Long-term neurosensory disturbances after modified sagittal split osteotomy.

We have investigated the long-term incidence of neurosensory disturbances after modified bilateral sagittal split osteotomy, and identified associated risk factors. We prospectively studied 376 patients, and their self-reported neurosensory disturbances were evaluated six months, and one, two, and three years postoperatively. The correlations between the following risk factors and neurosensory disturbances were investigated using univariate analysis and stepwise multivariate analysis: age at operation, sex, type of movement (advancement, setback, or rotation), concurrent genioplasty, type of detachment, iliac crest bone graft, and use of dicalcium phosphate synthetic bone graft. Probabilities of less than 0.05 were accepted as significant. Three years postoperatively, 57 patients (15%) reported altered sensation of the lower lip or chin. Older age correlated significantly with neurosensory disturbances (p<0.0001). Greater mandibular advancement correlated with postoperative "positive" neurosensory phenomena (right side p=0.08; left side p=0.03). Intraoperative surgical manipulation of the left inferior alveolar nerve was significantly associated with postoperative hypoaesthesia (p=0.014). Older age at surgery, extensive mandibular advancement, and surgical manipulation of the left inferior alveolar nerve, were associated with long-term neurosensory disturbances after modified bilateral sagittal split osteotomy. The modified operation seems to safeguard the inferior alveolar nerve from transection, without causing damage to other nerves.

Incidence and treatment of complications in patients who had third molars or other teeth extracted.

The aim of this study was to compare the incidence of complications after extraction of third molars (M3) or other teeth, and to describe their management. We made a retrospective cohort study of patients having M3 or other teeth extracted, and recorded complications up to two years' follow-up. A total of 142 complications developed after 2355 procedures (6%) - 7% after extraction of M3 compared with 5% after extractions of other teeth (p=0.024). The three most common complications were wound infection (2%), pain without apparent cause (<1%), and oroantral communication (<1%). Patients who had M3 extracted were at increased risk of complications compared with those who had other teeth extracted (Odds ratio (OR) 1.5, p=0.024), particularly for infection (OR 5.9, p<0.001) and hypoaesthesia (OR 8.4, p=0.027). Half of all patients with a complication were treated with antibiotics orally. The incidence of postoperative bleeding was 0.6% as a result of suboptimal management of antithrombotic drugs in extractions of teeth other than M3. Finally, optimal treatment of the complications was compared with the available evidence. Prevention and treatment of these complications could reduce the incidence, particularly of bleeding.

Comparison of 3D Scanning Versus 2D Photography for the Identification of Facial Soft-Tissue Landmarks.

BACKGROUND: Three dimensional facial scanning is an innovation that provides opportunity for digital data acquisition, smile analysis and communication of treatment plan and outcome with patients. OBJECTIVES: To assess the applicability of 3D facial scanning as compared to 2D clinical photography. MATERIALS & METHODS: Sample consisted of thirty Caucasians aged between 25 and 50 years old, without any dentofacial deformities. Fifteen soft-tissue facial landmarks were identified twice by 3 observers on 2D and 3D images of the 30 subjects. Five linear proportions and nine angular measurements were established in the orbital, nasal and oral regions. These data were compared to anthropometric norms of young Caucasians. Furthermore, a questionnaire was completed by 14 other observers, according to their personal judgment of the 2D and 3D images. RESULTS: Quantitatively, proportions linking the three facial regions in 3D were closer to the clinical standard (for 2D 3.3% and for 3D 1.8% error rate). Qualitatively, in 67% of the cases, observers were as confident about 3D as they were about 2D. Intra-observer Correlation Coefficient (ICC) revealed a better agreement between observers in 3D for the questions related to facial form, lip step and chin posture. CONCLUSION: The laser facial scanning could be a useful and reliable tool to analyze the circumoral region for orthodontic and orthognathic treatments as well as for plastic surgery planning and outcome.

Systematic review of the incidence of inferior alveolar nerve injury in bilateral sagittal split osteotomy and the assessment of neurosensory disturbances.

Extreme variation in the reported incidence of inferior alveolar nerve (IAN) disturbances suggests that neurosensory disturbances after orthognathic surgery have not been evaluated adequately. Here we review the reported incidence of IAN injury after orthognathic surgery and assess recently reported methods for evaluating sensory disturbances. A search was conducted of the English-language scientific literature published between 1 January 1990 and 31 December 2013 using the Limo KU Leuven search platform. Information on various aspects of assessing IAN injury was extracted from 61 reports. In 16 reports (26%), the incidence of injury was not indicated. Preoperative IAN status was not assessed in 22 reports (36%). The IAN assessor was described in detail in 21 reports (34%), while information on the training of the assessors was mentioned in only two reports (3%). Subjective evaluation was the most common method for assessing neurosensory deficit. We conclude that the observed wide variation in the reported incidence of IAN injury is due to a lack of standardized assessment procedures and reporting. Thus, an international consensus meeting on this subject is needed in order to establish a standard-of-care method.

Self-reported hypoesthesia of the lower lip after sagittal split osteotomy.

Sagittal split osteotomy may result in sensory impairment of the inferior alveolar nerve; altered sensation in the lower lip varies from patient to patient. We evaluated individual and intraoperative risk factors of sagittal split osteotomy and correlated these findings with self-reported postoperative changes in lower-lip sensation. Follow-up data for 163 consecutive patients who underwent a bilateral sagittal split osteotomy were assessed for self-reported sensibility disturbances in the lower lip at the last follow-up visit. These self-reports were categorized as normal, hypoesthesia, hyperesthesia, or slightly diminished sensation in the central area of the chin. The overall rate of self-reported changed sensibility was 15.1% (49/324; 13.0% on the right side and 17.3% on the left side). Of 16 patients (9.9%) who experienced hypoesthesia on the right side and 25 patients (15.4%) who experienced hypoesthesia on the left side, 10 experienced bilateral hypoesthesia (31 patients total, 19.1%). Genioplasty and age at surgery were significant predictors of hypoesthesia; a 1-year increase in age at surgery increased the odds of hyposensitivity by 5%, and the odds of hypoesthesia in patients with concurrent genioplasty were 4.5 times higher than in patients without genioplasty. Detachment of the nerve at the left side, but not at the right side, was significantly correlated with hypoesthesia.

CBCT-based predictability of attachment of the neurovascular bundle to the proximal segment of the mandible during sagittal split osteotomy.

Injury to the inferior alveolar nerve (IAN) during surgery is an important complication of bilateral sagittal split osteotomy. With cone beam computed tomography, the course of the nerve and its relationship to the surrounding structures can be assessed in three dimensions. This study aims to determine whether tomography can predict attachment of the neurovascular bundle to the proximal segment of the mandible during sagittal split osteotomy (SSO). Bilateral linear measurements were taken on cross-sectional tomography images. During osteotomy, it was noted for each patient whether the neurovascular bundle was attached to the proximal segment during the split. If attached, a bone-cutting instrument or a blunt instrument was needed to free the nerve. The nerve was attached at more than one-third of operation sites (170 sites). Of these, over 65% of attached nerves (108 sites) required a bone-cutting intervention to free them from the mandible. After correcting for confounding factors, the linear distances from the buccal cortical margin of the IAN canal to the inner and outer buccal cortical margins of the mandible were important predictors of whether the IAN will be attached to the proximal segment of the mandible during SSO.

Assessment of caries experience in epidemiological surveys: a review.

OBJECTIVES: To review aspects of methods for assessing caries experience (CE) in epidemiological surveys. METHOD: A search of English language literature published between January 2000 and December 2008 was undertaken using 'epidemiology', 'dental caries' and 'assessment' as search terms. Information on criteria for CE assessment, materials and settings, diagnostic threshold, training of examiners and validation of the screening results was extracted from the reports. RESULTS: Eighty-nine reports met the inclusion criteria. In 9 of the reports (10%) no reference was made to existing standardisation criteria for assessment of CE. Light condition applied (60 reports, 67%) and the use of a probe (60 reports, 67%) were frequently reported. Most reports mentioned that training and calibration of examiners took place, but the outcome of reliability checks were often not presented (48 reports, 54%). Only 28 of the reports (32%) specified that cleaning took place before the examination. Journals with Impact Factor (IF) provided specific information on methods more frequently than journals without. The WHO Basic Methods for Oral Health Surveys were most often applied (52 surveys, 58%). However, deviations from the original description were found especially for measurement and reporting of reliability measurement (24, 46% and 29, 56% respectively), type of probe used (27, 52%) and light condition (16, 31%). All of these hamper the (external) validity of the obtained results. CONCLUSIONS: There is a clear need for improvement of the reporting and application of methods for assessing CE in epidemiological surveys. A check-list of aspects of methods to be included in reports of surveys assessing CE is proposed by the authors.

Prevalence of neck and back pain among dentists and dental auxiliaries in South-western Nigeria.

Dental health workers like other workers have occupation related health problems and hazards which include neck and low back pain. Previous studies have shown that the prevalence and location of pain may be influenced by posture and work habits and as well as demographic factors. The aim of this study was to determine the prevalence of neck and back problems among dentists and dental auxiliaries in private and government dental hospitals in south western Nigeria. Structured self administered questionnaire was sent to dentist and dental auxiliaries by randomly selecting 3 out of the 6 state capital from the southwestern Nigeria. Participants included those in private clinics, teaching hospitals and general hospitals. The questionnaire was composed of respondents biodata, questions about specific information on neck and back pain and routine practice posture while working at chairside. The total number of properly filled questionnaire was 210 with a male to female ratio of 1.04:1. Respondents included 147 dentists, 37 dental surgeon assistants (DSA), 14 dental therapists and 12 dental technologists. Prevalence of back and neck pain among the respondents was 88.1% and 81.9% respectively. Among the male respondents, the prevalence of back pain was 86.9% and 89.3% in female while for neck pain, the prevalence was 83.2% in male and 80.6% in female. Within the different professional groups, the prevalence of back pain was highest among the DSA (89.2%), closely followed by the dentists (88.4%), then therapists (85.7%) and least among the technologists (83.3%). For neck pain, the prevalence was highest among therapists followed by technologists, dentists and least among the DSA. More females missed work due to back and neck pain than males. There is therefore the need to address ergonomic issues and change the way dentistry is practiced.

Prevalence of neck and back pain among dentists and dental auxillaries in South-western Nigeria

Dental health workers like other workers have occupation related health problems and hazards which include neck and low back pain. Previous studies have shown that the prevalence and location of pain may be influenced by posture and work habits and as well as demographic factors. The aim of this study was to determine the prevalence of neck and back problems among dentists and dental auxillaries in private and government dental hospitals in south western Nigeria. Structured self administered questionnaire was sent to dentist and dental auxillaries by randomly selecting 3 out of the 6 state capital from the southwestern Nigeria. Participants included those in private clinics; teaching hospitals and general hospitals. The questionnaire was composed of respondents biodata; questions about specific information on neck and back pain and routine practice posture while working at chairside. The total number of properly filled questionnaire was 210 with a male to female ratio of 1.04:1. Respondents included 147 dentists; 37 dental surgeon assistants (DSA); 14 dental therapists and 12 dental technologists. Prevalence of back and neck pain among the respondents was 88.1and 81.9respectively. Among the male respondents; the prevalence of back pain was 86.9and 89.3in female while for neck pain ; the prevalence was 83.2in male and 80.6in female. Within the different professional groups; the prevalence of back pain was highest among the DSA(89.2); closely followed by the dentists(88.4); then therapists(85.7) and least among the technologists(83.3). For neck pain; the prevalence was highest among therapists followed by technologists ; dentists and least among the DSA. More females missed work due to back and neck pain than males. There is therefore the need to address ergonomic issues and change the way dentistry is practiced

Lipoma of the oral cavity: clinicopathological review of seven cases from Ibadan.

This study provides documented basis of oral lipoma experience at the University College Hospital Ibadan. The study reviewed seven cases, seen over a period of 18 years. Peak age of occurrence way 40 years and above. The tongue, and cheek were the predominant sites while the overall incidence was 0.43%. Male to female ratio was 2.5:1. Surgical excision is the only treatment recommended in the present study and no recurrence was recorded in these case treated in this study.