Open bite: stability after bimaxillary surgery--2-year treatment outcomes in 58 patients.

Stability after bimaxillary surgery to correct open bite malocclusion and mandibular retrognathism was evaluated on lateral cephalograms before surgery, 8 weeks post-operatively, and after 2 years. The 58 consecutive patients were treated to a normal occlusion and good facial aesthetics. Treatment included the orthodontic alignment of teeth by maxillary and mandibular fixed appliances, Le Fort I osteotomy, and bilateral sagittal split ramus osteotomy. Twenty-six patients also had a genioplasty. Intra-osseous wires or bicortical screws were used for fixation. Twenty-three patients had maxillo-mandibular fixation (MMF) for 8 weeks or more, six for 4-7 weeks, 14 for 1-3 weeks, and 15 had no fixation. At follow-up 2 years later, the maxilla remained unchanged and the mandible had rotated on average 1.4 degrees posteriorly. Seventeen patients had an open bite. Among them, eight patients had undergone segmental osteotomies. The relapse was mainly due to incisor proclination. The most stabile overbite was found in the group with no MMF after surgery.

Patients' evaluation of the final result of sagittal split osteotomy: is it influenced by impaired sensitivity of the lower lip and chin?

The purpose of this article was to evaluate whether neurosensory disturbances such as impaired sensitivity of the lower lip and chin influence patients' final evaluation of the treatment result. Information about the patients' degree of satisfaction and about lip and chin sensitivity were obtained from final follow-up documents of 215 patients. All patients had undergone sagittal split ramus osteotomy for mandibular advancement. In patients with normal sensitivity on both sides of the lower lip and chin, the degree of satisfaction was equally distributed at a very high level through all age groups. Among those with some degree of numbness on either or both sides of the lower lip and chin, patients in the younger quarter and middle half of the group were as satisfied as those with normal sensitivity, while those in the oldest quarter with impaired sensitivity demonstrated a lower degree of satisfaction than the rest of the patients. Although the difference was not statistically significant, the finding strongly indicates that older patients seem to suffer more from neurosensory disturbances than do younger patients with similar conditions.

Five-year prospective follow-up report of the Astra Tech Dental Implant System in the treatment of edentulous mandibles.

This report of the 1st 2 prospective studies using the Astra Tech Implant System and fixed detachable bridges for rehabilitation of mandibular edentulism, presents clinical and radiographic data at the 5-year follow-up. The original material comprised 109 subjects, 56 of whom had been included in the original study, using the 1st generation Astra Tech Implant. Two subjects were excluded and the 3-year follow-up report was based on the remaining 54 subjects and 310 fixtures. After some minor changes to the fixture and the abutment, the 2nd generation Astra Tech Implant was used in 53 subjects and 308 fixtures. In all 16 subjects were lost to follow-up and the 5-year results are based on the remaining 91 subjects with 517 fixtures in function: 5 fixtures were lost due to mobility at abutment installation and during the 1st year, 2 fixtures were removed due to pain, and after 4 years in situ 1 fixture failed. As no clinical or radiographic differences were obvious in the annual registrations of the 2 studies the results have been combined. The fixed bridges were removed at 3 and 5 years to test each fixture and none was mobile. The cumulative fixture survival rate at 5 years was 98.7% and the bridge survival rate was 100%. Of the sites 82% were plaque free, and 96.8% showed no signs of inflammation. Over the 5-year period after bridge insertion, i.e. from baseline registration, there was only minor deterioration in marginal bone levels as measured on standardized intraoral radiographs: the mean differences in mm and standard deviations (SD) were -0.09 (0.27) in the 1st year, -0.20 (0.40) in the 3rd year, and -0.26 (0.53) in the 5th year. According to the stringent clinical and radiographic criteria by Albrektsson and co-workers, the successful treatment outcome and the survival rate in 91 subject over 5 years, indicates that the Astra Tech Dental Implant System with fixed detachable bridges is an appropriate method for rehabilitation of mandibular edentulism.

Inferior alveolar nerve function after mandibular osteotomies.

A total of 1034 patients who had undergone orthognathic surgery were examined after 2 years; 818 had been treated with varying types of mandibular osteotomy such as vertical ramus osteotomy, sagittal split ramus osteotomy, and genioplasty. Neurosensory function in the mental nerve region was assessed by evaluating light touch perception. The incidence of neurosensory deficiency was 216/548 (39%) after sagittal split ramus osteotomy, 26/140 (19%) after extraoral vertical ramus osteotomy, 9/78 (12%) after genioplasty and 60/650 (9%) after intraoral vertical ramus osteotomy. Additional genioplasty increased both the incidence and severity of neurosensory disturbance after intraoral vertical ramus osteotomy but did not significantly influence the neurosensory function after sagittal split ramus osteotomy. The incidences of neurosensory disturbance after mandibular osteotomies in this report correspond well with those previously reported, but the incidence of almost 40% after sagittal split ramus osteotomy must be considered a disquieting drawback of the procedure.

Inferior alveolar nerve function after sagittal split osteotomy of the mandible: correlation with degree of intraoperative nerve encounter and other variables in 496 operations.

Dysfunction of the inferior alveolar nerve indicated by various degrees of numbness of the lower lip and chin is one of the few drawbacks of sagittal split osteotomy (SSO) of the mandible. Although it has been recorded throughout the history of this technique its true aetiology is poorly understood. In this study of 496 SSOs, we have evaluated possible correlations between neurosensory dysfunction and several variables that have been implicated, such as the age of the patient, mandibular movement, type of split technique and osteosynthesis, degree of intraoperative nerve encounter, and surgical skill. Nerve dysfunction developed after 200/496 SSOs (40%). The patient's age had a significant influence on the recovery of the neurosensory function. Intraoperative nerve encounter such as nerve manipulation correlated with dysfunction to a much lesser degree than expected. Surgical skill seemed to influence the recovery of neurosensory function after SSO, which is often referred to as a technique-sensitive procedure. We suggest that the dissection of the soft tissue on the medial aspect of the mandibular ramus might be partly responsible for nerve dysfunction of the lower lip and chin after SSO of the mandible.

Pre- and perioperative suggestion in maxillofacial surgery: effects on blood loss and recovery.

The basic assumption underlying the present study was that emotional factors may influence not only recovery but also blood loss and blood pressure in maxillofacial surgery patients, where the surgery was performed under general anesthesia. Eighteen patients were administered a hypnosis tape containing preoperative therapeutic suggestions, 18 patients were administered hypnosis tapes containing pre- and perioperative suggestions, and 24 patients were administered a hypnosis tape containing perioperative suggestions only. The patients who received taped suggestions were compared to a group of matched control patients. The patients who received preoperative suggestions exhibited a 30% reduction in blood loss. A 26% reduction in blood loss was shown in the group of patients receiving pre- and perioperative suggestions, and the group of patients receiving perioperative suggestions only showed a 9% reduction in blood loss. Lower blood pressure was found in the groups that received pre- and perioperative and perioperative suggestions only. Rehabilitation was facilitated in the group of patients receiving perioperative suggestions only.

Clindamycin versus phenoxymethylpenicillin in the treatment of acute orofacial infections.

The efficacy of clindamycin and phenoxymethylpenicillin in the treatment of orofacial infections was compared in a randomised study in 60 patients: 30 patients received clindamycin 150 mg every 6 h for seven days, and 30 received phenoxymethylpenicillin 1 g every 12 h for seven days. Where indicated incision and drainage were carried out. All patients but one in each group responded satisfactorily to treatment. Although the clindamycin group had a shorter duration of pain, swelling and fever and more favourable laboratory findings, the differences between the groups were not statistically significant. Of the 60 microbiological specimens 23 yielded only anaerobic bacteria, 34 both anaerobic and aerobic bacteria, two aerobic bacteria only and one no growth. In the penicillin group one case of severe diarrhoea occurred, and six patients in the clindamycin group had moderate to severe gastrointestinal discomfort, including one case of Clostridium difficile associated diarrhoea. This difference was however not statistically significant. The results support the continued use of penicillin for treatment of orofacial infections, with clindamycin serving as an effective alternative.

A 3-year clinical study of Astra dental implants in the treatment of edentulous mandibles.

A prospective study for the treatment of mandibular edentulism using the new Astra dental implant system was conducted on 54 patients. The clinical performance of 310 implants was monitored over 3 years. The survival rate was 100% for the prostheses and 98.1% for individual implants. Four implants failed during the first 3 months after placement, one was retained as a "sleeper," and two more were removed because of persistent discomfort. Both resorption and deposition of mandibular marginal bone were observed. Bone changes from baseline to the end of the first year ranged from -0.4 to +1.0 mm (median 0.00), from the first to the third year from -0.8 to +0.6 mm (median 0.04), and over the 3 years ranged from -1.1 to +1.0 mm (median 0.01). No marked mean bone resorption was observed during the first year compared to the two following years. A significant gain in marginal bone level was recorded in males, but in females the level was unchanged. There were no serious inflammatory reactions in the surrounding soft tissues during the 3-year follow-up period.

Nasolabial morphology after Le Fort I osteotomies. Effect of alar base suture.

This paper describes the effect of an alar base suture in an attempt to gain control of the alar base flaring associated with maxillary advancement and/or maxillary impaction. The suture did reduce alar flaring but it also increased the nasolabial angle. The suture did not significantly influence nasal tip projection.

Effect of phenoxymethylpenicillin and erythromycin prophylaxis on anaerobic bacteraemia after oral surgery.

The effect of antibiotic prophylaxis on bacteraemia was assessed in 60 oral surgery operations. Fifty-one patients were divided in three groups receiving a 2 g dose of phenoxymethylpenicillin, a 0.5 g dose of erythromycin or no prophylaxis. During operation, the total numbers of bacteria were lower in the antibiotic groups than in the non-treatment groups (P less than 0.05). The number of patients with anaerobic bacteraemias, however, were similar in all three groups. The incidences of bacteraemia 10 min after operation were significantly lower in the antibiotic groups (P less than 0.05). The minimum inhibitory concentrations (MICs) of phenoxymethylpenicillin were below 2 mg/l in 93% of the strains and the minimum bactericidal concentrations (MBCs) were below this value in 80% of the strains. The MICs of erythromycin were below 2 mg/l in 80% of the isolates, and the MBCs were between 4-32 mg/l in 62% of the isolates.

Detection of anaerobic bacteria in blood cultures by lysis filtration.

An anaerobic adaptation of the lysis-filtration system for detection of anaerobic microorganisms in blood is described. The method was compared with a conventional broth bottle system in detection of anaerobic bacteremia after oral surgery. Of 43 blood samples obtained during and after surgery, 31 were positive with the lysis-filtration system and 17 were positive with the broth bottle system. Sixteen aerobic and 62 anaerobic strains were isolated with the lysis-filtration system versus 9 aerobic and 22 anaerobic strains with the broth bottles. The lysis-filtration technique was thus superior to the conventional broth bottle method in detecting anerobic bacteria.

Clinical appearance of orofacial infections of odontogenic origin in relation to microbiological findings.

Fifty-eight patients with acute orofacial infections of odontogenic origin were classified into two groups with respect to the severity of infection. A total of 174 anaerobic and 22 aerobic bacterial strains were isolated. Anaerobic gram-negative rods were isolated more frequently from the patients with severe infections than from the patients with infections judged as mild (P less than 0.05). The occurrence of Fusobacterium nucleatum especially appeared to be associated with the severity of the infections (P less than 0.05). Penicillin resistance among the anaerobes was rarely found, while resistance to erythromycin was a common finding. All aerobic and anaerobic bacteria were susceptible to clindamycin, and all obligate anaerobic bacteria were susceptible to nitroimidazoles.

Occurrence of penicillin-resistant and beta-lactamase-producing Bacteroides species in the oral cavity.

Bacteroides species are known to play an important role in orofacial infections. The present investigation shows that penicillin-resistant Bacteroides species are commonly found in the oral cavity and that their occurrence is related to previous penicillin therapy. Several of the penicillin-resistant isolates were also resistant to erythromycin and/or doxycycline while all strains were sensitive to clindamycin and tinidazole. the penicillin resistance was mainly due to beta-lactamase production. A selective cultivation method for detection of penicillin-resistant Bacteroides is described.

Replantation of avulsed teeth after long extra-alveolar periods.

In 11 patients, 18 teeth, with extra-alveolar periods ranging from 6 h to 48 days were replanted after root-filling with chloroform resin and guttapercha. After observation periods from 1 to 7 years, only 1 tooth was lost (after 5 years), but the remaining 17 teeth were clinically well functioning. All teeth were ankylotic and subjected to replacement resorption of various extent. Inflammatory root resorption and periradicular osteitis were not observed. Marginal bone loss up to 5 mm was noticed, but was accompanied by gingival retraction and thus pathological periodontal pockets (5 mm) were not observed. Consequently, teeth replanted after long extra-alveolar periods (even several days) can function for many years and thus postpone prosthetic treatment.

Ornidazole compared to phenoxymethylpenicillin in the treatment of orofacial infections.

A double blind, randomized study comprising 60 patients was undertaken to compare the efficacy of ornidazole to that of phenoxymethylpenicillin in the treatment of orofacial infections. Thirty patients received ornidazole 500 mg orally every 12 h for seven days and were all cured in less than seven days. Five of the 30 patients receiving penicillin, 800 mg orally every 12 h for seven days, did not respond satisfactorily to the treatment given. In two of these instances, beta-lactamase-producing penicillin-resistant Bacteroides strains were isolated. In the present study, ornidazole was found to be more efficient than penicillin in the treatment of orofacial infections. Anaerobes were isolated from all specimens except four that yielded no growth. Anaerobes only were isolated from 65% of the specimens. Since ornidazole was efficient in all cases when given, it is concluded that anaerobic bacteria are the causal pathogens in most orofacial infections.