Dental Implant Survival after Postoperative Infection.

Purpose: Early postoperative infection can lead to dental implant failure. This study aimed to evaluate the frequency of failed and survived implants after acute postoperative infection and the related factors. Materials and Methods: This cross-sectional cohort evaluated early infection after dental implant surgery. The study variables included the site of implant placement, age and gender of patients, bone augmentation, postoperative antibiotic therapy, smoking, and time of infection occurrence or diagnosis. Failed and survived implants were the outcome of the study. The patients were studied in 2 groups of survived implants (group 1) and failed implants (group 2). Results: Thirty-four (3.46%) out of 980 patients developed a postoperative infection following implant placement, which included 25 males and 9 females. Ten implants (29.4%) survived (group 1), and 24 implants (70.6%) failed (group 2). There were significant differences between the 2 groups regarding the number of smoker patients, fresh socket or delayed implant placement, patients who received bone graft, and the meantime of diagnosis (P < 0.05). Regarding the covariates, the Kaplan-Meier analysis showed that the risk of implant failure in patients who did not receive postoperative antibiotic therapy increased by 1.1 times (hazard ratio) when infection occurred four days after surgery. In patients who received postoperative antibiotics, the risk of failure increased when infection occurred after 6 days in smokers and after 9 days in non-smokers. Conclusion: Considering the study results, it seems that smoking, early infection, fresh socket placement, and placement of implants along with bone substitutes may increase the failure rate after acute infection in dental implant placement.

Does platelet-rich fibrin increase stability of the maxilla following Le Fort I osteotomy? A single-blind clinical trial study.

This single-blind clinical trial study aimed to assess the efficacy of platelet-rich fibrin (PRF) in increasing stability following Le Fort I osteotomy for maxillary advancement. Patients who underwent Le Fort I osteotomy for maxillary advancement were assigned randomly into two groups: in group 1 (the study group, n = 22) PRF was placed in the osteotomy sites following fixation, while no PRF was used in group 2 (the control group, n = 22). Lateral cephalograms obtained preoperatively (T0), immediately after surgery (T1), and 1 year after surgery (T2) were compared between the two groups, and the amount of relapse was determined. The amount of maxillary change (relapse) at the A point in relation to the x-axis was 0.45 ± 0.67 mm in group 1 and 1.86 ± 0.56 mm in group 2. There was a significant difference in mean relapse in relation to the x-axis between the two groups 12 months after osteotomy (p < 0.001). The mean maxillary change (relapse) in relation to the y-axis was 0.77 ± 1.15 mm in group 1 and 2.25 ± 1.22 mm in group 2. Analysis of the data demonstrated a significant difference in mean relapse in relation to the y-axis between the two groups (p < 0.001). PRF may enhance the stability of the maxilla following Le Fort I osteotomy. Based on the results of this study the administration of PRF should be considered whenever possible.

What factors affect the attachment of the inferior alveolar nerve to the buccal plate following sagittal split osteotomy?

PURPOSE: This study aimed to assess the factors that can possibly affect the positioning of the inferior alveolar nerve (IAN) in the proximal or distal segment following sagittal split osteotomy (SSO). MATERIALS AND METHODS: This was a prospective cohort study. The patients were assigned according to the position of the IAN: the IAN was attached to the buccal plate in group 1 (27 SSOs), while it was in the distal segment in group 2 (83 SSOs). RESULTS: The mean of the buccolingual thickness of the proximal segment at the vertical cut of the osteotomy (BLTP) was 5.0 ± 0.62 mm in group 1 and 4.16 ± 0.72 mm in group 2. The mean of the distance between the IAN and the external cortical bone at the distal of the second molar before the osteotomy (IANB) was 0.5 ± 0.24 mm in group 1 and 1.24 ± 0.45 mm in group 2. There were significant differences for the mean BLTP and IANB between the two groups (P = 0.001). CONCLUSION: It seems that the thickness of the buccal plate of the proximal segment, the distance from the IAN to the external cortical bone, the osteotomy technique, and the presence or absence of impacted third molars may be associated with the positioning of the IAN following SSO.

Angiolymphoid hyperplasia with eosinophilia in the angle region of the mandible.

Angiolymphoid hyperplasia with eosinophilia (ALHE), also called epithelioid hemangioma, is a rare benign vascular lesion usually affecting the muscular arteries of the head and neck in female patients. Here, we report a 30-year-old male patient who presented with painless swelling in the angle region of the mandible. The diagnosis of the specimen, which was surgically removed under local anesthesia, was made as ALHE. The patient has remained uneventful for 3 years.

The comparison of outcomes of surgically treated bilateral temporomandibular joint disorder in different groups: A retrospective study

Study design: Sixty five patients with 130 bilateral TMJ were included the study with the selection from consecutive 256 TMJ patients who were treated with open surgery who do not respond to conservative treatment. 65 patients were divided in to 3 main groups according to the clinical diagnosis of bilateral TMJ site. In the first group comprised 29 patients with 48 TMJ, the clinical diagnosis was bilaterally presence of anterior disc displacement with reduction (ADDR). In the second group comprised 19 patients with 26 TMJ, bilateral presence of TMD consisted of anterior disc displacement without reduction (ADDNR) on both site. In the third group comprised 27 patients with 46 TMJ, bilaterally presence of TMD consist of ADDR on one site and ADDNR on another site. The patients in three different groups were operated either high condylectomy alone or high condylectomy with additional surgical procedures. Results: In the evaluation of pain relief, clicking, crepitation, headache, marked improvement was determined in all groups, but it was statistically insignificant in the comparison of 3 groups. Slight increase in maximal mouth opening was determined in the mean values of the 3 groups and also in the comparison of 3 groups it was not statistically significant. Concluisons: These similar succesfull outcomes of bilateral TMD with the respect of TMJ surgical procedures were obtained in 3 main groups although different diagnosis on the patients' groups was present (AU)

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Marsupialization as a treatment option for the odontogenic keratocyst.

BACKGROUND AND PURPOSE: The odontogenic keratocyst (OKC) is an unusual cyst with a high recurrence rate. The most common site for OKCs is by far the mandible. The best treatment of OKC remains controversial. Recurrence rates ranging anywhere from less than 10% to more than 60% have been reported. The aim of our study was to evaluate marsupialization as a treatment option for OKC. METHODS: We managed 13 patients (8 male, 5 female) between the ages of 16 and 31 years (mean, 22.4 y) with biopsy-proven OKC. Radiographically, the patients' cyst sizes were between 25 and 90 mm. Treatment consisted of marsupialization. We followed up with patients for a total duration of at least 60 months, and posttreatment visits were carried out at 6-month intervals. RESULTS: We documented cured or reduced cyst size with radiography. The odontogenic keratocyst resolved completely in 10 patients, and the cyst walls shrank in 3 patients. The latter patients required a second operation to remove the associated impacted teeth. A histologic evaluation of 3 lesions showed metaplasia. Any case of recurring cysts was not seen during the entire follow-up period. CONCLUSIONS: Marsupialization is an effective and conservative treatment option for OKC. Nevertheless, future studies should conduct even longer follow-up periods to evaluate any recurrence of lesions.

The comparison of outcomes of surgically treated bilateral temporomandibular joint disorder in different groups: a retrospective study.

OBJECTIVES: The main purpose of this study was to determine the prognosis and outcomes of the patients with bilateral temporomandibular disorder which underwent bilateral temporomandibular joint surgery in a consecutive number of patients in a retrospective study. STUDY DESIGN: Sixty five patients with 130 bilateral TMJ were included the study with the selection from consecutive 256 TMJ patients who were treated with open surgery who do not respond to conservative treatment. 65 patients were divided in to 3 main groups according to the clinical diagnosis of bilateral TMJ site. In the first group comprised 29 patients with 48 TMJ, the clinical diagnosis was bilaterally presence of anterior disc displacement with reduction (ADDR). In the second group comprised 19 patients with 26 TMJ, bilateral presence of TMD consisted of anterior disc displacement without reduction (ADDNR) on both site. In the third group comprised 27 patients with 46 TMJ, bilaterally presence of TMD consist of ADDR on one site and ADDNR on another site. The patients in three different groups were operated either high condylectomy alone or high condylectomy with additional surgical procedures. RESULTS: In the evaluation of pain relief, clicking, crepitation, headache, marked improvement was determined in all groups, but it was statistically insignificant in the comparison of 3 groups. Slight increase in maximal mouth opening was determined in the mean values of the 3 groups and also in the comparison of 3 groups it was not statistically significant. CONCLUSIONS: These similar succesfull outcomes of bilateral TMD with the respect of TMJ surgical procedures were obtained in 3 main groups although different diagnosis on the patients' groups was present.

Comparison of the effect of 2 hypotensive anesthetic techniques on early recovery complications after orthognathic surgery.

The aim of this study was to evaluate the recovery complications following the use of 2 anesthetic protocols in orthognathic surgery, namely, propofol with remifentanil and isoflurane with remifentanil. Sixty-two patients with American Society of Anesthesiologists physical status I were selected. All underwent bimaxillary orthognathic surgery. Propofol with remifentanil was used as an anesthesia in group 1 (n = 32), and isoflurane with remifentanil was used in the patients in group 2 (n = 30). Early recovery complications consisting of pain, postoperative nausea and vomiting (PONV), shivering, and agitation were evaluated and documented. The length of the operation and duration of recovery were documented for all patients. Analysis of the data demonstrated no relationship between age and recovery time (P > 0.05). Analysis of data with χ(2) and independent t-tests did not show any difference between the 2 groups with regard to pain, agitation, PONV, and shivering (P > 0.05). Logistic regression was used to evaluate the effect of the operation time on recovery complications. The analysis showed that pain and PONV were significantly higher in those who experienced a longer operation time. With increasing operation time longer than 165 minutes, 64% of patients experienced pain, and 89% of them had PONV. General anesthesia can be provided via intravenously administered medications and/or inhaled volatile anesthetics. No significant difference in early recovery time was found in patients when either isoflurane or propofol was used to maintain the anesthesia. However, the length of the operation played a major role in increasing early recovery complications.

Management of bilateral masseter muscle hypertrophy.

Masseter muscle hypertrophy is characterized by unilateral or bilateral enlargement of the masseter muscles affecting both females and males after puberty. Limitations on mouth opening, swollen cheek, and also tension in the region of the hypertrophied muscle are symptoms reported. Also, masseter hypertrophy can cause aesthetic and functional problems. A 40-year old woman was referred to our clinic with the chief complaint of facial appearance with square-face type. To eliminate undesirable facial appearance, surgical intraoral approach compromising reduction of deep masseter muscle with monocortical and bicortical ostectomy of the angle of the mandible was performed. The patient was satisfied with both functional outcomes and aesthetic outcomes on both facial profile and frontal view. No complication was seen intraoperatively and postoperatively after a 12-month follow-up period. This treatment modality would be suggested to gain optimal aesthetic results especially in a square face from the lateral profile.

Nonossifying fibroma secondary to aneurysmal bone cyst in the mandibular condyle.

Nonossifying fibromas (NOFs) are benign lesions that unusually occur in the mandible. Nonossifying fibromas are asymptomatic and spontaneous resolution at skeletal maturity. Nonossifying fibromas associated with aneurysmal bone cyst (ABC) are very rare. In this clinical report, NOF secondary to ABC in the mandibular condyle was reported; however, it presents different clinical behavior than the usual NOF. In this case, severe destruction in the mandibular condyle as a characteristic of NOF was seen. In the follow-up period, no recurrence was seen subsequent to treatment of lesion with complete resection. Treatment of NOFs with secondary ABC would require aggressive intervention than the treatment of usual NOF.

Complete or a partial sheet of deep temporal fascial graft as a radix graft for radix augmentation.

Autogenous fascia, including the temporalis fascia, has a particular role in rhinoplasty as radix and dorsal onlay grafts. The main purpose of this study is to achieve desired appearance of facial harmony using either a complete or partial sheet of deep temporal fascia as a radix graft in the patients with required permanent radix augmentation. This is a prospective study of 15 patients who referred to Gandi Day Clinic, Tehran, Iran, between 2005 and 2006 and underwent rhinoplasty including nasal radix augmentation using deep temporalis fascia through external rhinoplasty approach. The patients with hump noses had low radix and required radix augmentation. Full sheet facial graft was used in 13 patients. Partial sheet facial graft was used in two patients. As a donor site problem, minor hematoma was observed in one patient. Temporary hair loss in incision line was another problem which were seen in five. As for the recipient site, no infection, persistent erythema of nasal skin extrusion, visibility, displacement of graft materials or irregularity of graft contour were observed postoperatively. Resorption rate was approximately 30% for grafted fascia. Using fascia grafts in radix point, the revision rate was minimal. In order to augment the radix, if 4 mm augmentation is needed, it should be considered that full sheet fascia graft alone would be insufficient. If more than 4 mm of augmentation is needed, 30% overcorrection would manage well the permanent radix augmentation without any problem.

Correction of lower facial wideness due to masseter hypertrophy.

Masseter hypertrophy is an uncommon condition that can cause aesthetic and functional problems. Various treatment options were suggested by authors. We used surgical intraoral approaches in 5 patients, which consist of masseter muscle reduction and monocortical ostectomy in the angle of the mandible. Results showed good aesthetic results without any complication. We suggest the use of surgical treatment to gain optimal aesthetic results especially in a square face.

Conservative Treatment Protocol for Keratocystic Odontogenic Tumour: a Follow-up Study of 3 Cases.

BACKGROUND: The keratocystic odontogenic tumour is classified as a developmental cyst derived from the enamel organ or from the dental lamina. The treatment of keratocystic odontogenic tumour of the jaw remains controversial. The aim of this study was to report the outcome of our conservative treatment protocol for keratocystic odontogenic tumour. METHODS: Three patients with different complaints referred to Oral and Maxillofacial Surgery Clinic, Faculty of Dentistry, Selçuk University. Initial biopsy was carried out in all patients and keratocystic odontogenic tumours was diagnosed subsequent to histopathological examination. The patients with keratocystic odontogenic tumours were treated by enucleation followed by open packing. This conservative treatment protocol was selected because of existing young aged patients. The average follow-up duration of the cases was 2 years. RESULTS: Out of 3 cases, 2 lesions were present in mandible and 1 lesion in maxilla. There was no evidence of recurrence during follow-up. All the cases were monitored continuously with panoramic radiographs, computed tomography and clinical evaluations. CONCLUSIONS: This conservative treatment protocol for keratocystic odontogenic tumours, based on enucleation followed by open packing would be a possible choice with a view of offering low recurrence rate and low morbidity rate particularly in young patients.

Chordoma in paranasal sinuses.

Chordoma is a rare malignant intercranial tumor. Cranial base chordomas usually occur extradurally. In the current study, a 44-year-old man with chordoma in cranial base and paranasal sinuses was reported. The patient was managed with combination of surgery and radiotherapy. Surgical phase comprised anterior cranial base osteotomy, removal of lesions, and replacement of osteotomy segment. One-year follow-up showed no evidence of recurrence of lesions. Aggressive surgery with postoperative radiotherapy for treatment of chordoma in the cranial base can be suggested as a proper treatment modality.

Craniofacial fibrous dysplasia of orbit.

Fibrous dysplasia is a benign, rare, and idiopathic skeletal disorder characterized by replacement and expansion of medullary bone by disorganized fibro-osseous tissue. Treatment for these lesions is usually sought for cosmetic or functional reasons. The surgical approaches vary from watchful expectancy for the lesion to stop growing after puberty to conservative resection to radical resection. In this case reports, 3 patients with craniofacial fibrous dysplasia involving orbital region underwent surgery. In these primary cases, resection and immediate reconstruction were performed to regain facial contour, dental occlusion, and masticatory function. Significant improvement was seen in facial appearance, and all patients also felt that there had been improvement aesthetically. Therefore, conservative treatment for fibrous dysplasia, unless there is involvement of vital structure as orbital region, can be suggested. Early surgery to address progressive sensory disturbance is recommended so as to avoid the hazards of late-stage decompression.

Paresthesia of the mental nerve stem from periapical infection of mandibular canine tooth: a case report.

Sensory disturbances such as paresthesia, anesthesia, hypoesthesia, and hyperesthesia may be present in the oral cavity. Paresthesia is defined as a burning or prickling sensation or partial numbness caused by neural injury. Paresthesia in dentistry can be caused by local or systemic factors. Local factors include traumatic injuries such as mandibular fractures, expanding compressive lesions (benign or malignant neoplasia and cysts), impacted teeth, local infections (osteomyelitis, periapical, and peri-implant infections), iatrogenic lesions after tooth extractions, anesthetic injection, endodontic therapy (overfilling and apical surgery), implantology, orthodontic surgery, and preprosthetic surgery. The main purpose of this case report is to present the treatment and resolution of a mental nerve paresthesia stemming from apical pathosis of a mandibular canine tooth and the follow-up of 3 years.