A single-centre retrospective 10-year experience of the rhombic 3D condylar fracture plate for open reduction and internal fixation of condylar neck and base fractures.

Fractures of the mandibular condyle account for a significant proportion of mandibular fractures. The specific functional loads require particular specifications for the implant design used for open reduction and internal fixation of such fractures. The clinical and radiographic outcomes in patients treated using a single rhombic 3D condylar fracture plate for open reduction and internal fixation at a single institution, and who fulfilled the inclusion and exclusion criteria, are presented. The primary outcome variables were: occlusion, maximum interincisal distance and mandibular excursion at 1, 3, and 6 months postoperatively, and radiographic measurements for mandibular height and gonion angle. In total, 263 patients were included, of whom 173 (65.8%) were male and 90 (34.2%) female. The mean age was 40.4 ± 18.9 years. There was satisfactory occlusion in 98.9% of patients at the 6-month follow-up, and a significant improvement in all parameters for mandibular excursion (p < 0.001), with a reduced ramus height and an increase in the gonion angle on the fractured side. Excellent clinical and radiographic results were achieved using the rhombic-shaped implant, deeming it appropriate for the osteosynthesis of mandibular condyle fractures.

Cost minimization analysis of indication-specific osteosynthesis material in oral and maxillofacial surgery.

PURPOSE: Following the introduction of the Regulation (EU) 2017/745 by the European Parliament, any bioactive substance or surgical implant introduced into the human body must be documented. The regulation requires any implant to be traced back to the manufacturer. Lot numbers need to be available for every single medical implant. Also, the manufacturer is required by law to provide implants individually packaged and sterilized. Previously, model tray systems (MOS tray) were used for osteosynthesis in oral and maxillofacial surgery, in which the individual implants could not be registered separately. The new regulation made it impossible to use such processes during surgery anymore and a need for a change in the medical practice surged. We examined a possible solution for the new legislation. The aim of this prospective cohort study is to analyze the MOS tray systems to osteosynthesis materials prepackaged in sets. We record and evaluate parameters such as surgical time and documentation time. We perform a short cost analysis of our clinic. The primary aim is to determine how much time is gained or lost by the mandatory increased patient safety. The secondary aim is to describe change in costs. METHODS: Patients that underwent standard surgical procedures in the clinic of oral and maxillofacial surgery of the faculty hospital Carl Gustav Carus in Dresden were included. We chose open reduction and internal fixation (ORIF) of anterior mandibular corpus fractures as well as mandibular advancement by means of bilateral sagittal split osteotomies (BSSO) as standardized procedures. Both of these procedures require two osteosynthesis plates and at least four screws for each plate. MOS trays were compared to prepackaged sterilized sets. The sets include a drill bit, two plates, and eight 5-mm screws. A total number of 40 patients were examined. We allocated 20 patients to the ORIF group and the other 20 patients to the BSSO group. Each group was evenly subdivided into a MOS tray group and a prepackaged group. Parameters such as the incision-suture time (IST) as well as the documentation time (DT) by the operating room (OR) staff to complete documentation for the implants are the main focus of investigation. RESULTS: For open reduction, the incision-suture time was significantly different in favor of the MOS tray (p < 0.05). There was no difference in the BSSO groups. However, we observed a significantly different (p < 0.01) documentation time advantage for the prepackaged sets in both the ORIF and BSSO groups. On top of that, we find that by using the prepackaged kits, we are able to reduce sterilization costs by €11.53 per size-reduced container. Also, there is also a total cut of costs of €38.90 and €43.70, respectively, per standardized procedure for implant material. CONCLUSIONS: By law, a change in the method of approaching surgery is necessary. For standardized procedures, the right choice of implants can lead to a reduction of documentation time and costs for implant material, sterilization, as well as utilizing less instruments. This in turn leads to lower costs for perioperative processing as well as provision of state-of-the-art implant quality implementing higher patient security.

Customized Allogeneic Bone Augmentation Improves Esthetic Outcome in Anteromaxillary Dental Implantation.

Purpose: In cases of severe atrophic maxilla or maxillary involution, augmentation is necessary for implant-supported prosthetics. Using bone grafts is a standard procedure, and using customized allogeneic bone blocks may be a predictable alternative before dental implantation. Clinical Findings. This case study shows the digital workflow, including a preimplantological augmentation by a customized allogeneic block, followed by soft tissue optimization and template-based dental implantation, after six months of healing. It is part of a three-year follow-up study on the resorption rate of allogeneic bone blocks. Outcomes. Allogeneic bone augmentation is an alternative treatment option to autologous bone grafts. It allows predictable advanced backward planning (ABP) even in the maxillary esthetic zone. Diameter-reduced implants show long-term stability of a minimum of three years after loading and excellent results of prosthetic fixtures. Conclusion: Prefabricated customized allogeneic blocks for augmentation may increase the fitting accuracy of the graft, decrease morbidity, and reduce the operation time in esthetic maxillary rehabilitation.

Advanced backward planning with custom-milled individual allogeneic block augmentation for maxillary full-arch osteoplasty and dental implantation:a 3-year follow-up.

In the case of maxillary involution, augmentation is necessary for implant-supported prosthetics. The use of bone grafts is standard; customized allogeneic bone blocks may be a predictable alternative before dental implantation. For maxillary full-arch reconstruction, this case shows a horse-shoe augmentation by four allogeneic blocks, followed by guided dental implantation and fixed prosthetics after 6 months of healing. Using allogeneic blocks is an option for full-arch maxillary augmentation and comparable with autologous bone grafts. There is no donor site comorbidity. Bone height is stable for a minimum of 3 years after loading with resorption less than 10% in vertical, buccolingual, and mesiodistal directions. Short-implants allow for the long-term stability of prosthetic fixtures. Prefabricated customized allogeneic blocks for augmentation may increase the fitting accuracy of the graft, decrease morbidity, and lower operation time in maxillary full-arch reconstruction. The percentage of resorption after 3 years is comparable to the commonly used iliac crest.

Multiple periapical dysplasias analyzed by cone-beam-computer tomography and 99Tcm-Scintigraphy.

Periapical cemental dysplasia (PCD) is considered a non-neoplastic proliferation of fibrous tissues and cementum-like hard tissues, usually occurring in the periapical regions of teeth. PCD is characterized by the presence of vital pulp and is often accidentally discovered during a general radiographic survey. PCD may arise from the tissue of odontogenic origin or occur as a reactive process in the periapical tissue. Multilocular occurrences in both jaws are rare. However, we encountered a case of multiple PCDs by orthopantomography, which showed different degrees of maturation in the mandible and maxilla by osteodensitometric detection via cone-beam computed tomography (CB-CT) validated by Tc-99m bone-scintigraphy (BS). Biopsies confirmed the radiological results. CB-CT osteodensitometry allows for the categorization and assessment of different stages of PCD maturation from beginning to florid, detection of remittent osseous changes, and evaluation in the clinical follow-up. When using the local cortical bone as a reference value of 100%, periapical dysplasias show density values of 75% in the mandible and 80% in the maxilla. Early classification of PCD is possible with CB-CT osteodensitometry.

Notch expression profile and satellite cell stimulation in masseter muscle before and after orthognathic surgery.

The aim of this prospective study was to compare the expression of the Notch receptor family with the biomarker for stimulation of satellite cells (SC), which are responsible for functional adaptation. Tissue samples from the masseter muscle were taken presurgically and 7 months later. Samples from controls came from the extraction of third molars. The expression of Notch 1 to 4 and the satellite cell markers CD34, Pax7, and MyoD1 were investigated. PCR was used for relative quantification of gene expression, which was calculated with the ΔΔCT method. The study involved 38 white patients - 10 prognathic, 18 retrognathic, and 10 orthognathic controls. The median value for Notch 1 was significantly reduced presurgically for prognathic (0.46, SD 0.45) and retrognathic (0.57, SD 0.35) patients compared with the controls. Postsurgically, Notch 2 was significantly upregulated in the prognathic group (0.55, SD 0.28/1.37, SD 0.85). Similarly, there was upregulation of Notch 3 in the prognathic group (0.33, SD 0.42/0.59, SD 1.37) and downregulation in retrognathic patients (0.59, SD 0.79/0.52, SD 0.97). Upregulations for the satellite cell markers CD34 and Pax7 were also found in prognathic patients. The significant upregulation of Notch 1-3 and CD34 in prognathics, but unchanged MyoD expression, signals high stimulation for SC and maintenance of the regeneration cell pool. A lower expression of Notch and SC in retrognathic patients could be responsible for weak functional adaptation.

Satellite cell capacity for functional adaptation of masseter muscle in Class II and Class III patients after orthognathic surgery-a pilot study.

AIM: The aim of the prospective pilot study was to analyze the biomarkers CD34, Pax7, Myf5, and MyoD for stimulation of satellite cells (SCs), which are responsible for functional adaptation. SUBJECTS AND METHODS: Forty-five Caucasian patients were consecutively recruited from the Maxillo-Facial-Surgery at TU Dresden. Eleven orthognathic Class III patients, 24 Class II patients, and 10 controls with Class I were involved in the study. Tissue samples from masseter muscle were taken from the patients pre-surgically (T1) and 7 months later (T2). Samples from controls were taken during the extraction of third molars in the mandible. Polymerase chain reaction (PCR) for relative quantification of gene expression was calculated with the delta delta cycle threshold (ΔΔCT) method. RESULTS: The results show significant differences for the marker of SC stimulation between the controls, the patient groups, males, and females. The gene expression of CD34 was post-surgically upregulated for Class III (0.35-0.77, standard deviation [SD] = 0.39, P < 0.05) in comparison with controls. For Pax7, there was a significant difference shown between the retrognathic and the prognathic group because of downregulation in Class II patients (1.64-0.76, SD = 0.55, P < 0.05). In Class III patients, there was a significant upregulation for Myf5 (0.56-1.05, SD = 0.52, P < 0.05) after surgery too. CONCLUSIONS: The significant decline of Pax7 in Class II patients indicates a deficiency of stimulated SC post-surgically. The expression of CD34 and Myf5 in Class II stayed unchanged. In contrast, there was an upregulation for all Class III patients, mainly in females, shown post-surgically. This may be one reason for weak functional adaptation and relapse in Class II patients.

Multifunctional Templates for Minimized Osteotomy, Implantation, and Palatal Distraction with a Mini-Screw-Assisted Expander in Schizodontism and Maxillary Deficit.

PURPOSE: Schizodontism is complete separation of a dental germ. It results in a twin tooth and supernumerary teeth. The treatment of transverse constriction in combination with supernumerary dental germs and impacted central incisors can pose a challenge, especially in young patients, when the number of permanent teeth is not adequate to ensure secure anchorage. The use of navigation templates based on three-dimensional X-ray images allows for precise insertion of temporary mini-implants for the acquisition of palatal distractors. In addition, templates allow for minimally invasive biopsies and osteotomies. METHODS: The treatment of schizodontism, dentitio tarda, and transverse constriction is to be assessed as an interdisciplinary method by using mini-screw-assisted devices. Minimized osteotomy of impacted supernumerary teeth or dental implantation can be carried out in a one-step-procedure based on digital preplanning and prefabrication of orthodontic devices. RESULTS: Multifunctional templates allow for early planning, preoperative fabrication, and intraoral fixation of orthodontic appliances. In the case of an adolescent patient, a sustainable, interdisciplinary treatment concept could be demonstrated that shows age-appropriate gnathological development and stable growth conditions over a follow-up period of 10 years. CONCLUSION: One can likely assume that multifunctional templates allow for minimally invasive one-step surgeries as an interdisciplinary tool between orofacial surgery and modern orthodontics.

Substantivity of amine fluoride/stannous fluoride following different modes of application: a randomized, investigator-blind, placebo-controlled trial.

OBJECTIVE: Amine fluoride/stannous fluoride (ASF) is proven to be effective against plaque and gingivitis. The purpose of this clinical controlled study was to investigate the influence of different application modes on the substantivity of this formulation. MATERIAL AND METHODS: Seventeen healthy volunteers received a professional dental prophylaxis. Undisturbed plaque growth was permitted for the next 48 h. In a crossover design, participants received ASF as a single mouthrinse, toothpaste, slurries with high (HA) or low (LA) air content, or a placebo. Vitality of plaque bacteria was investigated before and at 1, 2, 3, 4, 6, and 8h after application of ASF. ANOVA was applied on a 0.05 significance level. RESULTS: Highest reduction of plaque vitality resulted after toothpaste application, followed by mouthrinse, LA, and HA slurry. No changes occurred in the placebo group. Compared to baseline and placebo, statistically significant changes were detected up to 4h in all ASF groups. Toothpaste exerted antibacterial efficacy up to 8h. Vitality reduction was higher in the LA group than in the HA group. CONCLUSIONS: The concentration of ASF in formulations influences the time course of the antibacterial effect. Contact of ASF formulations with air might reduce their efficacy.