Total Mandibular subapical osteotomy to correct Class II with inferior alveolar retrusion.

PURPOSE: Class II dento-facial deformity due to inferior alveolar retrusion may be difficult to treat using conventional surgical procedures. The aim of this study was to report on total mandibular subapical osteotomy (TMSO) to correct inferior alveolar retrusion, to describe its indications, the surgical technique and to analyse the aesthetic, occlusal changes and stability. MATERIALS AND METHODS: Patients treated with TMSO from January 2004 to December 2014 were included and analysed retrospectively. Delaire's cephalometric analysis was performed before surgery and one year after surgery. Skeletal, occlusal and soft tissue changes were measured comparing lateral cephalographs before and after surgery. RESULTS: From January 2004 to December 2014, 8 patients were treated by TMSO. Six patients were analysed and presented a stable class I occlusion 3 years after surgery with an improvement of the labio-mental sulcus. Mean position of the dental apex of the inferior central incisor (ia) before surgery was -8.5mm corresponding on an inferior alveolar retrusion of -8.5mm. After surgery, mean ia position was -0.25mm showing an average of alveolar advancement of 8.25mm. Regarding the soft tissues movements, the mean labio-mental angle showed a variation from 84.7° to 120.3°, and the deepest point of the labio-mental sulcus (Mli) was advanced with a mean of 9.22mm corresponding to the bone movements. CONCLUSION: Total mandibular subapical osteotomy may be considered as a stable, safe and ideal procedure for patients having a class II deformity, due to a total inferior alveolar retrusion without mandibular retrognathism, improving labio-mental sulcus and chin shape.

Le Fort II Setback Osteotomy to Correct Naso-Ethmoido-Maxillary Protrusion.

BACKGROUND: Marked class II dentofacial deformity associated with centrofacial protrusion may be difficult to treat successfully. The purpose of this article was to report on Le Fort II setback osteotomy (LIISBO) to correct Naso-Ethmoido-Maxillary Protrusion (NEMP), to describe its indications and surgical techniques, and to analyze aesthetic and occlusal changes. MATERIALS AND METHODS: From November 2011 to November 2014, patients with NEMP, treated with LIISBO, were included in the study. Cephalometric analysis of Delaire was performed before and 1 year after surgery. Skeletal and soft tissues movements were measured between preoperative and postoperative lateral cephalographs. RESULTS: Fourteen patients were treated in our department by LIISBO. Ten patients were analyzed and presented a stable class I occlusion with reliable aesthetic results. The mean maxillary setback was -2.8 mm at nasopalatal point (Np), -3.1 mm at A point, and -3.7 mm at Pti (inferior pterygomaxilar point). The mean maxillary impaction was -2.4 mm at Np, -3 mm at A point, and -0.6 mm at Pti. The B, mental, and pogonion points showed an advancement with an average of +7.4, +7.9, and +7.7 mm, respectively. Measured soft tissues variations showed a backward movement of the nasal tip, the subnasal point, and the upper lip of -1.5, -1.6, and -0.7 mm, respectively. The lower lip, sublabial point, and the skin pogonion were advanced by +3.2, +5.4, and +6.2 mm, respectively. CONCLUSIONS: Le Fort II setback osteotomy may be regarded as the ideal treatment for adult patient presenting a NEMP syndrome.

Mandibular Tissue Engineering: Past, Present, Future.

Almost 2 decades ago, the senior author's (M.T.J.) first article was with our mentor, Dr Leonard B. Kaban, a review article titled "Distraction Osteogenesis: Past, Present, Future." In 1998, many thought it would be impossible to have a remotely activated, small, curvilinear distractor that could be placed using endoscopic techniques. Currently, a U.S. patent for a curvilinear automated device and endoscopic techniques for minimally invasive access for jaw reconstruction exist. With minimally invasive access for jaw reconstruction, the burden to decrease donor site morbidity has increased. Distraction osteogenesis (DO) is an in vivo form of tissue engineering. The DO technique eliminates a donor site, is less invasive, requires a shorter operative time than usual procedures, and can be used for multiple reconstruction applications. Tissue engineering could further reduce morbidity and cost and increase treatment availability. The purpose of the present report was to review our experience with tissue engineering of bone: the past, present, and our vision for the future. The present report serves as a tribute to our mentor and acknowledges Dr Kaban for his incessant tutelage, guidance, wisdom, and boundless vision.

Tissue-engineered bone with 3-dimensionally printed ß-tricalcium phosphate and polycaprolactone scaffolds and early implantation: an in vivo pilot study in a porcine mandible model.

PURPOSE: Deep bone penetration into implanted scaffolds remains a challenge in tissue engineering. The purpose of this study was to evaluate bone penetration depth within 3-dimensionally (3D) printed ß-tricalcium phosphate (ß-TCP) and polycaprolactone (PCL) scaffolds, seeded with porcine bone marrow progenitor cells (pBMPCs), and implanted early in vivo. MATERIALS AND METHODS: Scaffolds were 3D printed with 50% ß-TCP and 50% PCL. The pBMPCs were harvested, isolated, expanded, and differentiated into osteoblasts. Cells were seeded into the scaffolds and constructs were incubated in a rotational oxygen-permeable bioreactor system for 14 days. Six 2- × 2-cm defects were created in each mandible (N = 2 minipigs). In total, 6 constructs were placed within defects and 6 defects were used as controls (unseeded scaffolds, n = 3; empty defects, n = 3). Eight weeks after surgery, specimens were harvested and analyzed by hematoxylin and eosin (H&E), 4',6-diamidino-2-phenylindole (DAPI), and CD31 staining. Analysis included cell counts, bone penetration, and angiogenesis at the center of the specimens. RESULTS: All specimens (N = 12) showed bone formation similar to native bone at the periphery. Of 6 constructs, 4 exhibited bone formation in the center. Histomorphometric analysis of the H&E-stained sections showed an average of 22.1% of bone in the center of the constructs group compared with 1.87% in the unseeded scaffolds (P < .05). The 2 remaining constructs, which did not display areas of mature bone in the center, showed massive cell penetration depth by DAPI staining, with an average of 2,109 cells/0.57 mm(2) in the center compared with 1,114 cells/0.57 mm(2) in the controls (P < .05). CD31 expression was greater in the center of the constructs compared with the unseeded scaffolds (P < .05). CONCLUSION: 3D printed ß-TCP and PCL scaffolds seeded with pBMPCs and implanted early into porcine mandibular defects display good bone penetration depth. Further study with a larger sample and larger bone defects should be performed before human applications.