Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 14 de 14
Filter
Add more filters










Publication year range
1.
J Craniofac Surg ; 34(8): 2343-2346, 2023.
Article in English | MEDLINE | ID: mdl-37643127

ABSTRACT

There is no treatment algorithm to decide whether maxillomandibular or mandibular osteotomy alone should be performed in borderline cases. This study assessed the factors that affect the changes in soft tissue after mandibular setback. Patients who underwent mandibular osteotomy alone to correct mandibular protrusion were included in this study. Hard and soft tissue analyses were performed on lateral cephalograms before and 12±3 months after surgery. The popular points were set for referencing hard and soft tissues on the lateral cephalogram. Nasolabial, labiomental, and soft tissue facial plane angles were measured for the soft tissue assessment. To assess the mandibular setback amount, SNB was calculated. Twenty-one patients were included in this study. The nasolabial angle was increased after surgery and its change significantly correlated with the change in SNB ( P =0.00815). The change in soft tissue facial plane angle after surgery per change in SNB significantly correlated with the occlusal plane angle ( P =0.0009). An occlusal plane angle of at least 15.45 degrees was required for the SNB and soft tissue facial plane angle to change to the same degree. The occlusal plane angle (whether or not it was ≥15.45 degrees) may help in determining the surgical approach in borderline cases, specifically on whether maxillomandibular or mandibular osteotomy alone should be performed if the mandibular setback is simple.


Subject(s)
Malocclusion, Angle Class III , Mandibular Osteotomy , Humans , Chin/surgery , Malocclusion, Angle Class III/diagnostic imaging , Malocclusion, Angle Class III/surgery , Dental Occlusion , Cephalometry , Mandible/diagnostic imaging , Mandible/surgery , Treatment Outcome
2.
Article in English | MEDLINE | ID: mdl-36767291

ABSTRACT

Sagittal split ramus osteotomy (SSRO) is a standard surgical technique for patients with mandibular prognathism. However, the appropriate position of the proximal fragment is not strictly defined, and rigid fixation can induce early postoperative skeletal relapse and temporomandibular (TMJ) disorders. Loose fixation can be expected to seat the proximal bone fragments in a physiologically appropriate position, thereby reducing adverse events. Although long-term skeletal stability has been achieved using SSRO without fixation, the evaluation of preoperative and postoperative eating and swallowing functions remains unclear, and this study aimed to clarify this point. We evaluated mastication time, oral transfer time, and pharyngeal transfer time using videofluorography (VF) preoperatively, two months postoperatively, and six months postoperatively, and along with the position of anatomical landmarks using cephalometric radiographs, modified water swallowing test (MWST), food test (FT), and repetitive saliva swallowing test (RSST) were used to evaluate postoperative swallowing function. Four patients (one male, three females; mean (range) age 26.5 (18-51) years) were included, with a mean setback of 9.5 mm and 6.5 mm on the right and left sides, respectively. Postoperative eating and swallowing functions were good in VF, cephalometric analysis, MWST, FT, and RSST. In the present study, good results for postoperative eating and swallowing functions were obtained in SSRO with loose fixation of the proximal and distal bone segments.


Subject(s)
Malocclusion, Angle Class III , Prognathism , Temporomandibular Joint Disorders , Female , Humans , Male , Adult , Osteotomy, Sagittal Split Ramus/methods , Mandible/surgery , Prognathism/surgery , Mandibular Condyle , Retrospective Studies , Deglutition
3.
J Craniomaxillofac Surg ; 50(9): 712-718, 2022 Sep.
Article in English | MEDLINE | ID: mdl-35987801

ABSTRACT

The aim of this study was to clarify the effects of three different orthognathic surgical procedures on the temporomandibular joint after mandibular setback. Conventional sagittal split ramus osteotomy (SSRO) with segmental fixation (conv-SSRO), intraoral vertical ramus osteotomy (IVRO), or SSRO without fixation followed by the physiological positioning strategy (nonfix-SSRO) was performed for mandibular setback. Temporomandibular joint disorder (TMD) symptoms were clinically assessed, and the condylar head angle was measured. In total, 129 patients participated. Preoperative TMD and treatment procedure were related to postoperative TMD. A menton deviation of 3.43 mm was the cutoff for the risk of postoperative TMD. The incidence rate of postoperative TMD in the conv-SSRO group was higher than that in the IVRO (p = 0.0197) and nonfix-SSRO (p = 0.0001) groups in asymmetric cases. There was no significant postoperative change in the temporomandibular joint space in each group. In symmetric and asymmetric cases, the condylar head was rotated inwards by 5.82 ± 4.75° (p < 0.0001) and 5.44 ± 3.10° (p < 0.0001), respectively, in the conv-SSRO group, and outwards by -7.98 ± 5.05° (p < 0.0001) and -8.32 ± 6.38° (p < 0.0001), respectively, in the IVRO group, but it was almost stable in the nonfix-SSRO group. Within the limitations of the study it seems that nonfix-SSRO should be preferred over conv-SSRO and IVRO whenever appropriate.


Subject(s)
Prognathism , Temporomandibular Joint Disorders , Humans , Mandible/surgery , Mandibular Condyle/physiology , Mandibular Condyle/surgery , Osteotomy, Sagittal Split Ramus/adverse effects , Osteotomy, Sagittal Split Ramus/methods , Prognathism/surgery , Retrospective Studies , Temporomandibular Joint/surgery , Temporomandibular Joint Disorders/etiology , Temporomandibular Joint Disorders/surgery
4.
J Clin Med ; 10(8)2021 Apr 14.
Article in English | MEDLINE | ID: mdl-33919726

ABSTRACT

The purpose of this clinical study is to evaluate the safety and preliminary efficacy of autologous freeze-drying platelet-rich plasma (FD-PRP) on bone regeneration in maxillary sinus floor augmentation as a preliminary pilot study. Five patients that required sinus floor augmentation to facilitate the placement of dental implants participated in this clinical study. The PRP was prepared from the autologous peripheral blood and was lyophilized and stored at -20 °C for 4 weeks before surgery. At surgery, triple-concentrated FD-PRP (x3FD-PRP) mixed with synthetic bone grafting materials was rehydrated following the transplantation into the sinus floor. The primary outcome was a safety verification of x3FD-PRP, evaluated in terms of the clinical course and consecutive blood tests. The secondary outcome was clinical efficacy focused on bone regeneration in sinus floor augmentation evaluated by radiographic examination and implant stability. There were no adverse events, such as systemic complications, excessive inflammatory reactions, severe infection, or local site healing complications, besides those on the usual course associated with surgery. Vertical augmented height was maintained, and the initial stability of implants was achieved post-operatively in 6 months. The results obtained in this study suggest that x3FD-PRP can be used safely for bone engineering in clinical practice. Further studies are required to draw a conclusion concerning the efficacy of x3FD-PRP since this was a pilot study with a single arm and a small sample size.

5.
Materials (Basel) ; 13(16)2020 Aug 05.
Article in English | MEDLINE | ID: mdl-32764407

ABSTRACT

This study aims to evaluate the safety and efficacy of a poly lactic-co-glycolic acid (PLGA)-coated ß-tricalcium phosphate (ß-TCP) with N-methyl-2-pyrrolidone (NMP) liquid activator (PLGA/ß-TCP) on alveolar ridge preservation after tooth extraction in dog mandible. Thirty-two extraction sites were prepared in eight dog mandibles. A distal root of the mandibular premolar was extracted and randomly grafted with one of the following bone substitutes: (1) PLGA/ß-TCP, (2) ß-TCP, or (3) left empty as a control, and wounds were closed with keratinized mucosa graft. Post-operative wound healing was observed and scored to evaluate safety. After 12 and 24 weeks, the bone regeneration was evaluated with micro-computed tomography (CT) images and histomorphometric analyses. Gingival epithelization progressed over time without complication or infection. Micro-CT images and histological observation revealed that both PLGA/ß-TCP and ß-TCP granules supported sufficient new bone formation. Although bone formation and substrate resorption were delayed slightly with the PLGA and the NMP-containing plasticizer as compared to those treated with conventional ß-TCP, it can be concluded that the PLGA and the NMP-containing plasticizer that facilitated the in situ hardening properties of the material had no negative influence on the biocompatibility of the material.

6.
J Craniomaxillofac Surg ; 48(7): 638-644, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32439368

ABSTRACT

PURPOSE: To clarify whether intraoral vertical ramus osteotomy (IVRO) or short lingual osteotomy (SLO) induces less proximal segmental movement after surgery without bone fixation. METHODS: This study included patients who underwent IVRO or SLO without bone fixation. Cephalograms were taken before surgery (T1), immediately after surgery (T2), and >6 months after surgery (T3) to assess postoperative movement of the proximal segment and skeletal stability. The condylar angle was measured using computed tomography images taken at T1 and T3 to assess rotation. RESULTS: Ninety patients were included (IVRO, n = 25; SLO, n = 65). The proximal segment swung laterally on the frontal cephalogram in the asymmetrical IVRO group at T3. The condylar head was rotated outwardly 6.52 ± 4.49° (p < 0.0001) in the symmetrical IVRO group and 8.06 ± 6.88° (p = 0.030) on the non-deviated side in the asymmetrical IVRO group at T3. The condyles were almost stable in the SLO group. Temporomandibular joint disorders were found in 2 of 22 IVRO patients and in 2 of 42 SLO patients with asymmetry at T3. CONCLUSION: This study suggests that SLO with the physiological positioning strategy (PPS) should be preferred over IVRO with the PPS whenever possible.


Subject(s)
Prognathism , Cephalometry , Humans , Mandible , Mandibular Condyle , Osteotomy, Sagittal Split Ramus
7.
Cranio ; 36(3): 181-188, 2018 May.
Article in English | MEDLINE | ID: mdl-28391764

ABSTRACT

OBJECTIVE: The aim of this study was to elucidate the physiological position of the proximal segment for postoperative jaw movement in patients with mandibular prognathism. METHODS: Twenty-two patients with mandibular prognathism were treated by orthognathic surgery using bilateral mandibular sagittal split ramus osteotomies (SSRO) with a physiological positioning strategy. The skeletal stability was assessed, and the movement of the proximal segment was evaluated by cephalography and computed tomography performed preoperatively, immediately postoperatively, and one year postoperatively. RESULTS: The patients were divided into two groups: the stable group (SNB relapse <1.5°) and the relapse group (SNB relapse ≥1.5°). In the stable group at one year postoperatively, the average SNB relapse was only 0.29° (7%), the condylar head had moved posteriorly by 0.75 mm, and the proximal segment had rotated counterclockwise by 1.2°. CONCLUSION: This new physiological positioning strategy improves the position of the condyle compared with the preoperative position in patients with mandibular prognathism.


Subject(s)
Mandibular Condyle/physiology , Osteotomy, Sagittal Split Ramus , Prognathism/physiopathology , Prognathism/surgery , Adolescent , Adult , Cephalometry , Female , Humans , Male , Mandibular Condyle/diagnostic imaging , Prognathism/diagnostic imaging , Tomography, X-Ray Computed , Young Adult
8.
Arch Oral Biol ; 73: 172-178, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27771585

ABSTRACT

OBJECTIVE: Platelet-rich plasma (PRP) is typically isolated and applied immediately after preparation, making it both a time- and labor-intensive addition to the operative procedure. Thus, it would be convenient if PRP could be preserved. We evaluated the efficacy of freeze-dried PRP (FD-PRP), as compared with freshly isolated PRP (f-PRP) for bone engineering. DESIGN: FD-PRP was prepared by lyophilization of f-PRP and was subsequently preserved at -20°C for one month. It was then rehydrated with an equal or 1/3 amount of distilled water (×1FD-PRP, ×3FD-PRP, respectively), and we assessed its gelation properties and the release of growth factors (PDGF-BB, TGF-ß1, and VEGF). We also examined the bone forming ability with onlay-grafting on mice calvaria using ß-TCP granules as a scaffold. RESULTS: FD-PRP showed comparable gelation as f-PRP. In terms of growth factor release,×1FD-PRP released identical concentrations of PDGF-BB and TGF-ß1 to f-PRP, while ×3FD-PRP released approximately 3-fold concentrations when compared with f-PRP. In vivo, ×1FD-PRP promoted identical levels of the bone formation as f-PRP, and ×3FD-PRP induced more abundant bone formation. CONCLUSIONS: These results suggest that f-PRP can be stored without functional loss by freeze-drying and the concentration of PRP may improve its efficacy in bone engineering.


Subject(s)
Blood Preservation/methods , Freeze Drying/methods , Osteogenesis , Platelet-Rich Plasma/metabolism , Tissue Engineering/methods , Animals , Becaplermin , Calcium Phosphates/pharmacology , Humans , Immunocompromised Host , Intercellular Signaling Peptides and Proteins/metabolism , Male , Mice , Mice, Inbred BALB C , Mice, Nude , Models, Animal , Proto-Oncogene Proteins c-sis/metabolism , Skull/cytology , Skull/transplantation
9.
Odontology ; 105(3): 375-381, 2017 Jul.
Article in English | MEDLINE | ID: mdl-27796598

ABSTRACT

The soft tissue profile is crucial to esthetics after orthognathic surgery. The aim of this study was to assess the soft tissue changes of the subnasal and submental regions more than 1 year after a sagittal split ramus osteotomy (SSRO) in patients with skeletal class III malocclusion. A total of 22 patients with mandibular prognathism were included in this study. Patients had lateral cephalograms before and more than 1 year after they underwent an isolated SSRO. Soft and hard tissue changes were assessed using the lateral cephalograms. The lower lip, labiomenton, and soft tissue menton moved posteriorly by 85, 89, and 88% compared with the corresponding hard tissue, and the movement of the soft tissue B point and the top of the chin nearly reflected the displacement of the hard tissues, at 96 and 99%, respectively. The labiomenton, stomions, and naso-labial angles were changed after the mandibular set-back and the changes in these angles correlated with either the width of the soft tissue or skeletal displacement. The naso-labial angle could be altered even if an isolated mandibular osteotomy is performed. Changes to the stomions and naso-labial angles were affected by hard tissue movement, while changes to the labiomental angle were affected by the width of the soft tissue after the mandibular osteotomy. It is important to create an accurate preoperative prediction of the esthetic outcomes after a mandibular osteotomy by considering the interrelations between the hard and soft tissues.


Subject(s)
Face/anatomy & histology , Malocclusion, Angle Class III/surgery , Mandibular Osteotomy , Adolescent , Adult , Cephalometry , Chin/anatomy & histology , Esthetics, Dental , Female , Humans , Lip/anatomy & histology , Male , Nose/anatomy & histology , Treatment Outcome
10.
PLoS One ; 11(1): e0147235, 2016.
Article in English | MEDLINE | ID: mdl-26795024

ABSTRACT

OBJECTIVES: This study aimed to examine the influence of particle size and extent of demineralization of dentin matrix on bone regeneration. MATERIALS AND METHODS: Extracted human teeth were pulverized and divided into 3 groups according to particle size; 200, 500, and 1000 µm. Each group was divided into 3 groups depending on the extent of demineralization; undemineralized dentin (UDD), partially demineralized dentin matrix (PDDM), and completely demineralized dentin matrix (CDDM). The dentin sample was implanted into rat calvarial bone defects. After 4 and 8 weeks, the bone regeneration was evaluated with micro-CT images, histomorphometric and immunohistochemical analyses. Osteoblasts were cultured on UDD and DDM to evaluate the cell attachment using electron microscope. RESULTS: Micro-CT images and histological observation revealed that CDDM had largely resorbed but UDD had not, and both of them induced little bone formation, whereas all particle sizes of PDDM induced more new bone, especially the 1000 µm. Electron microscopic observation showed osteoblasts attached to DDM but not to UDD. CONCLUSIONS: PDDM with larger particle size induced prominent bone regeneration, probably because PDDM possessed a suitable surface for cell attachment. There might be an exquisite balance between its resorption and bone formation on it. PDDM could be considered as a potential bone substitute.


Subject(s)
Bone Regeneration/physiology , Bone Substitutes/chemistry , Dentin/chemistry , Osteoblasts/cytology , Tissue Engineering , Animals , Humans , Male , Particle Size , Rats , Rats, Inbred F344
12.
Cranio ; 33(4): 276-84, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26715130

ABSTRACT

OBJECTIVES: The aim of this study was to assess the positional changes of the proximal segments after intraoral vertical ramus osteotomy (IVRO). METHOD: Fifteen patients underwent IVRO and were followed according to the authors' unique postoperative management regimen. The analyses of the positions and angles of the proximal segments were performed on frontal and lateral cephalograms, which were taken before surgery (T1) and within 3 days (T2), at 4 weeks (T3), and later than 6 months after surgery (T4). The three-dimensional positions of the condylar heads were also assessed by CT images, which were taken before and 1 year after surgery. RESULTS: The proximal segments temporarily swung posteriorly and laterally with a center on the condylar head as a fulcrum point at T2 and T3, compared with T1, and they repositioned at T4. The condylar heads moved inferior approximately 2 mm with lateral rotation one year after surgery, as seen in the CT. DISCUSSION: The condylar heads changed their positions physiologically for newly established jaw movement after IVRO with the authors' post-operative management regimen because the post-operative skeletal stability and the jaw function were good and stable using this method.


Subject(s)
Cephalometry/methods , Imaging, Three-Dimensional/methods , Mandibular Condyle/pathology , Mandibular Osteotomy/methods , Adolescent , Adult , Exercise Therapy , Female , Follow-Up Studies , Humans , Male , Mandible/pathology , Occlusal Splints , Rotation , Temporal Bone/pathology , Temporomandibular Joint/pathology , Tomography, X-Ray Computed/methods , Young Adult
13.
Br J Oral Maxillofac Surg ; 52(10): 965-9, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25193636

ABSTRACT

The aim of this study was to estimate skeletal and dental stability after maxillomandibular osteotomy with physiological positioning. Ten patients (7 men and 3 women) with skeletal mandibular prognathism were treated by conventional Le Fort I osteotomy for the maxilla and unfixed short lingual osteotomy for the mandible together with physiological positioning. We used cephalometric analysis to evaluate the skeletal and dental stability preoperatively, immediately after maxillomandibular osteotomy, and more than 1 year later. The immediately postoperative measurements for the SNA and the SN-palatal planes were 0.15° (p=0.67) and 1.0° (p=0.17), respectively. The positions of the anterior nasal spine, posterior nasal spine, and A point showed minimal changes 1 year postoperatively. The postoperative difference for SNB was 0.76° (p=0.04). Dental stability was apparent postoperatively. We conclude that reliable stability of both the maxilla and the mandible was achieved after maxillomandibular osteotomy with physiological positioning in patients with mandibular prognathism.


Subject(s)
Mandibular Osteotomy/methods , Osteotomy, Le Fort/methods , Prognathism/surgery , Adolescent , Adult , Cephalometry/methods , Chin/pathology , Exercise Therapy/methods , Female , Follow-Up Studies , Humans , Incisor/pathology , Male , Mandible/pathology , Maxilla/pathology , Nasal Bone/pathology , Occlusal Splints , Palate/pathology , Patient Care Planning , Prognathism/pathology , Sella Turcica/pathology , Treatment Outcome , Young Adult
14.
Br J Oral Maxillofac Surg ; 52(2): e9-e13, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24380666

ABSTRACT

We describe the strategy of physiological positioning, which we regard as a new alternative treatment to conventional orthognathic operations, and treated 18 patients with skeletal mandibular prognathism using it. The positions of SNB, FMA, and Me were measured postoperatively to assess skeletal stability, changes in the angle and perpendicular length of the upper and lower central incisors were measured to assess dental stability, and we confirmed that both skeletal and dental stability were excellent. The width to which the jaw could be opened recovered early, and we saw only one case of disorder of the temporomandibular joint. Short lingual osteotomy with physiological positioning is an effective new approach to the treatment of deformities of the mandible.


Subject(s)
Mandibular Osteotomy/methods , Prognathism/surgery , Adolescent , Adult , Cephalometry/methods , Exercise Therapy , Female , Follow-Up Studies , Humans , Incisor/pathology , Jaw Fixation Techniques , Male , Mandible/pathology , Mandible/physiopathology , Maxilla/pathology , Nasal Bone/pathology , Range of Motion, Articular/physiology , Sella Turcica/pathology , Young Adult
SELECTION OF CITATIONS
SEARCH DETAIL
...