Modified Blair Approach for the Treatment of Mandibular Condyle Fractures.

PURPOSE: The management of fractures of the condyle of the mandible has been a topic of debate and still no consensus exists in the literature about the most appropriate approach. The objective of this study was to evaluate the efficacy and safety of the modified Blair approach for the open reduction and internal fixation of mandibular condyle fractures. METHODS: A retrospective study was conducted on 18 patients with 20 mandibular condyle fractures from 2014 to 2020. All patients were treated surgically using the modified Blair approach. Postoperative occlusion status and mouth opening were assessed for treatment outcomes. Also, the rate of complications such as facial nerve paralysis, wound infection, hematoma, salivary fistula, Frey syndrome, and greater auricular nerve paraeesthesia evaluated. RESULTS: Seventeen out of 18 patients (94.4%) achieved their original pretraumatic occlusion after the surgery. One patient (5.5%) had postoperative occlusal interference due to premature dental contact. The maximal postoperative interincisal distance was measured with a range between 33 and 41 mm (mean 37.6 mm). One patient (5.6%) had transient facial nerve palsy. Also, salivary fistula developed in 1 (5.6%) patient in the postoperative period. CONCLUSION: The results of this study revealed that the modified Blair approach provides satisfactory clinical outcomes with low complication rates and may offer an alternative, safe, and effective method for open reduction and internal fixation of mandibular condyle fracture.

What Is the Role of Endodontic Predisposing Factors in Early Implant Failure?

We aimed to investigate a possible relationship between early implant failure (EIF) and an adjacent root canal-treated tooth and/or tooth with a periapical lesion (PL), considering the duration between implantation and root canal treatment (RCT). The importance of prior RCT and/or presence of a PL before implantation was also investigated. A total of 810 implants from 342 patients were included and scored according to the implant failure before abutment connection, adjacent root canal treated teeth, adjacent teeth without RCT, no adjacent teeth, adjacent teeth with PL, extraction of teeth with PL, and/or RCT before implantation. The durations between the extraction and implantation and between RCT and implantation adjacent to the root canal-treated teeth were recorded. The time from the RCT of adjacent teeth to implant placement was categorized into 5 groups: less than 4 weeks before implantation, 4-12 weeks before implantation, at least 12 weeks before implantation, within 4 weeks after implantation, and at least 4 weeks after implantation. Among the endodontic predictors, a prior PL on the tooth extracted was associated with an increased risk of EIF (P < .05, odds ratio: 4.37; 95% confidence interval: 1.604-11.891). Furthermore, EIF was more likely to occur when the RCT of an adjacent tooth was performed within 4 weeks of implantation (P < .05). Additional investigations with larger sample sizes are necessary to validate our findings.

Management of Maxillary Deformity with Segmental Osteotomy followed by Implant Insertion in ß-Thalassemia Major Patient.

AIM: The aim of this report is to present the management of the maxillary deformity and subsequent implant therapy of a case with ß-thalassemia major. BACKGROUND: ß-thalassemia is a hematologic disorder that results from the abnormality of the ß-globulin chain synthesis. The best known thalassemia-induced dentofacial problem is the maxillary enlargement, and this undesirable growth of maxilla affects not only the facial esthetics but also dental occlusion, and leads to functional deficiency. CASE DESCRIPTION: A 16-year-old female patient with ß-thalasse-mia major was referred with the complaints of severe facial deformity and malocclusion, resulting in psychosocial and functional problems for her. The dentofacial deformity was characterized by an excessive premaxillary growth both in sagittal and vertical planes. Anterior maxillary osteotomy was performed with bilateral canines extraction, and dental implants were inserted to the canine regions, following bone healing. Postoperative course was free of problems with the crown restorations in function. Recurrence has not been occurred at 6 years follow-up. CONCLUSION: With maintaining hemoglobin level over 10 gm/dl, correction of maxillary defects is stable for long-term in ß-thalassemia major patient. Implant application to these patients may lead to unforeseeable results. CLINICAL SIGNIFICANCE: Although having some difficulties, such as overbleeding and stability problems, maxillary enlargement can be treated by segmental osteotomies successfully in ß-thalassemia major patient. Implant failure frequency may be higher, but many other studies are needed for determining implant survival rate in ß-thalassemia major patients.

Interdisciplinary management of an adult patient with a class III malocclusion.

The coexistence of a skeletal class III deformity and partial edentulism poses a clinical challenge and requires a comprehensive evaluation followed by a multidisciplinary approach. This clinical report presents the integrated management of a class III malocclusion in a 50-year-old woman with partial edentulism. The patient received adjunctive orthodontic treatment with a rigid temporary anchorage device, a Le Fort I maxillary osteotomy, and prosthodontic rehabilitation with removable maxillary copings, an overdenture, and a mandibular partial removable dental prosthesis with precision attachments.

The extent of chin ptosis and lower incisor exposure changes following the osseous genioplasties.

The incision and dissection of the mentalis muscles are inevitable to access the osteotomy line during genial surgery. As the mentalis muscles elevate the central lower lip and support the lip vertically, inadvertent scarring or lengthening of these muscles may lead to lip incompetence and may increase the lower incisor exposure (LIE) that will cause an unaesthetic result. The aim of this study was to evaluate the extent of lip ptosis, LIE, and other soft-tissue changes following different types of osseous genioplasty procedures.Twenty-nine patients (18 females, 11 males) were included in this study. Patients were classified into 3 groups with respect to their genial movement type as genial setback (n = 10), genial advancement (n = 10), and vertical reduction (n = 9). Preoperative and postoperative lateral cephalograms were analyzed to evaluate the horizontal and vertical soft-tissue changes of the lower lip and chin in the 3 genioplasty groups. The statistical evaluations were performed with regression analysis. The mean increase in the LIE was 1.88 mm. Lower incisor exposure and soft-tissue thickness at pogonion were increased significantly in all patients (P < 0.05). Statistically significant differences for lower lip length and vertical position of soft-tissue supramentale values were detected in patients who underwent vertical reduction genioplasty (P < 0.05). Genioplasty procedures requiring the mentalis muscle release cause a 1.88-mm increase in LIE. Vertical positional alterations of the lower lip were especially observed following the vertical reduction genioplasty. Clinician should be aware of this consequence in the course of treatment planning.

Coronectomy in patients with high risk of inferior alveolar nerve injury diagnosed by computed tomography.

PURPOSE: Previous studies have suggested coronectomy as an alternative procedure to decrease the risk of inferior alveolar nerve (IAN) injury when there are high-risk findings observed on panoramic radiographs. However, the exact relation between the inferior alveolar canal and the roots is not obvious on 2-dimensional imaging. The aim of this study was to evaluate the success of coronectomy by comparing it with conventional extraction for the treatment of the patients who had clear IAN injury risks that were determined on 3 dimensions by computed tomography. PATIENTS AND METHODS: Two hundred and sixteen teeth of 124 patients were evaluated by computed tomography and 175 teeth of 120 patients were enrolled in the study. Teeth were divided into an extraction group (n = 87) and a coronectomy group (n = 88) according to the operations planned. RESULTS: The mean follow-up time of the study was 17.29 months. There were 2 patients in the extraction group who had moderate IAN injuries that resolved in 1 month. Also 1 case of dry socket was observed in the extraction group and 1 patient in the coronectomy group had minor infection 1 month postoperatively, which was treated with antibiotics and subgingival irrigations. There were 2 failed coronectomies and neither had any postoperative complications. No cases of lingual nerve injury were noted in this study. CONCLUSIONS: Coronectomy appears to be a preferable alternative with a low incidence of complications and therefore a suggested technique for the treatment of impacted mandibular molars when there is a high risk of IAN injury.

Alveolar cleft closure by distraction osteogenesis with skeletal anchorage during consolidation.

Intraoral distraction osteogenesis (DO) has been widely used for the reconstruction of various dentoalveolar defects. However, its use in the management of alveolar clefts is relatively new. This method allows the closure of the cleft via the regeneration of new alveolar bone and attached gingiva through the distraction of a dento-osseous segment. It eliminates the need for a donor site for autogenous bone grafting and possible graft failure. However, the relatively long consolidation period required for the use of intraoral DO devices may result in soft tissue irritation that would compromise patient cooperation, especially in children. In the case presented, the intraoral DO technique was used for the treatment of a unilateral residual alveolar cleft and an implant was subsequently placed in the regenerated bone. A miniplate was also placed to serve as a skeletal anchor to enable the early removal of the distractor device. The distractor was removed before the beginning of the consolidation phase.

Midfacial protraction with skeletally anchored face mask therapy: a novel approach and preliminary results.

INTRODUCTION: The purpose of this pilot study was to investigate the effects of facemask treatment with a rigid skeletal anchor. METHODS: Miniplates were placed on the lateral nasal wall of the maxilla in 6 subjects (mean age, 11.8 +/- 1.1 years). No dental tissue was incorporated into the anchorage system. Lateral cephalograms of each patient were evaluated at the beginning of treatment (T1), at the end of active treatment (T2), and at the end of follow-up (T3). RESULTS: In the horizontal plane, mean A-point movement was 4.8 +/- 2.0 mm in a mean of 10.8 +/- 2.4 months. The infraorbital region showed significant anterior movement (mean, 3.3 +/- 1.1 mm) at T2. At T3, advancement of the maxilla and the infraorbital region was well maintained (mean follow-up time, 15.2 +/- 0.9 months). Miniplate stability was excellent in all patients throughout treatment. CONCLUSIONS: Remarkable advancement in the middle face and consequent fullness in the soft-tissue profile can be achieved by using skeletal anchorage in conjunction with facemask therapy in the late mixed-dentition period.

Management of chronic unilateral temporomandibular joint dislocation with a mandibular guidance prosthesis: a clinical report.

Recurrent or chronic dislocation of the temporomandibular joint is relatively rare and often results in facial asymmetry, impairment of function, and discomfort. Although manual reduction is the primary choice of treatment, patients presenting with recurrent or prolonged dislocations require conservative and surgical methods to limit forward movement of the mandibular condyle. This clinical report presents a 75-year-old woman with severe mandibular deviation and subsequent facial asymmetry caused by a chronic unilateral temporomandibular joint dislocation that was treated with a mandibular guidance prosthesis combined with physical therapy.

Displacement of tooth fragments to the lower lip: a report of a case presenting an immediate diagnostic approach.

Dentoalveolar injuries are common and are caused by many factors with falls accounting for the most frequent one. Dental trauma requires a special consideration when dental fractures accompany soft-tissue lacerations. Dental fragments occasionally penetrate into soft tissues and may cause severe complications. A thorough clinical examination with soft-tissue radiographs could provide an early diagnosis and surgical removal. This case report presents an immediate diagnosis and management of displaced tooth fragments to the lower lip following a dental trauma.

Coexistence of fibromyalgia, temporomandibular disorder, and masticatory myofascial pain syndromes.

The purpose of this study was to determine the association of fibromyalgia (FM) with temporomandibular disorder (TMD) and masticatory myofascial pain (MMP). Thirty-one consecutive women diagnosed as having FM according to American College of Rheumatology criteria and 21 consecutive women diagnosed as having TMD were included in this prospective study. All patients were examined by a dentist and a physiatrist to identify the coexistence of FM and TMD. In the FM group, TMD was found in 25 (80%) patients, and only 6 (19%) patients had arthrogenous origin with MMP, whereas 19 (81%) patients had only MMP without arthrogeonous orgin of those 25 women exhibited TMD. In the TMD group, the prevalence of FM was 52%, which was significantly higher in those with TMD of arthrogenous origin with MMP. Our results indicate that coexistence of FM and TMD with MMP is high. Pain and tenderness in the masticatory muscles appear to be an important element in FM, so in some patients it may be the leading complaint.

Maxillary molar distalization with a bone-anchored pendulum appliance.

To obtain an effective and compliance-free molar distalization without an anchorage loss, we designed the bone-anchored pendulum appliance (BAPA). The aim of this study was to evaluate the stability of the anchoring screw, distalization of the maxillary molars, and the movement of teeth anterior to maxillary first molars. The study group comprised 10 patients (mean age 13.5 +/- 1.8 years) with Class II molar relationship. A conventional pendulum appliance was modified to obtain anchorage from an intraosseous screw instead of the premolars. The screw was placed in the anterior paramedian region of the median palatal suture. Skeletal and dental changes were measured on cephalograms, and dental casts were obtained before and after distalization. A super Class I molar relationship was achieved in a mean period of 7.0 +/- 1.8 months. The maxillary first molars distalized an average of 6.4 +/- 1.3 mm in the region of the dental crown by tipping distally an average of 10.9 degrees +/- 2.8 degrees . Also, the maxillary second premolar and first premolar moved distally an average of 5.4 +/- 1.3 mm and 3.8 +/- 1.1 mm, respectively. The premolars tipped significantly distally. No anterior incisor movement was detected. The BAPA was found to be an effective, minimally invasive, and compliance-free intraoral distalization appliance for achieving both molar and premolar distalization without any anchorage loss.

Evaluation of nuclear morphometry and DNA ploidy status for detection of malignant and premalignant oral lesions: quantitative cytologic assessment and review of methods for cytomorphometric measurements.

PURPOSE: Detection of a precancerous or cancerous lesion when small is one of the most important factors to improve 5-year survival rates of oral cancer. Although surgical biopsy is the most definitive method for diagnosing oral lesions, it is impractical to routinely subject large numbers of patients to biopsy. Recently, cytomorphometric assessments improved by advanced computer-assisted image analysis systems have gained importance. This study was established to evaluate the efficacy of nuclear cytomorphometric analysis and DNA ploidy status for the detection of oral malignancies. Methods used for cytomorphometric analysis were also reviewed. PATIENTS AND METHODS: Oral mucosal smears (n = 44) were obtained from patients (n = 22) presenting with various oral lesions using a cytobrush immediately before biopsy. Cytomorphometric measurements and nuclear Feulgen DNA content analysis were carried out after the Feulgen staining procedure. Smears from the lesion site constituted the study group whereas contralateral healthy mucosal sites served as control. RESULTS: DNA ploidy analysis revealed 20 diploid (90.9%) and 2 aneuploid DNA patterns (9.1%) sampled from the lateral margin of the tongue and floor of the mouth. When only malignant lesions were considered, aneuploidy rate was 16.7% whereas a diploid pattern was indicated for 83.3% of the sample. With cytomorphometric measurements, a statistically significant difference was shown for nuclear perimeter, area, diameter equivalent to circle, minimum and maximum Feret, intensity, DNA content (c) and DNA index values. CONCLUSIONS: Cytomorphometric analysis via oral brush biopsy is a valuable adjunct to biopsy for identification of premalignant and early stage cancerous oral lesions as a rapid and minimally invasive procedure with high specificity and sensitivity rates, requiring no topical or local anesthetic.

Orthopedic protraction with skeletal anchorage in a patient with maxillary hypoplasia and hypodontia.

Multipurpose titanium miniplates were placed on the lateral nasal wall of the maxilla as anchorage for face mask protraction in an 11-year-old girl presenting with severe maxillary hypoplasia and hypodontia. Applying orthopedic forces directly to the maxilla resulted in an eight mm maxillary advancement. Intraosseous titanium screws were also placed on the palatal bone, near the alveolar crests, to provide anchorage for the expansion appliance. The maxilla was expanded from the median palatal suture, and seven mm of expansion was achieved across the buccal segments. No other tooth support was used for the expansion or the protraction of the maxilla.