A Modified of Bilateral Sagittal Split Osteotomy: Technical Note and Proposal of a Nomenclature on the Osteotomy Lines.

Bilateral sagittal split osteotomy for orthognathic surgery is the most used technique for mandible advancement or setback and has been well documented and modified over the years since Trauner and Obwegeser described it. The improvement brought by each technique allowed the surgeons to perform safer osteotomies, shorten the operative time, and increased the flexibility of the programmed mandibular movements. The authors present a modification of the bilateral sagittal osteotomy technique with the aim of making the technique easier to perform and more comfortable for the surgeon for the purpose of positioning the osteosynthesis plates and screws. Finally, the authors describe a nomenclature on the osteotomy lines of the bilateral sagittal split osteotomy.

W-Shaped Osteotomy to Avoid Paranasal Deformity After Standard Le Fort I in Orthognathic Surgery.

When occlusal alterations are not accompanied by paranasal deficiencies, mobilization of the maxilla via Le Fort I osteotomy should be made with a different design. In this preliminary report, a W-shaped osteotomy that doesn't change the position of the maxillary bone surrounding the pyriform aperture was presented for the first time. Advantages and indications of this new procedure are discussed.

Lorsque les altérations occlusales ne sont pas accompagnées d'anomalies paranasales, la mobilisation du maxillaire par l'ostéotomie de LeFort I devrait être conçue différemment. Le présent rapport préliminaire décrit une ostéotomie en W qui ne modifie pas la position de l'os maxillaire entourant l'orifice piriforme. Les avantages et les indications de cette nouvelle intervention sont exposés.

Segmental sandwich osteotomy and tunnel technique for three-dimensional reconstruction of the jaw atrophy: a case report.

BACKGROUND: A three-dimensionally favourable mandibular bone crest is desirable to be able to successfully implant placement to meet the aesthetic and functional criteria in the implant-prosthetic rehabilitation. Several surgical procedures have been advocated for bone augmentation of the atrophic mandible, and the sandwich osteotomy is one of these techniques. The aim of the present case report was to assess the suitability of segmental mandibular sandwich osteotomy combined with a tunnel technique of soft tissue. Based on our knowledge, nobody described before the sandwich osteotomy with tunnel technique to improve the healing of the wound and meet the dimensional requirements of preimplant bone augmentation in cases of a severely atrophic mandible. CASE PRESENTATION: A 59-year-old woman with a severely atrophied right mandible was treated with the sandwich osteotomy technique filled with autologous bone graft harvested by a cortical bone collector from the ramus. Clinical examination revealed that the mandible was edentulous bilaterally from the first molar to the second molar region. Radiographically, atrophy of the mandibular alveolar ridge in the same teeth site was observed. We began to treat the right side. A horizontal osteotomy of the edentulous mandibular bone was then made with a piezoelectric device after tunnel technique of the soft tissue. The segmental mandibular sandwich osteotomy (SMSO) was finished by two (mesial and distal) slightly divergent vertical osteotomies. The entire bone fragment was displaced cranially, and the desirable position was obtained. The gap was filled completely with autologous bone chips harvested from the mandibular ramus through a cortical bone collector. No barrier membranes were used to protect the grafts. The vertical incisions were closing with interruptive suturing of the flaps with a resorbable material. In this way, the suture will not fall on the osteotomy line of the jaw; the result will be a better predictability of soft and hard tissue healing. CONCLUSIONS: Segmental mandibular sandwich osteotomy is an easy and safety technique that could be performed in an atrophic posterior mandible. Future studies involving long-term follow-up are needed to evaluate the permanence of these results.

Disease recurrence following reconstructive procedures: a 6- to 8-year follow-up observational study.

PURPOSE: The aims of the present study were to determine (i) the long-term disease recurrence in intraosseous defects that had undergone an open flap debridement (OFD) procedure with or without enamel matrix derivative (EMD); and (ii) whether and to what extent clinical changes recorded on teeth treated with surgery were similar at sites involved or adjacent to the intraosseous defect. MATERIALS AND METHODS: Eleven patients contributing twelve reconstructed intraosseous defects were retrospectively recruited and included for analysis. Immediately before surgery, at 12 months post-surgery and at long-term examination (6-8 years post-surgery), probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at the test site (representative of the reconstructed intraosseous defect) and the control site (representative of an adjacent non-reconstructed site) of each tooth treated with surgery. RESULTS: All patients received monthly professional maintenance up to 12 months after surgery, and every 6 months or less frequently thereafter. In test sites, CAL varied from 5.4 +/- 0.8 mm at 12 months to 6.5 +/- 1.0 mm at the long-term examination. PPD increased from 3.7 +/- 0.4 mm at 12 months to 4.3 +/- 0.6 mm at the long-term examination, the changes being not statistically significant. When PPD and CAL changes from 12 months to the long-term examination were compared between test and control sites, no significant differences were found. CONCLUSIONS: Within its limitations and considering the limited sample size, the present study indicates that (i) the attachment gain that has been achieved by means of a surgical reconstructive procedure (based on OFD with/without EMD) may be mostly maintained over a 6-8 year follow-up period; and (ii) the extent of disease recurrence, as assessed by attachment loss and pocket deepening, was similar at sites involved or adjacent to the intraosseous defect.