Clinical and Cephalometric Analysis of Facial Soft Tissue.

OBJECTIVE: This study aimed to provide average of standard values in planning orthognathic surgery in Asians. MATERIALS AND METHODS: Thirty-three Asians with well-balanced facial profile, combined with class I occlusion and stabilized condylar head were evaluated using lateral cephalograms. RESULTS: Facial length (Nasion'-Menton') was 138.8 and 127.0 mm in male and female, respectively. Upper and lower lip length were 24.5 and 49.8 mm for male, and 22.2 and 45.1 mm for female, and maxillary incisor exposure was 2.0 and 4.0 mm in male and female, respectively. Nasolabial angle was 77.7° and 84.1° in male and female, respectively. Alar base, A point', and maxillary incisor were placed posteriorly to true vertical line by 10.6, 1.0, and 8.0 mm for male and 9.0, 0.8, and 6.9 mm for female. The horizontal distance between upper lip anterior and lower lip anterior was 2.1 mm for male and 2.6 mm for female, and the horizontal distance between A point' and B point' was 5.3 mm for male and 3.9 mm for female. Orbital rim' to A-point' was 12.4 and 11.3 mm in male and female, respectively. Pogonion' located posteriorly to glabella' by 2.7 mm for male and anteriorly to glabella' by 3.2 mm for female, and facial angle was 156.7° and 147.0° in male and female, respectively. CONCLUSIONS: This quantitative analysis of facial profile in Asian will be helpful in evaluation of facial soft tissue and establishment of treatment plans for orthognathic surgery.

Changes in condylar position after BSSRO with and without Le Fort I osteotomy via surgery-first approach in mandibular prognathism with facial asymmetry.

OBJECTIVES: This study aimed to evaluate changes in condylar position after bilateral sagittal split ramus osteotomy (BSSRO) with and without Le Fort I osteotomy via the surgery-first approach (SFA) in patients with facial asymmetry. STUDY DESIGN: Eighteen patients (36 condyles) who received surgical-orthodontic treatment using the SFA were included and divided into 2 groups depending on the extent of surgery: BSSRO-only group (n = 12) and BSSRO with Le Fort I osteotomy group (n = 6). Using computed tomography images taken preoperatively, immediately postoperatively, and 6 months postoperatively, surgical and postoperative changes of the condylar position were analyzed 3-dimensionally. RESULTS: Both groups showed mainly inferolateral displacement with inward rotation immediately after surgery, and superomedial returning movement with outward rotation 6 months after surgery. There was no statistical difference in time-course changes of the condylar position between the 2 groups. In comparing the deviated and nondeviated sides, the deviated side showed significantly greater amount of bodily shift and rotational movement after surgery compared with the nondeviated side in both groups. CONCLUSIONS: These results suggest that BSSRO via the SFA, either with or without Le Fort I osteotomy, may cause condylar displacement after surgery and that the displaced condyles return to their original position on both the deviated and the nondeviated sides.

Evaluation of clinical outcomes of implants placed into the maxillary sinus with a perforated sinus membrane: a retrospective study.

BACKGROUND: The aim of this study was to evaluate the clinical outcomes of implants that were placed within the maxillary sinus that has a perforated sinus membrane by the lateral window approach. METHODS: We examined the medical records of the patients who had implants placed within the maxillary sinus that has a perforated sinus membrane by the lateral approach at the Department of Oral and Maxillofacial Surgery of Chonnam National University Dental Hospital from January 2009 to December 2015. There were 41 patients (male:female = 28:13). The mean age of patients was 57.2 ± 7.2 years at the time of operation (range, 20-76 years). The mean follow-up duration was 2.1 years (range, 0.5-5 years) after implant placement. Regarding the method of sinus elevation, only the lateral approach was included in this study. RESULTS: Ninety-nine implants were placed in 41 patients whose sinus membranes were perforated during lateral approach. The perforated sinus membranes were repaired with a resorbable collagen membrane. Simultaneous implant placements with sinus bone grafting were performed in 37 patients, whereas delayed placements were done in four patients. The average residual bone height was 3.4 ± 2.0 mm in cases of simultaneous implant placement and 0.6 ± 0.9 mm in cases of delayed placement. Maxillary bone graft with implant placement, performed on the patients with a perforated maxillary sinus membrane did not fail, and the cumulative implant survival rate was 100%. CONCLUSIONS: In patients with perforations of the sinus mucosa, sinus elevation and implant placement are possible regardless of the location and size of membrane perforation. Repair using resorbable collagen membrane is a predictable and reliable technique.

Retrospective clinical study of an implant with a sandblasted, large-grit, acid-etched surface and internal connection: analysis of short-term success rate and marginal bone loss.

BACKGROUND: The purpose of this retrospective study was to evaluate the clinical utility of an implant with a sandblasted, large-grit, acid-etched (SLA) surface and internal connection. METHODS: Six patients who received dental implants in the Department of Oral and Maxillofacial Surgery, Chonnam National University Dental Hospital, were analyzed by factors influencing the success rate and marginal bone loss. Factors included patient's age, sex, implant installation site, whether bone graft was done, type of bone graft materials, approaching method if sinus lift was done, and the size of the fixture. In addition, the marginal bone loss was analyzed by using a radiograph. RESULTS: All implants were successful, and the cumulative survival rate was 100 %. Average marginal bone loss of 6 months after the installation was 0.52 mm and 20 months after the functional loading was 1.06 mm. Total marginal bone resorption was 1.58 mm on average. There was no statistically significant difference in mesial and distal marginal bone loss. CONCLUSIONS: The short-term clinical success rate of the implant with an SLA surface and internal connection was satisfactory. Moreover, the marginal bone loss was also consistent with the implant success criteria.

Postoperative changes in mandibular position after mandibular setback surgery via the surgery-first approach in relation to the increase of vertical dimension and the amount of mandibular setback.

OBJECTIVES: This study aimed to compare preoperatively predicted rotational relapse with actual post-treatment mandibular position after mandibular setback surgery via the surgery-first approach and to evaluate the effect of the increase of vertical dimension (VD) on surgical occlusion and the amount of mandibular setback on postoperative mandibular positional changes. STUDY DESIGN: Twenty-nine patients who underwent bilateral sagittal split ramus osteotomy for mandibular prognathism were evaluated by using lateral cephalograms, which had been obtained preoperatively, immediately postoperatively, and immediately after debonding. Increase of VD on surgical occlusion was measured preoperatively. We estimated the mandibular forward movement resulting from the postoperative mandibular anticlockwise rotation during postoperative orthodontic treatment and compared it with the actual post-treatment mandibular position. RESULTS: The actual postoperative mandibular forward movement (2.1 mm) was significantly greater compared with the forward movement (1 mm) predicted preoperatively (P < .01). The postoperative mandibular forward movement was greater in the groups with greater VD increase (>1.5 mm) or greater mandibular setback (>10 mm), even though there was no statistically significant difference. CONCLUSIONS: These results suggest that additional postoperative relapse may occur with mandibular rotational relapse, and VD increase and the amount of mandibular setback may affect post-treatment mandibular position in surgery-first orthodontic treatment.

Retrospective study on factors affecting the prognosis in oral cancer patients who underwent surgical treatment only.

BACKGROUND: This study was performed to evaluate their 5-year survival rates and identify the factors affecting the prognosis of oral cancer patients who had undergone surgical treatment only. METHODS: Among 130 patients who were diagnosed with malignant tumor of oral, maxillofacial, and surgical treated in the Department of Oral and Maxillofacial Surgery at Chonnam National University Hospital within a period from January 2000 to December 2010, for 11 years, 84 patients were investigated who were followed up for more than 5 years after radical surgery; oral cancer is primary and received only surgical treatment. The survival rate according to gender, age, type and site of cancer, TNM stage, cervical lymph node metastasis and its stage, recurrence or metastasis, time of recurrence and metastasis, and differentiation were investigated and analyzed. RESULTS: Overall, 5-year survival rate in patients who received only surgical treatment was 81.2 %, and disease-specific 5-year survival rate was 83.1 %. The disease-specific 5-year survival rate based on TNM stage, metastasis of cervical lymph node, N stage, and presence of recurrence/metastasis was a significant difference (p < 0.05). The disease-specific 5-year survival rate based on sex, age, type of tumor, primary site, and differentiation was not a significant difference (p > 0.05). CONCLUSIONS: These results suggest that good survival rate can be obtained with surgical treatment only, and stage of oral cancer, cervical lymph node metastasis and stage, recurrence or metastasis, time of recurrence, and metastasis have a significant effect on survival rate in oral cancer patients.

Aplastic anemia and dental implant rehabilitation: a clinical trial.

The purpose of this study was to investigate implant-supported restoration as a technique for restoring missing teeth in patients with aplastic anemia. Recurrent bleeding from wound sites leads to persistent release of iron in the tissue. Excessive iron in tissue is related to clinical findings, including fibrosis, poor wound healing, and high level of angiogenesis, which are possible etiological factors of reduced osseointegration. A 44-year-old female patient with aplastic anemia was treated with multiple endosseous implants throughout the mandible and in the posterior region of the maxilla. After 14 implants were placed, radiological and clinical parameters were assessed during the follow-up period. Marginal bone did not change significantly during the follow-up period. The fine trabecular bone in intimate contact and enclosing the implant fixture was sufficient for successful osseointegration. None of the 14 implants were associated with compilations during the seven-year experimental period. This study suggests that dental implant procedures are a safe and reliable treatment option for restoration of missing dentition in patients with aplastic anemia.

Condylar positioning changes following unilateral sagittal split ramus osteotomy in patients with mandibular prognathism.

BACKGROUND: This study was performed to evaluate three-dimensional positional change of the condyle using three-dimensional computed tomography (3D-CT) following unilateral sagittal split ramus osteotomy (USSRO) in patients with mandibular prognathism. METHODS: This study examined two patients exhibiting skeletal class III malocclusion with facial asymmetry who underwent USSRO for a mandibular setback. 3D-CT was performed before surgery, immediately after surgery, and 6 months postoperatively. After creating 3D-CT images by using the In-vivo 5™ program, the axial plane, coronal plane, and sagittal plane were configured. Three-dimensional positional changes from each plane to the condyle, axial condylar head axis angle (AHA), axial condylar head position (AHP), frontal condylar head axis angle (FHA), frontal condylar head position (FHP), sagittal condylar head axis angle (SHA), and sagittal condylar head position (SHP) of the two patients were measured before surgery, immediately after surgery, and 6 months postoperatively. RESULTS: In the first patient, medial rotation of the operated condyle in AHA and anterior rotation in SHA were observed. There were no significant changes after surgery in AHP, FHP, and SHP after surgery. In the second patient, medial rotation of the operated condyle in AHA and lateral rotation of the operated condyle in FHA were observed. There were no significant changes in AHP, FHP, and SHP postoperatively. This indicates that in USSRO, postoperative movement of the condylar head is insignificant; however, medial rotation of the condylar head is possible. Although three-dimensional changes were observed, these were not clinically significant. CONCLUSIONS: The results of this study suggest that although three-dimensional changes in condylar head position are observed in patients post SSRO, there are no significant changes that would clinically affect the patient.

A comparison study of different facial soft tissue analysis methods.

OBJECTIVES: The purpose of this study was to evaluate several different facial soft tissue measurement methods. MATERIALS AND METHODS: After marking 15 landmarks in the facial area of 12 mannequin heads of different sizes and shapes, facial soft tissue measurements were performed by the following 5 methods: Direct anthropometry, Digitizer, 3D CT, 3D scanner, and DI3D system. With these measurement methods, 10 measurement values representing the facial width, height, and depth were determined twice with a one week interval by one examiner. These data were analyzed with the SPSS program. RESULTS: The position created based on multi-dimensional scaling showed that direct anthropometry, 3D CT, digitizer, 3D scanner demonstrated relatively similar values, while the DI3D system showed slightly different values. All 5 methods demonstrated good accuracy and had a high coefficient of reliability (>0.92) and a low technical error (<0.9 mm). The measured value of the distance between the right and left medial canthus obtained by using the DI3D system was statistically significantly different from that obtained by using the digital caliper, digitizer and laser scanner (p < 0.05), but the other measured values were not significantly different. On evaluating the reproducibility of measurement methods, two measurement values (Ls-Li, G-Pg) obtained by using direct anthropometry, one measurement value (N'-Prn) obtained by using the digitizer, and four measurement values (EnRt-EnLt, AlaRt-AlaLt, ChRt-ChLt, Sn-Pg) obtained by using the DI3D system, were statistically significantly different. However, the mean measurement error in every measurement method was low (<0.7 mm). All measurement values obtained by using the 3D CT and 3D scanner did not show any statistically significant difference. CONCLUSION: The results of this study show that all 3D facial soft tissue analysis methods demonstrate favorable accuracy and reproducibility, and hence they can be used in clinical practice and research studies.

Use of spherical coordinates to evaluate three-dimensional facial changes after orthognathic surgery.

PURPOSE: This study aimed to assess the three-dimensional (3D) facial changes after orthognathic surgery by evaluating the spherical coordinates of facial lines using 3D computed tomography (CT). MATERIALS AND METHODS: A 19-year-old girl was diagnosed with class III malocclusion and facial asymmetry. Orthognathic surgery was performed after orthodontic treatment. Facial CT scans were taken before and after orthognathic surgery. The patient had a menton deviation of 12.72 mm before surgery and 0.83 mm after surgery. The spherical coordinates of four bilateral facial lines (ramal height, ramal lateral, ramal posterior and mandibular body) were estimated from CT scans before and after surgery on the deviated and opposite side. RESULTS: The spherical coordinates of all facial lines changed after orthognathic surgery. Moreover, the bilateral differences of all facial lines changed after surgery, and no bilateral differences were zero. CONCLUSION: The spherical coordinate system was useful to compare differences between the presurgical and postsurgical changes to facial lines.

Odontogenic infection involving the secondary fascial space in diabetic and non-diabetic patients: a clinical comparative study.

OBJECTIVES: This retrospective study was performed to evaluate the clinical impact of diabetes mellitus on the prognosis in secondary space infection. MATERIALS AND METHODS: Medical records, radiographic images, computed tomography, and microbial studies of 51 patients (25 diabetic patients and 26 non-diabetic patients) were reviewed. Patients were diagnosed as secondary fascial space infections with odontogenic origin and underwent treatment at Chonnam National University Hospital, in Department of Oral and Maxillofacial Surgery, from January 2007 to February 2009. RESULTS: COMPARED TO PATIENTS WITHOUT DIABETES, PATIENTS WITH DIABETES WERE PRESENTED WITH THE FOLLOWING CHARACTERISTICS: older age (diabetic patients: 62.9 years, non-diabetic patients, 47.8 years), more spaces involved (diabetic patients, 60%; non-diabetic patients, 27.3%), more intense treatment, longer hospitalization (diabetic patients, 28.9 days; non-diabetic patients, 15.4 days), higher white blood cell and C-reactive protein values, higher incidence of complication (diabetic patients, 40%; non-diabetic patients, 7.7%), and distinctive main causative microorganisms. CONCLUSION: These results suggest that the prognosis of diabetic patients is poorer than that of non-diabetic patients in secondary space infections since they had greater incidence rates of involved spaces, abnormal hematologic findings, more complications, and additional procedures, such as tracheostomy.

A simple technique for the treatment of inferior orbital blow-out fracture: a transantral approach, open reduction, and internal fixation with miniplate and screws.

PURPOSE: Infraorbital blow-out fracture (IOBF) is an uncommon midfacial trauma, and impairs eyeball function and causes esthetic problems. The extraoral approach can lead to some complications such as scarring, ectropion, and entropion. The intraoral approach, such as a transantral approach, has advantages such as no visible scaring, it can be used to simultaneously treat a zygomaticomaxillary complex fracture (ZMCF), and the procedure is relatively easy. PATIENTS AND METHODS: IOBFs were reduced from the maxillary sinus, and fixated internally using miniplates and screws with/without Medpor (Porex, Newnan, GA) via a transantral approach. We used this technique in 11 patients who had an inferior blow-out fracture. Patient's records and CT scans were reviewed. RESULTS: The mean age of the patients was 37 years (ranging between 15 years and 68 years). The mean follow-up period was 9.8 months, which ranged from 1 to 24 months. Before the operation, the patients had orbital symptoms: diplopia in 3 patients; enophthalmos in 4; and gaze limitation in 3. All the patients showed periorbital swelling and ecchymosis. After surgery, none of the patients had diplopia, gaze limitations, and enophthalmos. There were no orbital symptoms or sinus symptoms due to an infection or allergic reaction after surgery except in 1 patient. In 1 patient, maxillary sinusitis developed at 4 months after surgery which subsided with antibiotic therapy after plate removal. CONCLUSION: We think this technique offers an easy approach, and produces reliable, satisfactory results in IOBF.

Antibacterial activity of pyrrolidine dithiocarbamate.

Pyrrolidine dithiocarbamate (PDTC), an antioxidant with a metal-chelating activity, has been used widely to inhibit the expression of inflammatory genes in vitro and in vivo. This study investigated whether PDTC has an antimicrobial activity against various bacteria. The antibacterial activity of PDTC and other compounds was evaluated in vitro by the broth microdilution method against Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Staphylococcus aureus, and Escherichia coli. Bacterial growth was inhibited by PDTC, where a wide range of sensitivity was demonstrated among the tested bacteria. The antibacterial activity of PDTC was reduced by the addition of copper chloride; in contrast, it was enhanced considerably by zinc chloride. Two different zinc chelators, Ca-saturated EDTA (Ca-EDTA) and N,N,N',N'-tetrakis (2-pyridylmethyl) ethylenediamine, blocked the antibacterial activity of PDTC, whereas Zn-EDTA failed to reduce the activity of PDTC. These results demonstrate for the first time that PDTC possesses an antibacterial activity, for which zinc is required, and suggest that PDTC, possessing a dual anti-inflammatory and antibacterial activity, may be considered for topical use for inflammatory diseases of bacterial origin.

Altered expression of sodium transporters and water channels in the submandibular gland of rats treated with nitric oxide synthesis inhibitors.

A role of nitric oxide (NO) in the regulation of sodium transporters and water channels in the salivary gland was investigated. Male Sprague-Dawley rats were treated with N(G) -nitro-L-arginine methyl ester (L-NAME, 100 mg/L drinking water) for 1 week. The control group was supplied with normal tap water. The expression of Na(+),K(+)-ATPase, type 2 Na(+)/K(+)/2Cl(-) cotransporter (NKCC2), type 1 Na(+)/H(+) exchanger (NHE1), α-subunit of epithelial sodium transporter (ENaC), and aquaporin-5 (AQP5) and aquaporin-1 (AQP1) proteins were determined in the submandibular gland by Western blot analysis. Following the treatment with L-NAME, the expression of Na(+),K(+)-ATPase α1-subunit, NKCC2, NHE1, and ENaC α-subunit increased significantly. On the contrary, the expression of AQP5 was significantly decreased, while that of AQP1 was not significantly altered. These findings indicate that the sodium transporters and water channels may be under a tonic regulatory influence of NO in the salivary gland.

Upregulation of vascular renin-angiotensin and endothelin systems in rats inhibited of nitric oxide synthesis.

The present study was aimed at investigating whether the regulation of vascular renin-angiotensin and endothelin (ET) systems is altered by a chronic blockade of nitric oxide (NO) synthesis. Male Sprague-Dawley rats were supplemented with N(G)-nitro-L-arginine methyl ester (L-NAME, 100mgl(-1)) in drinking water for 4 weeks to inhibit the endogenous synthesis of NO. The mRNA expressions of renin, angiotensin converting enzyme (ACE), type-1 angiotensin II receptor (AT1R), ET-1, type-A ET receptor (ET(A)), and neutral endopeptidase (NEP) were determined in the thoracic aorta by reverse transcription-polymerase chain reaction. The treatment with L-NAME significantly increased the blood pressure, while it decreased the tissue levels of nitrite/nitrate. The mRNA expression of renin, ACE, and AT1R was increased in the aorta. The protein expression of AT1R assessed by Western blot analysis was also increased. The expression of ET-1 and ET(A) mRNA was increased, whereas that of NEP mRNA decreased. The increased expression of renin-angiotensin and ET system genes and the decreased expression of NEP may in part be causally related with the development of hypertension induced by a chronic blockade of NO synthesis.