Temporomandibular dysfunction in patients treated with orthodontics in combination with orthognathic surgery.

Fifty-two patients with malocclusions underwent orthodontic treatment in combination with orthognathic surgery involving a Le Fort I and/or sagittal split osteotomy. Approximately 5 years after surgery, the patients were examined for signs and symptoms of temporomandibular disorders (TMD). The frequencies were found to be low in comparison with epidemiological studies in this field. The aesthetic outcome and chewing ability were improved in most patients (about 80 per cent). Some of the patients had reported recurrent and daily headaches before treatment. At examination, only two patients had reported having a headache once or twice a week, while all the others suffered from headaches less often or had no headache at all. Eighty-three per cent of the patients reported that they would be prepared to undergo the orthodontic/surgical treatment again with their present knowledge of the procedure. This study shows that orthodontic/surgical treatment of malocclusions not only has a beneficial effect on the aesthetic appearance and chewing ability, but also results in an improvement in signs and symptoms of TMD, including headaches.

Two-stage maxillary sinus reconstruction with endosseous implants: a prospective study.

The aim of this prospective study was to evaluate the results of 2-stage maxillary sinus reconstruction using titanium implants placed into iliac corticocancellous bone blocks previously grafted to the floor of sinuses. Fifty consecutive patients received 314 Brånemark implants of varying lengths; 202 implants were placed in the grafted bone and 112 were placed in the adjacent anterior maxillary alveolar process, which had received buccal onlay bone grafts. Follow-up time was 9 to 48 months after implant placement, which was accomplished 5 months after bone grafting. Eighty-four percent of the implants were integrated into the grafted sinuses and 75% were integrated into the anterior graft. Six patients (12%) lost implants in strategic positions, leading to secondary implant placement prior to fabrication of fixed prostheses. Thirty-eight patients (76%) received fixed prostheses. Only 5 individuals (10%) attained permanent implant-anchored overdentures. One patient lost all implants. The total implant survival rate (80.9%) and the survival rate of the fixed prostheses (100%) compare favorably with other reports.

Importance of bone graft quality for implant integration after maxillary sinus reconstruction.

OBJECTIVE: The aim of this study was to determine whether bone quality, as assessed by osteometry and histologic parameters, can be used to predict implant integration in conjunction with maxillary sinus reconstruction. STUDY DESIGN: Twelve patients with severely atrophied maxillary alveolar processes were treated through use of a two-stage surgical reconstructive strategy with implant placement 4 months after bone grafting. Bone biopsy specimens taken from the iliac crest peroperatively and from the sinus inlay sites 1, 2, 4, 6, or 12 months postoperatively were analyzed by light microscopy and osteomorphometry. Bone mineral content was measured by osteometry. RESULTS: Osteometric and osteomorphometric data (trabecular bone volume [%], assessment of chromatin staining, and an osteocyte index) registered for the biopsy specimens were not statistically correlated with implant failure. CONCLUSIONS: Prognostic evaluation of implant survival is difficult. The tested methods did not contribute to the improvement of guidelines for the clinical handling of these patients.

Stability of Le Fort I osteotomy with advancement: a comparison of single maxillary surgery and a two-jaw procedure.

PURPOSE: This study compared single maxillary surgery and a two-jaw procedure in patients who underwent one-piece Le Fort I advancement without bone grafting. PATIENTS AND METHODS: Fifty-three patients had Le Fort I osteotomy performed using a standard technique. Twenty-two patients had maxillary surgery alone, and 31 patients additionally had a bilateral sagittal split ramus osteotomy performed. Both rigid and nonrigid fixation were used. The postoperative movement of the maxilla was investigated, comparing cephalograms taken preoperatively, 2 to 3 days postoperatively, and at least 6 months postoperatively. A computer program was used to superimpose the three radiographs. RESULTS: No difference in postoperative stability was found when the two surgical procedures were compared, and no correlation between magnitude of advancement and degree of relapse could be identified (P > .05). Nonrigid fixation in patients receiving only maxillary surgery resulted in greater postoperative forward movement of the maxilla (P = .022). CONCLUSION: This study indicates that postoperative stability of the maxilla in a two-jaw procedure is equivalent to that of single maxillary surgery. Nonrigid fixation in single maxillary surgery reduces the need for postoperative orthodontics.

Sensibility following sagittal split osteotomy in the mandible: a prospective clinical study.

Bilateral sagittal split osteotomy may be associated with postoperative sensory deficiency in the area innervated by the inferior alveolar nerve. The aim of this study was to assess the neurosensory response of the inferior alveolar nerve after such surgery. Fifty consecutive patients receiving mandibular setback or advancement were investigated. Four different neurosensory tests were used: light touch, pin prick, static two-point discrimination, and vibration thresholds. These tests were performed preoperatively, 2 days, as well as 3 months and 12 months postoperatively. The methodologic error was found negligible. The pin prick and light touch tests as well as vibratory thresholds often disclosed a short period of decreased local sensibility, whereas static two-point discrimination displayed a slightly more extended postoperative sensory reduction. The patients did not experience any practical problems or essential drawbacks postoperatively. The only variable significantly associated with neurosensory disturbance was age. In conclusion, bilateral sagittal split osteotomy, when properly performed, must be considered a safe and reliable surgical technique, even from a neurosensory point of view.

Sinus inlay bone augmentation: comparison of implant positioning after one- or two-staged procedures.

PURPOSE: This study was undertaken to compare implant angulation and position after one- or two-stage sinus inlay bone augmentation. PATIENTS AND METHODS: Twenty patients were retrospectively selected; group 1 (n = 10) was operated on with a one-stage procedure, and group 2 (n = 10) with a two-stage operation. Casts processed for the final permanent or temporary bridgework were collected and photographed from an oblique anterior view paralleling the alveolar crest on the right and left sides, as well as from an occlusal view. The angle between impression pins inserted in the abutments relative to the true vertical was recorded. In the occlusal view, the midpoints of the abutments were related to an individual computerized superimposed parabola. RESULTS: The implants inserted during the one-stage procedure were generally placed more palatally (Wilcoxon rank sum test, P = .0101) and angled more palatally (P = .0009) compared with those placed with the two-stage operation. CONCLUSION: This study showed that the two methods of treating patients by sinus inlay bone augmentation differed significantly with regard to placement and angulation of the implants. A two-stage procedure seems to offer the surgeon more optimal conditions for positioning the implants.

A comparison of skeletal stability after mandibular advancement and use of two rigid internal fixation techniques.

PURPOSE: Two different methods of rigid fixation were compared for postoperative stability 6 months after mandibular advancement for treatment of Class II malocclusion. MATERIAL AND METHODS: Sixty (30 + 30) patients from two different oral and maxillofacial units treated for a Class II malocclusion by bilateral saggital split osteotomy (BSSO), and two different methods of internal rigid fixation were prospectively investigated. Two groups (S1, n = 15; S2, n = 15) had bicortical noncompressive screws inserted in the gonial area through a transcutaneous approach, and the other two groups (P1, n = 15; P2, n = 15) had the bone segments fixed with unicortical screws and miniplates on the lateral surface of the mandibular body. Cephalograms were taken preoperatively, 2 days postoperatively and 6 months after the operation. A computer program was used to superimpose the three cephalograms and to register the mandibular advancement and postoperative change both sagittally and vertically. RESULTS: These were minor differences in the advancement and postoperative changes between the four groups, but statistically no significant difference was shown in either sagittal or vertical directions. However, statistically verified differences proved that increasing age was associated with a smaller amount of postsurgical relapse. Low-angle cases (ML/NSL < 25 degrees) had a bigger amount of surgical (P = .0008) and postsurgical (P = .0195) movement compared with the patients in the high-angle group (ML/NSL < 38 degrees). Using a multiple regression test, a positive correlation was also shown between the amount of surgical advancement and the amount of postsurgical instability (P = .018). CONCLUSIONS: This prospective dual-center study indicates that the two different methods of internal rigid fixation after surgical advancement of the mandible by BSSO did not significantly differ from each other, and it is up to the individual operator to choose the method for internal rigid fixation.

Patients' assessment of surgical removal of mandibular third molars. An inquiry study.

The aim of this study was to find out patients' experience of pain and discomfort in connection with removal of lower third molars under local anaesthesia. Patients consecutively referred to the Oral and Maxillofacial Unit in Halmstad for removal of lower impacted third molars were the selection for this study. Three surgeons operated 294 lower third molars under local anaesthesia. The Visual Analogue Scale was used to register pain at several occasions during the surgical performance. The patients experienced the operation as an acceptable procedure and the most painful event during the operation was the injection of local anaesthetic solution. The study showed that the surgical procedure was very well tolerated by the patients with only a minor incident of inconvenience or excessive pain.

Retrospective analysis of one-stage maxillary sinus augmentation with endosseous implants.

The aim of the present retrospective study was to evaluate the results of a one-stage reconstructive procedure using titanium implants placed in iliac corticocancellous bone blocks grafted to the floor of maxillary sinuses. Forty-nine patients received 314 Brånemark implants, of which 171 implants of various lengths were placed in the grafted bone and 143 implants in the adjacent maxillary alveolar process (which includes 11 implants placed in onlay grafts). Five patients also received onlay grafts to the anterior maxilla. Follow-up time was 3 to 49 months after abutment connection, which was performed 9 months after implant placement. Eighty-two percent of the implants were successfully integrated in the grafted area and 84.8% in the adjacent bone. Eleven patients (22.4%) lost one to four implants or a few implants in strategic positions, requiring secondary implant placement prior to the manufacturing of fixed prostheses, whereas 35 (71.4%) received primary fixed restorations. Only two individuals (4.1%) received permanent implant-supported overdentures. Assessments of esthetics, phonetics, and function were made by the surgical-prosthodontic team and compared with those of the patients. Opinions regarding the functional outcome of treatment appeared least correlated. The total implant survival rate compares favorably with other reports.

Factors in implant integration failure after bone grafting: an osteometric and endocrinologic matched analysis.

In a retrospective analysis of 49 patients who received bone graft augmentation to the maxillary sinuses in conjunction with implant insertion, 11 patients had a significantly reduced success rate. The aim of the present study was to determine whether bone quality, as assessed by osteometry and selected haematologic and urinary tests, influences the integration of implants, and whether such data can be prognostically useful. Relative bone mass density (BMD%) differed significantly among these patients as compared to age- and sex-matched control patients receiving the same reconstructive treatment (P=0.01). Other parameters tested did not demonstrate any significant differences. In addition to local complications, general disorders, such as osteoporosis, must be considered in cases of excessive implant loss.

Skeletal stability after mandibular advancement: a comparison of two rigid internal fixation techniques.

OBJECTIVE: To compare two different methods of rigid fixation for any difference in postoperative stability after mandibular advancement. MATERIAL AND METHODS: Thirty-eight patients with Class II malocclusion treated by bilateral sagittal split osteotomy (BSSO) and mandibular advancement were selected for this retrospective study. Group A (n = 16) had noncompressive bicortical screws inserted in the gonial area through a transcutaneous approach and Group B (n = 22) had the bone segments fixed with unicortical screws and miniplates on the lateral surface of the mandibular body. Cephalograms were taken preoperatively, 2 days postoperatively, and 6 months after the operation, and a computer program was used to superimpose the three cephalograms and register the advancement and postoperative instability. RESULTS: There was a minimal difference in advancement of the mandible in the two groups. Statistical analysis showed no significant difference in postsurgical stability. However, positive correlation between the amount of advancement and the amount of postsurgical instability was demonstrated using a linear multiple regression test (P = .0002). CONCLUSION: This study indicates that the two different methods of internal rigid fixation of the segments after surgical advancement of the mandible give equal stability postoperatively and their use is a matter of surgical choice.

Early results from reconstruction of severely atrophic (Class VI) maxillas by immediate endosseous implants in conjunction with bone grafting and Le Fort I osteotomy.

This report presents our experience with 12 consecutive patients treated by the method of SAILER19, comprising bone grafting to the floor of the nose and the maxillary sinus after a Le Fort I inferior repositioning of the maxilla followed by immediate implantation of endosseous implants. The corticocancellous grafts were harvested from the iliac crest. Fifty-nine implants were inserted in the bone grafts and eight in the adjacent nongrafted bone. Fourteen implants (21%) had to be removed because of nonintegration, of which 10 had been placed in two patients. The follow-up ranged from 11 to 24 months. No implants have been lost after loading. Six patients received fixed prostheses, and four overdentures. The importance of complete preoperative positional stability of the bone grafts and implants is emphasized.

A technique for inserting endosseous implants in the atrophic maxilla in a single stage procedure.

A technique is described for inserting autogenous iliac bone into the maxillary sinus of the edentulous patient via a fenestration of the anterolateral maxillary wall, maintaining the mucous membrane lining of the sinus intact, and allowing insertion of titanium screw implants into the atrophic maxilla at the same operation. This method avoids a Le Fort I osteotomy approach with its possible attendant complications.