Virtual surgical analysis: long-term cone beam computed tomography stability assessment of segmental bimaxillary surgery.

The assessment of the stability of orthognathic surgery is often time-consuming, relies on manual re-identification of anatomical landmarks, and has been based on short-term follow-up. The purpose of this study was to propose and validate a semi-automated approach for three-dimensional (3D) assessment of the long-term stability of segmental bimaxillary surgery. The approach was developed and validated using cone beam computed tomography scans obtained at 2 weeks and 2 years postoperative. The stability of the surgical outcome was calculated as 3D translational and rotational differences between the short- and long-term postoperative positions of the individual bone segments. To evaluate reliability, intra-class correlation coefficients were calculated at a 95% confidence interval on measurements of two observers. Ten class II and III patients (six male, four female; mean age 24.4 years), who underwent a combined three-piece Le Fort I osteotomy, bilateral sagittal split osteotomy, and genioplasty, were included in the study. Intra- and inter-observer reliability were excellent (range 0.82-0.99). The range of the mean absolute difference of the intra- and inter-observer translational and rotational measurements were 0.14 mm (0.13)-0.44 mm (0.50) and 0.20° (0.16)-0.92° (0.78). The approach has excellent reliability for 3D assessment of long-term stability of segmental bimaxillary surgery.

Autotransplantation of premolars: does surgeon experience matter?

Autotransplantation of premolars is a well-established method to rehabilitate aplasia of premolars. Nevertheless, with the introduction of titanium implants, not all surgical units offer this procedure. The aim of this study was to examine the predictability of autotransplantation of premolars on orthodontic indication as suggested by Andreasen et al., when performed by surgeons with or without prior experience of this procedure. A prospective protocol was implemented in 2001. All patients treated with autotransplantation of premolars during the years 2001-2015 were recalled to evaluate the long-term status of the teeth. The state of root development, need for endodontic treatment, presence of an apical pathology or ankylosis, and tooth loss were recorded. The results were divided into two groups according to the surgeon's experience: senior surgeons with prior training and experience in the procedure and junior surgeons without prior experience. A total of 89 teeth (66 patients) were treated. The mean observation time was 10.1 years (range 1.0-15.1 years). The long-term survival rate was 95%. No statistically significant difference between the results of the two groups of surgeons was found. Autotransplantation of premolars on orthodontic indication could be adopted successfully in the hospital setting regardless of surgeon experience.

Nerve lesions following apical extrusion of non-setting calcium hydroxide: a systematic case review and report of two cases.

We present two cases of apical extrusion of non-setting, calcium hydroxide paste which had been placed as an interappointment root canal dressing during routine endodontic treatment resulting in tissue necrosis of a large part of the mandible. Surgical intervention consisted of resections in both instances. In relation to the cases presented, a systematic review of similar cases in the literature between 1980 and April 2013 was conducted which resulted in eight cases meeting the criteria outlined. As with the two presented cases, half of these eight cases showed serious adverse effects and the use of an injectable system had most often been related to apical extrusion. Consequently, great care should be taken when applying the paste into the canal system.

Autologous fibrin glue with growth factors in reconstructive maxillofacial surgery.

The aim of this paper was to describe a method for the preparation of autologous fibrin glue with platelet growth factors and to report its use with particulate cancellous bone in reconstructive maxillofacial surgery. The fibrin glue is a two-component glue, where the one component is a concentrated fibrinogen solution with platelet growth factors and the other component is a thrombin solution. Both components were produced from the patients own blood, thus making the glue entirely autologous. The glue was prepared from platelet rich plasma separated from 200 ml of the patient's blood prior to the operation. The fibrinogen in the glue was precipitated from the platelet rich plasma by ethanol precipitation at low temperature and separated together with the platelets by centrifugation. Raising the temperature to 37 degrees C redissolved the precipitate. The thrombin solution in the glue was produced from prothrombin precipitated from 10 ml of the platelet rich plasma by lowering the pH and the ionic strength. The precipitate was separated by centrifugation and dissolved in a calcium ion solution. Increasing the pH to neutral value induced activation to thrombin. Preparation of the fibrin glue was performed in the blood bank within 60 to 90 min with the use of standard equipment. The outcome from 200 ml of blood was approximately 8 ml of fibrin glue: 6 ml fibrinogen to be coagulated with 2 ml of thrombin. The glue had a fibrinogen concentration of approximately 12 times the value in platelet rich plasma and the concentration of growth factors was approximately eight times the value in platelet rich plasma. We have used this glue successfully with particulate bone grafts for reconstructive purposes within the oral and maxillofacial field. It might as well be applied to other surgical areas. Whenever larger amount of the glue will be needed, a whole unit of blood may be taken from the patient, and the red cells re-transfused to the patient during or after the operation.

Dental caries and dental health behavior of patients with primary Sjögren syndrome.

This comprehensive study was carried out to describe and analyze the oral health status, perceived oral health problems, patients' costs, and oral health behavior in a group of patients with primary Sjögren syndrome (PSS). In particular, the objective of this report was to assess whether Sjögren syndrome patients had more dental caries experience than a control group. Data were collected by means of interviews and clinical oral examinations. The study comprised 53 patients with PSS and a control group of 53 persons matched by age. Among the younger patients the number of decayed, missing, or filled teeth (DMFT) was 22.3, compared with 18.8 among controls (P< 0.05). In parallel, the DMFT in the old-age PSS patients was 26.2, against a DMFT of 22.1 for controls (P< 0.001). On average, the young patients had seven teeth missing, whereas two missing teeth were found among controls (P < 0.01). PSS patients had more frequent dental visits--every 3-4 months (40%)--than controls (19%). In parallel, 78% of the PSS patients brushed their teeth more than twice daily, compared with 28% of the control group. The PSS patient group reported having had more teeth extracted, more trouble with their teeth during lifetime, and higher expenses for dental treatment than controls. In spite of the more regular oral health care practices than the general population, PSS patients had experienced more dental caries and more radical dental treatment. It is suggested that the National Health Insurance should give emphasis to preventive care to patients with PSS.

Periodontal disease in primary Sjögren's syndrome.

UNLABELLED: Occurrence of periodontal disease in Sjögrens's syndrome (SS) is still controversial. OBJECTIVE: To examine if the risk of gingival and periodontal conditions was increased in SS compared to the general population. MATERIALS AND METHODS: Fifty-seven patients (4 men, 53 women) with primary Sjögren's syndrome (Copenhagen criteria) and an age-matched representative sample of the general population of 80 controls (all women) were examined for gingival and periodontal disease. RESULTS: Gingival bleeding and supra-gingival calculus did not differ among SS patients and controls. Subgingival calculus occurred more often among the younger SS patients than controls, but did not differ among the older SS patients and controls. Periodontal pockets of 4-5 mm as well as pockets > 5 mm occurred with similar prevalences among the two groups. Smoking habits did not influence the results. The health status of the gingival and periodontal tissues were thus similar in SS and controls. CONCLUSION: Primary SS is not associated with increased risk of periodontal disease.

Osteoradionecrosis of the jaws: clinical characteristics and relation to the field of irradiation.

PURPOSE: This study focuses on the clinical characteristics of patients with osteoradionecrosis (ORN) of the jaws and on the relation between the extent of the ORN and the field of irradiation. PATIENTS AND METHODS: The study group consisted of 80 patients referred for treatment of ORN. Charts of the extent of ORN, based on panoramic radiographs, were drawn by the clinical investigator and compared with charts of the field of irradiation drawn by the oncologists. Also recorded was diagnosis of the lesion, stage, location, treatment schedule, and period and dose of irradiation. Also documented were various potential initiating factors for ORN. RESULTS: Smoking habits of ORN patients were similar to those of other patients with head and neck cancer. A new primary tumor or a recurrence was diagnosed in 10% of the patients at the time of ORN. Only 3 patients had received accumulated doses of less than 60 Gy. More than half of the cases were initiated by removal of teeth; however, one third occurred spontaneously. ORN developed within the first 3 years in 74%; but ORN can emerge on a traumatic basis for an infinite number of years after radiation therapy. Widespread ORN may be symptomless apart from a discrete dehiscense of the oral mucosa. The predilection site for ORN is the mandibular molar region. All cases of ORN but 1 were found in the field of radiation. CONCLUSION: Because many ORN case are symptomless, more focus on mucosal dehiscence in the follow-up after radiation therapy is advocated in an effort to detect ORN at an early stage. The consequence of practically all ORN cases being located in the field of irradiation, together with tooth removal frequently being the initiating factor, should lead to a more aggressive preirradiation approach to dental pathology located within the field of radiation.

The effect of hyperbaric oxygen on irradiated oral tissues: transmucosal oxygen tension measurements.

PURPOSE: This study measured the effect of hyperbaric oxygen (HBO) treatment on transmucosal oxygen tension in irradiated human oral mucosa. PATIENTS AND METHODS: Ten patients received 30 dives of HBO as part of their treatment for mandibular osteoradionecrosis. A noninvasive, nonheated oxygen electrode was used to measure the tissue surface transmucosal oxygen tension directly on the attached gingiva. Measurements were done before, during, and after HBO treatment. The normal level of gingival surface transmucosal oxygen tension was measured in five healthy volunteers. RESULTS: During HBO treatment, the transmucosal oxygen tension increased significantly after five dives of HBO (P < .05). After 30 dives, the increases were from a mean of 50% to a mean of 86% of the transmucosal oxygen tension of normal healthy gingiva. CONCLUSION: An increase in the transmucosal oxygen tension is based on neo-angiogenesis. Patients with subischemic tissues, such as the study population with postirradiation mucosal and osseous necrosis, therefore may benefit from treatment with HBO.

[Surgical versus non-surgical treatment of unilateral dislocated fractures of the lower mandibular condyle]. / Kirurgisk versus ikkekirurgisk behandling af unilaterale dislocerede lave collum mandibulae-frakturer.

To compare open versus closed reduction of unilaterally dislocated low subcondylar fractures in adults, 101 consecutive patients were treated either by closed reduction with a median of four weeks of maxillomandibular fixation or by a median of six weeks of maxillomandibular fixation after surgical repositioning and transosseous wiring of the dislocated condylar fragment. No selection of patients was done for either treatment. Fifty-two patients were observed for a median of two years after treatment. Complications such as malocclusion, mandibular asymmetry, impaired masticatory function, and pain located to the affected joint or masticatory muscles were significantly more frequent in patients treated with closed reduction (39%) compared with those treated surgically (4%)(p = 0.005). Neither the degree of dislocation of the proximal fragment, concomitant mandibular fractures, nor the absence of posterior occlusal support seemed to influence the results.

Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar fractures: a clinical study of 52 cases.

To compare open versus closed reduction of unilaterally dislocated low subcondylar fractures in adults, 101 consecutive dentulous patients were treated either by closed reduction with a median of 4 weeks of maxillomandibular fixation, or with a median of 6 weeks of maxillomandibular fixation after surgical repositioning and transosseous wiring of the dislocated condylar fragment. No selection of patients was done for either treatment. Fifty-two patients were seen at a median of 2 years postoperatively. Complications such as malocclusion, mandibular asymmetry, impaired masticatory function, and pain located to the affected joint or masticatory muscles were seen significantly more frequent in patients treated with closed reduction compared with those treated surgically (P = .005). Neither the degree of dislocation of the proximal fragment, concomitant mandibular fractures, nor the absence of posterior occlusal support seemed to influence the results.

Structural characterization of x2 glycosphingolipid, its extended form, and its sialosyl derivatives: accumulation associated with the rare blood group p phenotype.

It has been suggested that the x2 glycosphingolipid (GSL) could offer a structural basis for a P-like antigen activity found in blood group p individuals [Kannagi R., Fukuda, M.N., Hakomori, S. (1982) J. Biol. Chem. 257, 4438]. The structures of the x2 and sialosyl-x2 GSLs have been confirmed unequivocally as shown below by +FAB-MS, methylation analysis by GC-MS, and 1H-NMR. We have established a [formula: see text] monoclonal antibody (TH2) specific for the GalNAc beta 1----3Gal beta 1----4GlcNAc epitope, the terminal trisaccharide of x2 GSL. Application of MAb TH2 on TLC immunoblotting together with chemical analysis indicates the following points of interest: (i) the existence of extended type GSLs having the same x2 terminal structure; (ii) the chemical quantities of x2, sialosyl-x2, and extended x2 found in blood cells and in various tissues including carcinomas being nearly the same; (iii) considerably larger quantities of x2 and x2-derived structures found in blood samples of rare blood group p individuals. The accumulation of x2 and its derivatives in blood cells of p individuals is in contrast to the occurrence of these GSLs as extreme minor components in normal human red blood cells and tissues, and they may be responsible for the reported P-like activity in blood group p individuals [Naiki, M., & Marcus, D. M. (1977) J. Immunol. 119, 537].

Sialochemistry in Sjögren's syndrome: a review.

Sjögren's syndrome (SS) is an autoimmune exocrinopathy. The salivary glands are the site of activated T- and B-lymphocytes, along with gradual parenchymal destruction, diminished flow and altered composition of the secretory product. At present, sialochemistry has achieved no significance for the evaluation of SS patient. However, the number of sialochemical publications is steadily growing. This study review current sialochemical findings in patients with SS and relate the observations to the present concept of diagnosis, pathogenesis and prognosis of SS. An ideal combination of the collection of low-stimulated pure secretion, measurements of absolute flow-rates, and biopsy from the same glands seem to be unobtainable in SS patients. But two procedures may be appropriate: stimulated parotid secretion combined with parotid biopsies, or absorbance of low-stimulated labila saliva combined with labial gland biopsy. Sufficient data on disease-specific alterations in salivary composition in SS are still lacking. However, detection of specific changes in protein synthesis or in glycosylation as well as the detection of inflammatory cell products should be possible with the use of sensitive biochemical assays.

Course of various clinical forms of oral lichen planus. A prospective follow-up study of 611 patients.

The course of reticular, papular, bullous, plaque-type, atrophic and ulcerative lesions of oral lichen planus (OLP) was studied in 611 patients. Mean age of the patients was 53 years and two-thirds were women. The patients were followed for periods from 1 to 26 years (mean, 7.5 years). The various clinical types had somewhat different courses. Papular affections were seen mainly in the initial phase and had a transitory course. Ulcerative lesions, although more persistent, also generally showed a short-term course. The atrophic form was fluctuating with many remissions and new-established affections. The plaque-type was a more constant form, but also demonstrated many newly established affections. After a few years, many patients had persistent lesions that no longer included the affections most characteristic of OLP, i.e. the reticular and the papular form. Initial presence of papular affections was associated with ages below 50 and atrophic lesions with ages above 60. Plaque-type affections were seen with a significantly higher frequency among tobacco smokers at the onset of OLP. No other correlation was found between the initial presence, the remission and the development of the different clinical forms and various factors as age, sex, general diseases, medication and tobacco smoking. Treatment with topical steroid and/or antimycotics had no effect on the long-term course of the various clinical forms, and it had no persistent effect on symptoms related to OLP. Complete remission was seen in 17% of the patients, and it showed a reverse association with the initial presence of plaque-type affections. However, complete remission was associated with an initial presence of papular affections.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant development of lichen planus-affected oral mucosa.

The present report describes malignant development in oral lichen planus (OLP) among 611 patients (409 F, 202 M) followed for periods from 1-26 years (mean: 7.5). During follow-up, 9 patients (1.5%), 8 women (1.9%) and 1 man (0.5%) developed oral squamous cell carcinomas (SCC) in areas of lichen planus lesions. The age of the patients at diagnosis of carcinoma ranged from 56-79 years (mean: 70.4) and the length of follow-up before malignant development ranged from 4.9-24 years (mean: 10.1). The estimated number expected to develop oral cancer in a sample of the general Danish population of similar size, age distribution and follow-up was 0.18 (0.11 F, 0.07 M) i.e., OLP cases showed a 50-fold increase (F = 70- M = 14-fold). The observed number of cancer cases was significantly higher than the estimated number (p less than 0.00001). Therefore, oral lichen planus fulfils the WHO criterion of a premalignant condition.

High levels of complement fixing antibodies against cytomegalovirus in patients with primary Sjögren's syndrome.

Antibodies to cytomegalovirus (CMV) were examined in sera from 21 consecutive patients with primary Sjögren's syndrome (SS) and 19 consecutive patients with secondary SS, using a complement fixation (CF) test and an antibody capture enzyme-linked immunosorbent assay (ELISA). Sera from 15 CMV-negative subjects, 15 CMV-positive subjects, 3 patients with primary CMV infection and 3 patients with recurrent CMV infection served as controls. The prevalence of CMV antibodies in the patients with primary and secondary SS was found similar to the prevalence known to occur in the normal adult population. Unrelated to clinical parameters, 5 patients with primary SS (24%) had high levels of CF antibodies against CMV. Ig class antibodies to CMV were not elevated in these 5 patients. Preferential production of CF antibodies to CMV may be a pathogenetic factor in some patients with primary SS.

Yeast species and biotypes associated with oral leukoplakia and lichen planus.

Of 36 patients, 17 had oral leukoplakia, including homogeneous and nonhomogeneous types, and 19 had reticular lesions of oral lichen planus. A sample of yeast flora in each patient was taken from the pathologic lesion as well as from normal-appearing mucosa. The isolated yeasts were identified according to species level, and identification was extended beyond the species level for one species, Candida albicans, to reveal the biotype by means of the Odds and Abbott procedure comprising tests for acid and salt tolerance, proteinase production, resistance to 5-fluorocytosine and safranine, and assimilation of urea, sorbose, and citrate. Yeasts were present in the lesions of 82% of leukoplakia patients, compared to 37% of lichen planus patients, a frequency of yeasts corresponding to that in healthy adults. C. albicans was the dominating species in lesions of both diseases, constituting 82% of all yeasts in the leukoplakia lesions. In addition, the following species were identified: Candida tropicalis, Candida pintolopesii, Torulopsis glabrata, and Saccharomyces cerevisiae. Eighteen biotypes of C. albicans were encountered, the most frequently occurring biotypes being 355 and 177. Differences between C. albicans biotypes isolated from pathologic and normal mucosa were encountered in five of eleven leukoplakia patients and in one of three lichen planus patients. This indicates that the oral cavity comprises several ecologic niches for yeasts. As nonhomogeneous leukoplakias are more likely to develop into carcinoma than are homogeneous leukoplakias, it is interesting to note that the C. albicans biotypes isolated from nodular lesions (one type of nonhomogeneous leukoplakia)--biotypes 145, 175, and 575--rarely occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence and aetiological pattern of jaw fractures in Greenland.

All of the cases involving fractures of the mandible and/or maxilla in Greenland were recorded in a 1 1/2 year period beginning 1 July 1981. Further information of aetiological patterns was added from 2 studies of mandibular fractures in Godthåb/Greenland. The incidence of jaw fractures in Greenland (17 to 10,000 per year) was the highest ever reported. In 90% of these cases, the cause of fractures were interpersonal violence. Jaw fractures were encountered in nearly all districts of Greenland, most often in urban areas and the patients were chiefly of Greenlandic descent. The % of patients in the age group of 20-29 years was extremely high (57%) as was the women (36%). 75% of the women were ill-treated by their spouses. In half of the cases, the victims and the assailants were related. Victims unknown to the assailants made up only 20% of the cases. These were trends typical of a small society. Compared to other reports, violence in Greenland was aggravated and involvement of alcohol was seen in 4 out of 5 cases. Regulation and deregulation of alcohol in Greenland had only temporary effects on the occurrence of jaw fractures. Aetiological patterns of jaw fractures changes from one subculture to another depending on social conditions. The figures from Greenland demonstrated this.

Arterial embolisation in the treatment of central haemangiomas of the maxilla. Report of two cases.

The recent refinement of super-selective angiography and subsequent embolisation offer new promising possibilities in the treatment of central haemangiomas in the maxillo-facial area, either as a pre-operative measure allowing safer surgical removal, or as definitive therapy. Two cases of central haemangiomas of the maxilla are presented, both treated successfully by embolisation.