Pre-autotransplantation alveolar process augmentation and premolar autotransplantation as a treatment method for single tooth replacement in adolescents.

The treatment of young patients with missing teeth and an atrophied alveolar process after trauma or agenesis of a tooth can be challenging. The aim of this study was to evaluate autotransplantation of a premolar after pre-autotransplantation alveolar process augmentation (PAPA) as a treatment option for these patients. A retrospective cohort study was implemented to analyse the PAPA procedure and subsequent autotransplantation procedure. Alveolar process augmentation was performed using different types of autologous bone grafts. Subsequent autotransplantation of one or more premolars was performed approximately 4 months later. Nine patients with a mean age of 12 years were included. Twelve premolars were transplanted after a PAPA procedure: seven in the maxillary incisor region, four in the mandibular premolar region, and one in the mandibular incisor region. Initially all transplanted teeth functioned well. However, one mandibular premolar that was transplanted in the maxillary incisor region was lost because of resorption after 6 years of follow-up. The other 11 transplanted teeth functioned well. The mean follow-up was 6 years (range 3-13 years). The results showed that autotransplantation can be facilitated by PAPA with a high chance of success. It can therefore be a valuable addition to other existing treatment options.

[Incision of the third molar in the Netherlands. Incision tech-niques for the removal of impacted third molars in the mandible.] / Incisietechnieken bij verwijdering van geïmpacteerde derde molaren in de onderkaak.

Various incision techniques to remove impacted third molars in the mandible have been described, for example, the flap incision, the envelope incision, the distal incision and the modified envelope incision. The aim of this study was to record the incision techniques used by oral and maxillofacial surgeons in the Netherlands for the removal of impacted third molars in the mandible. All members of the Dutch Association of Oral and Maxillofacial Surgery (NVMKA) received a questionnaire. In this questionnaire, the surgeons specified their standard incision technique for the removal of, respectively, mesially impacted, upright, or distally impacted mandibular third molars. Of the 323 questionnaires sent, 172 were returned (53,3% response rate). The flap incision and the distal incision were the most frequently used incisions by oral and maxillofacial surgeons (including residents) in the Netherlands. The academic centre seems to have a lasting impact on the preferred way of removing an impacted third molar. It also seems that an oral and maxillofacial surgeon more frequently removes a third molar in the mandible from a sitting position than a resident.

[The 3D printed drilling template for bilateral sagittal osteotomy]. / De 3D-geprinte boormal voor de bilaterale sagittale splijtingsosteotomie.

The bilateral sagittal osteotomy (BSSO) is a widely used surgical technique within orthognatic surgery. The specific osteotomy design may vary from clinic to clinic. The best position of the bone cuts in a BSSO continues to be a point of discussion and probably differs from patient to patient. In addition, standardisation in, for example, research may be desirable. Pre-operative planning using a drilling template in order to position the planned individual saw cuts during BSSO can be of value. To achieve this goal, a pre-operative 3D printed biocompatible drilling template was manufactured for 1 patient on the basis of pre-operative planning. The difference between the pre-operatively determined bone cuts with the assistance of the drilling template and the actual bone cuts was still large.

Bilateral sagittal split osteotomy in cadaveric pig mandibles: evaluation of the lingual fracture line based on the use of splitters and separators.

OBJECTIVE: To analyze the splitting pathways of the (lingual) fracture lines during a bilateral sagittal split osteotomy (BSSO) in cadaveric pig mandibles. STUDY DESIGN: A BSSO was performed using splitters and separators. Special attention was paid to end the horizontal medial cut at the deepest point of the entrance of the mandibular foramen. RESULTS: Of all lingual fractures, 95% ended in the mandibular foramen. Forty percent of these fractures extended through the mandibular canal and 40% extended inferiorly along the mandibular canal. CONCLUSION: Almost all lingual fracture lines ended in the mandibular foramen, most likely due to the placement of the medial cut in the concavity of the mandibular foramen. The mandibular foramen and canal could function as the path of least resistance in which the splitting pattern is seen. We conclude that a consistent splitting pattern was achieved without increasing the incidence of possible sequelae.

[Automutilation of the palate in a psychiatric patient]. / Automutilatie van het palatum bij een psychiatrische patiënt.

A 46-year-old man with a history of alcohol abuse was referred to an oral and maxillofacial surgeon with a large necrotic wound with raised edges on the palate. After history taking, radiography and clinical assessment, together with a psychiatrist, the lesion was diagnosed as an automutilation resulting from a period of alcohol abstinence. After a period of care in a medical centre, the lesion improved quickly. Following this treatment, the patient was admitted to a psychiatric treatment centre for supplemental treatment of his addiction problems.

[Plastic surgery of oroantral perforations superfluous in the future?]. / Antrumplastiek in de toekomst overbodig?

An oroantral perforation can occur with the extraction of a premolar or molar in the upper jaw. Small perforations with a deep extraction alveolus can be treated using sutures only; larger perforations are treated surgically, using a buccal sliding or palatal flap. The distinction between small and large perforations can be difficult to make. As a result, oroantral perforations are usually treated by plastic closure. This pilot study presents a new, simple, time-reducing method for the treatment of oroantral perforations using a biodegradable membrane without primary closure of the wound. Six patients with a positive nose-blowing test after extraction were treated according to the new method. In all 6 patients the oroantral perforation was closed after 2 weeks and each showed adequate wound healing after 6 weeks. More research is needed to confirm the results of this preliminary study and the use of this technique on larger perforations.