ABSTRACT
FOCUSED CLINICAL QUESTION: What are the key considerations for the interdisciplinary dentofacial therapy (IDT) team in the diagnostic process to evaluate a patient for surgically facilitated orthodontic therapy (SFOT)? SUMMARY: SFOT creates a demineralized bone matrix and augments dentoalveolar deficiencies in the management of dentofacial disharmony malocclusion. Numerous indications and contraindications exist which are essential to the periodontal surgeon for proper case selection. A collaboratively focused workup by an IDT team is equally essential. Cone beam computed tomography (CBCT) and orthodontic simulation software which identifies changes in the dentoalveolar complex influenced by tooth movement are critical in providing transparency to the patient and IDT team during the treatment planning process. Such transparency can aid the team in assessing goals and outcomes that consider and respect foundational dentoalveolar parameters while contributing to sustainable outcomes. CONCLUSIONS: The SFOT IDT decision making process is complex, yet full of opportunities. Embracing SFOT IDT with innovative and novel 3D technology can optimize conditions leading to long-term outcomes that align with periodontal stability as well as patient goals and preferences which permeate beyond the achievement of "straightening teeth". Transparency of complex IDT through 3D CBCT and orthodontic simulation software engenders "collaborative accountability" and can improve patient communication which is critical to developing meaningful and essential treatment plans.
Subject(s)
Malocclusion , Tooth Movement Techniques , Cone-Beam Computed Tomography , Humans , Patient Care PlanningABSTRACT
Comorbidities that negatively impact orthodontic (malocclusion), periodontal (periodontitis, deficient dentoalveolar bone volume, mucogingival), and prosthetic (structural integrity compromise from caries, attrition, and erosion) conditions can affect the general health of the patient. In addition, emerging data highlights the importance of undiagnosed airway volume deficiencies and sleep-disordered breathing conditions in the adult and pediatric population. Deficiencies in dentoalveolar bone and discrepancies in skeletal relationships can impact the volume of hard- and soft-tissue structures of the periodontium and decrease oral cavity volume. Contemporary interdisciplinary dentofacial therapy (IDT) is a key process for addressing the comprehensive problems of patients based on etiology, homeostasis, and sustainability of physiologically sound outcomes. These provide the patient with sustainable esthetics and function. Surgically facilitated orthodontic therapy (SFOT) uses corticotomies and dentoalveolar bone decortication to stimulate the regional acceleratory phenomenon and upregulate bone remodeling and tooth movement as a part of orthodontic decompensation. It also generally includes guided periodontal tissue regeneration and/or dentoalveolar bone augmentation. SFOT as a part of IDT is demanding and requires extensive attentiveness and communication among all team members. This article focuses on the role of SFOT as an integral component of contemporary IDT to facilitate highly predictable and sustainable outcomes.
Subject(s)
Guided Tissue Regeneration, Periodontal/methods , Malocclusion/surgery , Malocclusion/therapy , Orthodontics, Corrective/methods , Surgery, Oral/methods , Tooth Movement Techniques/methods , Alveolar Process/surgery , Alveolar Ridge Augmentation/methods , Esthetics, Dental , Face/abnormalities , Face/anatomy & histology , Humans , Mouth/anatomy & histology , Mouth/surgery , Oral Surgical Procedures/methods , Orthodontics , Patient Care Team , SoundABSTRACT
Sleep disorders affect more than 20 percent of the U.S. population, but less than 7 percent have been medically diagnosed. Dentists are ideally positioned to identify many patients who fall under the grouping of sleep-disordered breathing. This paper presents perspectives on sleep-related issues from various medical specialties with a goal to broaden the dentist's appreciation of this topic and open avenues of communication. Algorithms are proposed to guide dentists following positive screenings for sleep-disordered breathing.
Subject(s)
Dentists , Patient Care Team , Sleep Apnea Syndromes/diagnosis , Algorithms , Communication , Humans , Interprofessional Relations , Mass Screening , Professional Role , Referral and Consultation , Sleep Apnea Syndromes/therapyABSTRACT
PURPOSE: This clinical study evaluated the use of transport distraction osteogenesis in reconstruction of the ramus-condyle unit (RCU) of the temporomandibular joint (TMJ). PATIENTS AND METHODS: Thirteen TMJ reconstructions were carried out in 12 patients. Diagnoses included tumors, trauma, ankylosis, and degenerative joint disease. The follow-up period has ranged from 7 to 59 months. RESULTS: Successful distraction was carried out in all cases, with development of solid regenerate bone and an effective new articulation. There were no complications. A good functional level was achieved in all cases. One patient with bilateral rheumatoid arthritis has experienced ongoing degenerative changes in the reconstructed condyles, with reappearance of an anterior open bite. The occlusion has remained stable in all other cases. CONCLUSIONS: Distraction osteogenesis is a promising treatment option in reconstruction of the RCU of the TMJ.
Subject(s)
Arthroplasty/methods , Mandibular Condyle/surgery , Osteogenesis, Distraction/methods , Temporomandibular Joint Disorders/surgery , Temporomandibular Joint/surgery , Adolescent , Adult , Bone Regeneration , Bony Callus/physiology , Chondrogenesis , Female , Humans , Male , Middle Aged , Oral Surgical Procedures/methodsABSTRACT
Corrective jaw (orthognathic) surgery is indicated for patients with a malocclusion caused by a skeletal deformity. This paper will discuss current concepts in patient evaluation and review contemporary surgical treatment.
