnea (apnea hypopnea index of 87.5/hour), who underwent bi jaw surgery with 2 piece Le Fort 1 maxiilary advancement, mandibular bilateral sagittal split osteotomy (BSSO) advancement, and genial tubercle advancement. Post-surgery sleep study demonstrated near resolution of previously severe obstructive sleep apnea with overall apnea hypopnea index (AHI) of 3.7/hour consistent with a successful surgical outcome.

[Sandwich osteotomy--a biologic method for vertical augmentation of edentulous alveolar ridges].

Vertical augmentation for rehabilitation with dental implants poses a clinical challenge. The surgical obstacles have been extensively documented within the literature. Outcomes of the multiple methods available are not predictable, and overall success rates are sub-optimal. This paper presents the Sandwich Osteotomy Technique (interpositional rhBMP-2 and bone subtitute grafting) in a young female with congenital oligodontia. The uniqueness of this method, like in distraction osteogenesis, is that the segmental bone remains attached to the mucoperiosteal flap and thus the blood supply is maintained. Bone graft or substitute is introduced into the interpositional space that was created. Advantages of Sandwich Osteotomy are minimal bone exposure, good blood supply, no need for donor bone graft and minimal overall morbidity. Limitations of the technique are soft tissue stretching, gingival fibrosis, and high technical demand. According to our experience with this surgical method, vertical augmentation is stable up to 8 mm. Beyond this height approximately 10% bone resorption was noticed.

Conventional wisdom and the surgical exposure of impacted teeth.

OBJECTIVES: To provide evidence against the notion that direct contact between the crown of an impacted tooth and alveolar bone is an impediment to orthodontically assisted eruption of teeth. SETTING AND SAMPLE POPULATION: The Department of Orthodontics at the Hebrew University-Hadassah School of Dental Medicine, in Jerusalem, Israel, and the private practices of the authors. MATERIALS AND METHODS: Patients reported were those affected by impacted teeth, including individuals who were normal healthy patients, with and without resorption of the adjacent incisor roots, as well as individuals suffering from Cleidocranial dysplasia and increased bone density, and individuals with autogenous and synthetic bone grafts. A closed eruption surgical technique was used in which only a small window was opened into the dental follicle of the impacted tooth, leaving a maximum amount of bone covering much of the crown surface. Orthodontic extrusion forces were then applied. RESULTS: For all teeth, enamel-to-bone contact did not prevent a rapid response to the extrusive forces. CONCLUSION: Radical removal of bone during the exposure of an impacted tooth is unnecessary and potentially may be harmful in terms of the periodontal prognosis of an otherwise successfully treated outcome.

[Orthodontic anchorage in the era of osseointegration].

The introduction of the concept of osseointegration had a profound impact on dentistry of the 20th century. The idea of using this concept in orthodontics already started in the late 70th. There demand for achieving optimal esthetic results in a minimal treatment time, and the significant increase in the number of adult orthodontic patients, made osseointegration an essential adjunct to orthodontic therapy. The use of osseintegrated anchorage devices helps the clinician to overcome one of the most limiting aspects of orthodontic therapy--inadequate anchorage. In the last years a large variety of osseointegrated anchorage devices have been developed and introduced in orthodontics. The purpose of the present article is to present several cases that illustrate how to solve anchorage problems by the using the principles of osseointegration and mechanical retention. The selection of the most appropriate anchorage device for each specific case will be emphasized.

Sialolithectomy done with a CO2 laser: clinical and scintigraphic results.

PURPOSE: This study reviews the results of sialolithectomy performed with the CO2 laser. PATIENTS AND METHODS: Forty-nine patients were treated under local anesthesia at initial presentation in the outpatient clinic. RESULTS: All patients had immediate relief after surgery. Clinical and scintographic follow-up of up to 28 months on 27 patients showed that all but 1 were asymptomatic. The single exception required excision of the submandibular gland because of two recurrences of sialoliths in Wharton's duct. Although some glands had no function clinically and scintigraphically, they were asymptomatic and needed no further treatment. CONCLUSIONS: Salivary glands that are nonfunctioning clinically and scintigraphically should only be removed when there is a recurrence of symptoms.

Structural and functional characterization of osteogenic growth peptide from human serum: identity with rat and mouse homologs.

The osteogenic growth peptide (OGP) was recently characterized in regenerating bone marrow. In experimental animals, OGP increases osteogenesis. Immunoreactive OGP (irOGP) in high abundance was demonstrated in normal animal serum mainly as an OGP-OGP-binding protein (OGPBP) complex. Here we show the presence of an OGP-OGPBP system in normal human serum. The total irOGP content, of which the bound peptide comprises at least 80-90%, ranged from 480-4460 mumol/L, several orders of magnitude higher than that of other regulatory polypeptides. The steady state/total irOGP ratio declined between 23 and 49 yr of age. The bound irOGP, purified by boiling, ultrafiltration, and hydrophobic high pressure liquid chromatography, was identical to OGP obtained previously from rat regenerating marrow and mouse stromal cell cultures in terms of its amino acid sequence, immunoreactivity, and mitogenicity. These data demonstrate the usefulness of our immunoassay to measure circulating OGP. More importantly, the identity of the human OGP with that of other species indicates the peptide's evolutionary conservation and, thus, its biological importance. The natural occurrence of OGP in man signifies its potential role in the prevention of bone loss and rescue of bone mass, especially in osteoporosis.

Gerodermia osteodysplastica: report on two patients and surgical correction of facial deformity.

We present four individuals with Gerodermia Osteodysplastica in a Jewish family from Morocco confirming the autosomal recessive inheritance of the disorder. Three previously unreported findings are described: a) enlarged funnel-shaped mandibular lingula; b) extension of the mandibular premolar and molar roots below the inferior dental canal, and of the second molars into the lower border of mandibular cortical bone; and c) hypercementosis of the maxillary incisors and mandibular molars surrounded by a radiolucent halo in several teeth. The facial deformity resulting from maxillary hypoplasia and mandibular prognathism was corrected by orthognathic surgery: Le Fort I maxillary osteotomy and vertical mandibular osteotomy.

Myxoid liposarcoma of the buccal vestibule. A case report.

A case of a myxoid liposarcoma in the buccal vestibule of the mandible is presented. The patient, an 86-year-old women, had 2 local recurrences after initial excision and died several months later. The literature is briefly reviewed.