Considerations for esthetic facial surgery in the African-American patient.

Due to the diverse ethnic nature of most communities, the perception of beauty is not homogeneous. Beauty is a perception of good balance, symmetry, harmony, and features that are pleasing to the eye. It is not possible to quantitate beauty. Many attempts have been made to standardize what is and is not beautiful by establishing the ethnic norms. Surgeons commonly attempt to achieve these ideal norms, but they may not necessarily be considered beautiful by the individual patient. Therefore, it is imperative for the surgeon to completely understand the patients' goals for surgery, which may not fit the ideal norms published in studies for that specific ethnic community. It also has become essential for patients to be made aware of the limitations of surgery, especially if their goals are unrealistic, to avert future distress and medicolegal problems. Thus, what is "normal" is not necessarily beautiful, and perhaps it would be better to strive for what is considered beautiful to the individual patient, rather than normal. Within the African-American population, the concept of what is beautiful can be extremely diverse. The number of African Americans who seek cosmetic or esthetic facial surgery is limited. As the number of esthetic procedures performed in the African-American population increases, however, the more educated this population will become regarding these procedures, and the more comfortable the surgeon will become regarding his or her own sense of "African-American beauty" and specific esthetic facial considerations for this population. It should be mentioned that as the number of African-American surgeons increases, their influence within the African-American population regarding the availability of esthetic procedures will also be felt.

Comparison of soft tissue healing and osseointegration of IMZ implants placed in one-stage and two-stage techniques: a pilot study.

The osseointegration of endosseous dental implants is well documented. Implants have proven to be a viable treatment option for the replacement of missing teeth. The surgical phase of implant dentistry for most implant systems involves two stages--the placement of the implant and its subsequent uncovering. The IMZ (Interpore International) implant system is classically a two-stage system. No significant differences were demonstrated in osseointegration and soft tissue healing for IMZ implants placed in one-stage and two-stage procedures in this pilot study.

Comparison of Periotest values of integrated implants with and without healing abutments: a pilot study.

The role of the Periotest in the clinical evaluation of osseointegration has been well documented. Some clinicians have used the initial Periotest values at second-stage surgery as a baseline to measure changes in integration at the bone-implant interface over time. The purpose of this pilot study was to compare Periotest values made with and without healing abutments in place. A statistically significant difference was found between the Periotest values that were recorded with and without healing abutments, with the values without the healing abutments being more negative and suggestive of greater osseointegration.

Preprosthetic surgery for the edentulous patients.

Preprosthetic surgery is a rapidly changing area of dentistry. A knowledge of the range, capabilities, and limitations of the commonly used surgical procedures is a must for anyone treating a patient who will receive a complete denture prosthesis. It cannot be overemphasized that the establishment of a clear treatment plan and close coordination of all parties involved in the reconstructive effort are essential to achieve the best overall result.

Evaluation of osseointegration of endosseous implants in radiated, vascularized fibula flaps to the mandible: a pilot study.

PURPOSE: This study clinically evaluated the osseointegration of implants placed into vascularized fibula flaps used in mandibular reconstruction of cancer patients following radiation treatment and subsequent hyperbaric oxygen (HBO) therapy. MATERIALS AND METHODS: Five head and neck cancer patients had mandibular resection and immediate reconstruction with a vascularized fibula flap. Subsequent therapy included greater than 50 Gy of radiation to the fibula flap over a 6 to 8-week period. Two to 6 weeks following radiation therapy each patient received 20 90-minute daily sessions of HBO at 2.4 atmosphere pressure. Stage 1 implant surgery was performed placing two to six implants (15 mm in length and 3.75 to 4.0 mm in width) into each fibula flap. This was followed by 10 postoperative HBO sessions using the previously mentioned protocol. The stage 2 procedure was performed 6 months after the stage 1 procedure. Osseointegration was assessed clinically using manual force and an electronic device at the time the implants were uncovered and monthly over a 6-month period. RESULTS: All 20 implants placed in the fibula flaps were osseointegrated clinically at the time the implants were uncovered and during the 6-month follow-up. CONCLUSION: In this pilot study, mandibular reconstruction with a vascularized fibula flap and endosseous osseointegrated implants, following radiation of the fibula, was successful. It was concluded that factors such as the graft having its own blood supply and the use of HBO contributed to the successful osseointegration of these implants.

Reconstruction of the head and neck cancer patient with a vascularized fibula flap and dental implants: preliminary clinical report.

Reconstruction and rehabilitation of the head and neck cancer patient is challenging. Vascularized fibula grafts can be used to reconstruct mandibular defects after resection of the malignancy and the surrounding bone. Prosthodontic treatment can restore function and esthetics. This preliminary report discusses the use of endosseous implants in radiated mandibular vascularized fibula grafts after surgical resection.

Diagnosis and treatment of transverse maxillary deficiency.

Treatment of skeletally mature patients is often complicated by inadequately treated or undiagnosed transverse skeletal discrepancy. This report emphasizes diagnosis of transverse maxillo-mandibular discrepancy and describes recommendations for treatment. Proper treatment strategy must consider the type and magnitude of transverse deficiency, patient's growth status, dentofacial esthetics, stability factors, and periodontal tissue health. Indications for surgically assisted maxillary expansion are listed, and the recommended surgical technique to improve frontal dentofacial esthetics, provide better stability, and enhance long-term periodontal health is described. Specific modifications in surgical technique to help prevent postoperative complications are included. New recommendations for sequencing, timing, and correction of transverse deficiency are presented.

The status of implant training in oral and maxillofacial surgery residency programs.

PURPOSE: The results of a survey concerning the status of oral and maxillofacial surgery resident training in oral implantology are discussed. RESULTS: The results demonstrate that oral and maxillofacial surgery residents are exposed to a variety of implant types and systems, with most implant surgery being performed in association with intravenous sedation. The number of implants placed by each resident during training varied greatly. CONCLUSION: Most program directors believe that the implantology training of oral and maxillofacial surgery residents is superior or comparable to that of periodontal graduate students. However, this survey suggests that certain aspects of residency training in implantology, such as the performance of sinus lift procedures and participation in implant research, may require more emphasis.

Double-gloving and the incidence of perforations during specific oral and maxillofacial surgical procedures.

The concerns of surgeons about effective means of barrier protection during surgery is increasing owing to concern about the human immunodeficiency virus (HIV). There are various oral and maxillofacial surgical procedures that require the use of sharp instruments, and the oral and maxillofacial surgeon may be at risk for contamination due to possible perforation of the surgical gloves when manipulating these instruments. This study evaluated the incidence of perforations when performing specific oral and maxillofacial surgical procedures when double-gloving barrier protection was used. It found an increased incidence of perforations when performing procedures that required the use of sharp instruments in comparison with those procedures that did not require the use of such instruments.

Rehabilitation of maxillofacial trauma patients with dental implants.

Maxillary and mandibular traumatic injuries are inevitable in our society. Dental implants can be considered for the replacement of teeth lost as a result of trauma, even in complicated cases where associated injuries, such as jaw fractures and bone loss, have occurred. Reimbursement for dental services by insurance companies in the case of traumatic injuries to the teeth and supporting structures is discussed.

Associations between severity of dentofacial deformity and motivation for orthodontic-orthognathic surgery treatment.

The successful outcome of orthognathic surgery is related to patient satisfaction and motivation. The aim of this retrospective study was to analyze the association between 1) severity of dentofacial deformity derived from cephalometric measures and 2) patient motivation for treatment. The initial cephalograms of 142 patients aged 16 years or older from the Dentofacial Program of the University of Michigan were traced and digitized. Inclusion criteria were established by assigning ANB 4 degrees to 15 degrees to define severe skeletal Class II (n = 65) and ANB - 15 degrees to -4 degrees to define severe skeletal Class III (n = 20). Motivation for orthodontics and surgery was derived from clinician administered forms scaled 1-10 with Low (1-5) and High (8-10). The cephalometric measure ANB was significant (p = 0.02) for high/low motivation for orthodontic treatment using Student's t test. No other cephalometric measures were significant for high/low motivation for orthodontics or surgery using Student's t test. Class II patients were significantly (p = 0.014) more motivated than Class III patients for orthodontic treatment. No significant difference was found for motivation for surgery between skeletal Class II and skeletal Class III patients. Patients with severe sagittal Class II deformities had higher motivation for orthodontics than surgery. The cephalometric measure, ANB, defining severe skeletal Class II and Class III patients did predict motivation level for orthodontics. None of the other 18 cephalometric measures were predictive of patient motivation for either orthodontics or surgery.

Osseous changes following placement of the transmandibular implant system in edentulous mandibles.

The transmandibular implant system is designed for the reconstruction and rehabilitation of the endentulous mandible utilizing an extraoral approach. Transmandibular implants were placed in 19 patients and mandibular bony changes were followed using standardized panoramic radiography. Eleven sites were identified on each postoperative radiograph and the percentage of radiographic enlargement was calculated for each site. The true bony changes were then computed for both short-term (9.4 months) and long-term (53.4 months) follow-up. Patients with an average mandibular height in the saddle areas of 3.5 to 8.9 mm showed bilateral bony regeneration in the saddle areas and over the most distal cortical screws of the implants. Most of these bony changes were seen in the first year, but continued beyond that time. Patients with residual bone height of 9.0 to 12.9 mm had little bone change, while patients with bone height of 13.0 to 20.5 mm demonstrated slight resorption. Theories for the observed changes are presented. The transmandibular implant is especially indicated for the severely atrophic mandible because its position within the mandible and the rigid box frame design of the implant promote bilateral bone regeneration distal to the framework of the implant.

The Dentofacial Deformity Program of the University of Michigan: organization, analysis of data, and benefits of program.

The Dentofacial Deformity Program of the University of Michigan was established in 1984 to provide a consulting service for the diagnosis, treatment recommendations, and management of patients with dentofacial deformities. This program was designed as a service commitment for the patient, referring doctors, and the medical and dental communities. Educational and research aspects of the program provide benefits for orthodontic and oral and maxillofacial surgery graduate students, and the dental school faculty. The organization, data analysis, and education, research, and service benefits of this program are discussed.

The transmandibular implant: implant reconstruction and rehabilitation for the atrophic mandible.

The transmandibular implant is specifically designed for the reconstruction and rehabilitation of the severely atrophic mandible utilizing an extraoral approach. The unique design and surgical protocol of the transmandibular system have proven to be predictable and successful. The indications, implant design and materials, surgical technique, advantages, and disadvantages of the transmandibular system are presented in this article.